Episode 12: Diabetes Prevention Programs with Dr. Tannaz Moin

Dr.  Wendy Slusser  00:03

In the United States, every other person over the age of 20 either has prediabetes or diabetes. Today we learn about the story behind this alarming statistic with diabetes expert Dr. Tannaz Moin. Dr. Moin graduated from the University of California, Irvine with a dual MD and MBA degree. She completed an internal medicine training and chief residency year at Yale University, followed by specialty training in endocrinology, diabetes, and metabolism at UCLA. She has quickly excelled in her field. Currently, she’s an assistant professor at UCLA and core investigator at the Center for the Study of Healthcare Innovation, Implementation and Policy at the Veterans Association, Greater Los Angeles, where her research focuses on comparing the effectiveness of different interventions for patients with diabetes and prediabetes. What exactly is diabetes? And what are the risk factors for it? What can you do if you are at risk, or have diabetes? Join us today as Dr. Moin unpacks these questions and shares what a successful diabetes prevention intervention looks like. Dr. Tannaz Moin, it’s so wonderful meeting you here and talking about this incredibly important subject, diabetes prevention programs and your record speaks for itself in terms of what you’ve accomplished over your lifetime, your short lifetime, I expect a lot more in the future. And also having someone as talented as you in so many ways, not just as a researcher and an accomplished physician, but also ability to really cross into other different departments and working with various different people with different skill levels, and educating them, and working with them, communicating. I think it really speaks for the well-roundedness that you are but also how you’re able to work in this field of diabetes, which really is requiring a large, multi-talented, multi-disciplinary group to accomplish your goal. What is your goal, actually, what is it? What would you say?

Dr. Tannaz Moin  02:13

Well, thank you. I’ll start by just saying thank you so much for having me here today. And it’s been an absolute pleasure working with you as well, and other folks across the campus who are thinking about prevention and healthier lives, and for our students, for our faculty, for our patients. So it’s really an honor to be here. And you know, in terms of my personal goals, I think, you know, I realized early on in my training here as an endocrine fellow, so I was studying diabetes in particular, that we have the opportunity to be proactive about a lot of things with respect to our health and well-being. But I think the way medicine is delivered in the US is often reactive. So we’ll be talking about prediabetes. And I think that’s a great example of us really trying to get ahead and empower our patients to lead healthier lives.

Dr.  Wendy Slusser  03:06

Right, working upstream.

Dr. Tannaz Moin  03:07

Yeah, absolutely. Instead of waiting, again, for bad things to happen, and then stepping in. And as an endocrinologist, you know, I sometimes get some slack, or I used to, why why are, you know, preventing the one thing you’re supposed to be treating? I would love that. Yeah, there’s a lot of really kind of bad things that we can’t prevent. But, you know, we’re learning more and more about the importance of prevention, and that even though I’m a subspecialist who focuses on diabetes, that is my passion. And I think part of that stems from seeing the negative impacts diabetes can have on my patients’ lives and their families’ lives. So really just using that as a motivation.

Dr.  Wendy Slusser  03:55

Yeah I mean, what you’re describing really is secondary prevention, right? Because primary prevention would be preventing even the prediabetes. Secondary prevention is taking someone with something that’s the harbinger.

Dr. Tannaz Moin  04:07

Right. And when we talk about prediabetes, so yes, we are trying to prevent diabetes. But you know, we’re still at a point where we’re, in technical terms, trying to prevent those bad things that can happen with diabetes, like heart problems, heart disease, strokes, MIs. And so in that respect, we’re still doing primary prevention of those kinds of negative side effects. So, yeah, this is something I feel passionate about. And I feel very lucky to be in sort of a university setting where folks are forward-thinking about these topics, including, you know, yourself. And we’re bringing together individuals from, as you said, different sectors. And all of us have, you know, something to contribute. And together, I think we can get a lot farther and be much more impactful than any of us sort of working alone.

Dr.  Wendy Slusser  04:59

For our listeners, can you give a bit of a background on what diabetes is?

Dr. Tannaz Moin  05:04

Sure, I’d love to do that. So diabetes, we can think about it broadly as a condition where blood sugars or glucose levels are higher than they should be in the body.

Dr.  Wendy Slusser  05:14

And what’s normal? What is higher?

Dr. Tannaz Moin  05:19

So a normal blood sugar, if you were to fast overnight, and we were to do a blood sugar test in the morning, normal is 100 or less. And so diabetes is when, you know, in the morning, if we were to do that blood test, is 126 or greater. And the reason that diabetes happens is that there’s dysregulation of a very important hormone called insulin, which controls blood sugar levels in the body. Insulin’s released by the pancreas, and it’s essential for life. We can’t live without insulin. And so there’s two types of diabetes. Type 1, where folks are usually diagnosed at a much younger age, and the pancreas stops producing insulin altogether.

Dr.  Wendy Slusser  06:03

Younger meaning less than 20.

Dr. Tannaz Moin  06:05

Yes, yeah. And you know, they can be toddlers and into the teen years. We do have cases of adults who are also diagnosed with Type 1 Diabetes. But what happens on a sort of a pathophysiologic level is the pancreas, the islet cells, stop producing insulin.

Dr.  Wendy Slusser  06:22

The Type 1?

Dr. Tannaz Moin  06:23

The Type 1. So folks who are diagnosed with Type 1 Diabetes, require insulin replacement therapy right after diagnosis. And the second and much more common type of diabetes is Type 2 Diabetes, which means that the body’s actually still making insulin. It just doesn’t know how to use it correctly. And that type of diabetes is usually diagnosed older, in adulthood. And individuals with Type 2 Diabetes are almost always started on oral medications. And with time, many of them also may need insulin therapy. So there’s an overview of the two different types of diabetes.

Dr.  Wendy Slusser  07:06

And what does it mean to have prediabetes?

Dr. Tannaz Moin  07:09

So what it means to have prediabetes is that the sugars are above normal, but not yet meeting the diagnostic threshold to be diagnosed with Type 2 Diabetes. So fasting between 100 and 125, is considered prediabetes. So less than 100 is normal. 100 to 125 is prediabetes, and 126 or more is considered diabetes. And there’s also another blood test, Hemoglobin A1C. So 5.7 to 6.4% is considered prediabetes, and 6.5% and above is considered diabetes. And so what it means to have prediabetes is that you’re on this spectrum of the sugars are a little above normal, but you don’t yet meet the criteria to be, you know, considered to have full-blown diabetes.

Dr.  Wendy Slusser  08:05

That sounds very clear. Thank you.

Dr. Tannaz Moin  08:08

You’re welcome.

Dr.  Wendy Slusser  08:09

The thing that, I think, has blown my mind away is this sort of statistic of one out of two over 20-year-olds in the United States are either prediabetic or diabetic. And I know people say one out of three are prediabetic, but to me, this other data point is even more profound. 50% of our population. One out of two, right? And tell me more about it, I mean, like, how have we gotten here? Like, it just blows my mind. As a pediatrician, it blows my mind.

