David Klonoff 0:12

Welcome to Diabetes Technology Report . I'm Dr David Klonoff . I'm an endocrinologist at Mills Peninsula Medical Center in San Mateo , California . We have a special guest today from Europe my co-host .

David Kerr 0:32

Dr David Kerr will introduce her . Hello everyone . Yes , this is David Kerr . I'm speaking to you from Santa Barbara , california , and it's a real pleasure to welcome the new managing editor of the Journal of Diabetes Science and Technology , dr Julia Mehta . Welcome , julia .

Julia Mader 0:43

Hi , nice to meet you guys .

David Kerr 0:45

And what we like to do with these is get a little bit of background . Try , you know , set the scene . So how did you end up being interested in diabetes and diabetes and technology ? Specifically , what were the drivers of this ?

Julia Mader 1:02

Well , so interestingly , already quite early during my career , I ended up in diabetes technology . I have to admit so when I was finalizing my last year in medical school , I ended up in diabetes for doing my thesis there , diabetes for doing my thesis there . And my first project already brought me to the field of diabetes technology . That was about glucose sensing in the intensive care unit . At that time it was a bit of a how do you say awkward theme that no one was believing in . And that's been nearly 20 years ago and fortunately I managed to stay on the bloodstream .

David Kerr 1:46

And what are you up to at the moment ?

Julia Mader 1:54

What sort of keeps you up at night thinking about diabetes and technology ? So what really keeps me up at night is I want to make the lives of people living with diabetes more easy . So , for example , I just came back from a diabetes camp with kids with diabetes , and then you see all the hassle and all the difficulties that they still endure , even if they now have probably way much better therapies than we had 10 or 15 or 20 years back . It is still for them an ongoing challenge and I hope at some point in time we can make it so much easier that they don't notice that they have any chronic condition to pick out .

David Klonoff 2:33

Julia , what would you say are the differences you see in the types of problems you have to address for type 1 people versus type 2 people ?

Julia Mader 2:42

So I think for type 1 , it's still more complex .

Julia Mader 2:47

Even if you're well trained and know what to do in different situations , you still have to take into account so much about exercise , so much about food , specifically , let's say , when you are on vacation .

Julia Mader 3:01

So I was on vacation with a good friend of mine who has type 1 diabetes and he made kind of a challenge out of it to go for the food that all of us had and we were doing a report for the Austrian society there and he took pictures of the food and then how we ended up needing glucose and he said , even if he was trying his very , very best , he ended up either in hype or hypoglycemia because he never was sure about what in that group .

Julia Mader 3:27

Specifically , he was not familiar with the kind of food in the workplace . And so type 1 is probably way more challenging if you compare it to xenocorpus tutoribus and I think for type 2 tutoribus the advances have been really ongoing . We have observed a lot of new medication , drugs that make light and walk in the air , so that people with type 2 diabetes nowadays don't need to go for complex count counting , for complex monitoring or advice by us , but with all the new drugs that we have available . In many countries , insulin is the last line of defense . It's not complex , it's just some new stuff .

David Klonoff 4:20

Julia , you live in Austria . Is the Austrian government interested in helping people with diabetes ? Do they have any programs that you work with ?

Julia Mader 4:31

So it's not so much the government that defines the programs , it's more the societies and also the hospital center people caring for people with diabetes who enable that . But what we have to definitely admit is that in many of the European countries , including Austria , access to medication is very good , so that people really pay a low amount of money compared to what I've heard at least people in other places of the world need to put in terms of money on the table . So , for example , in my country , if you have no special other insurance , usually you pay seven euros per package of medication . You're respective of what the costs are if you have it approved for your condition , but otherwise you pay seven euros a bed for whatever the cost of the medication is itself .

David Kerr 5:30

Julia , I'm just interested in comparing the US with Europe . What do you think is the rate of type 1 diabetes ? The proportion of people using closed-loop or artificial pancreas systems ? How much penetration is there ?

Julia Mader 5:46

That's a very good question . I think that depends a little bit on the age of the people , so it's fully covered for everyone who wants to go for it . The obstacle is more into who wants to go for it . So I guess in the pediatric field we are at 70% to 80% to 90% , depending on the clinic that people are taking care of . In the adult population I guess it's roughly around 60 percent , 50 to 60 percent again , depending a lot where you are in uh in care . So it might be that the gp takes care of you and that they are not familiar with that technology and then you don't end up using it . But in general the uptake is increasing with better systems becoming available . Only drawback that we still have in my country we only have two systems available and none of that includes a patch plant .

David Kerr 6:44

Interesting . I mean our own data here in California suggests that the use of AP is actually a lot lower than that . So we're very jealous . What about the use of wearable technologies such as CGM in people who are not on insulin ? Is that becoming a big deal in Europe ?

Julia Mader 7:02

Not yet because that's not reimbursed and , in contrast to the US , people are not really used to pay out of the pocket for any healthcare-related expenses . Well , nearly not so for people without insulin . They might be really a minority in the one-digit area . So I don't even have one single patient who is using CGM without insulin at present . You see a slight uptake , even if it's not funded , in terms of those double agonists regarding obesity . So that's maybe something new that they did not have in the past before , because there they truly have the need on their own perspective . But for CGM in those without insulin , I don't see really a big uptake .

