An interview on diabetes management and emerging technologies with Robert A. Gabbay, MD, PhD, Chief Scientific and Medical Officer of the American Diabetes Association.
An interview on diabetes management and emerging technologies with Robert A. Gabbay, MD, PhD, Chief Scientific and Medical Officer of the American Diabetes Association.
Welcome to Diabetes Technology Report. I'm Dr David Klonoff. I'm an endocrinologist at UCSF and Sutter Health. We have a very special guest today. My co-host, Dr David Kerr, will introduce our guest.
David Kerr:Hello everyone. I'm David Kerr. I'm also at Sutter Health and based in Santa Barbara, california. We have a very special guest, no doubt about it Bob Gabay. I see you almost every day on LinkedIn and you're all over the place. You're the face of Diabetes for the American Diabetes Association. How did you end up there? What made you become interested in diabetes?
Bob Gabbay:Wow, david, that's a great question. Thank you for that. I do get around and it turns out I like traveling. This is a perfect role for me. I started as a basic scientist looking at the mechanisms of insulin action in cells. At the time I actually was so basically focused Somehow I didn't even really know that it was connected to this big disease. As I went through my PhD, I realized I wanted to impact people more than just doing basic science work. I went to medical school with the intention of just going back to the lab and not treating patients and ended up finding wow, I really enjoy caring for people. I kept re-enlisting and through that whole process would oscillate between research and research. I started to oscillate between research now in diabetes and clinical care. That just opened so many doors.
Bob Gabbay:I think one of the exciting things about the world of diabetes is in the old days they used to teach knowing tuberculosis is to know medicine. I think this was one of the great. I think in modern times it's knowing diabetes is to know all of medicine, because diabetes touches really everything. My journey has allowed me to not only learn about many different organ systems and disease states associated with diabetes or potentially, but also then getting into other areas of how care is delivered and organized, how to deliver better care, what chronic care looks like, what population health might be. All of these often apply to diabetes for a variety of different reasons. The journey has taken me there and behavior change and the importance of that Over the last few years. I think we share a passion around digital health and technology that's transforming diabetes care.
David Kerr:Thank you. I'm just wondering where you see the next frontier is in diabetes care. Is it just a natural progression or do you see a big topic on the horizon?
Bob Gabbay:Yeah, that's a good one. There are probably a few things that I would think. One there's all that we know and have figured out and tools that we have, and yet they're only a minority of people, in many cases, that are benefiting from them either because of access issues and inequities that exist there. Also, I think solving the fundamental problem of knowledge to action it's like one thing to know, but it doesn't necessarily translate to action. That's true for people with diabetes, but it's very much true for healthcare and the healthcare system. If you were to ask most clinicians how often should someone with diabetes get an eye exam, they would know that it's yearly for most people and yet maybe 60% of the time that happens across the US. It's not just knowledge, it's knowledge to action.
David Klonoff:Bob, I'd like to ask you, in your role at ADA, what are your goals? What would you like to see happen at ADA and in the world?
Bob Gabbay:Yeah, that's a great one. I think fundamentally, it's about improving the lives of people affected by diabetes in a variety of different ways and preventing the complications that they can occur, and then also going upstream to honestly bend the curve on the number of people that are developing diabetes. So I think those are really the big focus and mindful that we want to make sure that people have access to the treatments that we know are effective, because we've made incredible progress over the last years and yet, as they say, the future is here, but it's not evenly distributed.
David Klonoff:Since this is the technology report, what do you see as the role of technology for people with diabetes? Oh, huge.
Bob Gabbay:I think it's revolutionized care, from just continuous glucose monitoring I mean, you ask anybody living with diabetes it has one and they will tell you it has changed their life, so that's amongst the most obvious you take that a step further, and automated insulin delivery for those that are using it has also been a big opportunity. I think the pandemic has gotten everyone to embrace telemedicine and telehealth and what that can offer, and then I think the area where there's still more to happen is in terms of digital health solutions and greater adoption and refinement of that, and then figuring out what is the role of AI in all of this.
David Kerr:Can I just follow up on that, because I'm intrigued by your personal and also the ADA's perspective on AI. Are they fearful or are they welcoming, or what's the view from the top?
Bob Gabbay:I think both. In both cases, I think we're excited and there is some trepidation. On the one hand, we know we've already endorsed, through the standards of care, retinal imaging that can be read by AI and is FDA approved, and so that is a solution that is working and great. On the other side, and then there are a variety of AI-driven digital tools that can help coach patients and guide them, and so I think there's real value there. And then there's this newer area of synthesizing information and either making clinical decisions, where there's maybe a little bit more trepidation, because at least the tools that I've seen are good, but they're not always great, and so how do you navigate all of that? But it's a fast-moving area that certainly needs to be monitored.