Dr. Tannaz Moin  08:39

Well, as an adult endocrinologist, it also blows my mind. The statistics are really alarming.

Dr.  Wendy Slusser  08:45

And what data is this?

Dr. Tannaz Moin  08:47

This data? So there was a study published in the New England Journal of Medicine, one of the highest tier kind of journals that we have. And it comes from data and investigators from the CDC, Centers for Disease Control and Prevention, who have a really strong interest in diabetes prevention these days. And yeah, it’s absolutely shocking. And I think there are a lot of risk factors for diabetes and prediabetes. Obesity being one of the biggest, and we know those rates are continuing to increase as well. So you know, and it’s not that every person with prediabetes or diabetes is obese. We have different phenotypes or body types, but definitely higher risk. Also, lack of physical activity, we know is a risk factor for both prediabetes and diabetes, and our lives have become more and more sedentary. You know, we sit behind our computers or when we get home from a long day of work, we’re not doing as much physical activity as we should be doing.

Dr.  Wendy Slusser  09:53

Yeah. And why is that? Why is physical activity so protective?

Dr. Tannaz Moin  09:58

So there’s a lot, you know, we understand and there’s some things we don’t fully understand. So obviously, weight maintenance or prevention of weight gain is one very important thing about physical activity. So we know as individuals age, they gain weight. But folks who are more physically active are less likely to gain weight, they also tend to have more muscle mass, which, when we think about the balance between insulin and glucose, or sugar levels in the body, is a protective thing. And there’s all these other factors like stress, which we know, you know, sort of there are stress hormones. Stress levels can increase blood sugar levels in the body, and physical activity is protective in that way as well. You know, there are again, numerous other risk factors, the ones we’ve talked about so far are what we call modifiable. So these are things that every single person has the power to change. I can eat healthier, I can be more physically active. There are some things, though, that are non-modifiable. So that might be our family history. So a parent, a brother, or a sister with diabetes, will increase your risk. And certain racial and ethnic groups. If you’re African American, of Hispanic background, Asians, all have increased risk. And those are things, unfortunately, none of us can change about ourselves. So it’s very important to focus on the things we can. And I think, healthier lifestyle is really the key here.

Dr.  Wendy Slusser  11:26

I want to go back to two things that you said just earlier. I’d like to debunk a myth, in the sense that, yeah, I think, as you age, you can gain weight. But I don’t know. It’s like, everyone says, oh, you know, going through menopause, you’re going to gain weight.

Dr. Tannaz Moin  11:45

Yeah. So it’s not that you have to gain weight. But when we look at population-level data, and this is not just one study, I mean, numerous studies have shown this. And part of this is our metabolic rate actually does decrease as we get older. So that plays into it. And so even if you’re physically active and kind of eating the same things, with age, you’re at increased risk. So I think the better way to phrase it is, with age ourpropensity to gain weight goes up.

Dr.  Wendy Slusser  12:14

If you don’t modify your diet and listen to your hunger cues.

Dr. Tannaz Moin  12:18

Yeah, and obviously stay physically active. Absolutely. So all of those. Again, the things we can modify the things we have power to potentially sort of be proactive about, as opposed to wait until something happens and then react after the fact.

Dr.  Wendy Slusser  12:32

Yeah, because I feel that one thing that I feel is a myth is the fact that, you know, women who go through menopause are going to gain weight. Whereas what you could really be considering as not denying yourself food, but just listening and being more mindful of your hunger cues. Yeah,

Dr. Tannaz Moin  12:48

Yeah, I just read a study about children and hunger cues. So you know, parents say, eat more finish your plate. And how, you know, sort of culturally, that can be, you know, a belief or a personal family sort of tradition that, you know, people clean their plates. And that we should, as parents, stop doing that because you kind of suppress those cues. And we should be listening, because oftentimes, we’re eating much beyond that hunger cue, and that, again, puts us at risk for all kinds of health problems.

Dr.  Wendy Slusser  13:19

Yeah. Well, actually, there’s research that shown, out of Penn State, Leann Birch did a lot of research on parents who are controlling over their child’s intake actually backfires, ultimately, and especially with girls, Caucasian girls. The data shows that they will actually be much more likely to be overweight later in their 7, 8, 9, 10-year-olds, period of age.

Dr. Tannaz Moin  13:44

Yeah, and I think there’s even some data about, you know, sort of, especially women compared to men, that the more controlling parents might be around food and intake, the propensity to have eating disorders in young adulthood. And we see that in our patients with diabetes, too, who are transitioning to adulthood and might have had lots of do this, don’t do that, eat this, don’t eat that. And that can definitely backfire as they get older.

Dr.  Wendy Slusser  14:08

So when we’re talking about diabetes, when we say one out of two people are either prediabetic or diabetic, we’re talking about Type 2 Diabetes?

Dr. Tannaz Moin  14:17

Yes. So those statistics, when the CDC, Centers for Disease Control and Prevention pulls the statistics, they’re pulling from different data sources, and they try as much as possible to make sure that it’s Type 2 Diabetes and prediabetes. But as you know, there’s another type of diabetes, Type 1 , juvenile onset, insulin dependent. Because from the get-go, the body has stopped producing insulin. The pancreas, the organ that’s responsible for insulin production. But what happens, you know, and my work is in large data sets, when you’re trying to tease out Type 1 from Type 2 Diabetes, sometimes it’s not a perfect science. But yes, when we talk about those statistics, we’re talking about prediabetes and most patients with diabetes actually do have Type 2 Diabetes. That’s a much, much, more common form.

Dr.  Wendy Slusser  15:07

And so the other thing that you were mentioning which is non-modifiable are your genes. And that’s when you referenced certain ethnic or racial groups have a higher tendency, right. It’s really related to the genetic makeup. Now there’s also this belief, of course, which you’ve talked about modifiable behaviors. So you can have genes but they don’t have to be your destiny.

Dr. Tannaz Moin  15:30

Absolutely. I’m a wholehearted believer. But it does mean that if you have those certain risk factors you should be talking to your doctor a lot sooner. Typically we start screening for Type 2 Diabetes at age 40 or 45.

Dr.  Wendy Slusser  15:48

And how do you screen them?

Dr. Tannaz Moin  15:49

So there’s very simple blood tests. The one that’s most commonly used these days is called a Hemoglobin A1C test.

Dr.  Wendy Slusser  15:55

And what does that mean?

Dr. Tannaz Moin  15:56

Yeah, so what does that mean? So this test measures the amount of glucose on red blood cells. It’s sort of a very plain definition of what the test is actually doing. It reflects the level of glucose that’s circulating in the body over three months’ time on average. And so for prediabetes, it’s an A1C of 5.7 to 6.4%. 6.5% and above is considered diabetes. So it’s a very simple test. You don’t need to fast or do anything different with respect to your diet but your doctor could simply order the tests for you and so you could know. And if you do have some of these other risk factors, it’s better to get screened earlier.

Dr.  Wendy Slusser  16:41

Yeah, earlier meaning 40?

Dr. Tannaz Moin  16:43

At a younger age, yeah, absolutely. If you’re overweight, if you’re not that physically active, you may want to get tested sooner as well.

