Mashantuckets get assist combating diabetes, a well being disaster indigenous to tribes


May 23 – MASHANTUCKET – Both parents had diabetes. Her grandmother lost both legs to the illness.

Heather Mars-Martins, a member of the Narragansett Indian Tribe and longtime associate of the Mashantucket Pequot Tribe, grew up thin and ate what she called the “ancestral way of life” as naturally as possible. Aware of the importance of fitness in keeping the disease at bay, she participated in athletics and cross-country skiing.

“You think you’re doing everything right …” she said.

But when Mars-Martins woke up one day in 2003, her vision was blurry. The ophthalmologist asked her how long she had been diabetic. Her GP ordered tests that confirmed she had type 2 diabetes.

Especially among the tribal populations, she is anything but alone.

While it is estimated that more than 10% of the US population has diabetes, the prevalence among Native Americans – Indians and natives of Alaska – is nearly 15%, double that of whites, according to the US Centers for the United States Disease control and prevention.

Today, more than 17 years after her diagnosis, 55-year-old Mars-Martins, a North Stonington resident, has benefited from a virtual treatment approach based on frequent communications with doctors who remotely monitor her blood sugar levels and blood pressure and other biomarkers and a “coach” who provides highly personalized feedback and advice on their diet and lifestyle.

“It’s basically an online diabetes clinic,” said Dr. Jeff Stanley, medical director of Virta Health, the San Francisco-based start-up who hired Pequot Health Care of Mashantucket to improve the health of tribal members and contain costs.

Pequot Health Care manages the tribe’s self-funded health plan available to tribe members and staff at Foxwoods Resort Casino. It also manages plans for other tribes and other trading companies. Mars-Martins is the Administrative Assistant to the President of Pequot Health Care, Christopher Manzi.

The story goes on

“The local economy spends hundreds of millions of dollars treating acute illnesses,” said Dr. Setu Vora, Chief Medical Officer of the Mashantuckets. “We asked, how can we move upstream? How can we focus on disease prevention, disease control or reversal. Diabetes is a real crisis; we were looking for real solutions.”

Vora’s search led him to join Virta Health’s diabetes reversal program. Seventy-four type 2 diabetes patients originally participated in the Virta program. Finally, through Pequot Health Care, the Mashantuckets aim to improve the treatment of prediabetes and obesity.

After a year, 93% of Mashantucket participants in the program had lowered their blood sugar as measured by A1c tests, while reducing insulin and other diabetes-specific drugs prescribed for them by 78%, Virta Health reported. Almost 70% of the patients lost more than 5% of their body weight.

The tribe also benefited from cutting their drug spending by 50% and saving more than $ 3,800 per patient per year, according to Virta.

“Typically, a patient’s insulin increases year after year,” said Stanley. “Once you’re on insulin, you’ll be on it for life. So it’s unheard of to see the opposite trajectory … When you’re told you’re on it for the rest of your life and then you’re told you need to it doesn’t, it can be one of the most impactful days of your life. “

Mars-Martins said she stopped taking fast-acting insulin injections before meals two months after starting the Virta Health program almost two years ago and reduced the dosage of long-acting insulin she takes once a day before bed. She said she has telemedicine visits to Virta Health doctors four times a year and otherwise communicates with Virta staff via text and video chat. And there is the monitor that she always wears on her stomach and that transmits data to Virta Health.

“Telemedicine has really changed my ability to deal with my illness,” 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 treating 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 and can’t break down. It’s not like dieting. It’s not that I can reach a goal and stop. Certain foods my body doesn’t know how to process. It’s about a lifestyle change. “

Fortunately, Mars-Martins can handle local foods. She has returned to nuts and berries, meat and seafood. New England clam chowder – “family love,” she calls it – is okay without the potatoes she personally prefers. She also loved baked bread and learned to do without the not-so-indigenous white flour for almond flour and coconut flour.

She has lost the 30+ pounds she added over 17 years.

During the first year of the Virta Health program, Mars-Martins communicated almost daily, and sometimes several times a day, with her Virta trainer, Leah Wakefield. They texted back and forth and talked over video calls. The discussions ranged from the question of why the patient’s blood sugar rose to the effects of stressful events such as the coronavirus pandemic or the pregnancy of a relative.

“Stress eating can be a problem, as can lack of access to a gym,” said Wakefield.

She said Mars-Martins was so successful because of her commitment to the program. Wakefield also recalled that one of the first dishes Mars-Martins worried about was New England clam soup.

“We talked early on about how she made it without the potatoes – or how she could eat it before adding the potatoes for the rest of the family,” said Wakefield.

Such patient support is “the big differentiator” in treating diabetes, said Stanley, medical director of Virta Health.

“Decades of research have shown that limiting sugar and carbohydrate intake in diabetes can have dramatic effects. However, you need help navigating the food landscape,” he said. “This would not have been possible 10 years ago with an inpatient clinic. Today’s technology enables us to do this.”

“I’ve got my life back,” said Mars-Martins.