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Scott Webb: Living with diabetes has never been easier thanks to the latest in treatment options and technologies and joining me today to discuss diabetes and the overall health benefits of successfully treating it is Dr. John Osborne, Head of Cardiology for the Low T Center. This is age is just a number by the Low T Center. I'm Scott Webb. So Dr. Osborne, thanks so much for joining me today. We're talking about diabetes. So let's start here. Take us through the types of diabetes, and is one more serious than the other?

Dr. Osborne: Diabetes is just an absolutely important medical disease. So patients with established diabetes is at least 30 million people in the United States, and probably a quarter of those people actually have diabetes, have diabetes, and are completely unrecognized as having it. So it is a major cardiovascular risk factor still terribly underappreciated. And to make that matter worse, it's estimated probably about 70 to 80 million adults in the US that have metabolic syndrome or prediabetes that are headed to develop diabetes unless they change the trajectory. So there's two major types of diabetes, although as it turns out, there's multiple subtypes. The easiest way to think of it is about 5% of people with diabetes have what we call type one diabetes. But the kind of diabetes that usually happens in young kids and what happens is that is actually an autoimmune disease which attacks what are called beta cells, which are in your pancreas, which is the organ that produces all of your insulin. And with this autoimmune disease that knocks out your beta cells in the pancreas, it renders you unable to make insulin.

And in that case, if you do not get insulin given to you by your medical doctor, it is a completely a hundred percent and fairly rapidly fatal disease. So that changed roughly just a little less than a hundred years ago when we discovered insulin began to produce it initially from animals, and then now it's all produced with a biotechnology. So that's type one diabetes. And the numbers of people who develop type one diabetes have been relatively stable. If you look at people develop diabetes, the main difference between type one and type two, type two are your patients that typically are older adults? That usually most not, although have some degree of being overweight and the heralding signs long before you develop type two diabetes or adult onset diabetes, as we used to call it, of course, we don't call it adult onset diabetes now because now we have kids, teenagers who are overweight developing classical type two diabetes because their weight issues.

That is 95% of patients with diabetes and that is the form of diabetes that has just rocketed up dramatically over the last 30 years as far as affecting people, not just in the US but really globally as well. The key to both of these forms of diabetes is as a cardiologist is that both of are major, major risk factors for cardiovascular disease that stents, balloons, bypass surgeries, heart attacks, strokes, all of those different manifestations of plaque that builds up in the heart. Because what diabetes does, whether it's type one or type two is tends to make your vessels very, very sticky. It also causes high blood pressure and is associated very much with high blood pressure. And also thirdly is associated with certain changes in your cholesterol profile that tend to really enhance the ability to deposit these fatty plaques that cause the strokes, the heart attacks, the bypass surgeries, the balloons, the stents, all of those various manifestations of heart disease.

Host: And so when we talk about type two that can be avoided, right?

Dr. Osborne: Yeah. Type two can be very successfully avoided and prevented in fact from study done over 15 years ago and still relevant today. They did a study of people that had prediabetes, which again is extremely common. 70, 80 million people in the US have that. They randomized these patients to a control group, to a group where they took a drug called Metformin, which is used to treat diabetes or to basically good old diet, exercise, weight loss. And now they also in the third group with diet, exercise, weight loss, they also gave them trainers, they gave them nurses, nutritionists. So a lot of support. But that translated to these individuals losing about five to 7% of their body weight. And that translated over the course of several years into a 58% reduction in the risk of transitioning from prediabetes or metabolic syndrome as we call it, to frank diabetes. So just diet, exercise, weight loss was profoundly effective in helping people to avoid the progression on to type two diabetes.

Host: That's so good to know. You know, diet, exercise, weight loss is obviously so key and the type two can be avoided. Let's just say a patient has done everything they can to try to, you know, not go from pre-diabetic to actually having, you know, type two diabetes, but it's just not working for them. What would you then do and prescribe? Like how would you treat diabetes for those patients?

