By Blythe Nett, Kevin Watanabe and Tetine Sentell
 
Sept. 20, 2020 

Underlying health conditions such as heart disease, obesity and diabetes increase the risk of severe illness from COVID-19. Managing chronic disease, and preventing it when you can, is critical during this public health crisis. This helps with the pandemic and will keep our communities and families healthy over time.

Recent research from Centers for Disease Control and Prevention (CDC) reported that three-quarters of those who died from COVID-19 had an underlying medical condition. The three most common conditions were cardiovascular disease, diabetes and chronic kidney disease, which were present in 60%, 40%, and 21%, respectively, of deaths due to COVID-19. These conditions, especially diabetes, were even more common among young and working age adults who succumbed to the virus.

Despite Hawaii’s reputation as one of the healthiest states in the nation, a disproportionate number of our residents suffer from the very chronic diseases that place us at greater risk for severe COVID-19 illness. An estimated 1 in every 2 adult residents in Hawaii has diabetes or prediabetes. Of those with prediabetes, more than 80% do not know that they have it. A recent study found high rates of chronic disease, including diabetes, in young people in Hawaii.

Preventing and managing diabetes is not always easy. The pandemic makes this harder. Thankfully, Hawaii has many options to assist people in managing their prediabetes or diabetes, even during the era of coronavirus. Experts agree that people should continue the same critical steps of managing their disease which include: being physically active, managing stress, and eating a healthy diet.

People should also keep monitoring their blood sugar, keeping appointments with their primary care provider, and maintaining a supply of their medications.

While it can be hard to take many of these steps at the moment, there is support and guidance available. Hawaii has 24 accredited or recognized Diabetes Self-Management Education and Support (DSMES) sites across the state. These DSMES programs provide coaching and tips for managing diabetes to help people maintain control of their blood sugar. Many of these programs have modified their delivery to accommodate virtual appointments, recognizing the importance of continuity of care for people especially during the outbreak.

Additionally, across the islands, the National Diabetes Prevention Program (DPP) is offered in a variety of community and health care settings, including community health centers, retail pharmacies (KTA Super Stores, Times Pharmacy) and medical centers (Kauai Medical Clinic, Queen’s Health Center) — often at no cost to participants. (Find options at www.healthyhawaii.com/ prevent-diabetes/ find-a-cdc-approved-dpp/.)

The DPP is an evidence-based lifestyle change program, that can prevent or delay the onset of Type 2 diabetes. It supports participants in modifying their eating habits, being physically active, and losing weight. HI DPP will soon be offered by several CDC-recognized organizations that will allow more people to participate in DPP from the comfort and safety of their home.

Ultimately, prioritizing and sustaining prevention and management programs is vital both to short-term and long-term healthcare and economic stability. Diabetes costs the state $1.8 billion in direct health care costs and loss of productivity.

Without an intervention program, a significant number of people with prediabetes will develop diabetes. This in turn will ultimately increase the economic burden on our families, communities, and health care system. Prevention programs, such DPP, and disease management programs, such as DSMES, are essential to our COVID-19 recovery and long-term viability for both our state and our communities. And they can help us recover and stay healthy together.

Blythe Nett is the chronic disease detection and control section supervisor at the Hawaii Department of Health (DOH); Kevin Watanabe is DOH’s diabetes program coordinator; Tetine Sentell is professor/director of the Office of Public Health Studies, University of Hawaii-Manoa.

Researchers from the University of Hawaiʻi Cancer Center and Office of Public Health Studies found that patients who have type 2 diabetes in addition to other chronic diseases have a lower survival rate for colorectal cancer.

A study published in the International Journal of Cancer investigated the survival rates of colorectal cancer patients with or without type 2 diabetes, and with additional diseases such as heart disease or stroke. The findings showed type 2 diabetes alone does not significantly affect survival for colorectal cancer patients. However, patients with type 2 diabetes as well as other chronic diseases had a lower survival rate.

The researchers looked at 24 years of health data of more than 215,000 adults from California and Hawaiʻi who participated in the multiethnic cohort to identify predictors of survival. Among 3,913 new cases of colorectal cancer, the 707 participants with type 2 diabetes were compared to those without type 2 diabetes.

“The multiethnic cohort is an excellent resource that allows us to study diseases in diverse ethnic groups,” said Yvette Amshoff, lead author and education coordinator at the UH Cancer Center. “Relationships between type 2 diabetes and colorectal cancer have been studied before, with most studies finding a lower chance of survival of those with both diseases. However, in our study population of Caucasian, African American, Native Hawaiian, Latino and Japanese, only Latinos with a history of type 2 diabetes had worse survival. This shows a possible disparity in healthcare that should be addressed.”

Added Andrew Grandinetti, study co-author and associate professor of epidemiology in the Office of Public Health Studies, “The findings that participants with additional diseases and possibly those with long-term type 2 diabetes experience higher mortality are significant to policymakers and health-care providers, because they encourage screening and early detection in colorectal cancer patients to help increase life spans.”

Colorectal cancer is the second leading cause of cancer death in men and third among women in Hawaiʻi. There is an average of 224 deaths from colorectal cancer each year in the state, with an average of more than 700 new cases diagnosed each year, according to the UH Cancer Center’s Hawaiʻi Tumor Registry. In the U.S., colorectal cancer is the fourth most commonly diagnosed disease. By 2040, 642 million people worldwide are predicted to have type 2 diabetes.

In addition to Amshoff and Grandinetti, research team members include Gertraud Maskarinec, a professor of epidemiology at the UH Cancer Center, and collaborators at the University of Southern California’s Keck School of Medicine and Norris Comprehensive Cancer Center.

A recent study by researchers at the Office of Public Health studies found that among those 65 years and older, Native Hawaiian, Filipino, and Japanese men and Filipino women all have a significantly higher risk for diabetes-related potentially preventable hospitalizations than Whites. Dr. Tetine Sentell, assistant professor of health policy and management and the lead author of the study, notes that the increased risk for potentially preventable hospitalizations were found among Asian and Pacific Islander groups even when the higher rates of diabetes among these groups were considered.