Dr.  Wendy Slusser  16:54

Even if you don’t have a relative, is that it?

Dr. Tannaz Moin  16:56

Yeah, so you know, depending on the patient and their risk factors, we would even screen teenagers. And we’re doing more and more of that because there are more individuals who are overweight and at risk. So those are the the national guidelines that, sort of, are phrased that way.

Dr.  Wendy Slusser  17:13

Well and even, correct me if I’m overstating, but from what I understand is, if you do run a higher blood sugar level when you’re a teenager, you’re much more likely to accelerate your expression of Type 2 Diabetes because of growth hormones and the other hormones that are circulating?

Dr. Tannaz Moin  17:30

Yeah, absolutely. And I’m by no means, you know, sort of a research expert in that area but definitely, I think we’re seeing the onset of what we would call dysglycemia or sort of abnormal glucose regulation and slight elevations in the glucose levels at earlier ages. So decades ago, it was very rare, I would say, for someone who’s a teenager to be diagnosed with Type 2 Diabetes. Now it’s a lot more. You know, sort of, we’re seeing more cases of it. So there’s definitely things that happen, usually 6 to 10 years before you’re diagnosed with diabetes is when we start to see lab changes, physiologic changes. So this is a very long, kind of indolent process that’s almost completely asymptomatic, so you wouldn’t otherwise know unless you had the conversation with your physician and thought about getting yourself screened for diabetes.

Dr.  Wendy Slusser  18:25

So with prediabetes, you’re describing that there are effects on your body, even that aren’t negative?

Dr. Tannaz Moin  18:33

Yes, absolutely. So, you know, I like to think about normal blood sugar, prediabetes, and diabetes as a continuum. So we have sort of a slow progression throughout all of these different stages. It’s not like everybody knows, actually, about the bad side effects of diabetes: heart disease, you know, it’s the number one cause of kidney failure, blindness, preventable amputations in the U.S. and in the world. That’s sort of general knowledge. Most people are aware that diabetes is not a good thing, but it’s not like there’s an on-and-off switch, so you all of a sudden have this risk when your blood sugar reaches a certain threshold. In the prediabetes range, you’re still at risk, an increased risk, for those things.

Dr.  Wendy Slusser  19:16

And why is that?

Dr. Tannaz Moin  19:18

So we have yet to really fully understand the pathophysiology, I would say, of why increased blood sugars directly, you know, are related to cardiovascular events. But there’s some thought about glucotoxicity, so that the glucose itself is actually toxic, the sugar. And so in prediabetes, of course, your sugars aren’t as high as diabetes. That’s sort of by definition what it is. But it’s still above normal. And so all of those things that we worry about. Retinopathy, when vision is impaired by diabetes, also happens in prediabetes. The rate of it is lower, but it’s still a risk. So absolutely something to take seriously.

Dr.  Wendy Slusser  19:59

So one out of two over 20-year-olds are either prediabetic or diabetic in the United States. And I’m assuming that it’s less in the 20-year-old range and it’s sort of rises as people age?

Dr. Tannaz Moin  20:12

Absolutely. Because as you get above, sort of, in the fifth or sixth decades, so 50 to 60, absolutely, the prevalence even goes higher and higher. Because age, in and of itself, is actually a risk factor for diabetes. So as I was mentioning, most national, sort of, care guidelines would say, even in someone with absolutely no risk factors for diabetes, by age 45 they should have been screened for it, because age itself is a risk factor.

Dr.  Wendy Slusser  20:39

And another statistic that’s quite dramatic to me is the one out of ten do know. Only nine out of ten don’t know that they’re prediabetic or diabetic.

Dr. Tannaz Moin  20:51

Yeah so and this is where my work has focused, you know, sort of in the last five to seven years. I think it’s shocking. Every time I hear that, I’m not less shocked. I mean, it’s really alarming, especially because prediabetes is a time, I’ve always thought of it as, you know, the silver lining is even if you’re at risk you know that there are things, and we’ll talk about those, hopefully, but there are things you can do to prevent Type 2 Diabetes or at the very least delay the onset. Yeah, glass half-full is what I always tell my patients. But if you don’t know that you have this condition, how would you know to sort of do anything differently or to be proactive? And again, these statistics come from the CDC data, and they’re kind of now a decade old, so we’re hoping that with some of the national campaigns that are ongoing from the CDC, the American Medical Association, and I know when I give talks sort of anecdotally, I always ask people to raise their hand. There’s sort of more, I think, attention to the issue but yeah, I would say most patients and there are recent studies show that it’s maybe closer to 20 or 30% know. So we’re making headway, but that still means, you know, three-fourths of people have no idea.

Dr.  Wendy Slusser  22:11

Well yeah, you’re definitely making headway. I have a friend who, in her union, she got a newsletter this week that said one out of three Americans have prediabetes. So she couldn’t believe it. She, like, texted me, oh look at this, Wendy, and that’s what you told me and there it is! So I mean, that would be terrific, right, if our organizations that normally are dealing with other health and welfare issues could also telegraph this message.

Dr. Tannaz Moin  22:40

Yeah, absolutely. And I think you know, the old saying is knowledge is power. And so I think everybody has the right to know about their you know their health conditions, their risks. And some people may choose not to do anything about it. You know that’s not their priority right now. But I think giving folks the information to make those kinds of informed choices about their health is really important. And you know I have yet to meet a patient in all of my years of training and faculty that doesn’t care if they get diabetes. Yeah, who wouldn’t be motivated?

Dr.  Wendy Slusser  23:16

If they have had a relative that has had it.

Dr. Tannaz Moin  23:18

Yeah, so everybody you know most people are sort of, have some experience either through family or friend or colleague. And you know when we talk about prediabetes, if they’re at risk, again, I’ve yet to meet someone who says, oh that’s really not that important to me. Of course everybody’s motivated. And it’s interesting and it’s sort of a contrast to when I talk to patients about weight management. For some folks it’s not as important maybe to lose weight, or you know, but when we talk about in the context of diabetes prevention, it becomes a priority, usually.

Dr.  Wendy Slusser  23:50

Well I can understand that because it’s focusing on something that is a positive, you know, outcome that isn’t necessarily the values of how you look, which are different for different people. But your health, everyone wants to be healthy, right? Everyone defines it differently. That’s one of our Semel HCI values, you know. Everyone wants to be healthy but everyone might define it differently. So one thing that has struck me about this whole conversation about one out of two are prediabetic or diabetic, only one out of 10 know it, that we’ve known since 2002, a way to reduce your risk of developing diabetes if you are prediabetic. So tell me about that study from 2002. I mean, we’re almost two decades after.

Dr. Tannaz Moin  24:42

Yes, so well, that study, commonly referred to as the Diabetes Prevention Program or DPP study, was published again in that same New England Journal of Medicine, which is one of the highest tier journals, and was conducted in 27 centers in the US. Patients who had prediabetes and were overweight, were randomized to receive an intensive lifestyle intervention which we also now commonly referred to as the Diabetes Prevention Program or DPP, to metformin or to placebo, which was basically some informational flyers and “usual care.”