Dr. Osborne: If you're ever going to have diabetes, I don't want anyone to have diabetes, but if you do have it, it is a phenomenal time to be alive. Just over the last several years, they've developed several new drug therapies with new, what we call mechanisms of actions. In other words, new ways, new pharmacologic approaches that can dramatically assist patients with diabetes. In fact, if you look at drugs for diabetes, of course insulin is almost a hundred years old. Back in the 1950s, we've developed drugs called Symphorium that if you look at the data with the outcomes, they control blood sugar but they translated to a higher risk of cardiovascular events. And then there was really a big desert for decades until really the early nineties when we began to develop new drugs to help treat diabetes and lower blood sugar. And really within only the last several years have developed newer drugs and new mechanism of actions.

These particular drugs are called SGLT two drugs, which is a class of drugs, and there's several members of that classmate by different companies. And there's also what are called GLP1 agonist, which are injectable but they're once a week injections. None of them cause low blood sugar to any significant degree. And an interestingly, both of these drugs, particularly GLP1s are actually quite effective at helping people lose weight as well, in addition to lowering blood sugar. And for me as a cardiologist, understanding how, what a profound risk factor diabetes is for heart disease is that we've actually done trials looking at people treated with these drugs and showing that these drugs not only lower blood sugar, they do it effectively, safely. They help you lose weight. They also have some positive effects on blood pressure, which is very, very common in patients with diabetes.

But most importantly, the use of these drugs translates to less cardiovascular events, less strokes, less heart attacks, less heart failure. And in fact, you actually live longer with less cardiovascular events and cardiovascular death, that's deaths due to strokes and heart attacks. And in fact, some of these studies that most of them show a reduction in all cause mortality. So if you have diabetes, you take this drug versus not taking this drug, you literally live longer. So very, very exciting and promising advances in the world of pharmacology when that's appropriate. And I will say at the Low T Centers, we're really at the forefront of bringing these tools to our patients to improve their health risk and better treat their diabetes. But ultimately too, again, this cardiologist and helping to combat the massive risk factor that diabetes is and really helping to mitigate that risk in our patients with diabetes.

Host: That's really amazing. And I know that you probably don't refer to it like this, but that kind of like one stop shopping. I know what else is amazing is the latest in diabetes technology, monitoring blood sugar is a lot easier today than in the past. You know, and I've heard you say this before, it helps people to live longer and healthier lives. So let's talk about the latest in technology.

Dr. Osborne: Yeah. So on the monitoring side, just to understand how you're doing with respect to your blood sugars. Again, over the last several years, the monitoring tools have really dramatically improved and got much better. So we have a whole spectrum of devices, even devices now that can check your blood sugar without a pinprick, which is a big deal, to what we call CGM or continuous glucose monitoring. These devices basically you kind of stick under your skin and could leave them there for several days and they'll give you continuous glucose measurements. So you can both understand if you're too high, but also particularly people on insulin to make sure you don't go too low, which could both be not only dangerous but even life threatening. And again, not only do we have all these tools that have been developed over the last several years, there even little watches you can wear that show your blood sugars, but the pace of development is breathtakingly fast as far as that goes too. So even what we have today will be even better a year or two from now, even though it's pretty phenomenal now. So again, it's a good time to be alive if you have diabetes or at risk for it.

Host: Isn't it an interesting way to put that? But it's so true that the diabetes is not this cumbersome or even a death sentence that it might have been years ago, that people live long, healthy lives with diabetes in both on the treatment side and the monitoring side. So much great stuff out there. I did want to ask is we're hearing from across the country that people are not going to the hospital because of COVID-19, because of fears of COVID-19, and I wanted to give you a chance to put it in your own words that emergent conditions, concerns, heart attack, stroke, even diabetes. These are all good reasons to go where people are, you know, protected. The safest place to be right now is treatment centers is hospitals, is emergency departments, right?

