Tennessee nurses develop a six-week course that can help reverse Type 2

I Na former church parsonage in Grundy County, Tennessee, Karen Wickham ladled out her lentil stew as people arrived for an evening health education class. Wickham and her husband, Steve, are semi-retired nurses who have dedicated the last years of their working lives to helping people with Type 2 diabetes control and even reverse the condition with diet and exercise.

Wendy Norris is in the group, and she has brought along her father and daughter. Since her diagnosis several years ago, Norris said, her doctor prescribed insulin shots and told her to watch what she ate.

She recalled thinking at the time, “Well, what does that mean?”

The Wickhams have set out to answer that question in Tennessee’s Grundy County, which ranks lowest on the scale of residents’ health. Grundy’s population of 13,000 has the shortest life expectancy in the state and an elevated rate of diabetes

(16 percent of adults), which can eventually result in blindness, kidney failure or amputations.

Trying to overhaul her diet by herself was confusing and difficult. When things didn’t change, the doctor just kept increasing her dosage of insulin.

Then Norris lost her health insurance.

The injectable insulin cost her hundreds of dollars a month — money she didn’t have.

She enrolled in a six-week seminar the Wickhams offer and is seeing results in how many shots she needs: “I’ve got it down to one already.”

Kicking bad habits

With slide presentations, the Wickhams explain the difference between sucrose and glucose, and the science behind the fact that certain foods, like potatoes, spike blood sugar. They preach eating as much fiber as a stomach can stand, and dropping almost every sweetened beverage.and they demonstrate ways to burn all those calories.

All workshop participants have to find a way to get active at home or in a state park nearby because there’s no gym in the county. There’s not a proper grocery store nearby either, so healthy cooking can be a real chore.

These communitywide obstacles reveal why it can be a struggle for people to maintain their health in rural America. But the Wickhams are working to overcome those barriers.

Many people think of Type 2 diabetes as practically incurable, though it has long been known that the condition can be reversed with weight loss and exercise. But research shows people need lots of help to change their lifestyle, and they rarely get it.

“I had taken care of diabetic patients for so long, and I knew the progression,” Karen said. “If you truly want people to get better, you have to treat it with lifestyle interventions.”

Along with lifestyle counseling, the Wickhams always give a disclaimer, advising people to consult with their doctors. They also acknowledge that their seminars are not yet “evidencebased” or backed by peer-reviewed scientific literature.

Experts weigh in

But there are studies showing that people with blood sugar levels in the “prediabetes” range can get back to normal blood sugar by losing 5 percent of their body weight.

Weight loss and exercise have been shown to lower hemoglobin A1c levels, a test used to monitor a patient’s blood sugar over two to three months.

And new research from Dr. Roy Taylor of Newcastle University in England shows promise for true remission.

Taylor’s research finds that by losing 30 pounds or so, Type 2 diabetes can be reversed in the early stages. Even the

Diabetes Association has been changing its views. The advocacy group has a new position on reversal:

“If a patient wishes to aim for remission of Type 2 diabetes, particularly within six years of diagnosis, evidence-based weight management programs are often successful.”

Dr. John Buse, chief of endocrinology at the University of North Carolina medical school, helped write the new position on reversal.

“We’ve known, literally since the 17th century, that diet is the key to managing diabetes,” he said.

But it’s hard to write a prescription for a lifestyle change.

“Doctors don’t have the time to do it well, so we have often used . ... “‘Eat less carbohydrates and walk every day’ … that has basically no impact.”

The Wickhams are doing their part to add to the scientific data, tracking the blood sugar of the participants in their program. The anecdotal, short-term evidence they’ve gathered is resonating far beyond Grundy County.

The couple just sold their retirement home so they can say “yes” to all the invitations they’ve received to present their program to other communities around the country.

This story is part of a reporting partnership that includes Nashville Public Radio, NPR and Kaiser

Health News. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.