Blood, Sweat and Peers

After 10 years as a clinical endocrinologist, Dr. Matthew Corcoran, founder of the Diabetes Training Camp, was frustrated. Having seen thousands of patients—as assistant professor of medicine at the University of Chicago Hospitals and most recently as a physician in Lehigh Valley Hospital's diabetes and endocrinology group—he wondered why more wasn't being done to prevent the very complications he spent so much time trying to treat. So in March, the 39-year-old physician quit his job to focus full time on developing the camp—the first of its kind. This summer, 28 campers came from all over the country, ranging in age from 16 to 66. Some are competitive athletes looking to fine-tune their skills. Others just want to start an exercise program. All have type 1 diabetes, an autoimmune disease that occurs when, for unknown reasons, a person stops producing insulin, a hormone that turns glucose into energy. Next year, Corcoran plans to add a sports camp for adolescents. Eventually he'll add a program for people with type 2 diabetes, which occurs when excess weight and other factors inhibit the body's ability to metabolize sugar efficiently. In between camp sessions, he hopes to teach diabetes educators and personal trainers his methods, so that they can take them back to their own communities. NEWSWEEK's Jennifer Ordonez, who attended the Allentown, Pa.-based camp in June, spoke to Corcoran on the diabetes epidemic and why exercise could be critical in curbing it—as well as its costs.

NEWSWEEK: You quit your job with a prominent diabetes clinic to focus full time on the Diabetes Training Camp. If exercise is so critical to good diabetes management, why wouldn't patients already be getting similar instruction from their physicians?
Dr. Matthew Corcoran: When I started practicing, it struck me that we were working at the wrong end of the disease; that we were sort of busting our humps all the time to treat people very quickly in clinics—trouble-shooting and taking care of complications. But when it came time to do actual preventative measures, people with diabetes were just really short-changed. First, when you're seeing so many patients a day, there's no time, and education systems aren't reimbursed well by insurance. In general, I think our medical system is just not set up appropriately for chronic-care wellness and prevention, and it really became abundantly clear to me that there's just no overlap between the worlds of exercise and the worlds of diabetes and that the two disciplines weren't working together on it.

So how did you initially get interested specifically in the exercise part of the wellness equation?
I've always had a particular interest in exercise. With my patients, I was definitely emphasizing lifestyle modification, especially exercise and its role in prevention or treatment of people with type 2 diabetes. At the same time, when I was at the University of Chicago, I was working with 10 or 20 people with type 1 diabetes who were pushing the envelope and training for marathons or triathlons. It really just lit the light bulb for me and I guess unofficially I became the go-to guy within the Chicagoland area for patients who were interested in exercise and sports. Even if they weren't my patients, they would utilize me as a resource and we would sort of focus on the exercise piece.

When I was diagnosed with type 1 diabetes 22 years ago, my parents were told that it might be dangerous for me to exercise too rigorously. Now, we're seeing diabetics like Jay Hewitt win Ironman triathlons and Will Cross, who last year summited Mt. Everest. What's changed?
Several things. Twenty-two years ago when you were diagnosed, the medical-care system was sort of limited by poor tools. The insulins weren't great and the blood-sugar-monitoring technology wasn't great. Everything was happening in sort of a big black box and you didn't know when your blood sugar was going to come crashing down. But in the past five to seven years, much has improved. For starters, the development of new types of insulin that enable people with diabetes to operate in ways much more like their bodies would if they didn't have it, letting them lead a much more normal lifestyle. That then allows people to go out and pursue these activities. All of this is happening in concert with some important social forces. There's greater awareness of diabetes—you have folks out there who are high-profile people with diabetes who are doing amazing things. Some are athletes, artists, actors; some of them are professionals doing amazing things with their careers and they're all doing it sort of in the face of, or in spite of, diabetes, so that people say to themselves, "All right, people really can have diabetes and do anything they want to do."

It seems like every day I read something to the effect that diabetes is the scourge of our public health-care system. Is that overstating it?
No. All of this is happening within the context of an absolute epidemic. About 21 million people in this country have diabetes and 45 million others are extremely high risk. The numbers are astounding. It's estimated one in every three children born today will develop diabetes. But the really scary piece right now is that our youth and adolescents are developing type 2 diabetes at alarming rates. The No. 1 cause of death in our country is cardiovascular disease. And one of the major risk factors for that, and for strokes, is diabetes. Now, typically these are problems known to occur in people who are in their 50s, 60s and 70s, because these are folks who have had diabetes for 15-20 years. But from a public-health perspective, now, if we're looking at 10-, 12-, and 14-year-olds who are developing type 2 diabetes, they're going to be in their 30s when they start to develop heart attacks and strokes. You're looking at an accelerated, and costly, process.

