♪ opening music ♪ ♪ ♪ Welcome to "Palmetto Perspectives."

I'm Thelisha Eaddy.

Tonight we're taking a deep dive into diabetes.

It's the seventh leading cause of death in adults here in South Carolina, and the palmetto state is eighth in the nation when it comes to the prevalence of the disease.

We just watched "A Touch of Sugar," where we heard from five South Carolina residents impacted by the disease, and they're far from being alone.

We also learned tonight that nearly half of adults here in the palmetto state have a problem with their blood sugar.

So now, a conversation with those working to make a difference.

We have some joining us in the live studio audience here and also our panel of community stakeholders.

Thank you all so very much for joining us.

Thank you for being here tonight.

And so, let's introduce you to our panelists.

First up, joining us tonight at the very end is Doctor Ebony Toussaint from M.U.S.C.

Thank you for being here tonight.

Doctor Tim Lyons is chief of endocrinology at the Medical University of South Carolina and if he looks familiar, that's because he was featured in tonight's mini documentary, "A Touch of Sugar."

Also joining us is State Senator Mia McLeod, who also sits on the Medical Affairs Committee.

And rounding out our panelists this evening is Doctor Kobra Eghtedary.

She is with the Department of Health.

Thank you all for being here.

We really appreciate your time.

So I wanted to start with the basics.

We see that, we've heard that more than 88 million Americans are living with pre-diabetes, 34 million with diabetes.

Kind of go over the basics for us.

What's the difference between those two classifications?

Doctor Lyons.

Yes, we'll start with you.

Nicely, Thelisha.

Well, pre-diabetes, diabetes, is in a sense, not an all or nothing thing.

We go from entirely normal blood sugars, and then we can get to blood sugars, which are diagnostic of diabetes.

The definition was defined according to risk for diabetic eye disease in the past.

But between being normal and between actually being diabetic, there's a range of blood sugars that are not normal but not high enough to be regarded as diabetes.

And we now know that in that range, there is still a significantly increased risk for cardiovascular disease.

So many cardiovascular deaths and illness in the state are actually underpinned by some degree of blood sugar problem, which may not be recognized very often.

So that's what's called prediabetes.

It's that intermediate level of blood sugar elevation that you have to go through between being normal and between actually being diabetic.

<Thelisha Eaddy> Again, going over the basics, explained to us type one versus type two.

<Dr.

Lyons> So type one diabetes is caused by an immune reaction which damages the cells in the pancreas, called the beta cells that make insulin.

And over a period of time we think typically about two years the beta cells are wiped out.

By the time you get down to less than 10 percent of the beta cells, you should have blood sugar starts to go up, and as you lose the rest of them, you become entirely dependent on insulin that has to be given by injection.

In contrast, in type two diabetes, the body, the cells of the body, cease to respond properly to insulin that your pancreas is making.

So insulin levels initially tend to be high, but the body's not responding.

And so blood sugar levels, rise not because insulin isn't there but because the cells are not responding to it.

<Thelisha Eaddy> Reversible or permanent conditions.

So when someone is talking with their doctor and they learn, you're hearing these terms for the first time.

What does the road ahead look like for them?

<Dr.

Lyons> It's a very interesting question, talking about the reversibility of diabetes, because, many people, if they live a lifestyle which is promoting the presence of their diabetes and they revert to a lifestyle that prevents it or slows it down, their blood sugars may return to normal.

There's still nevertheless, a person who is prone to developing diabetes.

They've shown that by the fact they had it, and then it reverses.

But, there's still a resistance to the action of insulin, and this is all in type two diabetes.

In type one diabetes, so far, we don't have a way to restore insulin, production by the beta cells, but, there's a lot of progress going on that leads for significant hope for type one diabetes in the future.

<Thelisha Eaddy> We're hearing a lot that the number of cases or prevalence are increasing, not just here in Columbia and in South Carolina, but across the country.

From the perch, if you will, of each of your work areas, how do you see diabetes impacting within your, within your circle?

And we'll start with you, Ebony.

That's an excellent, excellent question.

Thank you for asking that, Thelisha.

It's, I think when I toured hospitals for where exactly I wanted to work in the state, looking at Prisma, Lexington and the Medical University of South Carolina, I'm Gullah Geechee, so I was drawn to being closer to home, but, I hadn't known yet since I've recently moved back home a few years ago that I was in the place with some of the highest instances of stroke and diabetes, not just in the state or the country, but the world.

And so that was very jarring for me.

And so when people come in, through the front door of the hospital, I don't think I fully anticipated how that would present itself in the emergency room.

I was expecting primarily traumas and, things like that, but, we see people all the time with, cardiovascular complications.

