Remarks as prepared; not a transcript.

RADM Kenneth P. Moritsugu, M.D., M.P.H
Acting Surgeon General
U.S. Department of Health and Human Services

Children With Diabetes Friends for Life Conference
Thursday, July 12, 2007
Orlando, FL

"Taking Control of your Diabetes"

Good morning. Thank you, Jeff, for that kind and generous introduction. [Jeff Hitchcock, Founder and President of Children with Diabetes]

It is truly an privilege for me to join you here today.

I’m especially honored to be here at the 8th Annual Children with Diabetes/Friends for Life Family Conference. This is my second year of attendance.

I am inspired by your energy and your eagerness to learn more about the care and treatment of diabetes in our children.

Why are you here?

Why are you here? You adults wouldn’t be here today if you didn’t have a desire to learn more to support our young people with diabetes. You young people would not be here today if you didn’t have a desire to learn more about how to live healthy and productive lives with diabetes.

But some of you are here, because you are terrified of this disease, and the toll it can and will take on our young people if not controlled and treated well. You want to learn more, to do more, to protect our young people, our children with diabetes.

Why am I here

Why am I here? To join you, as a fellow diabetic, and to show my support for the effort you are putting in to learn more about this disease, this chronic ailment that affects you or your child. To emphasize that this is a growing problem in the United States, and that you can do something about it for yourself. To show that there is progress and hope – hope for better diagnosis, hope for better treatment, hope for a better quality and length of life for children with diabetes.

I have no doubt that you can make a difference and improve the health and vitality of our children living with diabetes.

To the parents here today — thank you – for your willingness to be here and to be a part of making a difference in the lives of your children.

And I understand that this is the largest attendance of grandparents at a Children with Diabetes Conference.

It is exceptional that parents are seeing the value of bringing extended family here to learn about best practices in diabetes management.

To our young people here today – you can make a difference. You are the future. I know you will go home armed with valuable information, but you will also take with you memories of the friendships you’ve made at this conference.

As the proud father of three daughters, I am aware that being a parent is the most difficult job in the world.

We want our children to have better lives than ours, an easier time of everything.

But the reality is that sticking to what's easy isn't always the best way to become engaged in and involved in the world around us.

We can only hope that our young people have the strength, the courage, the wisdom, and the knowledge to move forward in their lives – no matter what obstacles they face.

As Eleanor Roosevelt said, “you gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do.”

I believe that every young person in this room today has that ability, and it is that spirit of living that is precisely what will make our world a better place for future generations.

I also believe parents can instill in our children that sense of personal responsibility so they will make the right choices for their health and well being.

It is never too soon to take control and educate yourself about living with diabetes. And I know that isn’t always easy.

My Story

Seven years ago, after a routine physical exam, I was surprised to learn my own health was at risk. I had high blood glucose levels, but it wasn’t type 2 diabetes.

I was soon diagnosed with latent autoimmune diabetes of adults – or sometimes known as LADA.

LADA occurs in 10 percent of individuals older than 35 years and in 25 percent below that age.

Within a year of my diagnosis I began using insulin. Yes, I am a ‘pumper’. How many of you are ‘pumpers’.

Although I am the Nation’s top doc, I too have challenges in understanding and managing my own diabetes.

Living with diabetes is a part of my life, it’s part of my health, and it’s part of my future quality of life.

I am not ashamed and it’s not a limitation, but a challenge.

I’m the Acting Surgeon General and I need to remember what I need to do; to ask for counsel and help; to be aware of my environment; to adjust my activity and my insulin for what I am doing, and where I am doing it...like right now as I’m giving this speech.

It’s something you and I can control.

If you take anything home with you today, I hope it’s the message that you can take control of your diabetes.

From learning to talk with our teens, to healthy living and proper exercise, to the future and research of Type 1 diabetes, many of the topics on the Friends for Life Conference agenda are issues that the Department of Health and Human Services is working on every day.

My bosses, Department of Heath and Human Services Secretary Mike Leavitt and Assistant Secretary for Health Admiral John Agwunobi, both asked me to bring you their best wishes during this very encouraging conference.

We are committed to working with all of you.

Priorities

I want to spend a few moments discussing the health priorities President Bush assigned to the Office of the Surgeon General.