Julia Mader 7:59

The only group that uses it but those are keeping without diabetes are people in training in the sense that who are training maybe , let's say , for marathon or long-distance runs or cycling , because they want to understand better their refueling procedures during exercise . But for type 2 and oral agents I would not see that . There is maybe a small niche where how I can still request reimbursement for people without basal bolus therapy If I indicate okay , people are using basal insulin with bolus on demand and the insurance companies don't ask how much the demand of bolus insulin is . So that's kind of a little way how to get around the reimbursement . Slotted genes , but only for those who are insulin-model .

David Klonoff 8:53

Julie , you mentioned these new GLP-1 receptor agonists . In the US they're becoming very popular . Some people think that that's going to become first-line treatment , even ahead of metformin . These drugs are very effective . Are they used much where you are , and what do you think about them for type 2 ?

Julia Mader 9:14

I think they are becoming more and more wide and loose and they will become for sure a game changer . If they will end up before metformin I do not yet know , but I think they are at a very strong position at least in coming in a second in those I do not yet know , but I think they are at a very strong position at least in coming in a second in those who do not meet the targets . Before it was only people who had either HbA1c above 8.5% , preferentially in those who had also a BMI above 30 . But the insurance companies nowadays at least recognize advantages and allow us to use them in a broader clinical cycle so that meta-OR should be present and even in type 1 diabetes they are becoming reimbursed nowadays consensus panel that advocated the use of making GLP-1 RAs available for T1D patients using automated insulin delivery systems .

David Klonoff 10:13

We worked on that together , and David Kerr is as well aware of that . So , Julia , what types of technologies do you see now that look very promising ?

Julia Mader 10:25

So I think for people who are not wanting to go for an AID system , connected pens and more of that , even smart pens , are becoming really important because they help people to really not only track better their insulin doses but also to help them to calculate , because calculation is a big deal Hopefully also with some technology included that tells them , as according to the glucose rise , how much insulin they should inject , because that's still the largest burden .

Julia Mader 10:59

I also think that glucose monitors , even if they are not combined with the ID system , as soon as they give better insights and deeper understandings of how to re-inject to glucose values , will become important . I'm not so sure how soon we're going to see ketone meters or combined meters on the market , but I guess that will also facilitate some of the diabetes management , because sometimes you just simply don't know is it the meeting of the eating room , the fat content of the meal , because it's not going down , or is it the catheter cooling ? In that sense we could do the benefit also of a combined and PCOS monitoring approach and we also observe in some people and some research that's ongoing , some technology to track other conditions like that . But it took disease , but that's still something very young , so I've been involved in one project , but it's not so sure how easily that's going to be realized on one side and we'll get the better treatment that we have . Maybe we also see deep decline in those complications that we don't need to monitor those conditions anymore .

David Kerr 12:18

but I mean that would be another three the other thing I would like to ask all of our contributors is about artificial intelligence , because every time you open social media or the news , there's something about artificial intelligence . What's your thoughts on how it's going to influence what we do on a day-to-day basis in the near future and in the longer term ?

Julia Mader 12:47

That's a very good one .

Julia Mader 12:48

So I think artificial intelligence will help us , at least with data interpretation a nd musicas . But it's maybe not as marked as all of us had thought it already is , because it's just learning from what is known in many places . So I think you can get something out of it , but you need to be very sure that the model is underlying it . You need to find the face , otherwise you don't get suggestions out of it . If you just simply test and go and try to write up some simple article , you might get very fun facts out of that , and the same is happening , of course , for certainly medical care , if the underlying database is not good . But on the other hand , we've seen that clinical interpretation of state or by machine can be better than by genome because they are not so much influenced by the individual sitting in front of them . So because each person has either dark or light errors in my immune smart or not smart I might have different approaches to them and the computer would be probably more neutral and not taking into account my personal observations .

David Klonoff 14:11

Julie , I have one last question for you . Now you're managing editor of the Diabetes Technology Society Journal , which is the Journal of Diabetes Science and Technology . What's it like ? How do you plan to handle that new position ?

Julia Mader 14:27

It's a really important position position and thanks again , david , for having me and for asking me for that one , so I had very , very positive responses to that . A lot of people approached me to it , so obviously this is something that doesn't go unnoticed . That's one thing . On the other hand side , of course , I hope that we can together further develop the journal and really keep it as successful as it is . So it's really on a very , very good track in my opinion , and that's all your longstanding , sustained work in this trial that's put into it and I think it's becoming , or it is , the leading trial for novelty colleges . Also , when I see the articles that are submitted , they are of high quality and people really want their data to be published here .

David Klonoff 15:32

Well , with you at the helm , we'll reach even higher heights . So , Julia , thank you for being interviewed today . David , thank you for interviewing .

David Kerr 15:41

Pleasure . Really welcome aboard .

Julia Mader 15:44

Thank you so much .

David Klonoff 15:46

This completes the podcast . This podcast is available on Spotify , Apple Store and the Diabetes Technology Society website . We look forward to seeing everyone at our next podcast and , until then , have a good day . Bye-bye .