As Doctor Lyons said, a lot of heart disease, a lot of problems.

We see a lot of, not just heart attacks, but brain attacks or strokes, as most people know of it, and people in kidney failure.

And so, I think one of the women shared their stories in the documentary we just saw, that had someone told her that beyond just, I need to control my food and the things I eat, that this would impact my kidneys, I may end up having an amputation or other types of complications that maybe, that could have been clear.

And so for me, in my work, I try to make sure I'm not solely focused on the health literacy of patients, because we know literacy is an issue here in the palmetto state, but how am I, as both a clinician and a scientist, communicating the science of the disease and what those complications can look like for patients and their families?

<Thelisha Eaddy> Doctor Lyons, you have an extensive background in the area.

How is diabetes impacting the work that you do and why you do the work?

<Dr.

Lyons> Well, I'm not quite sure how do answer that.

It's impacting the work that we do because we are, we're doing the work because of the problem.

But, what I think is important to say is that so much of this is preventable.

It doesn't have to be this way.

And one of the things we're trying to do now is emphasize the importance of a good start in the life.

And by that, I mean good pregnancy management, good preparation for pregnancy, good postpartum management, good management of metabolic health in childhood and adolescence.

Sadly, the fastest increasing group in percentage per year, of diabetes Is in African-American teenagers.

And that's a real tragedy because it does not have to be happening.

It's happening because of lifestyle issues, essentially, that have changed over time.

We know why it's happening, but we're not doing well at changing that trajectory and preventing it from happening.

And if you get diabetes, type two diabetes as a teenager, by the time you're in your 30s and 40s, you've had it for 20 or 25 years, and all that time that's been doing damage to your body.

And so the cardiovascular disease, the kidney disease and the other complications are taking their toll silently over time until they present with something that could have been prevented.

<Thelisha Eaddy> Senator McLeod, I'm thinking you have a really interesting perspective, actually sitting on our state's medical affairs committee.

Same question for you.

Frustrating.

You know, it's, as he said, to think that so many South Carolina residents are living with diabetes.

Some know, some don't.

But South Carolina as a whole, in terms of our politics and our policies, we are notoriously reactive and rarely proactive.

So for me, to sit on medical affairs and see just the, the suffering of our citizens as a whole, as it relates to diabetes and the complications from diabetes, it's totally preventable and it's, I think, extremely disheartening to think that Our leaders have refused to expand Medicaid.

I'm from a rural community.

I grew up in Marlboro County, Bennettsville, South Carolina, and, I can relate to so much of, what was covered in that documentary because of that.

You know, when I go to my hometown now and see, people who don't have access to quality health care, they are living with food deserts.

They don't have the resources or the means to eat healthy.

And it shows.

And I mean, we're losing people, to diseases that are completely preventable.

So it's really frustrating.

It's really difficult for those of us who are in politics and in positions supposedly of power, and we lack the power to really make those kinds of life altering, changes for the majority of South Carolinians.

<Thelisha Eaddy> Doctor Eghtedary, within the Department of Health, how is diabetes impacting your day to day?

What role do you play in this process?

We look at diabetes from kind of prevention and also treatment and what affects.

So everything that's been, discussed here from, not just looking at the after the fact, after diabetes happened and some of the information that was provided is how do you, how do we deal with it once, diabetes here.

But how do we prevent it?

How do we kind of let the population have enough information, enough resources?

That's where Department of Health, comes in.

The type of, diabetes education, involving, the, community health workers in diabetes education.

Also looking at, the disparities in diabetes.

What bring us to the place of becoming diabetic?

There is, much more complexity in the process of getting there and that's, some of the issues that were brought up, the social determinants of health.

So when we're talking about housing, when we're talking about poverty and income, education, neighborhood safety being able to walk, have nutritious food, all of those impact the, this process of preventing, diabetes.

So there are two side of the equation, two side of the coin, that we need to put our efforts in.

And sometimes, as Senator, brought up very rightfully is that the politics of things looks at, the cost of, programs.

And yet it's so much cheaper to prevent a big issue, life changing issue, lifelong issue, such as diabetes, than to treat it.

The treatment is so much more expensive.

So in our, the state program, we do have 1.1 million that is provided, from C.D.C.

to our diabetes, division.

However, we have no funding from the state in preventing diabetes or, dealing with this huge program or, problem in, South Carolina.

So it's really looking at the process comprehensively from that department of public health perspective, and looking at both sides of the coin.

<Thelisha Eaddy> You bring up cost and, I don't know about you guys, but show of hands, one of the numbers that we saw and heard on the, on the documentary that shocked me was that $6.4 billion.

Anyone else?

That's the cost of diabetes, what it cost the Palmetto State every year.