The Office of the Surgeon General oversees a cadre of 6,000 Commissioned Corps officers.

We are charged with protecting, promoting, and advancing the health and safety of the nation.

And there are three priorities that we are focusing on heavily.

Our first priority is Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.

We want to transform our health care system from a treatment oriented sector to an interconnected system. We need a system that focuses on preventing disease and treating disease early, in their most treatable stages.

The second priority is Public Health Preparedness.

This includes preparation and rapid response to all hazards, including natural events like hurricanes, earthquakes, and pandemics; and human-generated crises, like bioterrorism. And what can happen to individuals with diseases during these natural or man-made disasters – like how do insulin dependent diabetics like us obtain and maintain our monitoring, our medication, and our activities during these disasters.

The third priority we're focusing on relentlessly is Eliminating Health Disparities.

Diabetes has taken a toll on certain populations.

The health status of people with diabetes in the United States is expected to worsen in many vulnerable, high-risk populations— such as African Americans, Hispanics, American Indians or Alaska Natives, Asians or other Pacific Islanders, elderly persons, and economically disadvantaged persons.

It is simply unacceptable that in our great nation, there are such stark differences in health between populations based on race, socio-economic status, and geography. We must eliminate these disparities.

Health Literacy: An American Problem

Right now, there's a widespread problem that is seriously impacting our progress in all of these three priority areas.

It is low health literacy.

Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

Why is health literacy important?

Low health literacy impacts health.

People with low health literacy are:

• Less likely to know how to navigate the health care system,
• less likely to understand basic health information,
• less likely to get preventive health care services,
• more likely to use expensive emergency care services, and
• more likely to be hospitalized more often for longer periods of time.

When a patient does not understand that certain factors increase his risk for a disease...that is a problem.

When a mother does not understand when her child should be getting vaccinations...that is a problem.

When a patient is rushed to the emergency room due to a misunderstanding in how much medicine should be taken...that is a problem.

When an insulin-dependent diabetic does not understand how to maintain good blood glucose levels, or how to prevent hyperglycemia or hypoglycemia...that is a problem.

This is unacceptable.

And it’s an especially challenging topic for the child with diabetes.

Young people with diabetes must hear, understand, embrace, and ultimately put into action what they need to know and do to promote, protect and safeguard their health.

Today, low health literacy is a threat to the health and well-being of Americans and to the health and well-being of the American health care system.

I know that for many of you, clear communication about managing your diabetes is important to improving your overall health and well-being.

The reality is that we are largely a health-illiterate society.

• Only 12 percent of adults have proficient health literacy.

• Let me repeat this in another way: Nearly 9 out of 10 American adults lack the skills needed to take care of their own health, or how to prevent disease.

• I hope that those of us here have a better understanding and appreciation of our disease than those 9 out of 10. And if not, then that is the reason we are here, to learn more, to understand more, to put into action more information to help us take care of ourselves

Language barriers due to low-English proficiency add another layer of complexity:

There are more than 21 million people in the United States who have trouble speaking and understanding English.

Patients with low English proficiency are more likely to experience adverse health events in U.S. hospitals than those who understand English.

We all know that ineffective communication between health providers and persons with diabetes can result in medical errors due to misunderstandings about self-care instructions.

Compounding the health literacy problem is the fact that most patients hide any confusion from health professionals, because they are too ashamed and intimidated to ask for help.

Let's face it, many of us won't even stop to ask for directions when we're lost in a new city, let alone when we have a health question.

Low healthy literacy is especially difficult when dealing with the complex health conditions that many diabetics face.

And it is a concern not only for our family members or loved ones, but also for those of us who work in the health care system.

Every day, health care professionals are witnessing the health literacy gap.... This gap is the chasm of knowledge between what professionals know and what patients understand.

Even seemingly highly educated patients can have trouble understanding basic health information. Not every American is a scientist or a doctor or a health care professional, and we can't expect them to understand what it took us years of training to learn.

I know that my mechanic doesn't expect me to know how to change the transmission in my car. And I shouldn't expect him to know how to perform a tracheotomy.

Our nation has some of the world's greatest medical research institutions, but we are not fully benefiting from all the medical advancements and tools we have in our research labs.

Even our brightest scientists cannot help people if the information is known only to researchers and health professionals.

