The Centers for Disease Control are painfully aware that diabetes is out of control. If they were to audit the charts of diabetics in any primary care physician's office in the country, they could only expect an average A1c between eight and nine, far above the current American Diabetes Association goals. Gradual weight gain would also be found. This is why they accepted an abstract from Aynor entitled “Aynor Family Practice Diabetes Management Program: a Patient-Friendly and Staff-Efficient Program for Solo Family Physicians to Achieve Diabetic Glycemic Control without Weight Gain.” Aynor Family Practice achieved an average A1c below seven with no weight gain. People are starting to wonder what’s going on in the small town of Aynor.
Effective patient care begins with identifying a patient’s problems and ends with taking the appropriate measures to remedy the underlying cause of that problem. Mark Meijer, M.D., F.A.A.F.P. of Aynor Family Practice goes to great lengths to assess patient needs and provide the most fundamental and concise method of treatment. This simple no-nonsense approach has been effective for accomplishing improved patient health.
One problem that Dr. Meijer has been forced to address is the effects of the American diet on health, especially as a cause of Diabetes Mellitus type 2 and obesity. When previous attempts to improve diet failed, he began developing new ways to convince patients that diet is crucial in the treatment and prevention of diseases such as diabetes. It started 11 years ago when he began instructing his patients on a one-to-one basis. Now armed with proof of success and a comprehensive diabetes management program, Dr. Meijer is sharing his ideas with others. Dr. Meijer has addressed audiences in the community about the impact his program has on diabetes and in March will present his conclusions in Atlanta at a National Conference on Chronic Disease Prevention and Control.
Advanced Medical Treatment in a Rural Community
Dr. Meijer’s interest in medicine began with a keen enthusiasm for science. After graduating Summa cum Laude from The Catholic University of America in Washington, D.C. with a bachelor’s degree in biology in 1980, he went to medical school at Temple School of Medicine in Philadelphia, PA. In 1987, he completed his Family Practice Residency training at UMDNJ Robert Wood Johnson Medical School in New Brunswick, New Jersey.
Dr. Meijer is board-certified in family medicine and a fellow with the American Academy of Family Practice. He is a member of the South Carolina Medical Society and the Horry County Medical Society. He has been treating patients at Aynor Family Practice, an extension of Conway Hospital, for eleven years. In these eleven years, he has developed much clearer and straightforward methods to communicate with his patients, which has allowed his patients to achieve important ADA goals.
The Aynor Family Practice staff supports Dr. Meijer in his endeavors to promote healthy lifestyles. The staff consists of six members, each trained and qualified to carry out important tasks. Cynthia Hamilton, Nurse Practitioner, began seeing Aynor patients three years ago and increasingly supports Dr. Meijer’s educational style of treatment. Before coming to Aynor Family Practice, she found it difficult to work with diabetic patients. The patients were often non-compliant with their treatment. Hamilton began implementing Dr. Meijer’s plan into her own style of treatment. The plan has proven effective despite the obvious differences in demeanor between Hamilton and Dr. Meijer.
“His program does work. It’s a simplified approach and I’ve seen great results. It works a lot better than the traditional approach. Patients understand it so they are more willing to comply,” said Hamilton.
Office manager Judy Squires is the practice problem solver. She works with the staff and patients to keep the practice running smoothly. Sheila Baxley is the practice billing and insurance clerk. She also helps with x-rays and is a licensed Phlebotomist. Gretchen Rabon serves the practice as a certified x-ray technologist and assistant to the nurse practitioner. Dr. Meijer’s new nurse, Pam Gillig, L.P.N., who has more than 18 years experience, works closely with Dr. Meijer and sees first-hand the impact of his program. The newest member of the staff is receptionist Kathy H. Hardwick. The team, although small, has been effective in achieving results that other organizations with armies of support staff have failed to do.
Challenging Obesity and the Diabetes Epidemic
Dr. Meijer’s greatest concern is the increase in the number of obese patients that he encounters. More and more patients were coming to him for treatment of illnesses that were obviously caused by obesity. When it became necessary to replace the office scales because they would not weigh people over 350 pounds, he decided to take action.
It is common knowledge that obesity is the major factor in the onset of Diabetes Mellitus type 2. Obesity increases resistance to insulin, which characterizes DM type 2. Insulin, which regulates blood sugar levels in the body, becomes increasingly ineffective in those suffering from this disease.
According to South Carolina statistics, more than one-half of all South Carolina residents are overweight and the state ranks 10th highest in obesity. South Carolina also ranks 15th in diabetic deaths in America. Children are even being affected. The number of obese children has doubled in the last 20 years and the results are a 400% increase in DM type 2 in children.
Primary care physicians treat 80 to 90 percent of DM type 2. Dr. Meijer felt he needed more support to treat DM type 2 and obesity. Referrals to dieticians did not seem to help. He noted that dieticians inundated patients with materials and they became frustrated and overwhelmed. He decided it was important to design and perfect a new method of primary care treatment plan. By dividing and simplifying information, he was able to gradually introduce small amounts of necessary information to patients during the course of a normal office visit. Ultimately, he created a 10-step program to effectively help the diabetic maintain consistent, acceptable glucose levels and weight control.
The Importance of Diet
Dr. Meijer believes the first treatment for diabetes is diet. The first step is convincing patients to believe this as well. A three-day fast was found to be a simple way to demonstrate this point to patients.