Also in the doc, we heard that it's, of course, the seventh leading cause of death, within adults.

That was shocking to me.

Before we get into the state's response or how the state is attacking or combating this problem, I want us to take a listen to this.

<Dr.

Lyons> If we had a war going on or we were being attacked by some foreign power that was killing tens of thousands of South Carolinians and hundreds of thousands, if not millions of Americans, we would have an ordered, structured response to that that would not be similar to our response to diabetes in South Carolina or anywhere in this country.

<Thelisha Eaddy> So the thought that first hits me is during the coronavirus pandemic, it seemed like there was a coordinated effort to combat that health crisis.

Doctor Lyons, I want to start with you.

Of course, that was you in the clip.

Is there something like that in South Carolina and in the country that coordinated effort to combat diabetes?

Absolutely not.

I mean, we are fragmented.

We're siloed.

We do not take a coordinated response to these non-communicable chronic diseases, which are killing millions of people.

We just shrug our shoulders, and we do not respond appropriately.

<Thelisha Eaddy> Ebony.

I like that you mentioned the coronavirus pandemic because it's infectious in nature, something people can see.

And so there's a coordinated response for that.

But I think something that people also forget is that it's the Centers for Disease Control and Prevention.

So it's not just, coordinated efforts to control the spread of outbreaks, but it is to prevent chronic diseases from happening, such as diabetes.

And there's programs like the Diabetes Prevention program, but as Doctor Lyons said, it's up to states to decide whether they want to implement said programs and receive, federal funding, from the C.D.C.

to fund those types of programs.

I think one of my favorite projects, actually, that South Carolina, has done since the 1990s.

Again, I'm always going to mention being Gullah Geechee because I'm from Beaufort County, but one of the projects they did was the Sea Island Sugar Project and to Doctor Lyons' point of that, we see African-Americans are getting diabetes at higher rates than other groups.

So not only that, we have some within group dynamics that differ.

Gullah Geechee people, they discovered we're getting higher rates of diabetes diagnosis compared to other groups of African Americans.

And so that kind of pulled me in back home to say, wait a minute.

We've now even looked down to the genome of these hundreds of Gullah Geechee families and seen two different spaces on the genome that were reacting, responding differently to excess levels of glucose in the blood.

And so when you talk about what are we doing now that we have all of that, to Dr. Lyons' point, we need to be attacking it as if it is a war, because in a way it feels very personal to me especially, and it should feel that way to all of us that are South Carolinians, that we have this data, we have this information, but it's up to us to now take the funding and have a coordinated plan.

<Thelisha Eaddy> Any other thoughts on the coordinated efforts of, I like to ask this question.

If you had a crystal ball, if we had that power, Senator, you talked about having the power, what would you implement so that we did have a more coordinated effort and just like, you know, military strikes, we could we could combat and overcome this problem?

Crystal ball.

There are a number of things that I would implement if I had a crystal ball.

And not just related to diabetes.

I think at the state level, what is so infuriating is we have the ability to, to treat and prevent diabetes and other diseases.

We just won't.

And, I think ground zero is expanding Medicaid.

I mean, not just because of the health, the obvious health benefits, but because it's also an economic benefit.

And it makes health care more accessible.

The video talked about the fact that so many people are living with diabetes and don't even know it.

And so, you know, when I think about education and prevention and funding, all of those things go hand in hand.

When I think about the coordinated response that we had during the height of the pandemic, that too was lacking and it was politicized.

I mean, we have government leaders who refuse to promote vaccinations, although they were vaccinated.

We've got elected officials who, you know, declare that the pandemic was a hoax.

So, it's not, it shouldn't be surprising that we are where we are and where we're not, as it relates to diabetes.

I mean, it's personal for me as well.

I've got family members who have lived with diabetes and died with diabetes.

Friends.

I mean, it's just, it's like an epidemic in our community.

And government leaders should not be able to throw up our hands and say, well, you know, we'd rather focus on abortion or we'd rather focus on, you know, something that benefits us or benefits our loved ones.

It's not right and, you know, the thing that is really going to change that is when people are engaged enough to realize that the people that they vote for or not, that are serving in these positions can be voted out just like they are voted in.

And if their vision for South Carolina and their values and, I mean, all of us aren't going to agree on everything, but ideally, our health and well-being should be prioritized by all of our elected officials.

We can't afford to not.

I mean, I'm deeply concerned about the state of our state as it relates to not just access to health care, but preventing diseases like diabetes.

I mean, that's something that we can do.

And we have consistently refused as a whole.

<Thelisha Eaddy> We're hearing preventable a lot.

Preventable a lot.

Doctor Kobra, you're with the Department of Health Agency, Lots of programs, lots of outreach.

