What advances do you see prevailing in the diabetes care landscape?
Technology’s involvement in modern healthcare is deepening, specifically in the field of diabetes, to the great benefit of patients. The incidence of type 2 diabetes is certainly on a rise partly due to the growing obesity epidemic. In this period of public health crisis, technological advancements have made lives easier when it pertains to glucose monitoring or taking medications, specifically insulin’s modes of delivery.
Inspite of the technological trends, do you see any challenges from a doctor’s perspective when it comes to providing care to these patients?
The news of a chronic illness like diabetes is definitely a hard pill to swallow for newly diagnosed patients. They have difficulty coming to terms with adopting a new set of life circumstances, as a chronic condition requires treatment, management decisions, and major change of lifestyle. This presents another big challenge, which is, medication compliance on part of the patients; because, for a chronic condition, taking a pill and forgetting about it is not acceptable. The condition requires them to think every day about their physical activity and eating habits, taking medications on time, and often monitoring sugar four or five times a day. Ultimately, it comes down to having the discussion with the patient about the condition that they will be dealing with for the rest of their life and all these changes to their daily way of living.
On a regular, basis when you engage with clients, what approach do you take to make it a little bit easier when delivering this message?
My biggest goal is to make lives easier for the people.
"Patients called the CGM a life changer"
As we share the diagnosis with a patient along with its impact on their life and the complications that it can cause, I counsel them on how to make it as easy and as less overwhelming as possible for them. Technology has really helped us in that regard. Consider the development of continuous glucose monitors (CGMs)for patients with type 1 or even type 2 diabetes who need multiple insulin injections per day and have to monitor their sugar four or five times a day. The use of traditional glucometers was challenging and received a great amount of resistance from the patients as it involved pricking the patient’s finger four or five times a day. On the other hand, CGMs are wearable devices, about the size of a hair, filament, or needle that stays under the skin, where it measures the glucose level from the interstitial fluid.
Patients called the CGM a life changer. It’s not just a matter of avoiding the finger sticks. The CGMsalso provided a huge amount of additional information, such as the effect of different food types on sugar level. The CGM has further proven to improve diabetes control, causing significant reductions in hemoglobin A1C.
Are there any criteria that patients need to fulfill before you advise these devices to your patients?
Healthcareunfortunately is largely insurance-driven. The coverage criteria for Medicare or Medicaid services mandates that patients need to provide evidence that they are engaged enough in their diabetes care; it ends up being primarily type 1 and advanced 2 diabetes patients that use multiple insulin injections. A good number of my patients had commercial insurance coverage even with bills. We are looking for CGMs to be more accessible in the future where they are not just confined to patients with insulin use. Anyone who wants more insight into their sugar background should be able to use these monitors. Oftentimes, we are going through long, time-consuming processes involved with prior authorizations and drowning in paperwork. It is an extremely big challenge when I cannot have it arranged for a patient who I feel absolutely needs it.
In the future, is there anything particular that you expect out of the industry in terms of improvements or trends?
The latest in the insulin pump technology is a pump from the medical device giant Medtronic, that allows automatic insulin adjustment. Depending on how a person’s sugar levels are at a certain time, the insulin pump, with the help of an inbuilt algorithm, can regulate the amount of insulin that needs to be delivered. In the future, I am looking forward to insulin pumps that would have built-in mechanisms for preventing or even managing hypoglycemia, where patients can stay in stable sugar control without having to worry about low sugar.
What is your advice to peers or young professionals straight out of medical school who wish to step on the same career as yours?
Diabetes care is a field where we require more professionals. There is a great demand for endocrinologists in general, partly because of the rising diabetes rate. The younger crowd that is fresh out of medical school would find no other field with more advancements happening than in endocrinology, especially if they are enthusiastic about the field or want to incorporate technology into the medical field.
I myself developed an interest in endocrinology during my residency, and it became my first elective as an intern. There are exciting advances in the field of endocrinology each year; it is professionally challenging to be part of a field that is progressing rapidly in how effectively we can treat patients with a range of endocrine conditions. But, my work is also about relationships; I work with my patients over a period of time, often years, as we problem-solve together on how to best manage or treat conditions and improve their quality of life.