David Kerr:Just just exploring a little bit more. I mean, you get to see a lot of things really early. I'm sure all sorts of Innovators and entrepreneurs are wanting to meet you. Is there an area where we are missing something, where you think more Technological, technological innovation needs to take place?
Bob Gabbay:Yeah, that's an interesting one. One of the, I think the the well, I'll say two pet peeves that I would point out. One is most of the solutions live in this universe, really separate from the traditional healthcare system, and and they run the risk of really fragmenting care. Whatever is happening in that other world is not transmitted to whoever might be their primary care provider, and I think that's a. That's a missed opportunity, and Figuring out how to do that and have those two efforts work in concert can make a huge difference and I think would really Move things forward in a really big way.
Bob Gabbay:The the other is the challenge of having so many solutions out there and most stakeholders have really no great way of knowing Whether these are good or bad. Like anything there, they're good ones and bad ones. Right For things that are FDA approved, there's been a process and, sure, for digital therapeutics, you have a way of knowing that. But for many of the other solutions, it's hard to judge, and so if you're, if you're a provider and you're asked, hi, you know you may know a few of them and you could recommend, but most of them you wouldn't know. If you're a person living with diabetes, you really would have very little way to knowing, and and payers Are also wanting to know what what to do, and so we've been working with NC QA, the National Center for Quality Assurance, see if can establish some kind of certification program. That may not be the only solution, but I think there needs to be some way to sort out the the, the, the good from not quite as good.
David Klonoff:Bob, many people with diabetes Either are unable or unwilling to follow some of the treatments from their doctors. How important is behavior and or a lifestyle in managing diabetes?
Bob Gabbay:Probably one of the most important things, and I I think it's understanding the layer below that right. So you know, some clinicians will say, well, my patients just don't. They don't do what I tell them to do, and that's a little bit of a cop out in my mind, right like our job is to help guide them to what and figure out why. I mean, people typically have reasons and and you've got to approach them in a way where they're open to sharing that could be they can't afford it. It, you know, could be a variety of things, could be what's happening in life right now, which is Eclipse, is the importance of diabetes. So I Think solving that behavior piece is really critical and I think that's another place where technology could really help because it allows the frequent touch that is needed. Because you know, typically these clinicians, we see our patients, you know only episodically and and behavior changes about what happens day after day, not every three months.
David Kerr:Bob, I've got to ask you this because we've got you here. Do you think we're doing a good job with diabetes education, particularly in the area of technology?
Bob Gabbay:I think we could do better. I think one of the challenges I find is for people with diabetes. The word diabetes education is not helpful in my mind. I've had patients tell me this I don't need to be educated. I've had diabetes for 20 years. What you might want is to learn how to problem solve around your diabetes and have someone guide you on how to navigate. Some is the terminology and I know that that's complicated to change and all that and how you frame it. We also know that maybe only 10% of people actually see a diabetes education specialist. What about the other 90%? An area that we're trying to lean into is if you look where these people are practicing and you look where the patients are, there's a huge mismatch. These educators are either in hospitals or within a chronologist and, of course, 90% of patients are in primary care. I think we need to move them together somehow.
David Klonoff:Bob, there are several new types of medications that are becoming available. There's the GLP1 receptor agonists for diabetes and obesity. There's SGLT2 inhibitors. There's new kinds of insulin. What do you think about these or some other types of new drugs?
Bob Gabbay:Also a big step forward Our ability to treat obesity in some ways for the first time like we've had bariatric surgery but lifestyle has been somewhat effective, but not as effective as we would like. Now there are treatments that really can pharmacological therapy that can make a huge difference. I think that has been really an extraordinary change. I think all of these advances are steps in the right direction. Again, the access and ubiquitous availability of them to all people that could use them is a challenge we still have to overcome.
David Klonoff:Bob, I'd like to thank you for taking time out of your job and your research to work with us. This has been very interesting for me. On behalf of both David and I, I would like to thank you, thank the audience, remind everyone that Diabetes Technology Report is available at Spotify and at the Apple Store and at the Diabetes Technology Society website. Once again, bob, thank you. We look forward to connecting with you and the audience at the next Diabetes Technology Report. Goodbye everybody.
David Kerr:Thank you, Bob.
Bob Gabbay:Thank you Bye.