What's needed to help solidify or create or solidify, a more coordinated effort to, to really make gains in this preventable?

<Dr.

Kobra Eghtedary> So thank you for that question, because it, makes me very excited because of the project that we're working on right now with, multiple partners from across the state.

And it is, specifically toward this effort at the State Health Improvement Plan.

So a part of the State Health Improvement Plan, one of the priorities that were voted on was, health equity.

And as a part of health equity priority, one of the indicators that were brought to the forefront based on data and based on input from our partners from across the state was diabetes.

And what the effort is, is really an opportunity for the first time to define the State Health Improvement Plan from that coordinated effort.

Looking at collaborative action, looking at, so we're talking about the efforts from across the state and what we find in our work and in talking to our partners from across the state and multiple stakeholders, multi-sector stakeholders.

We see that there's a lot of great work is being done at the individual level, at the small organization level, at even community level.

But these efforts are fragmented and they are siloed, and, they are not, kind of all kind of cooked.

And that's what, the State Health Improvement does.

Bringing partners together from across the state and saying, let's put our efforts together.

One agency with big grant, can provide the money and other agency and can provide resources and expertise.

There is, if we put all our efforts together and work toward the same goals, then there is hope for us.

And then maybe we can impact, politics.

Maybe we can help our legislators because we believe that our legislators, regardless of where they are in their politics, they really want their constituents to live better lives.

So it is our responsibility as public servants, our responsibility as researchers, our responsibility as service providers and health providers to provide that foundation for our legislators to make better policies, to provide the funding for our programs.

Like I said before, our state, our whole state, public health, doesn't have a state funding for diabetes, prevention or treatment.

That has to change and we think if, as a part of this State Health Improvement Plan, if we put our efforts together and, Doctor Lyon and M.U.S.C.

and many other partners that are sitting here are actually part of that effort, to come up with these, plans so we work together and, only putting our resources together, then we can change policies, then we can make sure that we show not only just the data, because the data has been around for a long time.

This is not the first time we're hearing that, you know, number seven, reason, for death in South Carolina is diabetes or that there is 2.5, time more, non-Hispanic, Black population is dying from diabetes than the White.

It's not the first time.

The data is there.

The data has been there.

How do we use that data effectively to then come up with policies?

Come up with and use our resources?

And the source of funding that's available, to kind of bring us together as collaborative action to make, that, kind of collective impact.

That's what I think the senator's talking about and that's what Doctor Lyons and, my partner, from M.U.S.C.

is talking about that It is a different kind of war.

It's a different kind of pandemic.

And we need to approach it from that point of view.

<Thelisha Eaddy> You spoke about community, and as you were talking just now, the age old saying came to mind that it takes a village, and so let's listen to the role of community right now, Being able to hold, whether it is our politicians or different organizations accountable to make sure that they're doing their part to help the community be healthy because I can check in on you all day, but if you don't have a supermarket to go to, and you don't have gas to drive 45 minutes, like it's so many different factors that I think play into what makes managing diabetes much more challenging.

But, I think as a community, we can do it together.

But, you do need outside support to help kind of bolster that.

<Thelisha Eaddy> I want to turn to our audience members now because I know you're representing many different communities across South Carolina, and I'm eager to know if someone has an example of what's being done maybe uniquely, maybe not uniquely within your community.

How is, your community stepping up and being collective in this fight?

Yes, ma'am.

<audience member #1> So, yeah, first and foremost, thank you so much for having us.

<Thelisha Eaddy> No, no, you're good, but we just want to make sure we hear what you said.

So, there's, a mic is coming.

<Oh, Okay> And so, while we wait, what community, where are you from?

<audience member #1> I'm local here to Columbia <Thelisha Eaddy> You're in the Midlands.

Okay?

<audience member #1> Yes, absolutely.

And so, I wanted to kind of shared kind of the community efforts and the added resources.

<silence> <Thelisha Eaddy> All right.

Here we go.

So unique in your community.

What's happening in your community?

First tell us your name and what community you're part of.

<audience member #1> Absolutely.

So my name is Kalia Poshean and I live locally here in Columbia.

But, as part of our community, so, I represent a nonprofit, mail order pharmacy.

We're a medication assistance pharmacy, and we serve the entire state, and we provide free medications to uninsured residents of South Carolina.

And so, talking about that piece in the, documentary about, I think we could talk at length about, in addition to prevention and, and how do we treat it, but also the astronomical cost that comes together with the, you know, being treated and the supplies that go along with it.

And so, it's a very helpful resource.

We work with, you know, M.U.S.C., the Department of Health, Eau Claire, to help those patients that are in that, in between, right.

So they're not old enough to be provided Medicare.

A lot of the, pediatric patients fall into the Medicaid portion when it comes to financial.

