Mashantuckets get help fighting diabetes, a health crisis indigenous to tribes
Mashantucket — Both of her parents had diabetes. Her grandmother lost both legs to the disease.
So, Heather Mars-Martins, a member of the Narragansett Indian Tribe and a longtime employee of the Mashantucket Pequot Tribe, grew up skinny, eating as naturally as possible, following what she called “an ancestral way of life.” Mindful of the importance of fitness in keeping the disease at bay, she participated in track and field and cross country.
“You think you’re doing everything right ...,” she said.
But when Mars-Martins woke up one day in 2003, her vision was blurry. The eye doctor asked her how long she’d been diabetic. Her primary doctor ordered tests that confirmed she had type 2 diabetes.
Among tribal populations, in particular, she is anything but alone.
While it’s been estimated that more than 10% of the U.S. population has diabetes, the prevalence among Native Americans — American Indians and Alaska Natives — is nearly 15%, twice what it is among whites, according to the U.S. Centers for Disease Control and Prevention.
Today, more than 17 years after she was diagnosed, the 55-year-old Mars-Martins, a North Stonington resident, has benefited from a virtual approach to treatment that’s based on frequent communications with clinicians who remotely monitor her blood sugar level, blood pressure and other biomarkers and a “coach” who provides highly personalized feedback and advice on her diet and lifestyle choices.
“Basically, it’s an online diabetes clinic,” said Dr. Jeff Stanley, medical director of Virta Health, the San Francisco-based start-up that Mashantucket-owned Pequot Health Care engaged to help improve tribal members’ health and contain costs.
Pequot Health Care manages the tribe’s self-funded health care plan, which is available to tribal members and Foxwoods Resort Casino employees. It also manages plans for other tribes and other commercial enterprises. Mars-Martins is the administrative assistant to Pequot Health Care’s president, Christopher Manzi.
“Local economies spend hundreds of millions of dollars treating acute sickness,” said Dr. Setu Vora, the Mashantuckets’ chief medical officer. “We asked: How can we start moving upstream? How can we focus on disease prevention, on controlling disease or reversing it. Diabetes is a real crisis; we were looking for real solutions.”
Vora’s search led him to Virta Health’s diabetes-reversal program. Seventy-four type 2 diabetes patients initially enrolled in Virta’s program. Eventually, the Mashantuckets, through Pequot Health Care, intend to add coverage of prediabetes and obesity treatments.
After one year, 93% of Mashantucket enrollees in the program had reduced their blood sugar, as measured by A1c tests, while reducing by 78% the insulin and other diabetes-specific medications prescribed for them, Virta Health reported. Nearly 70% of patients lost more than 5% of their body weight.
The tribe benefited, too, reducing its spending on medications by 50%, saving more than $3,800 per patient per year, according to Virta.
“Usually, (a patient's) insulin increases year after year,” Stanley said. “Once on insulin, you're on it for life. So, to see the opposite trajectory is unheard of ... If you’re told you’ll be on it for the rest of your life, and then you’re told you don’t need it, it can be one of the most impactful days of your life.”
Mars-Martins said she stopped taking fast-acting insulin injections prior to meals two months after starting the Virta Health program nearly two years ago, and has reduced the dosage of the long-acting insulin she takes once a day at bedtime. She said she has telemedicine visits with Virta Health doctors four times a year and otherwise communicates with Virta staff by text and video chat. And there’s the monitor she wears on her abdomen at all times, transmitting data to Virta Health.
“Telemedicine has really changed my ability to manage my disease,” she said. “I haven’t had a diabetic low or high in two years.”
Mars-Martins said the Virta Health program provided her with videos and other material that helped her better understand the science behind the treatment of her disease.
“The idea is to see food as medicine, not poison,” she said. “What I didn’t know is which foods my body could break down and which it couldn’t. It’s not like going on a diet. It’s not like I can reach a goal and stop. Certain foods my body doesn’t know how to process. It’s about a lifestyle change.”
Fortunately, indigenous foods are the ones Mars-Martins can process. She’s gone back to nuts and berries, meat and seafood. New England clam chowder — “family love,” she calls it — is OK, sans the potatoes she personally favors. Also fond of baked bread, she learned to forgo not-so-indigenous white flour for almond flour and coconut flour.
She’s shed the more than 30 pounds she had added over 17 years.
In the first year of the Virta Health program, Mars-Martins communicated almost daily and sometimes multiple times a day with her Virta coach, Leah Wakefield. They texted back and forth and talked on video calls, the discussions ranging from why the patient’s blood sugar was spiking to the effect of stressful events like the coronavirus pandemic or a relative’s pregnancy.
“Stress eating can be a problem, and so can lack of access to a gym,” Wakefield said.
She said Mars-Martins has succeeded so well because she's committed to the program. Wakefield, too, recalled that one of the first dishes Mars-Martins was concerned about was New England clam chowder.
“Early on, we discussed her preparing it without the potatoes — or how she could eat it before she added the potatoes for the rest of the family,” Wakefield said.
Such patient support is “the great differentiator” in treating diabetes, Stanley, the Virta Health medical director, said.
“Decades of research showed us that with diabetes, limiting your sugar and carbohydrate intake can have a dramatic effect. But you need help navigating the food landscape,” he said. “It wouldn’t have been possible 10 years ago with a bricks-and-mortar clinic. Today’s technology allows us to do it.”
"I've got my life back," Mars-Martins said.
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