So is exercise somehow more beneficial for people with diabetes than it is for even the unafflicted population?
In the past five to 10 years some very important studies have come out that actually document how good exercise is for people with diabetes or at risk for developing it. The National Institute for Health did a study to find out whether the onset of diabetes in a high-risk group could be prevented. They compared a lifestyle- modification program that included healthy nutrition, exercise and a minimal amount of weight loss with a treatment program that relied on medication. What they found is the lifestyle program trumps the medications. It's twice as good, twice as powerful, with an almost 60 percent reduction in the onset of diabetes, compared with those using medications, which reduced it by 30 percent.

So why, then, do you think health-care systems aren't spending more money on preventative exercise programs?
It's complicated. You've got health-care systems that have to move in a different direction. You've got insurers and third-party payers and health-maintenance organizations moving in a different direction. You've got physicians who have become somewhat apathetic to the cause and maybe think that either their patients just won't do it and/or the docs don't understand it. They're not trained in exercise and nutrition and lifestyle. And they don't have time to do it. You can't teach this in 10 to 15 minutes. There are ways you can structure office visits so that you can maybe hit a couple of major points, but it's really challenging.

But couldn't a motivated person with diabetes do the same at a general fitness camp, a gym or with a personal trainer?
Prior to this, there have not been camps simply geared toward diabetes and exercise for the adult population that I'm aware of. The critical thing is to get all of the important team members—the docs, the diabetes educators, the exercise physiologist, the coaches, the nutritionist and the person with diabetes, who is the quarterback of the team—into one place, so that there's this supportive environment to figure out the best strategies on how to manage the diabetes with exercise. First and foremost, there is an emphasis on safety. If we can have people exercising safely we also think it will be fun, and that's something that just can't happen in a run-of-the-mill sports camps. Having held three camps so far, we know that you can take somebody, and in just a few days time, introduce them to some very fundamental concepts about how to manage diabetes during exercise. Apply it to them individually—and I think that's really important because everyone is different—and they employ it right then and there and see results in just a couple of days. That's going to go a long way to making them feel much more comfortable when they leave camp, whether they want to exercise for an hour or run a marathon or everything in between.

Right, because whenever I've tried to start an exercise program, it seems like it wreaks havoc on my blood sugars. Before long I feel like I've set myself up for failure.
Yes, and I think many people with diabetes get that sense of failure—"this is just not going to work, this can't work, I can't do this"—and the immediate result is that they stop. And some of those people, you lose them. They won't go back and these are the folks that the health-care system says, "Well, they're just not going to do it anyway." The health-care system doesn't understand that a significant portion of those people have tried, and they quit. So this is where it gets tough. But there is a certain amount of hand-holding that has to go on initially, so that you can look somebody in the eye and say, "You can do this. You can absolutely do this. Let's see what happens and then we'll go back to the drawing board again and we'll keep chipping away at it until you can feel really comfortable that everything's OK."
Now, that's for the people who come to camp looking for a general fitness program. But I will tell you that even the folks who come into the camp who have had lots of experience with marathons and triathlons, it's been trial and error for them for so many years that we're able to really uncover some pretty fundamental points about diabetes and exercise that they're able to implement right away. And within a week or two's time I continually hear from these folks that they're seeing levels of control and performance that they've never seen before. And we can only hope that that will go a long way to being a safer way for them to exercise for them. That it keeps them from having to drop out of events, or slow down, because their sugar gets too high or too low.

Some of the coaches in your roster are considered super-elite, among the top in their fields. Why would they be interested in working with people with diabetes, some of whom, like me, are pretty out of shape?
I'm being serious when I tell you this: they love it and they have come back to me repeatedly over the past two years and said, "This is what it's all about. This is what I do." They are in awe of what the campers are doing. They recognize now, even the coaches who didn't have a lot of experience with diabetes, what a challenge it is for our coaches and attendees who do have diabetes. And they absolutely love coaching—each and every one of them. We have Olympic athletes, national champions, elite triathaloners on our staff and across the board, all of them demonstrate so much humility. You would never know how unbelievable their résumés are.