And so, we serve the entire state with providing the diabetic insulin that they need, the test strips, the glucometer, all of that, that cost a lot of money that our, community just doesn't have.

And I think currently the state is at 12 percent of uninsured rates for a multitude of reasons, and we're just not hitting the mark.

We're not reaching into those rural areas.

And so, those partnerships, Doctor Lyons, it's always a pleasure to see you, is super helpful to, you know, provide that community effort.

So, we can only provide the medications, but we need someone that's providing the care and we need someone that serving those other patients, that maybe we're not reaching.

And so the community efforts are huge.

<Thelisha Eaddy> Anyone else?

In our documentary, we heard about the 29203 ZIP code here in the Midlands.

But also, we know that this problem is not just specific to Columbia or to the Midlands.

The documentary also reference our rural areas.

I believe some 30 percent of South Carolinians live in South Carolina's rural parts.

When it comes to community, what are some of the differences or challenges or roadblocks between those of us living in rural areas and those of us living in urban areas when it comes to our health overall and then diabetes?

Anyone.

<Dr.

Toussaint> So, I will answer that first, because while I live here, I told you I'm Gullah Geechee and I'm from Beaufort County, specifically Saint Helena Island, and I actually just got back from home from our annual Heritage Days celebration at the Penn Center, which is part of the Gullah Geechee Cultural Heritage Corridor.

Many of you know Congressman Clyburn, and so that was established about 20 years ago.

But before that, the Gullah Church Nurses was started about 30 years ago and that's from a long history of nursing and midwifery on the Sea Island, because at one point in time we only had one physician.

But anyway, they were a crucial part to recruiting all those Gullah Geechee families at the Medical University of South Carolina to even test their genetics and talk to them about diabetes and things of that nature.

So when you talk about the importance of communities and being empowered as a part of their own health, I think about my community a lot.

And I'm glad you mentioned the rural urban differences in the state because it is very, very different.

So while here in 29203 one of the things I noticed during the past year, placing a lot of continuous glucose monitors at the Prisma Family Medicine Clinic, was that people talked about food insecurity here a lot and limited access to food, while along the Gullah Geechee Cultural Heritage Corridor, being very, very rural, there's a lot of, how do we kind of come in together and bring each other in to kind of get back to some of our fishing and farming practices.

And, nowadays, many of you may be familiar with KJ Kearney and Black Food Fridays.

One of the conversations I had with KJ was, you get the fun part.

You get to go travel and taste food and eat food and tell people, come, come here and eat our good Gullah Geechee foods.

And I'm like, but we got to really talk about our food ways.

So beyond food efficiency and insecurity, I think in rural areas, the challenges, especially in faith based communities like mine, is our food way, which is beyond just the consumption of food.

This is the production of food and the preparation of food.

And so a lot of our culture is around Frogmore Stew, we got fish fries and fried fish.

So some of it's not just the sociopolitical and waiting on the policy and the money, which is, you know, tremendous a part of my career before clinical practice, but a big part of it is also that cultural component.

And I think that's where communities partnering with the Department of Health and partnering with the Medical Affairs and Senate committees, all of that coming together is really, really important at this point in time.

<Thelisha Eaddy> And speaking of Mr. Kearney, I just want to let you know that you can watch him on "Citizen Better" on South Carolina E.T.V.

But, I had to plug it.

But again, differences urban versus rural.

So, just talking about the difference in culture.

So, that is a very, key component of education and communication.

We just had our Live Healthy South Carolina Conference and one of the speakers, had diabetes, and he was talking about having pre-diabetes or the doctor telling him having pre-diabetes.

And, he said it very, in a very casual way from a patient's point of view, that, so if you tell me I have pre-diabetes, doesn't make any sense in my, assumption that I'm going to get diabetes.

If you tell somebody who is pre pregnant, they're not going to think they're going to be pregnant.

So why are you telling me I'm pre-diabetes, diabetes and just like the audience there, everybody laughed.

And that clicked something in my head, thinking, how do we, it isn't just, so yes, money, resources, funding, policies are critical a component, but understanding culture, understanding history and working with it, not trying to eliminate or go from one direction to the next, but really being able to work it in as a part of the community, as the part of the church, a family, to using our congregations, which are very strong in South Carolina, using them as our allies, because that's where actually our key efforts in the pandemic, our key success in our Covid vaccination came from our congregations.

So using those established community partnerships and trust and communicating in a way that our educations everybody talks about health, education, diabetes education and the importance of it, how do we do that effectively So the information is heard by the patients?

So when we're talking even about nutrition and the type of food.

So that's one of the issues, I think, the cultural issues.