Dr.  Wendy Slusser  25:18

And metformin is?

Dr. Tannaz Moin  25:19

Metformin is an antiglycemic, it’s a diabetes medication.

Dr.  Wendy Slusser  25:24

The oldest one, right?

Dr. Tannaz Moin  25:25

Yeah. The oldest.

Dr.  Wendy Slusser  25:26

From the lilacs, from France.

Dr. Tannaz Moin  25:28

Yea, actually, it is. It’s derived from the French flowers. So it’s, yeah, and it’s one of the oldest, safest medications. And these days actually one of the cheapest, it’s pretty low-cost and low-risk. And so patients were randomized to these three arms and then followed over time, the intensive lifestyle intervention, metformin, or usual care.

Dr.  Wendy Slusser  25:56

And what was the intensive lifestyle intervention?

Dr. Tannaz Moin  25:59

So the intensive lifestyle intervention in this study was one-on-one, face-to-face weekly sessions over 16 weeks. And overall, these were conducted over 12 months’ time. So they could be, you know, biweekly, depending on the participant’s needs. And there were some very specific goals. 150 minutes of moderate physical activity. So everybody was aiming to do a minimum of that.

Dr.  Wendy Slusser  26:26

They could build up to it, though, right?

Dr. Tannaz Moin  26:28

Yeah, they could. And there was actually a run-in period of a couple of weeks before, to get folks sort of starting to be active if they’ve never been active.

Dr.  Wendy Slusser  26:35

So 150 minutes a week means 30 minutes a day for 5 days.

Dr. Tannaz Moin  26:39

Yes. And moderate means, you know, you don’t have to go run marathons. We’re talking about brisk walking. So you sort of can still carry on a conversation, but feeling a little bit, sort of, out of breath, but could still speak a full sentence.

Dr.  Wendy Slusser  26:55

It wouldn’t have to be all at the same time. It could be, like, ten minutes, ten minutes, ten minutes.

Dr. Tannaz Moin  26:59

Yeah, and it’s actually better.

Dr.  Wendy Slusser  27:01

Isn’t it also better to exercise after you eat? Or walk after you eat?

Dr. Tannaz Moin  27:07

So yeah, it’s great in terms of, you know, digestion. I think there’s some data about sort of being able to digest food. But also after you eat is when your blood sugar levels tend to rise and activity helps reduce blood sugar levels.

Dr.  Wendy Slusser  27:20

How does it do that?

Dr. Tannaz Moin  27:22

So activity, one, you’re burning calories, I think that’s a very sort of straightforward way of thinking about it. So you’re burning calories, and you’re burning kind of the food that you’re taking in. It’s one of the main ways, yeah. So those muscles are working, and they need glucose, right? They need to take it.

Dr.  Wendy Slusser  27:37

So the glucose will be out of the bloodstream. So the insulin doesn’t have to be doing it as much.

Dr. Tannaz Moin  27:43

Exactly. Well, the insulin helps, yeah. So when glucose goes up, insulin goes up. And when you don’t have diabetes, there’s sort of a perfect match of the insulin and glucose. So all that extra sugar is taken up. When you have diabetes, that balances off, so insulin may go up, but it’s not being used appropriately, and the sugar levels stay up. So 150 minutes of moderate physical activity a week, and then in the original trial, it was 7% weight loss. So the actual amount of weight loss varied at one year. It varied depending on the person’s starting weight, but it was to aim for 7%. And the third part of this intervention was really reduction of calories to be able to meet that 7% weight loss goal. So actually, they followed these participants for three years. But at the end of the study, they looked at, you know, weight loss in the first year, which was on average, about 5%.

Dr.  Wendy Slusser  28:41

On average, so some people lost ten percent, some lost one percent.

Dr. Tannaz Moin  28:46

Yeah. And what they found in this study was that that amount of weight loss, we’re talking about 5%, in those first 12 months, was correlated with a 58% relative risk reduction for progression to Type 2 Diabetes, as compared to the placebo arm. And the data we have on prediabetes that comes out of some studies that were done in China, is over the lifetime, prediabetes represents about a 70% risk of progressing to Type 2 Diabetes. So not every single person who has prediabetes is going to get diabetes, but you know, the lifetime risk is actually pretty high. And you know, so we talked about all these risk factors. And so you know, if someone’s overweight and doesn’t lose the weight, or if they are from certain racial or ethnic groups, their risk might even be higher.

Dr.  Wendy Slusser  29:41

Yeah. And so getting back to preventive medicine, which I think is really a unique characteristic of your work, because it is true as a specialist, even in this day and age, a lot of medical doctors are still not devoting the amount of time that they’d like to or they even have the skills for. So why is it so important for long-term health for your patients or our community overall? What’s driving you to focus on this?

Dr. Tannaz Moin  30:06

Yeah, I think for me personally, it really has been what I see in my everyday sort of clinical practice of with respect to diabetes, sort of the negative impacts. And so at the same time, so you see all of these negative things that can happen, and it’s physical, a whole change of life. Yeah, absolutely emotional. And, you know, living with diabetes is, you know, something that folks can do very successfully. But it’s a whole added bunch of thing you have to do. Check your blood sugar, you know, I mean, there’s a lot of other things that come with that.

Dr.  Wendy Slusser  30:39

What is it, what comes with it?

Dr. Tannaz Moin  30:42

Checking your blood sugars, medications that you’re taking. And in some instances, you know, usually we start with oral medications, but often, might be insulin, and that’s multiple daily injections that someone’s giving them. And so you can think about, we can think about the average working person and how much of a disruption something like this can be to their life. And so you know, if we’re in a position where we can, again, prevent, or at the very least, we can delay the onset by years, I think we’re doing so much for, you know, quality of life, really, more than anything else. And, you know, in terms of our healthcare costs, and from a societal perspective, prevention is key. As most of our healthcare spending happens, in a reactive fashion, people are hospitalized, you know, sort orf fo these diagnoses and complications from the diagnoses. So in the US, one out of every seven healthcare dollars goes to diabetes-related care and complications. One out of every seven.

Dr.  Wendy Slusser  31:44

Wow, what is our health care spending, do you know?

Dr. Tannaz Moin  31:48

So in terms of diabetes-related healthcare spending, we get great estimates from the American Diabetes Association, which are published about every five years. In 2017, the ADA estimated that we spent $327 billion on diabetes-related healthcare in the US. In comparison, in 2012, we had spent $245 billion. So in the span of just five years between 2012 and 2017, diabetes-related healthcare spending has increased by 26% in the US, so from an individual quality of life perspective, it’s critical that we try to prevent diabetes, but also from a societal and sort of big picture, also really, really important that we prevent.

Dr.  Wendy Slusser  32:39

Yeah. So what what are the makings of a successful diabetes prevention program?

