The Future of Diabetes Care – Perspectives from Global Leaders
By Eliza Skoler
By Eliza Skoler and Brian Levine
The diaTribe Foundation’s sixth annual “Solvable Problems in Diabetes” in Barcelona brought together more than 140 leaders to discuss challenges and opportunities in diabetes
At the diaTribe Foundation’s sixth annual “Solvable Problems in Diabetes” event, doctors, researchers, and diabetes advocates gathered from around the world to discuss the most urgent challenges and opportunities in diabetes today. The event was held on the first day of the 2019 European Association of the Study of Diabetes (EASD) conference in Barcelona, Spain. The panel was moderated by diaTribe’s Kelly Close and featured (from right to left):
Professor Stephanie Amiel of King's College London
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Professor Juliana Chan of the Hong Kong Institute of Diabetes and Obesity
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Professor Tina Vilsbøll of The Steno Diabetes Center Copenhagen
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Professor Chantal Mathieu of Katholieke Universiteit Leuven, Belgium
Panelists first said what they were looking forward to at EASD 2019, and then discussed diabetes advocacy, improving care through telemedicine, and updates to guidelines from the European Society of Cardiology. Here are some of the most memorable, insightful, and quotable quotes from the event.
What’s On Your Mind?
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“I’m interested not so much in technology development, which is fantastic and definitely happening quickly, but also understanding how people use this technology. We have the assumption that tech will solve problems and while it does, we’re rushing forward with them. Some of the things we have to understand are how people work with these technologies.” – Professor Amiel
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“A lot has been going on over the last 20-30 years, and the questions now are ‘how’ and ‘at what time’ – giving the right drug, the right technology, to the right people, for the right reason.” – Professor Chan
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“I’m a type 2 diabetologist. Looking back 21 years ago, at my first conference, it wasn’t fun being a type 2 diabetologist. Everyone was talking about type 1 diabetes. Being a type 2 diabetologist is actually really, really fun this year. And from a scientific point of view, I’m indeed looking forward to future treatments for obesity with and without diabetes. Obesity today is where diabetes was 20 years ago. To have new and better treatments for obesity is of major importance for the future.” – Professor Vilsbøll
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“What is really interesting me the most is finding new biomarkers, and this concept of heterogeneity. Heterogeneity in type 1, also in type 2, and also in therapeutic response. I’m always envious of the cancer field and where they are in phenotyping and genotyping individuals and giving them the right therapies, avoiding futile therapies, improving outcomes. Scientifically that’s the big goal for me.” – Professor Mathieu
On diabetes advocacy:
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“The voice of the person living with diabetes – that’s what works. That’s how we got FreeStyle Libre, and other things reimbursed. By bringing patients to look payers in the eyes and say, “We need to do this.” We can show all the evidence in the world, but it is their voices that need to say it.” – Professor Mathieu
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“I think the type 1 community is very vocal and works well often. The type 2 community is much more diffuse, and in many parts of the world a big issue is stigma. Trying to get people to come forward for treatment, and to advocate for future treatment, can be very difficult. One thing we have to deal with is stigma for obesity rolling over to people with diabetes. Public perception is that diabetes is diabetes, with no distinction. It can be difficult to get enthusiasm amongst communities, politicians, until you can get through that.” – Professor Amiel
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“I believe in data. Facts and figures are very persuasive. How can we systematically collect this data and track them over time? We’re in a big data world – especially with CGM and these new medications. We must combine this data with research and engage the practitioners and managers so they are all together, trying to learn from the patient. In Hong Kong, that’s what we did.” – Professor Chan
On improving care through telemedicine:
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"My dream diabetes clinic would have diabetes educators available online, all the time. Having partners to support the motivational needs and emotional needs of people with diabetes is critical." – Professor Mathieu
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“We’ve talked about places where 80% of people are using technology, but my clinic in South London isn’t like that, unfortunately. Sometimes, it’s the first time people get to talk to someone else with type 1. To see people who have felt terribly isolated with a disease they don’t want to talk about, interacting with each other, is transformative. Our new programs are trying to mix together technology and face-to-face interaction. Yes, it’s more time consuming, but the benefits are much greater, because people learn from people.” – Professor Amiel
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“In 10 or 20 years, the doctors will be very familiar with technology, and on top of the technology getting better. Maybe you’ll only need to see the patient once a year, with technology in-between, but I don’t think you’ll ever replace the face-to-face interaction. I gave an e-learning talk with 20 patients and it was very good. That kind of group learning can be very empowering, and in a setting like that they don’t have to travel.” – Professor Chan
On the latest European Society of Cardiology Guidelines that recommend SGLT-2 inhibitors and GLP-1 agonists as first-line therapies for people with diabetes who have heart disease or a high risk for heart disease (learn more about the exciting updates here):
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“I think it’s too early, but I love this discussion. Cardiologists were too quick, but this is a discussion we need. Of course, the cardiologists are overwhelmed, because it’s the first time they have a drug for heart failure – we gave them a gift! In the UK, I know that heart nurses can even prescribe heart medications. Soon, they might be prescribing GLP-1s to patients with prediabetes or even no diabetes. I’m afraid this will mask the diabetes and they won’t see an endocrinologist.” – Professor Vilsbøll
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“I hate to be a naysayer, but these aren’t medications entirely without side effects for some people. The diabetes community is more familiar with these drugs, but the cardiologists have a different way of thinking. You see things very beautifully in trials where everything is very well controlled and we wish everyone could be in a trial because outcomes are better even in the placebo group. You have to be aware that you’re treating a much wider section of the community than the population in trials. If things go wrong, we need to be in a position to fix them up quickly. I think it is very exciting, and I think we should be moving much more quickly than we are – but I just want a note of caution. We are poised to really improve outcomes, but we need to do it carefully.” – Professor Amiel
