Dr. Judith Fradkin: Director of the Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDK
Dr. Judith Fradkin is the director of the Division of Diabetes, Endocrinology, and Metabolic Diseases (DDEM) within the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH). She has a biochemistry degree from Harvard University and a medical degree from the University of California at San Francisco. She oversees more than $600 million in research funding and is one of the most influential people in diabetes. Dr. Fradkin also oversees the appropriation of the multi-million-dollar Special Statutory Funding Program for Type 1 Diabetes Research, which has just been extended for another two years and $300 million. In a conversation with diaTribe, Dr. Fradkin discussed, among other things, health care economics and special funding for type 1 diabetes research.
movements in diabetes
Mark Yarchoan: Thank you so much for joining us today. Given your important role in diabetes research, we’re curious to hear what your vision is for diabetes treatment in the future. Where do you see diabetes ten years from now, and how do you see us getting there?
Dr. Judith Fradkin: We're looking both at cell replacement therapy, and we’re trying to move forward with the artificial pancreas-type approaches. For the artificial pancreas, it's going to be really important to try to marry behavioral research with technological advances. It’s crucial that we make sure that as we move forward on the technological front, we also do some of the research to make sure the technologies are useable in real life.
Kelly Close: Being on a pump myself, I certainly agree with your point about usability in everyday life. Do you hear a lot about patients having problems with their pumps?
Dr. Fradkin: I think in general most problems are not reported to the FDA. I’m hugely in favor of pumps. I think the point is that we need to make sure that people know how to use them.
on healthcare provider economics in diabetes
Kelly: How can health care providers push for more diabetes education when it is not reimbursed by insurance? Do you think that we will get to better reimbursement?
Dr. Fradkin: Take the Diabetes Control and Complications Trial (DCCT); everybody who was involved with the DCCT knows that it was the diabetes educators who made the intervention work. As soon as the DCCT ended and the patients moved on to the follow-up study, their A1c gradually moved up. If you look at the cost effectiveness of the trial at the end of six and a half years versus over 10-20 years, you would see that it's the long-term benefits that change the balance in cost effectiveness for intervention. From my perspective, I think patient education and empowerment is just critical.
overview of the special diabetes funding program 1
Kelly: We attended the recent NIH Special Diabetes Funding Program conference in Washington that you led – we found it impressive but also daunting in terms of thinking about next steps in research. We were wondering if you could tell us more about the funding program and what you consider the biggest successes of the program so far.
Dr. Fradkin: I think the special funding has really enabled us to do things on a scale that we would never have been able to do otherwise. And I think, in many cases, we've started things that haven’t yet come to fruition. We have the ability now to do trials to try to prevent type 1 diabetes. We've already seen now that we can very accurately identify people who have an 80 percent chance of developing type 1 diabetes over five years. I think we've seen progress in the most important aspects of type 1 diabetes. People are living longer with fewer complications. It’s interesting when you see that in each successive decade since the 1950’s type 1 patients are living longer and having fewer complications than those diagnosed ten years before. That kind of shows you how things are moving along.
Kelly: DiaTribe recently completed a survey showing that barely 1% of medical school students surveyed wanted to specialize in diabetes, which is obviously a problem given how fast the disease is growing. Do you agree, and can you talk a bit about why you think this might be happening?
Dr. Fradkin: I think you're absolutely right, and I think that funding plays a big role. I think that young people who are starting careers want to see secure futures ahead of them. So if a medical school has a grant so that they can definitely offer a research trainee a position, that helps to recruit people. The National Diabetes Education Program (NDEP)
Kelly: Could you talk a little bit more about NDEP (National Diabetes Education Program) because it sounds like there's a lot of amazing educational work being done there.
Dr. Fradkin: I'm glad you asked. The National Diabetes Education Program is a federally funded program sponsored by the NIH and the CDC. It has a lot of strengths because the NIH and the CDC are working together: the NIH brings the research to the table, and the CDC brings the public health apparatus to the table. It started off with the message to control your sugar and extended our message to include controlling blood pressure and cholesterol to help prevent complications. After the Diabetes Prevention Program results showed that type 2 diabetes can be prevented or delayed, we started a major prevention campaign. We've extended our messages to focus on specific groups of people who may not get the care that they need, such as minority groups. We've had campaigns focused on children, and we just started a campaign for gestational diabetes and children who are born to mothers with gestational diabetes to try to encourage diabetes prevention. We have terrific materials on our website, www.ndep.nih.gov.
Kelly: On that note, we say thank you incredibly for all your time and your commitment to diabetes. Your contributions to the field are truly remarkable and we feel incredibly lucky to have been able to spend this time with you.
Dr. Fradkin: Thank you.