Dr. Tannaz Moin  32:45

Sure, that’s a great question. And I think we’re fortunate that we are in a time that we have very clear guidelines about how to do diabetes prevention program delivery and how to do it well. And we have national guidelines on what the makings of a successful program are. And all of that is informed from the trials, the randomized control trials and all the studies that have been done over the last two decades. So critical things are that the program is vetted by and sort of recognized by the Centers for Disease Control and Prevention or CDC. There’s a national registry that’s publicly available, a website that you can go and look up programs by your city, by your state. So that’s key. And and the reason that’s key is all of the programs that are in that registry follows some very basic standards for delivery, based on the research. And the coaches are certifiedl they’re trained the curriculum.

Dr.  Wendy Slusser  33:48

And they don’t have to be college educated.

Dr. Tannaz Moin  33:50

Absolutely not. But they have some training to do what they’re doing. The curriculum is, you know, again, informed by the original research studies. And also, it’s an intense program that’s delivered over time. So we know the more sessions that are a part of the program, the better in terms of someone’s ability to lose weight. So the programs are all at least a year long, 12 months, and at least 22 sessions in those 12 months, and some programs offer more. And when we talk about those numbers, it can be a little overwhelming. It doesn’t mean that you have to come to every session. But the idea that, you know, when you’re making healthy lifestyle changes, it’s not overnight. You’re doing it slowly and over time, and that any of you do it in that way are more likely to succeed.

Dr.  Wendy Slusser  34:38

Well I remember, you said the sweet spot’s 10, right?

Dr. Tannaz Moin  34:41

So we know, sort of, 9 or 10 is critical, you know, dose and again, every sort of study that’s looked at this, the more sessions, the more lasting and the more the actual amount of weight loss. Yeah. Part of that is because more motivated, you know, individuals might be self-selecting. Yeah, but that session attendance and the number of sessions is highly correlated with weight loss, for sure.

Dr.  Wendy Slusser  35:11

Yeah. And so, tell me long-term outcomes, like you’re telling one year. What’s the sort of return on the investment, so to speak?

Dr. Tannaz Moin  35:21

Yeah, so the Diabetes Prevention Program study that was published in the New England Journal in 2002, you know, they’ve published their 10-year outcomes, their 15-year outcomes, and that cohort of patients is still being followed. So under sort of the auspices of NIH that sponsored the trial. And you know, so what it looks like is that the protective sort of risk-lowering effects of intensive lifestyle intervention, and also the m metformin, which was one of the other arms of the study, and

Dr.  Wendy Slusser  35:50

What was that reduced risk?

Dr. Tannaz Moin  35:52

So in the first three years, it was 31% relative risk reduction. But that protective effect, or the risk-lowering effect of both the intensive lifestyle intervention and metformin, are lasting to 15 years, so they decrease over time. But there’s still a significant degree of risk reduction. Even 15 years out where a lot of folks have regained the weight they lost in the original intensive program.

Dr.  Wendy Slusser  36:18

Their diet must have changed, or their activity levels.

Dr. Tannaz Moin  36:22

Yeah, what we know from this study is that, you know, again, even if you can do the intensive lifestyle intervention, or even with respect to the metformin, even if you did it for a period of time, it’s somehow protective for 15 years.

Dr.  Wendy Slusser  36:34

It gave your pancreas a break or something.

Dr. Tannaz Moin  36:36

Yeah, again, the pathophysiology is yet to be fully clear. That is the largest cohort of patients with prediabetes who’ve been followed over time in any, you know, study conducted anywhere in the world. But there are also large studies that have been conducted in China and Finland, where patients have been followed over time and showing, again, sort of this protective benefit that lingers even years after the trial is completed.

Dr.  Wendy Slusser  36:37

Well, you know what, it makes me wonder, and it’s something that I know you’re going to be looking at, in our groups that we are having here at UCLA. But I’m wondering, the sort of other secondary outcomes, not just related to the physiologic changes, but this social cohesion or social connectivity, that might be a result of these group classes, which were up to only 20 people in class.

Dr. Tannaz Moin  37:30

Right. So it’s sort of a small group environment is how the DPP is delivered. And again, that’s another aspect of a successful program to look for. You don’t want to be in an auditorium with 100 people trying to sort of take the course.

Dr.  Wendy Slusser  37:45

Are there some courses that are taught that way?

Dr. Tannaz Moin  37:47

I’m sure there are. They won’t be CDC recognized, but there are and so, you know, I mean, the day and age we live in, if you go onto Google and say, you know, diabetes, there’s a whole series of things that might come up. And not that sessions like that aren’t helpful and refer you to get more information and, you know, sort of an overview. I’m a big supporter of the more, sort of, information is a good thing. But in terms of the Diabetes Prevention Program, you know, we have some really kind of very clear guidelines on how to do that program and do it well, based on the research. So that’s important to sort of keep in mind. And in small groups, so we’re talking about 20 or fewer participants, and there’s a coach who shares information from the curriculum, but folks are coming together. And they’re supposed to share their shared, you know, challenges, and also their successes. And, you know, there isn’t a lot of data that we’ve seen in terms of when you bring people together around this topic of prediabetes. We know there’s group cohesion over time, right? So you’re meeting with the same people and the same coach. And you would think that that hopefully, is a motivating force for individuals. And in studies we’ve done and the VA particpants, the Veteran’s Association, talk about accountability. So I know when I’m going to my group, you know, I am accountable to myself for these promises to live a healthier life and be more physically active. But, you know, I’m also accountable to my group members. And that’s another form of social support. So, yeah, we’re really excited to look at these things and see, you know. We know quality of life improves with the DPP, an intensive lifestyle intervention that’s been shown, but it could be because of social support.

Dr.  Wendy Slusser  38:03

And how do you measure quality of life?

Dr. Tannaz Moin  39:40

So there are different survey instruments that can be used in studies and the original cohort of patients who was in that DPP study from the New England Journal is still being followed, as I’ve mentioned. Then they’ve had standardized assessments, measurements of how they rate their own quality of life. And with the folks who were in the intensive lifestyle intervention, they are rating higher quality of life, again, whether or not they were able to lose weight, whether or not they were able to stick with the intervention. Their quality of life over time seemed higher. We didn’t see that change with the metformin arm or with the usual care arm.

Dr.  Wendy Slusser  40:18

That’s very interesting and it will be interesting. Hopefully you’ll have some data for social well-being since we know that’s a big predictor of health and longevity in other studies around just aging Americans. You mentioned your work at the Veteran’s Association, and you mentioned earlier the diabetes prevention seems to be more motivating than weight loss. Your studies that you’ve published, too, have shown that kind of data or observation is played out.

Dr. Tannaz Moin  40:51

Yeah so I spend, you know, part of my time in the VA and actually some of my initial interests around diabetes prevention are based on work I did really many years ago with veterans. And part of the issue or the challenge with veterans is the rates of obesity are even higher than the general population. And the VA has always had what we would call a standard-of-care weight loss program known as the MOVE! Program that’s delivered actually at 150 VA medical centers everywhere. But it’s sort of delivered in different ways based on the site so we were really interested, now this is going back to 2012, to do a comparative effectiveness trial, to compare DPP, which is a much more intense diabetes prevention program, meaning more number of sessions and you know certified coaches, same group, that group accountability kind of cohesion we were talking about, to compare outcomes and patient experiences with the DPP as compared to MOVE!.

