Amanda Wilde (Host): Welcome to the Sinai Chicago Health and Hope podcast, where caregivers from Sinai Chicago share insights, updates, and important advice on the health topics impacting our communities. From the latest in medical research to practical tips for improving wellness, our doctors, nurses, and health professionals are here to help you and your families take control of your health.

I'm Amanda Wilde, joined by endocrinologist, Dr. Mahwash Siddiqui from Sinai, Chicago. We're going to explore diabetes from insights on risk to innovative treatment strategies. Welcome to the podcast, Dr. Siddiqui.

Dr. Mahwash Siddiqui: Thank you so much.

Host: We are taping this in November, which is Diabetes Awareness Month. So in the big picture, why is it important for people to pay attention to their blood sugar and overall metabolic health even if they don't have diabetes?

Dr. Mahwash Siddiqui: Yes. Thank you so much for podcasting on the Diabetes Awareness Month. Blood sugars and metabolic health is important for everyone, not only with people with diabetes, because the early signs of hyperglycemia can be so subtle that patients do not even feel that they have it. But any level of dysglycemia or high blood glucose in the background create a level of inflammation that does start affecting the organs. It does start affecting the blood vessels. It does start affecting the nerves. And we have seen many times, and when patients are diagnosed with diabetes, they already have established cardiovascular disease or they present with a stroke or they present with any complication and then it's when they find out that they have diabetes. So, it's very important to understand and pay attention to metabolic risk factors, because before the diabetes develops, there's a stage of the prediabetes in which the patients are already at a higher risk of heart attack, stroke, and early microvascular changes.

So, again, it's important to be proactive about their health. And the reality is that millions of the people are walking around with undiagnosed diabetes, especially the people who have a high family history, those who are of certain ethnic background like African American patient population, Hispanic patient population, and then those who have high blood pressure or high cholesterol levels. So, screening for diabetes is a very important tool because when we screen the patients early, and we pick the patients in the stage prediabetes, that can be totally reversible with lifestyle intervention, and they can prevent them from developing all those complications.

Host: You mentioned some of the risk factors. What are some of the early warning signs people should look out for that might indicate diabetes or prediabetes?

Dr. Mahwash Siddiqui: Yeah. And that's a very good question, because just like I mentioned, the early warning signs could be subtle or none. So, screening and knowing your risk factors is very important. So, risk factors that include patients who have a small, like a strong family history, or those who have higher BMI or living with obesity, or people who have history of gestational diabetes or PCOS, these all raise the risk factors. And we also know that there are certain racial or ethnic backgrounds like African American, Hispanic, Latinos, Native Americans, Asian American individual, they all have high likelihood.

The other important thing is the metabolic risk factors like the high blood pressure, abnormal cholesterol. There are certain medications like people who are using steroids or some antipsychotic medications, so they should be screened. And when the patients develop the symptoms, diabetes is already established. And those symptoms include increased thirst, increased urination, blurry vision, fatigue, or slow healing wound.

And on from the lab standpoints, we have certain criteria for the fasting blood glucose, for your A1c values, and for two-hour blood glucose test after the glucose load that defines the thing. So, my advice is that it's very important to screen. It's very important to know your numbers if you have the risk factors that put you at high risk for developing diabetes.

Host: So, screen and monitor over time to see if there are any changes. Can someone lower their risk factors through everyday habits, diet, exercise, or sleep?

Dr. Mahwash Siddiqui: Absolutely. Absolutely. And that's a very, very good questions, because every single thing that we do every day matters. And here, I know our life is already very complex. So, let's focus on the small little things that can make things matter. And then, first of all, let's talk about the diet. It's about keeping a balance. When you're making your plate, half of the plate, vegetables; choose the lean proteins, and then whole grains and high-fiber diet. And then, sequencing of the protein of the diet is important. Like, pick the protein first because there has been the data that taking protein first when you're choosing your meal plate already helps to lower the blood glucose after the meal. Simple things like cutting out the sugary beverages or substituting or stopping ultraprocessed food and substituting with a more healthier food options, which could be simple like: not taking butter and using the olive oil, taking the whole grains instead of refined carbohydrates.

And in terms of the exercise or physical activity, again, as small things can make a difference, just taking a 10-minute walk after meals helps to lower the blood sugars; tracking your steps, moving around, aim for 7,000 steps a day, and then incorporating the physical activity, like simple things like walking, brisk walking, cycling, jogging. Takes time for 30 minutes, a few days a week, and that will show to decrease your overall health and metabolic risk factors.

So, these are the small little things a patient can do. And then, I think your question also talk about the sleep. Taking sleep is also very important, and I feel like this is one of the things which we have to prioritize, that the good seven to nine hour of the sleep is important. A good sleep hygiene, first of all, helps lower the cortisol level that comes with the stress, that comes with nighttime waking decreases the risk of major cardiovascular diseases. So again, sleep hygiene is equally important for managing those risk factors.

Host: How does mental health or stress affect blood sugar, or does it?

Dr. Mahwash Siddiqui: Yes. So, just like I think this way, that just when we are making the diabetes comprehensive plan, we talk about lifestyle intervention, we talk about the medications in the same way is stress and mental health are so important components for patients living with diabetes, because there are so many challenges. It's a disease management burden. It comes with anxiety, it comes with the stress. There is so much demand of taking care of their health. It is a part of the comprehensive management plan.

So just to give an example, when you talk about the stress, we know there is an evidence like if somebody is stressed, whether this stress could be from work-related distress or financial distress or any kind, or just being anxious all the time increases the level of the cortisol in the body. And that high cortisol has altering effects the blood sugar.

