Straight Talk About Diabetes: More Tools Needed

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This post is part of ongoing coverage of Cleveland Clinic’s 2013 Medical Innovation Summit: Finding Balance through Innovation. Obesity, Diabetes & the Metabolic Crisis.

During a panel discussion with other doctors and drug industry executives, William Herman, MD, made a statement that seemed pretty innocuous.

“I think the key to controlling diabetes is prevention.”

Preventative measures should actually include bariatric procedures, he added, noting, “The risk reduction (following bariatric procedures) is anywhere from 22 percent to 70 percent.”

But Dr. Herman, who is Professor of Internal Medicine and Epidemiology, University of Michigan, also said that many healthcare insurance programs are simply not aligned with the end goals of treatment.

Healthcare system’s ‘unintended consequences’

John Brooks, President and CEO of the Joslin Institute, agrees that such “unintended consequences” disincentivize patients to properly manage their conditions.

For example, when diabetes patients who have co-pays for eye exams forgo the exams, they’re cutting off a crucial means of monitoring the disease because an eye exam can show symptoms of diabetes. Not only can diabetes cause blindness but it is the leading cause of blindness in United States.

“I’m mad that we haven’t figured this out,” adds James Young, MD, and Chair, Endocrinology.

In spite of the relative success of bariatric surgeries to reduce risks associated with diabetes, Dr. Young says it’s far easier to get a patient into heart surgery than it is to get a patient into bariatric surgery for diabetes treatment.

“There are too many hoops to jump through,” he says.

What the panelists all seemed to agree on is that more tools – of all kinds – are needed to manage diabetes.

“I believe there is a role for technology to play,” says Stu Randle, President and CEO of GI Dynamics. “We need more therapies used in more combinations than we have today… more collaborations in drugs and devices is where we need to go.”

Complicated disease requires collaborative approach

“Diabetes is always going to be with us,” said Sandra MacRury, MD, Professor of Clinical Diabetes, University of the Highlands and the Islands. Dr. MacRury said about 10 percent of costs associated with diabetes in Ireland are due to complications, including heart disease and amputations.

While Dr. Young supports the role of surgery to help control the disease in some patients, he believes endocrinology is the missing piece in studies and development to treat diabetes.

“You hate to say we need a pill… but the reality is unless certain societal things change, we need a solution.” Dr. Young said he is hopeful about the use of a Polypill, a pill containing a number of medicines that is being used in India.

Technology and the human factor important in managing diabetes

Kris Peterson, CEO of Valeritas, which develops drug delivery devices, says the company’s disposable V-go insulin delivery device (which is marketed to patients who are already taking the drug to control diabetes) is successful because it was developed based on human factors, including diabetic patients’ feelings of embarrassment at having the disease.

“It’s interesting that many patients who should be on insulin are afraid to be on insulin,” Brooks said, “it’s almost like taking insulin makes having diabetes real.”

Peterson says patients use V-go because they can use it discreetly.

Collaboration key for control, better treatment of diabetes

Brooks believes the key to successful diabetes treatment is understanding the whole patient as an individual, including their lifestyle and mindset.

“Bariatric surgery itself is not going to be a panacea … we have to not just change the gut flora, the diet and the lifestyle, but also the mindset.”

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This is precisely why the focus must be shifted from treatment of acute cases to prevention of metabolic syndrome, or pre Diabetes, from evolving into Type 2 Diabetes. Drugs are not the answer to this challenge.
Type 2 Diabetes is fundamentally a lifestyle related condition that can be prevented. The most important preventatives are:
1. Diet - Low carbs, Very little or no refined sugar, no high fructose corn syrup, heaps of fruit, little or no processed foods, low saturated fat.
2. Chemo preventative dietary supplements. Transmax and Bioforte Resveratrol have been conclusively shown to lower blood glucose and blood pressure, improve insulin sensitivity, and help to keep one's weight in check. These supplements are also effective as a treatment when administered to patients who are and are not taking the Metformin type drugs. Ask your endocrinologists. He should be familiar with Transmax. Given the mass of peer reviewed evidence in the public domain, any physician who does not consider Transmax or Bioforte for his Type 2 Diabetes patient is negligent.
3. Exercise and weight control. Obesity is the prime cause of Diabetes.
If the patient waits until he has Type 2 Diabetes to think about prevention he/she will be facing a lifetime of drugs, disability, and eventual loss of sight and possible limb amputations from its complications.