Dr.  Wendy Slusser  41:57

Which doesn’t have the same, like you don’t have to go to the same group.

Dr. Tannaz Moin  42:01

Right it’s sort of a come-as-your-schedule-allows, your goals are not, you know, the same. I might want to just be more physically active, you might want to just eat healthier. Whereas the Diabetes Prevention Program has standardized goals so everybody in the group is working towards the same goals. So we did this study, initially we started with just an in-person version of the DPP, which is the way it’s traditionally delivered, compared to MOVE!. And we saw that around six months there tends to be more weight loss with the DPP as compared to MOVE!.

Dr.  Wendy Slusser  42:38

Even though MOVE! was a weight loss program.

Dr. Tannaz Moin  42:40

It is. And this is a really active comparitor. We’re not comparing patients to usual care. And by 12 months, though, the weight loss seem similar between the two groups or it was approaching the same. And part of that is regained, so what happens is the program went from being very intensive to less intensive, the Diabetes Prevention Program. But patient satisfaction was much higher with the DPP. Participation tended to be higher so veterans were coming. They were more likely to come to a DPP session than they were to a MOVE! session and as this study started getting underway, we actually decided because at the time there was a lot of interest in technology and how we can deliver DPP differently, we actually added on an online or virtual group form of the DPP. And those results were really kind of interesting because then we were doing a three-way comparison and it seemed like online and in-person DPP, you know, they’re very similar in terms of the amount of weight loss that they resulted in. We’re talking about around four kilograms. And and the MOVE! participants were kind of hovering around the same weight over the 12 months.

Dr.  Wendy Slusser  43:54

They didn’t gain weight but they didn’t lose weight.

Dr. Tannaz Moin  43:56

Right and so, you know, it was really interesting to see that, you know, you could deliver a traditional face-to-face program, maybe using a web-based platform that might provide some convenience and flexibility.

Dr.  Wendy Slusser  44:10

So it’s another option that might be available and acceptable to some people. So the social learning aspect. Was that maintained in the online, like there were forums for the groups?

Dr. Tannaz Moin  44:24

Yeah. And online DPP is delivered in different ways and by different vendors. There’s a lot of them out there and, again, I would encourage our listeners to reference the CDC lists because they tend to vet the programs.

Dr.  Wendy Slusser  44:37

So just go to cdc.gov and search for “diabetes prevention program.”

Dr. Tannaz Moin  44:42

And you can see a registry. But yeah, usually the way online DPP programs are delivered is asynchronously, which means I can log in at 2am and you can log in at 12am, you know, or 1pm. It’s not a group time, it’s not like a Skype, you know, or a WebEx or something. There are programs that do it that way. But most are providing some educational materials and it might be through videos or other sort of interactive means. But I can sort of go through those materials at a time that works for me. And then I have sort of access to what’s happening with other people in my same group. So I log in and imagine kind of a Facebook group. And so I can see their pictures, they can see my pictures, they can see how I’m doing in terms of my goals, and I see how they’re doing. We have a coach, we can send each other messages, we can post to the group site, and we all have wireless scales. So we’re weighing ourselves instead of driving in for an appointment, you’re kind of doing that conveniently at home. So that’s a more multifaceted kind of way of thinking about online DPP.

Dr.  Wendy Slusser  45:53

So you could still get support, but in a non, like, live situation, or ideas from other people, because that’s what I find that social learning is so useful for people to say, hey, you know, I couldn’t fit in the walk.

Dr. Tannaz Moin  46:08

And that’s what we saw. We actually did a study where we looked among women veterans who tend to be more reluctant to participate in any of the in-person weight loss programs in the VA. I think the number was an average of 70 posts, you know, over the first couple weeks of the program. So it takes effort, you know, it was very interactive. And we did interviews with these participants and I was really surprised to find out that they still felt accountable to their group. And they felt like they were part of a group, you know. This wasn’t, you know, sort of a random set of people that they, you know, had no interest in getting to know, and some of them actually even formed, if they lived close together, were interested in forming walking groups. So again, there is that social component. And the coach, any successful online program should have a live coach, you know, there should be someone that you can talk to by phone, or would even call you if you haven’t logged in in a week to say, hey, is everything okay? And that’s a real important piece of success. We had that, and any program that, you know, someone’s looking to sign up for should have that.

Dr.  Wendy Slusser  47:18

And so if you were to say, a 40-year-old, you’re a specialist, so you wouldn’t see a 40-year-old that was just coming in for a checkup, but say you’re like supervising internal medicine resident in clinic, and there was a 40-year-old coming in who looked like they had a healthy weight and no family history of diabetes, what would you do? For a checkup?

Dr. Tannaz Moin  47:43

For a checkup? Yeah, it’s been a long time since I’ve done general primary care. There are other age, you know, appropriate screenings. I think I would talk with them, I would, you know, even if their weight was normal, I would talk about the importance of avoiding weight gain, because, as we talked about, as you get older, your risk of potentially gaining weight goes up. And I would also ask a lot of questions about the other potential risk factors. So in someone who’s 40, I would ask about, if they’re a woman, you know, how much weight they gained during pregnancy, if the baby was over nine pounds. That’s a risk factor for diabetes, and really try to make sure that we, you know, aren’t missing any other risk factor.

Dr.  Wendy Slusser  48:28

Even though they had a normal glucose tolerance test?

Dr. Tannaz Moin  48:31

Yeah. So baby over nine pounds at delivery is a risk factor for future diabetes development. So some women have a known diagnosis of gestational diabetes, where, you know, the glucose isn’t normal during pregnancy. But on a baby that’s large for the age or the mean, is also a risk factor.

Dr.  Wendy Slusser  48:53

Even though they pass their glucose tolerance test? Oh, that’s interesting. It’s not a perfect science, is it?

Dr. Tannaz Moin  49:00

Not a perfect science. And that’s why there’s great screeners, and that might be something else I would do or encourage our residents to do, share that information with patients. There’s nine questions and there are different versions of this screening, but it literally takes 30 seconds. And the questions are about your age, your physical activity or family history. You know, if you’re a woman, whether or not you had gestational diabetes, a baby over nine pounds, and it can give you a risk score.

Dr.  Wendy Slusser  49:26

Without having a blood test?

Dr. Tannaz Moin  49:28

Without having a blood test. And if your risk score is elevated, the data, the research and the national guidelines would say you should be thinking about being checked and participating potentially, in a DPP program.

Dr.  Wendy Slusser  49:42

So if you were, say, maybe you just want to prevent or you want to institute healthy lifestyle, and you are less than 40 and you’re not in any of the risk categories, what would you do? First of all, I think that the Diabetes Prevention Program, I’ve heard people really enjoy and totally talk about how it changed their life in terms of just socializing with their family and feeling better, and being able to hike and all this stuff. So I always like to sort of, I’m sure you do, to like gear people towards the positive and not like, oh, you have to give up this or that. But what’s your standard, kind of, coaching that you’d like to see people to do in their in their day-to-day life? Like, what would you recommend?