Dr. Osborne: Yeah, absolutely. And certainly at the Low T Center we've obviously been very cognizant of all these issues and taking all the appropriate measures as well to keep people both safe from all these things we've talked about. Diabetes, high blood pressure, cholesterol disorders, cardiovascular events, as well as being very proactive in treating other things such as sleep apnea that causes manifest problems of high blood pressure and increased heart rhythm problems and as well as just making you feel terrible and tired and fatigued, thyroid disorders, all of those things. So we've really developed some very impressive cutting edge, state of the art approaches for all of these different conditions that utilize the latest technologies and tools available. But also too, we have as an organization have really gone to great lengths to ensure that we do that in a very, very safe way with the underlying COVID pandemic raging right now ensuring that both our staff and you minimize any risks from developing these conditions. In fact, I will tell you even sort of, despite all of the academic issues having both occurring over the last couple of months or so, that we really haven't been affected by that here at the Low T Centers, which I'm very proud of and I think it testifies to our approaches to help mitigate and minimize risk of the spread of COVID within our organization. Both to our health providers, all of our MAs, our staff, and of course most importantly to our patients as well.

Host: So good to know that people are still going to the Low T Center, that they feel safe there and as well they should with everything you all have done. You know, to deal with COVID-19 and I've talked to you many times and we always come back to the same thing, which is that most of the stuff you know that people have an experience is treatable. If you get on those things early, right, and you seek the proper treatment and you follow the course of action from your doctors. A lot of these things are treatable and you could live long and healthy lives. As we wrap up today here, Dr. Osborne, anything else we need people to know about diabetes and how the Low T Center specifically can help people to live with it.

Dr. Osborne: Big picture, just to follow up on your last comment is that historically what we've accepted is that about half of men, two thirds of women, the first symptom of heart disease is you die from it, it kills you. And then we take the survivors that survived their heart attack or their stroke and then they get stents and balloons bypass surgery. Or if you had a stroke, get put in a nursing home and then we say, geez, we need to treat your blood pressure, need to treat your diabetes, need to treat your cholesterol, get you quit smoking, you know, whatever be most appropriate for that particular patient. And to think that this is a disease that's been there for probably 20 to 30 years. Asymptomatically causing those symptoms and festering there and only becomes manifest at the very end of that resulting in killing about half a man and two thirds of ones with the first symptom. Completely unacceptable.

And we at the Low T Center very much appreciate that and we really want to be, and we are leaders in helping to identify this condition early, long before it kills you, long before you need stents or balloons or bypass surgery with the latest technology. To identify it early and also using the latest data literature tools to help dramatically change that trajectory so that we avoid the sudden acute cardiovascular event, which we call a stroke or heart attack and instead say, Hey, we have some issues that we need to work on. These are straightforward. We're going to successfully treat these and then therefore dramatically lower the rate of death from cardiovascular disease, which still even with COVID still kills 40% of all Americans.

Host: Yeah. You know, and I always find it a little bit ironic that you know, we're doing these podcasts for the Low T Center, but we often don't talk about low T. We talk about all these other things because it's sort of implied in the name like Low T, you know what the Low T Center can do for you related to Low T, but all these other things that we talk about that we want people to understand that treatment is available. Therefore you experts are available, therefore you, whether it's sleep apnea, diabetes, whatever it might be. The Low T Center is the place now during COVID-19 and any time. So Dr. Osborne, thank you so much for being on as always.

Dr. Osborne: As always, Scott, thank you so much.

Host: That's Dr. John Osborne, head of cardiology for the Low T Center, call (866) 806-8235 or go to lowTcenter.com for more information or to book an appointment. Thanks for listening to Age is Just a Number, a podcast by the Low T Center. If you found this podcast helpful, please share it on your social channels to check out our entire podcast library for topics of interest to you. I'm Scott Webb. Stay well and we'll talk again soon.