But also when we talk about a rural, rural and urban, that social determinant of health impact is different for those communities, from, a rural a point of view, it could be transportation and lack of access to care, could be a huge issue.

And also we're talking about insurance, availability and reimbursement rates for those rural physicians.

So the complexities of issues in a rural community and urban community is very different.

And we need to be aware of it and address it specifically.

<Thelisha Eaddy> Yes, Doctor Lyons, So, one thing I have to take issue with is the pre-pregnancy pre-diabetes.

This is not a valid comparison because pregnancy is an either yes or no event.

Diabetes is absolutely not.

Diabetes is a continuum of risk according to blood sugars.

The same applies to blood pressure, blood cholesterol levels.

You know, it's very difficult to define normal levels because it's a continuum.

Coming to the urban and rural situation, I think we have to be cognizant that it's very rapidly changing.

Rural populations here and almost everywhere in the world are declining.

Urban populations are rising.

Rural populations are characterized by aging, communities.

Urban populations are full of young people.

I think as a country that spans more than twice as much per capita on health care than really any other country in the world, and still has.

Sadly to say, we need to face, you know, if you're an alcoholic, you need to face it before you can solve it.

If you've got problems, you've got to be honest about facing them.

We have the worst outcomes for chronic disease management of any developed nation in the world.

Not just the worst, but by far the worst.

And we spend by far the most.

So I think it behooves us to recognize that issue and just have the humility to go and look at how things are done in other places, and maybe try to learn from them.

Other places also have rural communities and urban communities.

Nothing unique about that.

There are other ways to do things than what we do, and we've got to open our eyes.

And until we do so, these numbers that we've been talking about, they're not getting better.

They're getting worse.

All the agencies meeting, they have nice meetings where everybody agrees that, the terrible problem.

Nothing happens, because we're not doing anything that's reaching scale.

We're doing a community thing here, another community thing there, another community thing over there.

Different communities.

It's all nice.

Lasts for a few years.

Maybe it continues, maybe it doesn't.

But nothing is systematic.

And that's why I said about the war situation.

If the Russians invaded here, we wouldn't be reacting to it with a few philanthropic organizations raising money to resist it.

Right?

Or church bake sales.

We would not be doing that.

We would be organized and we'd be fighting.

And until we change our course, we will go on getting the same results, we've been getting for decades, actually getting worse.

<Thelisha Eaddy> You know, our ZIP code really does matter.

And before before I get to that, I do want to ask this question and audience as well.

Is personal responsibility key and should be pumped up a little bit higher in this equation?

<Dr.

Lyons> Yes and no.

<Okay> Yes, personal responsibility is important, but as health care providers, it's not our judgment to judge whether somebody is reacting responsibly.

You don't know the totality of their life.

You're not in a position to make that judgment.

Many people will not take your advice.

Just accept it and do what you can for the people in front of you.

And of course, personal responsibility is important, but none of us are really fit to judge somebody else's reaction to a tragic situation that they find themselves in.

We don't know their history.

<Thelisha Eaddy> Okay.

Yes, sir.

<audience member #2> So personal responsibility, I find in health care that there is a lot of shame that if you develop diabetes or you don't have health insurance or you're, having these, social determinant challenges, you're almost shamed that you did this to yourself as opposed to the environment that you grew up in.

And so, I find that, you know, self guilt, shame for your, what you're experiencing and even with diabetes is very important and also how others look at you.

Oh, you did this to yourself through whatever, food choices that you made.

And so there's, shame, but there's also guilt, and not really understanding that for, many of our citizens who are managing through this, they really didn't have a lot of choice in the neighborhood that they grew up on, the street that they grew up on, that, whether they had health insurance or they didn't.

And, so I think that that's a very important thing in terms of how we look at it and being shamed and how others are, you know, accusatory that you did this to yourself.

I don't have diabetes and, because I did this, this and this, you have diabetes and you made the wrong choices and not really understanding that there's a lot more to it than that.

<Thelisha Eaddy> Thank you.

We want to also thank those making comments right now on our YouTube channel.

Thank you.

We are broadcasting live on South Carolina E.T.V.

but also on our Facebook channel and our YouTube channel.

Thank you for those comments.

Speaking about diabetic shame, let's take a watch.

<Courtney Hunt> You'd be surprised how many people have diabetes and their families don't know that they have diabetes, or they don't feel comfortable sharing that information with friends or co-workers.

Some people feel that I did this to myself, or this is the choice that I made, so I have to kind of suffer in silence.

<Thelisha Eaddy> Thoughts?

Yes, ma'am.

In the...

Hold it up high.

[silence] <audience member #3> Good evening.

I'm really disheartened by, the many conversations where we're actually missing the elephant in the room, and it is simply, it's a moneymaker.