Dr. Tannaz Moin  49:42

So I think simple and small steps are really important. So obviously, I’m a huge proponent of the Diabetes Prevention Program, but that’s a big commitment and it’s hard, you know, for some folks maybe to commit to doing the program. But there are little things you can do, and goal-setting, and thinking about, you know, one thing you can change. I think, it’s something that’s reasonable, it’s feasible, it’s something you can do. You know, there are all these fad diets, and you go on these sort of crazy calorie restriction, but if it’s not something you can maintain, chances are, you’re going to do the sort of the yo-yo, the up and the down weight cycles that we try to avoid.

Dr.  Wendy Slusser  51:11

What happens if you are a healthy weight already, like, a 20-year-old? What would you say, not to give up or change? But what do you should be done? Where should people go, what direction?

Dr. Tannaz Moin  51:23

So one thing I actually do talk to patients, and actually friends and colleagues about is this concept of self-monitoring. So I think, especially with diet. We often aren’t thinking about what we’re eating, and not just calories, but the sort of the nutritional component. I think someone who’s at a healthy weight probably is doing that and obviously is lucky in terms of the metabolic rate and things like that. But I would encourage them, you know, to do a food diary, and you can do it with a good old journal and pen. But there are all these really neat apps and kind of things that are available. And to really take a look at the foods they’re eating, and both in terms of calories, but the nutritional component. And even if you’re a healthy weight, there’s always things that you might be able to improve in terms of your health. And then of course, physical activity is huge.

Dr.  Wendy Slusser  52:17

And walking. Just plain old walking.

Dr. Tannaz Moin  52:20

And walking. Just park a little farther. You know, so I think that’s something again, that we could all do more of. And it’s not easy. It’s hard to do, but something for folks to think about, yeah.

Dr.  Wendy Slusser  52:33

And so for, like, the foods that you would suggest are good foods, period, but also good if you are prediabetic. I know fiber, high-fibrous foods.

Dr. Tannaz Moin  52:44

Yeah. And we are, you know, learning more and more about the ideal dietary makeup for someone with prediabetes. It’s sort of relatively speaking, still a newer, you know, concept in the last decade or two, I think fiber and sort of complex grains are really important. We also are hearing more and more about the Mediterranean diet. So nuts and you know, sort of the olive oil and fish, and kind of staying away from heavy meat products, I think might be something else to think about. But the idea is to eat a balanced diet, try to avoid processed foods.

Dr.  Wendy Slusser  53:30

And sugar really sneaks into all foods, even mayonnaise has sugar.

Dr. Tannaz Moin  53:35

Everywhere. And that’s why I like these apps a lot. I mean, the one I’ve personally used is MyFitnessPal. But there’s a million out there, but it actually gives you, once you put in sort of the food item, it shows you everything, not just calories, but how much salt, how much sugar, you know, and that’s eye-opening.

Dr.  Wendy Slusser  53:52

And that’s much more important to me. I mean, I think carbohydrate content is much more important than the calories.

Dr. Tannaz Moin  53:59

Yeah. So it’s really amazing. And, you know, again, physical activity is so important. But, you know, I tell my patients, when I see them in clinic, you know, I can be on the treadmill for like an hour and I burn maybe 400 calories. In a minute, you can, you know, consume something and you’re just not even sort of thinking about it. So self-monitoring, you know, someone who’s at a healthy weight and has made lots of good decisions so far, I think that might be something they could do to see, gosh, you know, what am I eating?

Dr.  Wendy Slusser  54:31

Yeah, that’s been proven in both just healthy maintenance, but also weight loss.

Dr. Tannaz Moin  54:37

Yeah, absolutely.

Dr.  Wendy Slusser  54:38

Well, so from your perspective as an endocrinologist, what’s the number of grams of sugar that you would recommend a prediabetic, in percent of their caloric intake?

Dr. Tannaz Moin  54:49

Oh, that’s a tough question. Yeah. I don’t know that we have a prescription for something like that. You know, for our patients with diabetes, there’s been a lot, you know, more studies and I think if we follow the general guidelines for diabetes, they’re  about 60 grams of carbohydrates per meal. Not more than though, per meal, three meals a day. But that’s still, I mean, if you think a slice of bread is about 15 grams, if you had a sandwich, that’s half, and then you might have an apple, which is another 30 grams. So that’s generally the recommendations for someone with diabetes. For prediabetes, we don’t have clear, set guidelines like that, but that might be sort of a framework to think about.

Dr.  Wendy Slusser  55:30

So would you recommend for like a prediabetic, well, obviously diabetics do, but to actually, in terms of self-monitoring, monitor their carbohydrate intake?

Dr. Tannaz Moin  55:41

Yeah, so carbohydrate intake. And again, it’s not just about the calories and the carbohydrates, but making sure they’re getting balanced intake from sort of a nutritional perspective, too. So if we think about, you know, the My Healthy Plate, you know, the idea is half is coming from salads, and green vegetables and things. And so to be thinking along those lines of eating balanced meals, is really important. And of course, avoiding high-sugar drinks and kind of any sugar sweetened beverage, you know, eliminating that altogether.

Dr.  Wendy Slusser  56:19

Which includes sugared sodas. And also what about the sodas that are artificial flavors? Or artificial sugar?

Dr. Tannaz Moin  56:30

Yeah, so this is where, you know, I don’t want to say the jury’s still out. But I’m, you know, not a basic scientist, but there are basic science studies that have been done, you know, using animal models, showing that animals that are taking in high levels of these artificial sweeteners are more likely to be at risk for diabetes and weight gain.

Dr.  Wendy Slusser  56:54

And what’s the pathophysiology behind that?

Dr. Tannaz Moin  56:56

So, you know, it’s not one that I’m familiar with, but you know, in my own sort of thinking about this, I’ve thought it’s like, you taste sweet, but the sugar isn’t the sugar that your body’s expecting. So maybe there’s some kind of hormonal dysregulation, and that might be happening, but we don’t have human studies. We don’t have large trials that have been done, you know, in adults or obviously not kids that have looked at this. So the data about whether it’s good or not really comes from animal studies. And it’s hard to extrapolate that to humans, but there is some indication that, you know, maybe it’s not a healthier choice.

Dr.  Wendy Slusser  57:36

Right. And do you know anything about, I know, there’s herbs that are considered moderating, like cinnamon?

Dr. Tannaz Moin  57:46

Cinnamon, and actually tumeric is another one.

Dr.  Wendy Slusser  57:49

Sage?

Dr. Tannaz Moin  57:50

Yeah, not my area of expertise. But, you know, I do get patients who ask about this. And I’m always of the thinking that, you know, to try. A lot of these things are sometimes advertised as supplements and so it gets into this sort of gray area. But I think, again, thinking about what we’re consuming and why, is an important thing for all of us to be doing.

Dr.  Wendy Slusser  58:13

Right. And certainly, those particular herbs make things taste better. So that’s important.

