By Amanda Dolan for Diabetes1
Dr. Peter Sheehan, MD is a Senior Faculty member at the Mount Sinai School of Medicine in New York City. Dr. Sheehan is a graduate of the SUNY-Downstate School of Medicine, where he also completed his residency in Internal Medicine. He continued his training at the Yale University School of Medicine in New Haven where Dr. Sheehan completed a fellowship in Endocrinology and Metabolism.
A well-respected specialist in the field of diabetes, Dr. Sheehan’s practice focuses on the lower extremity complications of the disease. He has a particular research interest in peripheral neuropathy, wound healing, Charcot osteoarthropathy, and peripheral arterial disease. Dr. Sheehan has worked on both the local and national level with the American Diabetes Association (ADA) where he has served as Chairman of the Council on Foot Care. He led a consensus panel on peripheral arterial disease and diabetes sponsored by the ADA and the American College of Cardiology (ACC). Dr. Sheehan has been appointed to the Boards of Directors of the American Diabetes Association, the PAD Coalition, and the Wound Healing Society. Presently, he is the Chair of the Cardiometabolic Risk Initiative of the ADA, as well as President of the ADA’s New York City Board.
Dr. Peter Sheehan has an extensive background with wound-healing that has allowed him to help the diabetes community unique way. When it comes to diabetes care, wounds are especially important to consider as healing can be difficult for those with the condition. In fact, if a person with impaired wound-healing suffers a chronic wound—most commonly a foot ulcer—this could result in an infection that enlarges the ulcer and may result in the need for amputation. “It’s a clinical issue,” says Dr. Sheehan, “and the leading cause of non-traumatic amputations in the US. With 80,000 amputations performed every year.” Because of these potential complications, it is important for people with diabetes to determine their individual risk for foot ulcers.
The greatest risk-factor is the presence of peripheral neuropathy, or nerve damage that occurs to the long nerves in the foot. Patients with peripheral neuropathy may have what’s known as “a loss of protective sensation,” or an inability to feel an injury. If a person has an improperly fitting shoe, foot abrasion, or strenuous walking or running session—the result could be a skin breakdown and foot ulcer. “The main task is to identify those with peripheral neuropathy – this is done with a monofilament which tests for a protective sensation and a test of vibrating sense using a tuning fork.”
Dr. Sheehan believes there is not enough awareness about the risk of wounds and complications among those with diabetes and within the medical community as a whole. “It’s important that all people with diabetes are screened for neuropathy and those who have loss of protective sensation should be given specialty foot care, skincare, nailcare, and shoewear. This is best offered by a podiatrist,” he recommends. Dr. Sheehan believes that, among podiatrists, there is adequate awareness of risks associated with diabetes and that, today, podiatrists are doing a very good job with providing treatment.
Lately, when it comes to diagnosing diabetes, the American Diabetes Association (ADA) has discussed changing certain guidelines to favor the Hemoglobin A1C test (HbA1C). Dr. Sheehan agrees that this test has become more uniform among pathologists internationally and, because of this there is a widespread familiarity with these tests. He also believes that the A1C test tends to be more accurate and is easier for patients to be screened with because they do not have to fast. Dr. Sheehan notes that, “with the finger stick blood glucose test, there is often quite a degree of variability” and that “hemoglobin A1C greater than 6 percent would be an acceptable method for diagnosing diabetes.” The scientific and medical basis for the test is sound, but according to Dr. Sheehan, the cost of the test is what is keeping the A1C from being implemented regularly. Paying for the A1C is challenging, “especially for the developing world,” Dr. Sheehan adds, “where diabetes is an epidemic.”
In developing nations and non-Caucasian parts of the world including Africa, South Asia, and East Asia there is a high genetic tendency toward type 2 diabetes. “As these economies grow and rural populations move into cities, we are seeing this disturbing increase in diabetes,” he says. Because of this, the ADA is working to alert people in the parts of the world where there is a high risk. “The ADA believes we have a big role to play internationally. We have a very healthy international membership.”
Problems with diabetes care, however, are not relegated to only developing nations. In the United States the biggest issue, according to Dr. Sheehan is access to care. “This is very much a part of the healthcare reform debate that’s going on right now. We have a country where the prevalence of diabetes is 8 percent and not all people have access to quality care.” For those who are privileged enough to have access, “the care is good. But on average, because of the lack of access we’re not doing as good as we should in the US.” Dr. Sheehan believes one area where the United States needs to work harder is in the prevention of obesity and diabetes. “We’re doing a very dismal job. These are the two diseases that are getting worse and they’re doing so at a very alarming rate. We shouldn’t be complacent. The job we’re doing is inferior.”
What is the biggest message Dr. Sheehan would like to extend to the public about diabetes? Type 2 diabetes is avoidable. “It runs in families and runs in certain ethnic groups (black, Hispanic, Asian). The key message is type 2 is preventable. People should look to their families and neighbors and try to prevent them from developing type 2.” He believes that the key to prevention is simple weight loss. If lifestyle changes do not work, there is a way to include medication, but Dr. Sheehan thinks people should start with safe, modest weight loss.
“I’m of the belief that, for a person with type 2 diabetes, weight loss is as important or more important, than blood sugar control. With weight loss, you’re reducing cardiovascular risks: blood pressure, cholesterol, and central obesity. There is more benefit to weight loss than glycemic control.” How does one go about achieving this modest weight loss? It is not as complicated as you might think. “Weight loss has to be individualized. From the diabetes prevention program we learned that modest weight loss is a great benefit that can be generally achieved with portion control and reduced fat intake. The other healthy way is by regular exercise and regular activity. Such as 30 minutes of walking every day.” Dr. Sheehan puts the idea of being overweight into perspective, “what people should realize is that they can still be obese but [still] be healthy if they can lose 7-10% of their body weight.”
Learn more at the American Diabetes Association website
Watch this video on Foot Care