I mean, everybody on the panel with the exception of maybe Mia, makes money from diabetes being a problem.

So to actually really address the issue is to actually ban companies from having so much sugar in everything we eat.

If there was some collaborative effort to get these companies that feed us and make our food lower their sugar content or remove it completely, then maybe we wouldn't have an issue because the campaign to eat right and give us all the information on what to do, is just like the cigarette campaign.

They knew that if they told you what not to do and what it would do to you, then you wouldn't stop doing it.

So I just think it's a bigger issue of the money that is made for the treatment of diabetes is a reason why you will not solve the problem.

<Thelisha Eaddy> Okay.

I saw a hand here.

Or did I see your hand here?

Nope.

So let, let's respond to that.

At first, you know, as she was talking, I was like, well, when she mentioned cigarettes, you know, I was like, okay, maybe we were going through the, I don't know what we're going to call it, but, results from, opioids and that fiasco.

But what are your thoughts to that, to that question, that comment?

I mean, there's food addiction just like there's smoking addiction.

So I appreciate the the comparison and it takes me back to my community and the point of care with, clients or patients that I see.

It does feel very much like a partnership and that we're in it together because I'm multilingual.

Again, I work in a Gullah Geechee community.

So, when they see me and they hear me and I speak and I code switch, we can begin to talk about foods and connect in a different way.

And they trust me, I think, in a different way.

And we can have certain conversations where it does remove some of that shame because I understand like them, too, I grew up in the culture.

I grew up in the way that they did.

And then now we can remove that barrier and have a conversation about the food.

And here's how you might can make that gumbo, how you can prepare that okra differently.

Instead of saying, well, you just need to stop eating fried okra.

You need to stop eating that all together.

We can then move forward in the conversation about different ways to perhaps prepare okra, different rice varieties, because we are rice eating Geechee people.

So just removing some of those barriers, I think allows us to have more of a partnership and collaboration in their care that removes some of that guilt and shame, because I too, grew up in the community and grew up eating the same foods and still do.

<Thelisha Eaddy> Doctor Lyons.

I agree.

Absolutely.

I mean, I think we live in a health system which basically is there for profit.

The profit based health system.

I mean, we talk about the health industry.

That's what it is.

And so, as a nation, we do very well with cancer treatments, but cancer is an acute, fearful event that happens to somebody at some point in their life.

And we do very well with that.

On an international comparison, American cancer survival numbers are good.

But we do very badly for slowly developing chronic diseases.

And that, is, I mean, cancer and heart disease are the two big killers.

Most heart disease is driven by insulin resistance and is underpinned by some diabetes.

We have a system whereby we have huge numbers of people doing heroic things for cardiac disease that should never have happened for kidney disease, the entire dialysis industry, 80 percent of it shouldn't be there because it shouldn't be necessary.

We're all back loaded in the time frame of illness.

We wait for the crisis.

We're reactive, as you said.

Then we deal with it.

We could have prevented it at a fraction of the cost and had a healthier community.

We need to stop having health of our society as being profit driven, and have it as something that is for the well-being of the entire society.

Which, by the way, would produce huge profits because we'd have a healthier workforce, and we're a healthier, happier community, and I think it would be a win win.

But you're absolutely right.

Yeah.

Yeah.

I was going to say she is absolutely right.

One of the things that I was really taken aback by, during the pandemic was that our elected officials were focused on, oh, getting people back to work, getting back to life as usual, and I thought, how are we supposed to do that when we're not even willing to put extra safety measures in place for people who are being sent back to work, for people who are deemed, who were deemed at that time because of that situation as essential.

They've never been essential before.

Seven dollars and 25 cents an hour doesn't make them essential?

But yet these were the people that were being sent back to work, during the height of the pandemic.

And I thought, what's the logic behind that?

You know, sick people don't work and dead people don't either.

So why are we doing things that are counterproductive to what we say we want?

We say we want a strong workforce.

A workforce can't be strong if people are sick.

But yet we're monetizing that sickness and it's unbelievable that we, in every other aspect, attempt to deregulate what we can be, what we can eat.

The industries that just have free rein to put whatever they need to put into their products to produce them mass and then we sit back and, you know, wonder why diabetes is at the level that it is.

And, you know, South Carolina has one of the highest.

We're one of the highest in everything bad.

And really and, and particularly, diabetes.

I often think about being from a rural community when I was growing up, we didn't have cancer treatment centers on every corner, it seems.

Now we do.

And, you know, the more I hear well, there's no cure for cancer.

So you can be in remission, but there's no cure.

Nobody's talking about diabetes.

I've lived, with sickle cell, and nobody's talking about sickle cell.

Nobody's talking about any of the chronic, you know, people live with lupus.

