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.
Getting Results
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.
MARK ERIK
MEIJER, MD, FAAFP 
