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Mapping the Cardiometabolic Patient Journey

by Shilpa P. Saxena, MD

As of 2015, the combined prevalence of diabetes and prediabetes was 45.4% among adults in the United States. Approximately 11% have diabetes and 33.9% have prediabetes, representing 84.1 million people who could develop type 2 diabetes within five years, according to the CDC in the 2017 National Diabetes Statistics Report.

"We must continue to innovate in scientific research and to translate findings to the clinical level to decrease the prevalence of diabetes,” said William T. Cefalu, MD, chief scientific, medical, and mission officer of the American Diabetes Association.

Despite this call to action by a diabetes thought leader, the prevailing management approach still prioritizes drug therapy with relatively little focus on nutrition education. This simplistic strategy fails to include the complex and epigenetically unique path each patient walks before acquiring a cardiometabolic disease diagnosis. Whether diabetes, NAFLD or Alzheimer’s dementia, reducing the prevalence of these metabolically driven disorders will require a disruptive strategy incorporating what we know about the power of lifestyle medicine plus what we are learning about genomic medicine. We must look beyond oversimplified targets such as LDL-c, blood pressure, blood glucose and pharmaceuticals toward successful interventions such as advanced lipoprotein testing, collaborative care teams and gene-directed personalization of nutraceuticals and/or pharmaceuticals.

The next, more meaningful evolution will involve us understanding these advanced concepts beyond isolated notions. Today’s practitioner must grow to integrate the latest evidence-based solutions, carefully sifting through the therapies that are not ready for prime time in the exam room and/or not needed for the patient at that moment along their health journey. This is where we must meet as custodians of health, creating synergies where the potential of personalized lifestyle medicine can remedy the reality of clinical practice confines to ultimately serve our patients better.



About Shilpa P. Saxena, MD

Shilpa P. Saxena, MD is a Board-Certified Family Practice physician whose passion and purpose come to life through sharing her innovative patient education and practice management solutions in her classic ‘keep it simple’ style. She serves as Faculty with the Institute for Functional Medicine, the Arizona Center for Integrative Medicine, the University of Miami, Miller School of Medicine, and the Metabolic Medical Institute at George Washington University. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.


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