Getting a head start 

When it comes to a disease like diabetes, the “hole in the bridge” often occurs before a person is born. 

“Obesity and diabetes prevention start with mothers before they even become pregnant, while they are pregnant and post-partum,” Phillips said. “Maternal behaviors impact the new life being born. That’s why upstream approaches, such as the quality of living conditions, fair wages, and access to healthy foods and health care, are so important.” 

DFSC launched in 2020 with a mission to engage South Carolinians to live healthier lives. Dr. Tim Lyons, executive medical director with DFSC, explains the initiative’s multipronged approach that focuses on pregnant women and children in addition to supporting efforts to help adults develop healthier habits. 

“A key concept in mitigating the effects of diabetes across the human lifespan is the need to establish ‘metabolic health’ early in life. Good health in utero, throughout childhood and into adulthood sets the scene for good health in later life. Similar efforts later in life are much less effective,” Lyons said. 

The pregnancy initiative launched through DFSC aims to improve the outcomes of pregnancy complicated by diabetes, either pre-gestational Type 1 or Type 2 diabetes or gestational diabetes. 

“There is abundant evidence of the fetal origins of chronic disease. This means an unhealthy intra-uterine environment — poorly controlled maternal diabetes is a common example — creates health risks for the baby. This is not only true during the pregnancy and at the time of birth but also decades later. These risks can manifest as a propensity to develop cardiovascular disease, high blood pressure, obesity and Type 2 diabetes,” Lyons said. 

The pregnancy initiative also aims to improve the mother’s health. 

“Good management of diabetes is crucial for the mother’s own health, during her pregnancy and for years afterward. Pregnancy provides a critically important opportunity to improve community health through care and education of young women and by ensuring a healthy start for their children,” Lyons said. 

Keeping the momentum going 

The efforts do not stop after birth. Babies grow into children and spend most of their time in school. This is an ideal time to reinforce the importance of developing healthy habits. 

“In South Carolina, about half of our public-school students do not meet health-related fitness standards for cardiorespiratory fitness. Schools are not solely responsible for this, but they can provide more opportunities for physical activity before, during and after school,” Phillips said. “By integrating physical activity into the school day and through quality physical education, students would not only receive physical benefits but also mental, emotional, and social benefits as well.” 

DFSC began working works schools to help school district leaders improve the health of their students. 

“Our partners with the Alliance for a Healthier Generation and Boeing Center for Children’s Wellness work to create healthier environments in schools for children to be more active and have access to healthy foods,” King said. “Generally, working with children is considered more upstream because it works to improve their health at a younger age and has the potential to decrease their long-term risk for diabetes and other conditions as they get older.” 

The school-based wellness programs benefit more than just the students who participate in them. They have the potential to affect wide-ranging change in the school community. 

“These initiatives also work at the policy, systems and environmental change level. They seek to create healthier opportunities for all kids that are woven into the culture of the whole school community instead of just focusing on a smaller intervention to address a certain group of kids,” King said. 

Combining upstream intervention with disease management 

Upstream prevention is just one piece of the complex puzzle to eliminating diabetes in South Carolina. These efforts must be combined with secondary and tertiary prevention methods to care for all South Carolinians affected by diabetes.  

“It would be easy to put the responsibility on the people with obesity or diabetes to change their behaviors (or to stop falling into the river) but that would not be fair or helpful. What are we doing collectively to plug the hole in the bridge? No one person or entity can do this alone,” Phillips said. “To truly prevent these diseases means to keep people from developing them in the first place. This means that to prevent these diseases, we must start early and focus on our children. We must fill the hole in the bridge.”