David Klonoff 0:15

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 0:31

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 0:57

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 2:12

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 3:25

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 3:41

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 4:51

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 5:01

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 5:53

Since this is the technology report , what do you see as the role of technology for people with diabetes ? Oh , huge .

Bob Gabbay 6:02

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 6:58

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 7:13

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 8:26

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 8:47

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 9:39

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 10:45

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 11:01

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 12:10

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 12:20

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 13:41

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 14:01

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 14:46

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 15:20

Thank you , Bob .

Bob Gabbay 15:21

Thank you Bye .