People live with C.O.P.D.

They live with complications from diabetes.

I'm a stroke survivor.

And so I know that even those of us who have access to quality health care are still at risk for, expensive medications, life threatening complications.

And there's really no appetite.

To put it bluntly, diabetes doesn't win elections.

And so my colleagues aren't concerned in the least about it.

And they're not concerned about the other, chronic diseases and illnesses that are plaguing their constituents and communities.

So I was really encouraged to see that the communities are doing what, what we can, to not only supplement in some cases, but to be, the assistance that our community members need and to educate them and enlighten them, people can't do better until they know better.

And even when they know better, there has to be, there have to be resources and support in place that will enable them to make better decisions.

Right.

So, you know, it's, it's tough.

It's a tough position for, all of us to be in because we know what would actually.

Help to resolve a lot of the issues that we're seeing.

And we've, we now find ourselves in a position where our elected officials are like, oh, well, you know, I'm glad y'all know, but we're going to focus on, you know, this issue over here.

And we're not, we don't have time to, we don't have the funding and we don't have, you know, there's always a reason.

So.

<Thelisha Eaddy> We've talked about where we are and how we got here and the rising costs.

What do things look like if we don't do anything different?

What is South Carolina looking at?

<Sen.

McLeod> People will continue to suffer and die, needlessly, but, it will continue to happen.

I mean, there are very few of us who are willing to disrupt the status quo in this state, and I'm unapologetic about disrupting it.

<Dr.

Lyons> There's an enormous amount of apathy.

<Sen.

McLeod> Right.

<Dr.

Lyons> The apathy is in communities.

People accept this.

This happened to their parents.

They're fatalistic.

Just think, that's always been like that.

<Right> That's not the case.

But providers are apathetic to.

And the medical profession is apathetic.

Providers in general just say, well, that's the way it is and we've got to do another.

This one goes on dialysis.

That one gets an amputation and, it's just, nobody feels they can do anything about it.

And the reason they can't do anything about it is talking as a physician, I think many physicians are now working in large organizations that tell them they've got to see a patient in ten minutes, and they've got to see four new patients a day, and a bunch of follow up patients.

They don't have proper time to do it.

They never establish a real relationship with that patient in depth, create the foundation of care that enables subsequent visits to be efficient.

The subsequent visits are inefficient because the information was never granted in the first place.

As long as we go on doing these things, nothing will change.

<Sen.

McLeod> Right.

<Dr.

Lyons> That's obvious stuff that needs to be done.

It's clear as day.

If we don't do it, we're going to go on the way we are, which is bottom of the class in the world and top of the class for expense.

<Thelisha Eaddy> A lot of information tonight for the person that has to take the insulin shot tonight before they go to bed, or for the person that has that patch on the arm, or for the person that has to go to dialysis tomorrow morning, What are the next steps?

What are the actionable steps that can, if not immediately, help them?

At least give them that hope and faith that we talked about?

And I want to start with you, Ebony.

I think what gives me hope is the same type of hope I try to transfer to my clients and patient point of care, as well as, community members, is I think we have to continue to use our imaginations.

And I don't discount the role of faith in many people's lives as well, and the role of community.

So community is extremely important to me.

And I can see for many of the patients it's the same thing, especially because, again, many of us belong to the same community.

But, what I would say to them is the things that I always say, is continue to advocate for yourself and ask questions if you don't understand.

I think I had a 40 something year old patient the other day that said, yeah, I think somebody told me I had diabetes once, but I can't read.

And so that was very jarring for me.

And so, I had been being paged to come and I'm like, I'm with the patient or I just didn't respond.

And they try to knock.

I'm like, don't come in, Because I'm taking my time and that extra time.

As Doctor Lyons said, because we're being dinged if we don't see a certain number in a certain period of time.

But I'm trying to explain things to them and also refer them to where they can go get extra information in their community.

But I think that's important.

<Thelisha Eaddy> Kobra.

Very quickly, next steps for those listening tonight.

I think, look for resources, and also support from, we talked about, shame and guilt, really starting with, your own well-being and looking for support.

So, it's like everything we talked about that was brought up.

It's the complexity of this issue.

It is very complex.

So it isn't just one individual or one, topic or one solution.

So just accepting that, that you're part of that bigger, kind of community.

<Thelisha Eaddy> Thank you all very much for your time this evening.

We appreciate your time.

Thank you.

To our studio audience.

We appreciate your time as well.

For those of you watching online, thank you for joining us.

We appreciate you as well.

This is a great conversation.

Thank you for the information for all of us here at South Carolina Public Radio and South Carolina E.T.V.

Thank you.

And stay connected with our website where you can watch this program again and share it with others.

Good night.

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