It's critically important that we transfer health discoveries from researchers ... to practicing professionals ... to the general public as quickly as possible.

On average, medical technology and advances languish for 15 to 18 years before coming into practice. We all know that means lives lost and pain suffered - needlessly.

We can start correcting this problem by improving our nation's health literacy and incorporating health education into everything that we do.

We have to make sure that good health information is getting into the hands of the people who need it. From researchers...to practitioners... to patients...we all have a role to play.

Don’t be afraid to ask your provider when you don’t understand.

Basic health literacy is fundamental to the success of each interaction between you and your health care professional - every prescription, every treatment, and every recovery.

The more people know about health, the better they can take care of themselves, their friends, their families, and their communities.

I am very passionate about health literacy because I firmly believe that by improving health literacy, we can save lives.

Improving Health Literacy

And that is why health literacy is the currency of everything we do in the Office of the Surgeon General. For the past few years, I've been working with colleagues throughout the nation to improve Americans' health literacy.

And I know that it is important to practice what we preach.

I'll be the first to recognize that we have a long way to go in this area.

But the U.S. Department of Health and Human Services is committed to getting it right.

We now have a dedicated health literacy team that meets bimonthly.

And we have set ambitious goals for improving communication in Healthy People 2010, which is the HHS' "road map" for the nation's health.

Healthy People 2010 recommends activities to improve health literacy, including:

• building a robust health information system that provides equitable access,
• developing audience-appropriate information and support services for specific health problems for all segments of the population, especially underserved persons, and
• training health professionals in the science of communication and the use of communication technologies.

And you can help. By asking your health professional when you do not understand what he or she is saying to you, rather than just nodding and leaving only partially understanding what your professional has told you.

Our Healthy People 2010 goals are aimed at improving the health literacy of all Americans, including people with diabetes.

The reality is that for too long some diabetics have received lesser care, and communication barriers have interfered with their quality care.

Diabetes Today

There is no question that diabetes is becoming more common in the United States. Let me rephrase that.

There is no question that diabetes is becoming worse in the United States.

About 150,000 young people under 18 years — or about one in every 400 to 500 — have diabetes.

What does 150,000 really mean?

Well, the Florida Citrus Bowl Stadium here in Orlando seats 70,000 people. The amount of young people with diabetes would more than double the seating capacity in that stadium.

That’s a lot of our young people.

And we’re seeing an increase in the prevalence of type 2 diabetes in epidemic proportions throughout the U.S. and the world – in both children and adults.

Today, nearly 21 million Americans have diabetes, and at least 54 million people over age 20 have pre-diabetes.

One of the reasons is “Westernization,” which includes a diet high in fat and processed foods as well as total calories, has been associated with a greater number of overweight persons in the United States.

Obese children and adolescents have shown an alarming increase in the incidence of type 2 diabetes.

The Dietary Guidelines for Americans recommend that to build a healthy base, persons aged 2 years and older choose a healthful assortment of foods that includes vegetables; fruits; grains -- especially whole grains -- fat-free or low-fat milk products; and fish, lean meat, poultry, or beans.

The guidelines further emphasize the importance of choosing foods that are low in saturated fat and added sugars and, whatever the food, eating a sensible portion size.

I do recognize that there are many challenges facing parents. This guidance may be particularly challenging when eating out, because of today’s large portion sizes with unknown amounts of saturated fat and added sugars.

I know that it is not always easy to get our children and adolescents to listen to advice; especially as they grow older and make diet and exercise choices on their own.

Remember that actions speak louder than words. We all have the responsibility to lead by example so that our children can SEE us practicing healthy habits, and that they will imitate our healthy behavior.

A healthy diet and regular physical activity are both important for maintaining a healthy weight.

Over time, even a small decrease in calories eaten and a small increase in physical activity can help prevent weight gain or facilitate weight loss.

Diabetes Detection

Many of us know what we need to do to prevent some forms of diabetes; we have plenty of information to maintain our diabetes. However, there are still people out there who don’t even know they have the disease.

Unfortunately, 6.2 million people (or nearly one-third) are unaware that they even have the disease.

Almost all of those with unrecognized diabetes have type 2 diabetes and may not have symptoms or be aware of them even though the disease is present.

Not everyone with Type 2 diabetes will show signs immediately.