Dr. Meijer discovered from older physicians that a lot of good science about fasting has been forgotten in spite of the 1986 NIH recommendation on diabetes that conceded its effectiveness. Fasting for three days has been shown to lower A1c values for six months. Correctly selected glucotoxic patients feel much better after a three-day fast; additionally, blood glucose becomes much easier to control when the fast ends.
Diet pills or fad diets are not recommended; only a plan of eating the right amounts of nutritious foods. Dr. Meijer insists that patients eat six small meals per day to prevent hypoglycemia, a much bigger problem in a practice where 68% of patients have an A1c of six for more than four years without weight gain. He discourages snacking.
“We refer to the six small meals as equally important. Patients bring out the cookies and ice cream when we refer to any meal as a snack,” said Dr. Meijer.
To help patients grasp this concept, he suggests that they imagine all the food that would be eaten in a single day, and that they divide it into six equal portions. Each portion is to be eaten at the same time each day.
Patients are gradually introduced to the more complex concepts of keeping a food diary, counting calories and fiber, and reducing food intake. By addressing issues one at a time, in ways anyone can understand, patients gradually change their lifestyle. This requires patience from the physician and the patient, but Dr. Meijer believes that this is effective in achieving long-term results.
Dr. Meijer likes to use the coined term Diabesity to stress the link between DM type 2 and obesity. The most important function of his program is to communicate clearly to patients the serious nature of their illness and the importance of caring for it. He believes to “sugar-coat” any message is to do a disservice to the patient.
“The sweet tooth has to be treated like alcoholism and denial is a big problem for patients that need to abstain from sweets. I sometimes would be a lot more popular with many of my patients if I were to shut up. My decision not to do so is based on my concern for my patients’ health. I feel that I am morally obliged to identify and treat any preventable illness including DM,” stressed Dr. Meijer.
Dr. Meijer also thinks that making information understandable for patients is a key success of his program. To accomplish this, Dr. Meijer has composed a series of clearly written articles that are as easily understood as any daily newspaper. Articles accompany handouts for each step of his program. These articles cover practically every topic that affects the diabetic including defining the specifics of the disease, how food intake affects the body, complications caused by diabetes and what needs to be done to manage the problem. The articles and handouts are designed to explain and continuously reaffirm what a patient must know to achieve and maintain good health and quality of life. Patients can expect to be quizzed on article and handout content on each follow-up visit.
Spelling Out the Truth
Not only does Dr. Meijer explain things very clearly, he also uses very direct and frank language. By doing so, he is able to create in his patients an aversion to the things that are most harmful to them. One of his most successful methods of encouraging patients to cut out foods that are unhealthy is to bypass fad terms, such as “junk food,” and label food that is high in sugar and fat and low in nutrients and fiber as “crap.” In his language and literature, he uses this term repeatedly, not to offend, but to defend his position that the intake of unhealthy food equals bad health and needs to be eliminated. He finds that the patient’s affinity for foods containing useless calories decreases when associated with distasteful terms.
Because the world of advertising has so effectively used slogans to encourage Americans to eat improperly, Dr. Meijer has created several slogans to combat current campaigns that promote poor eating habits. Among the most creative are “Eat like an American, die like an American” and “Eat to live, don’t live to eat.” The use of slogans helps patients identify with the lessons that they must learn in order to successfully accomplish goals that lead to good health.
Other slogans are incorporated into program handouts and articles to instill important information concerning diet. A helpful hint about eating fruit so that you are reaping the full benefits of fiber and decreasing calories is easily remembered with the slogan, “Eat fruit, don’t drink it.” This reminds the patient that fruit juice is a poor substitute for fruit. Patients can remember that calorie-wise, juice is as bad as soda. Dr. Meijer believes that prescribing medication and regular exercise is also an important part of the treatment of DM type 2. These issues are addressed in his program. He believes the advances in modern medicine are crucial to saving lives. However, ignoring the effects of diet on diabetes is a big mistake.
“As obesity increases, the risk for DM Type 2 increases more than 60-fold. America is one of the fattest countries in the world and is getting fatter faster. Currently, one in five Americans can expect to become a diabetic. As obesity increases, this number will rise,” adds Dr. Meijer.
The effectiveness of Dr. Meijer’s program includes African-Americans. “South Carolina Medical Review confirmed our results that our black Medicare patients did as well as whites,” said Dr. Meijer. The results were measured by comparing the A1c levels (blood glucose levels) of these Aynor Family practice patients over a one-year period. Medicare patients had no significant weight gain. Outcome did not vary for race, even though the baseline A1c was much higher, as one would expect, for African-Americans. The average A1c rate for South Carolina is 8.5 percent. All of Dr. Meijer’s patients’ average A1c rate is 6.9.
Dr. Meijer has designed a slide presentation geared for the public and an additional presentation for physicians to promote awareness of his Aynor Family Practice DM type 2 Program and the effects of diet on diabetes. The presentation utilizes the same straightforward language and basic information that his program provides to the individual patient at Aynor Family Practice. In addition to speaking to the community and at the National Conference on Chronic Disease Prevention and Control, he is working on an article he hopes will be published in medical literature. Dr. Meijer hopes then to hear from other physicians with similar interests.
Aynor Family Practice patients are the first to reap the benefits of the devotion to quality medical care that Dr. Meijer and his staff provide. Dr. Meijer offers medical expertise, encouragement and sound advice to patients. By addressing every question during visits or in handouts, he ensures that each patient gets the proper education needed to cope with and manage difficult health issues. He is honest and straightforward with patients so that they will not be deceived about the importance of aggressive preventative treatments. The results are healthier patients who feel better and have improved quality of life. ©