We often think that the blood sugars are affected by diet and physical activity, but there are 42 things that can affect the blood sugars, and the stress is one of those. And in terms of the management, of course, for the stress management, taking time for yourself, the meditation, relaxation, coping mechanism on how to deal with that, have a conversation, which is hard, easier said than done.

Host: You have to cultivate that.

Dr. Mahwash Siddiqui: Exactly. You have to work on yourself, and seeking behavioral health and support, it's about building the self-efficacy. I think it's a journey where people learn. In the same time, if the people have underlying depression, that is also important to take care of. So, you have to be, what I would say that you have to open to the help which is available, your care team, mental health, as a part of the care team, taking psychiatric help is a part of the care team of a comprehensive diabetes management plan.

Host: So for those living with diabetes, what are the latest advancements or strategies in treatment that are improving care today?

Dr. Mahwash Siddiqui: Oh, that's a wonderful question, because we are living in a very exciting time, and the last few years have been transformational in the diabetes care. And it's happening basically in the two major fronts. One is the technology and the other is the medications. So in the diabetes technology, we have made huge strides. We have now continuous glucose monitors. They give the real time glucose readings without requiring to have the finger stick. And in that way, patients can see what are the things that can affect their blood glucose.

In the same time, we also have automated insulin delivery system, insulin pumps that use that glucose monitoring through the CGM and helps to adjust the insulin level. So, it's more like that you have an artificial pancreas that adjusts the blood glucose prevented from low, prevented from going high, which has made managing diabetes easy, relatively easy for patient and take off a lot of pressure from their day-to-day management. We are also seeing more smart insulin pumps, diabetes technology, where the patient's data can be shared with the healthcare provider. We can do the remote glucose monitoring and provide the patients with the right read, which is required for them without them needing to come to the clinic

in the field of diabetes medication, the most exciting and I would say the two rising stars are the GLP-1 medication, the GLP/GIP medications, and also the SGLT2 inhibitors, which have transformed the care of diabetes from beyond the A1c. And now, these medications not only help with the glucose management, but they also protect the kidneys, protect the heart, decreases the risk of coronary artery disease, the stroke, heart attack, and so many other complications of the diabetes, irrespective of the A1c. So now, we have the tools which we can use to manage the diabetes, as well as protect the complication and protect the end-organs, which is very exciting. And also, the technology to help facilitate those.

I just want to always remember when I started with Sinai, because we are seeing so many patients with complicated diabetes, I often used to hear, "Somebody in my family died from diabetes" and I always used to tell them that people do not die from diabetes. They die from complications of the diabetes. So if we have the tools to help prevent the complications, help their progression, that's a big win.

Host: You have the tools and you mentioned really exciting advancements in the field medically and technologically. We know diabetes impact some communities more than others. You mentioned that earlier. What can health systems and communities do to close gaps in care and in access?

Dr. Mahwash Siddiqui: You're absolutely right. It's a problem of health equity. We see the diabetes disproportionately affect marginalized, minoritized populations. It's a patient with low income. It's a patient with limited education or living in underresourced or rural neighborhood. It affects certain ethnicity more, like non-Hispanic African Americans. It affects the Latinos and Hispanic patient population. So yes, there has been disparity. And I say it this way, that even though we have all these tools available, it is so important to look at the social determinants of health. When we talk about the principles of beneficence, which is do the best for your patients, the benefits in this time also involve a different lens, taking care of the social determinants of health because we can make a great diet plan or exercise plan. But if the patients have food insecurity, if the patients do not have safe walking place to walk or just not able to afford the medication, then it automatically widens the disparities.

And then, the few things which we can do, I mean, it requires a multilevel, multifaceted health because as a physician and in healthcare organization, and also at the community and the government and the policy level, as a physician, it's important when we are seeing patients with the diabetes to screen them for social determinant of health. And to help them connect with the resources that are available. The community health workers, they play a very important role to provide the support. They understand the community, they understand the language, they help them connect to the right resources and knowing the resources which are available for their patients is important, connect them to those resources and the communities, they can help and find them, help find the food pharmacies, help them find the health programs which can be offered to them.

And then, even the training of your staff is important, because they could be biased. So, those trainings are very important and help them have that understanding that how to take care of the needs of those special populations in order to have a successful impact. If there is a problem with the transportation. Make them easy, provide them transportation. Accessibility issue, telehealth, the digital technology. So, what are the resources? I think at this point, knowing the resources available in the community, but unless we don't screen, we do not know the challenge.

Host: There are community support systems then to help with this, which is very empowering for the patient. What's one thing you wish everyone knew about diabetes? Whether they're newly diagnosed, caring for someone, or just trying to stay healthy?

Dr. Mahwash Siddiqui: I think there are many things, but I would just try to summarize. So, the one thing I would like the people to know is that diabetes is preventable by screening. Diabetes is manageable, and the technology and the tools that we have available, that has taken a lot of burden off the diabetes management so people with diabetes can live a very happy, long, vibrant life.

I want to tell them that you are not alone in this journey. So, you have your care team to help you. You have your family to support you. You have your community to support you, and it is very important to engage with everything, to feel empowered, to find the resources, to find the right help you are required to take care of this medical condition. It's about empowerment. It's your journey where every small step you take counts, whether it's about checking your blood sugar or just planning your meal, or just improving your physical activity or taking your medications the way you should, every little thing counts. And diabetes doesn't define who you are. It's your courage. It's your resilience. It's every single day what you do matters the most.

Host: That is greatly encouraging, Dr. Siddiqui. Thank you so much for your insights today and your support.

Dr. Mahwash Siddiqui: My pleasure. Thank you for having me.

Host: That was endocrinologist Dr. Mahwash Siddiqui. For more information, please visit sinaichicago.org. And if you found this podcast helpful, please share it on your social media. And thanks again for being part of the Sinai Chicago Health and Hope podcast.