For many, the complications of diabetes -- eye and kidney disease for example -- are often present when the disease is finally found.

You can help us by educating people in your community, in your families, in your schools, about the dangers and risks associated with undetected diabetes. If you suspect someone you know may be undetected, ask them to seek medical advice. You could save their life.

Diabetes Management

Although diabetes is a serious chronic disease, it CAN be managed through lifestyle changes and medication.

We can learn to avoid the long-term problems of diabetes, such as foot ulcers, kidney failure, and complications with eyesight, by taking good care of ourselves, these include:

• Using our diabetes meal plan. If you do not have one, ask your health care provider about one.
• Eating healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
• Choosing foods that have less fat and salt.
• Getting 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more.
• Staying at a healthy weight
• Asking for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.

Research

Although we have a ways to go, there have been some improvements in the monitoring and treatment of diabetes.

We know insulin is not a cure, but our National Institutes for Health, National Institute of Diabetes and Digestive and Kidney Diseases, and other organizations continue to work on ways to more easily and cost-effectively deliver insulin-based treatment.

We’re also seeing improvements in monitoring. Recently, our U.S. Food and Drug Administration approved a continuous glucose monitoring system that measures glucose levels every five minutes throughout a seven-day period. You had an opportunity yesterday to see a number of these breakthrough devices.

This additional information can be used to detect trends and track patterns in glucose levels throughout the week that wouldn’t be captured by fingerstick measurements alone.

The N-I-D-D-K also continues to conduct research in its own laboratories and supports a great deal of basic and clinical research in medical centers and hospitals.

It also gathers and analyzes statistics about diabetes. Other Institutes at N-I-H conduct and support research on diabetes-related eye diseases, heart and vascular complications, autoimmunity, pregnancy, and dental problems.

Our Centers for Disease Control and N-I-D-D-K have teamed up for a multi-center study focusing on children and youth in the U.S. who have diabetes. The SEARCH study is being conducted at six clinical centers across the nation.

It will invite approximately 9,000 children and youth who have been diagnosed with diabetes to participate in this study. Data from these children and youth will provide more information and help us better understand diabetes.

The study hopes to identify the number of children and youth under age 20 who have diabetes, learn more about the complications of diabetes in our youth and children, and to also study how Type 1 and 2 differ. In addition to NIDDK and CDC, other Government agencies such as the H-H-S Indian Health Service, the Department of Veteran Affairs, and the Department of Defense, sponsor numerous diabetes programs.

Message of hopeM

Before I leave you today, I want to tell our parents, grandparents, aunts, uncles, cousins, friends, and children with diabetes – don’t give up.

I know it can be frustrating sometimes.

Many of you are first timers here at this meeting. I hope you take full advantage of this conference and truly appreciate the people and the organizations that make this happen.

I was impressed by my first Children with Diabetes conference, which was just last year. I felt the energy – the energy of people who are making life-long changes, for their health, for life.

This is truly a celebration, a celebration of life, a celebration of our lives, and the real potential of children with diabetes.

We have the opportunity to learn more about diabetes from experts, to meet other families and children with diabetes, to learn more about how we can take charge of our lives, and to live long, happy, and productive lives.

This is a safe place, a place where we can talk about our concerns and our fears, as well as our challenges and opportunities.

I encourage everyone to talk with one another, get to know each other, learn from each other, and to show your support.

As children with diabetes, you are not alone: this is a disease that affects people everywhere. Remember that you can be whatever you want to be.

You can be a famous basketball or football player, and run a camp or write a book, or encourage others to take charge of their lives.

There are many people you may not have known who are living or have lived with diabetes.

Actress Halle Berry, legendary singer Johnny Cash, jazz singer Ella Fitzgerald, author Anne Rice, NFL Cornerback Mike Echols, Pro golfer Scott Verplank, the inventor Thomas Edison, and former Miss America Nicole Johnson – all live or have lived with diabetes.

You can even grow up to be the Surgeon General of the United States, and help a nation to be healthy in body, in mind, and in spirit.

You can grow up to be whoever you want to be, and to do whatever you want to do.

We can control our diabetes; our diabetes doesn’t have to control us.

Enjoy your time here in Orlando. Enjoy and take full advantage of this conference and all of its events.

Most of all, take control, and enjoy your lives.

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Last revised: July 18, 2007