Meet our doctors: Endocrinologist Raynald Samoa on diabetes
City of Hope endocrinologist Raynald Samoa, M.D., has seen a lot of people struggle with their weight. His roots are in the South Pacific, a region that has eight of the 10 countries with the highest prevalence of obesity in the world, according to Forbes.com.
Now, as a physician, Samoa is committed to fighting obesity and its associated diseases, including diabetes. Here he offers insight into how certain lifestyle changes can make a dramatic difference in the lives of people with diabetes, whether young or old.
What is an endocrinologist, and who should see one?
An endocrinologist is a specialist who deals with hormonal issues and who is specifically trained to help patients with diabetes, thyroid disorders (including thyroid cancer), osteoporosis and many other hormonally based diseases.
Why is the prevalence of diabetes rising in the United States, particularly among children?
Type 2 diabetes prevalence is rising in the U.S., and many have associated the increase with the rise in obesity. Although the relationship between diabetes and obesity is not a direct one, they do share common causes, such as a high caloric intake and not enough exercise. As processed food has made food more accessible in the U.S., it has also made it easier to increase our caloric intake.
What can one do to prevent diabetes?
To prevent diabetes, one must understand the different types of diabetes:
- Type 1 diabetes is caused by a destruction of the cells in the pancreas that secrete insulin, the main hormone that helps control blood sugar. The destruction of these insulin-producing cells are caused by one’s own immune system. Although many preventive studies are being conducted, there has not been any consensus regarding the prevention of type 1 diabetes. There are some experts who propose that early feeding of cereal to infants may be a contributing factor.
- Type 2 diabetes is associated with weight gain. In type 2 diabetes, the body still secretes insulin but can’t use it effectively. If one can still secrete enough insulin, then blood sugars can still be controlled. But when one’s pancreas can’t secrete enough insulin, then blood sugars start to rise. Several landmark studies show that modifying one’s lifestyle via eating healthier and regular exercise is the best way to prevent type 2 diabetes. A medication called Metformin was also shown to prevent diabetes (but not as well as lifestyle modification) in high-risk patients.
It all starts with education. If people take simple steps like eating better and exercising, and make them a part of their routine for a lifetime, many can deter type 2 diabetes. They just need to know how. And in addition to our research, education is part of how City of Hope can help.
How is diabetes treated? Are there any new emerging therapies or techniques?
The mainstay for treatment of type 1 diabetes is to replace insulin. This can be done through injections either with a syringe, pen or an insulin pump. Newer studies are looking at the utility of transplanting pancreatic cells into patients with diabetes as a form of treatment, and currently is being studied for patients with low blood-sugar awareness. Type 2 diabetes treatment revolves around making one more sensitive to the effects of insulin and giving more insulin to control blood sugars.
Both types of diabetes require a multidisciplinary team. Treatment plans should include dietary education and follow-up, glucometer use to check blood sugars, identification and treatment of low blood sugars, and medication assessment. With type 2 diabetes, oral medications have been used to both improve insulin resistance and/or provide more insulin to control blood sugars.
Why did you choose this specialty?
I chose this specialty because I am strongly interested in the hormonal pathways that cause these diseases. The epidemic of diabetes that is sweeping across our country motivates me to take the best of science to help patients find the best way for them to live healthier.
Read more about options and approaches for treating diabetes in our Division of Molecular Diabetes Research section.