By Charlotte Sutton, Times Health and Medicine Editor
Thursday, January 19, 2012
When popular TV chef Paula Deen announced she has Type 2 diabetes and started hawking a drug for it this week, she set off a controversy hotter than anything that comes out of her famous deep fryer:
Will her campaign for pharmaceutical giant Novo Nordisk put an inspiring face on a public health crisis that affects at least 25 million Americans, and is escalating as the nation gets older and fatter?
Or will the fact that she plans to keep cooking unhealthy fare on TV while preaching moderation online only mislead people struggling to make tough lifestyle changes? And will her endorsement of the drug Victoza prompt patients to pressure their doctors for a product that is both costly and controversial?
The Internet lit up with criticism over Deen's failure to mention that she's had the condition for at least three years, while continuing to dish up fattening cuisine on her Food Network shows. For example, on Saturday, Deen, 65, is preparing beef sandwiches with a sauce containing a cup of mayonnaise and six strips of bacon.
Around the Tampa Bay area, diabetes experts and patients viewed the uproar with interest — and hope that Deen's example might spur interest in a common, yet misunderstood condition.
"Anybody that comes out and talks about diabetes generally is going to help the whole country because of the number of people that have it and don't know about it,'' said Tyler Wening, a retired mortgage banker from Palm Harbor who was diagnosed with diabetes seven years ago, at age 60. He saw Deen on the Today show Tuesday, and noticed she looks slimmer.
In a video on her Novo Nordisk site, diabetesinanewlight.com, Deen says, "A while back I was told that I have Type 2 diabetes. I wasn't about to change my life. But I have made simple changes in my life.'' She mentioned cutting back on sweet tea and taking walks with her husband, but didn't get specific about her diet.
Diabetes is different for every patient, but if anyone thinks the remedy is simple, Wening says they're mistaken.
After his diagnosis, Wening lost 40 pounds and has kept it off through careful diet and exercising five or six days a week. He measures his blood sugar four times a day, takes two oral medications plus slow- and fast-acting insulin. And he attends a Morton Plant-Mease diabetes support group.
"It is a lifestyle change, and people who refuse to do it are going to suffer the consequences,'' he said.
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Wening's endocrinologist, Dr. Susan Boston, says she'd be happy if Deen's news gets more patients talking about diabetes management.
"I see people in denial every day ... It's often not a quick acceptance. Sometimes it can take months and even years.''
A quick diabetes primer: Type 1 diabetes is an autoimmune condition — most often diagnosed in adolescents — in which the body produces little or no insulin, the hormone that allows glucose to enter cells, where it's used for energy.
In the far more common Type 2, the body becomes resistant to the insulin it produces, or doesn't make enough. (To show how complicated this is, Wening says he has Type 1-1/2, something between the two.)
Type 2 is widely associated with obesity, but weight alone doesn't cause it. Rather, extra pounds trigger insulin resistance in the presence of risk factors like age and heredity.
But the first-line treatment, weight loss and exercise, is famously tough. Further, the stigma of obesity makes many people reluctant to talk about Type 2 — one reason Deen is winning fans for her disclosure.
And unlike Type 1, Type 2 can come on so slowly that people don't even know they have it in the early stages, when lifestyle changes alone can stop the disease in its tracks, said Dr. Henry Rodriguez, medical director of the University of South Florida Diabetes Center.
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But the longer you have Type 2 — even if you lead a healthy lifestyle — the more likely you'll need medications and insulin, Rodriguez explained.
There are a variety of non-insulin drugs for Type 2 diabetes, some pills, some injectables, categorized by how they work in the body. Often patients must try several drugs and combinations before finding what works best, with tolerable side effects.
Victoza, approved by the FDA two years ago, is injected once a day to stimulate the release of insulin. It's often used with other diabetes drugs, though Deen hasn't revealed her full regimen.
It should not be the first drug a patient tries, the FDA says, due to incidence of a rare thyroid cancer in animal testing, a finding that earned it a "black box'' warning. Victoza also carries a slightly higher risk of an inflammation of the pancreas.
Plus, it's expensive — about $8 a day. Compare that with Metformin, a generic Type 2 drug some pharmacies provide for free.
But Victoza doesn't cause weight gain, unlike some Type 2 drugs. It even can promote modest weight loss — as long as you follow a proper diet, said Boston, who has seen good results from Victoza in her patients.
It's too soon to tell whether Deen's endorsement will make patients seek Victoza. But studies indicate that when a pricey brand-name drug is marketed directly to consumers, patients ask their doctors for it and sales shoot up. Critics say this feeds soaring medical costs, sometimes with serious health consequences, as when pain reliever Vioxx was shown to increase risk for heart attacks only after Dorothy Hamill promoted it on TV, helping make it a bestseller.
Diabetes is a complicated disease requiring carefully tailored treatments, which is why so many different drugs are needed to augment a healthy lifestyle.
"I'm happy for (Paula Deen) if this drug is really doing it for her,'' Rodriguez said. "But if any patient gets the message, 'If I take this drug I can do whatever I want,' that's the wrong message to send.''
Charlotte Sutton can be reached at sutton@tampabay.com