Dr. Tannaz Moin  58:19

Right, so cinnamon’s a favorite and tumeric, we use a lot in, I mean, Middle Eastern foods. I think, yeah, try it and, you know, see how it works.

Dr.  Wendy Slusser  58:31

It’s good for your gut health, as far as the data that’s out there. So, to wrap up, I want to leave our listeners with some resources to go to if they’re seeking to improve their health and live a healthier lifestyle. Do you mind sharing some resources, both nationally, and within California? And even here at UCLA?

Dr. Tannaz Moin  58:53

Sure, so I’ll start nationally, I think there’s a lot of really incredible information on the CDC website. And those, again, you can just go Centers for Disease Control and type in “diabetes” or “prediabetes” on Google. And there’s really helpful information about what diabetes is and what prediabetes is, and, you know, even some questions about pathophysiology, but really national statistics, what the trends look like. And then the CDC also has, what we had mentioned, this national registry of DPP programs that are certified. So that would be one of the main sites I would send folks to to get more information about the clinical side, but also some potential resources.

Dr.  Wendy Slusser  59:40

And if you wanted to start a program on your university campus, you could also get information from them about that?

Dr. Tannaz Moin  59:50

Yeah, the standards for delivery. So the metrics that they expect if you’re going to deliver a program and that process, absolutely. And I think the American Medical Association also has a prediabetes STAT, which stands for a Screen Test Act Today site. And that also has patient-facing materials, it has provider-facing materials that are helpful for thinking about how to screen, who to screen. You know, it’s geared at both providers and healthcare organizations. So that’s a great resource. And locally, so obviously, we’re so proud to have our local campus, UCLA-based Diabetes Prevention Program, which is open.

Dr.  Wendy Slusser  59:55

One of the firsts, right, on a university campus.

Dr. Tannaz Moin  1:00:37

Yeah, which we’re really proud of, and it’s offered through Campus Recreation. And in addition to the Diabetes Prevention Program, our campus offers other classes and group-based weight management programs and things that folks would probably be interested to learn about. And that program, our UCLA DPP program, is now a model for the other UC campuses. So if someone’s listening, and they’re on another UC campus, there should be a DPP even closer to home that they can reach out to. So yeah, lots

Dr.  Wendy Slusser  1:01:12

Campus staff are able to use that for free. And here at UCLA, students as well.

Dr. Tannaz Moin  1:01:18

Yeah, absolutely. So it’s a program that would normally cost around six, seven, maybe, you know, $100. But it’s offered free for faculty and staff and students on the campus. That’s a huge benefit. Yeah. And hopefully more people learn about it. We do have waitlists. So I mean, we’re, again, very excited about the program.

Dr.  Wendy Slusser  1:01:18

Oh, we have waitlists now? Oh my goodness.

Dr. Tannaz Moin  1:01:43

Yeah, we have waitlists. So, we don’t want to turn anyone away. But you know, we are trying to accommodate.

Dr.  Wendy Slusser  1:01:51

We want to keep it at 20 participants.

Dr. Tannaz Moin  1:01:53

The smaller group, yeah, because you’ll get more out of the program in a smaller group. So yeah, we’re really excited about our campus leading the charge here.

Dr.  Wendy Slusser  1:02:04

Well, so we’ll end this with some questions. I haven’t covered anything. But also I’d love to know, like, what’s your home kitchen look like?

Dr. Tannaz Moin  1:02:12

Oh, well right now we’re in temporary housing, but my home kitchen is relatively small. But it often includes the kids and I cooking together, we sort of tend to do that as a family.

Dr.  Wendy Slusser  1:02:28

And how old are your kiddos?

Dr. Tannaz Moin  1:02:29

So I have a six and an eight year old, so they’re kind of stove-safe at this point. They  want to help. But you know, we’re really trying to do balanced meals at home. But you know, that can be challenging sometimes after school, and it’s a rush.

Dr.  Wendy Slusser  1:02:46

How do you overcome that challenge?

Dr. Tannaz Moin  1:02:50

Yeah, so some days are better than others, but, you know, even if it means, we’re rushed, even if it means taking some vegetables and doing a steam quickly and sort of having them on the side. We’re trying and I have help at home so that really does make it easier. The other thing I’m trying to do is, and this is a personal thing, less frozen stuff. We tend to like freeze everything. And I know in Europe, the refrigerators are smaller, and you’re trying to eat fresher, but that’s also challenging, so something we’re working on.

Dr.  Wendy Slusser  1:03:27

Well, frozen vegetables are considered to be almost even more nutritious.

Dr. Tannaz Moin  1:03:32

Absolutely. And I have a whole stockpile of them for sure. But yeah, trying to think about all of us. But no juice, you won’t find any juice in my house.

Dr.  Wendy Slusser  1:03:41

So making a healthy choice, the easy choice, right? And the less healthy choice the not-so-easy choice.

Dr. Tannaz Moin  1:03:47

Yeah. And that’s the way I sort of grew up too, you know. I don’t remember soda. I don’t remember chips, you know, in my household.

Dr.  Wendy Slusser  1:03:57

And you don’t make them forbidden foods. If they’re at someone else’s house, it’s not like oh, they can’t do that. Yeah. Yeah, that’s always the hitch in certain circumstances. It’s no question. Was there anything that we haven’t covered that you’d like to share?

Dr. Tannaz Moin  1:04:04

Yeah. And it’s not like, I mean, we definitely have our days when we will eat out. We have our days where things aren’t as ideal as I’d like them to be. But, you know, I think one thing is this hunger cue. And that’s something culturally for us and for my family. It’s always about like, finish your plate, you didn’t eat it. And you know, so that’s something we’re really trying to work on at home so that when you feel full, it’s okay to be excused. You don’t have to keep eating for the sake of eating. So that is something we’re trying to work on, with the grandparents especially. No, just thank you so much for this opportunity. Thank you for your leadership on the campus. I don’t think any of this, what we’ve accomplished with the UCLA DPP program, and a lot of other really exciting things that are happening on campus, would have been possible without you, Wendy.

Dr.  Wendy Slusser  1:05:05

Well, thanks Tannaz, we’ll stay tuned. We’re going to do more, onwards and upwards.

Dr. Tannaz Moin  1:05:10

Thank you.

Dr.  Wendy Slusser  1:05:11

Thank you so much. Thanks for your valuable time.

Dr. Tannaz Moin  1:05:14

Thanks so much.

Dr.  Wendy Slusser  1:05:14

On all of this work that you do. Thank you so much for tuning into Live Well. Today’s podcast was brought to you by UCLA Semel Healthy Campus Initiative Center. During these extraordinary times of the COVID-19 pandemic, UCLA’s Diabetes Prevention Program has transitioned online, and demonstrated that it is possible to create a strong sense of community virtually. Many participants have shared that this program has enhanced their current life in providing a strong social support network. We’re learning how to stay connected during this new normal and invite you to learn more about how you can become involved in the Diabetes Prevention Program. For more information on Dr. Tannaz Moin, and the DPP, please visit our website at healthy.ucla.edu/livewellpodcasts.