Fighting A Diabetes Epidemic

Dr. Mary Pixler follows her own advice about exercise.
Amanda C. Gregg photo

Dr. Mary Pixler
Director, Health Advantage Program

Interviewed By Amanda C. Gregg

Dr. Mary Pixler is an internist at Kaua’i Medical Clinic who directs the Health Advantage Program, which aims to improve the quality of care that doctors give to patients by measuring against national benchmarks. The first woman president of the Alpha Omega Alpha Honor Medical Society at Temple University in Philadelphia, Pixler is a Pennsylvania native and had a private family practice before moving to Kaua’i. She came to the Island in 1992 following an interview in August of that year, during which time she stayed at the Coco Palms hotel before its infamous demise with Hurricane ‘Iniki the following month.

What is your background?

My undergraduate, I attended Bucknell University (the fourth-most expensive school in the country) and I attended Temple University for my medical training. I did my residency in Pennsylvania at Reading Hospital. I had a family practice in Kutztown, Pa., for 10 years prior to moving to Kaua’i in 1992.

What’s your job description?

I’m an internist at Kaua’i Medical Clinic in Lihu’e, and I am the director of the Health Advantage Program, which is a program to improve the quality of care that the doctors give to patients. It also involves getting patients more involved in their care. You can e-mail the doctor questions, request a refill or make an appointment.

When did it begin and how is the program doing?

It was started about a year and a half ago. It’s getting better and better – the goals comes from Hawai’i Pacific Health System. The idea is you can go to Kaua’i Medical Clinic, Straub or Kapiolani, Pali Momi or Wilcox, and it’s all in one system, so it allows better communication between physicians, sub-specialists and patients.

What is your area of focus?

It used to be there were no sub-specialists here in internal medicine. No pulmonologist, cardiologist, endocrinologist – so each internist carved out a little area in which they were the expert. I had this patient who came from California and relied on an insulin pump, so I began getting referrals from other doctors for diabetes-related issues.

For those who may not know, what is an endocrinologist?

They focus on diabetes, thyroid, adrenal gland and pituitary gland. Insulin is a hormone. Basically a hormone is when something is secreted into the bloodstream by a gland that does its work not just for that local area – in that way it’s different than say, digestive enzymes that secrete into the digestive gut to break down food.

When did you know you wanted to become a doctor?

Originally (around age 16) I wanted to be a veterinarian. I was a live-in baby-sitter for a summer and I baby-sat for a woman with two children, and her father was my family doctor. I did pre-med and went straight through – I wanted to fast-track my way through it.

Can you talk about diabetes and its different forms?

It is kind of scary. There are 130 million Americans either with diabetes or pre-diabetes. Pre-diabetes is when a patient’s blood sugar is not normal, but isn’t high enough to say they have Type-2 diabetes, which used to be called adult-onset diabetes, but now we have youths getting it. We’re seeing kids with Type 2 now, and that means they’re going to get complications early in life. We’re seeing the first generation that isn’t going to outlive their parents.

What sort of preventative methods can you recommend for Type 2?

Diabetes 1 (the type you are born with), you can’t prevent. For Type 2 diabetes, I would recommend parents start early. Get kids off their video games and limit their sedentary activity. Get them out on the bike path, get them swimming, hiking, playing soccer. I would say paddling, but exercise should start much younger (than that sport permits). Even when they’re little, set an example: Walk them in the stroller. If they can’t walk yet, at least they are attuned to being outside rather than in front of a television set.

How is what we’re eating affecting this Type 2 diabetes epidemic?

It drives me crazy as I watch people buy groceries and I am just thinking, “Diabetes, diabetes, diabetes.” A lot of it is just knowing how to read labels, like when it is called “juice,” but it’s really sugar water. Or sugary cereals – this is what we shouldn’t be feeding youths. Of course, Ding Dongs, Ho-Hos, Twinkies, Spam and white rice aren’t any better. You want your carbohydrates to have fiber so it’s absorbed more slowly and doesn’t cause the insulin and blood sugar to spike. So choose high-fiber carbohydrates such as whole-grain cereals, and aim for 35 grams of fiber a day. Also, remember brown rice is better than white. Breads should be whole-grain breads as opposed to white bread. It’s also about quantity, not just quality. You don’t need two scoops of rice (even if it’s brown). Some people eat the right things, but just too much of it. Portions matter.

What type of screening would you recommend?

You don’t have to fast for the kind of screens we use now – a hemoglobin A1c test. You may have to ask for it, but you should request it from your doctor, especially if you have these risk factors: a family history of diabetes, are non-Caucasian (people of color, Asians, Pacific Islanders, African-Americans, Hispanics), are overweight, sedentary, or are “apple shaped” and have central obesity – thin arms and thin legs relative to the trunk or waist area.

Tell me about the work you’re doing with your Health Advantage Team and who is involved?

The team is made up of Don Traller, physician’s assistant and certified diabetes educator; Michelle Barnhart, administrative assistant; Carey Fujimoto, medical assistant, and Norissa Ahlgren, nurse educator. Our training has included six workshop sessions on Oahu, which are every few weeks. The next conference is March 4. We decided that we would focus on hypertension because it is very common – more so than diabetes – and probably the most important risk factor for stroke, heart attack and kidney disease. About 79 percent of my patients’ blood pressure is controlled by medication. Though that’s better than the national average – we’re at 77 percent nationally – we call our own statistics the “cream of the crap.”

What advice would you give to those who are at risk for Type 2 diabetes?

Type 2 diabetes is a preventable disease, but it takes a lifelong commitment to lifestyle change. I have a very strong family history of diabetes. If I let myself gain weight and didn’t exercise, I would have it myself. It’s been shown the most effective way to prevent it is diet and exercise. But you can’t just do it here and there. It takes a lifelong commitment.