America’s Growing Diabetes Threat: American Diabetes Association’s Dr. Louis Philipson on Challenges and Breakthroughs for Nation’s 30 Million Diabetics

Dr. Louis Phillipson – American Diabetes Association

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Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthca re of the future.

This week , Mark and Margaret speak with Dr. L ouis Philipson for
National Diabetes month. He's the President of Medicine and Science
at the American Diabetes Association and Director of the Kovler
Diabetes Center at the University of Chica go Medical Center.

He talks about the huge toll of 30 million diabetic s in America and 89
million pre - diabetics and some promising areas of research as well as
the need for better prevention in diabetes management tools.

Lori Robertson also checks in , Mana ging Editor of FactCheck .org , looks
at misstatements spoken about h ealth policy in the public domain,
separating the fake from the facts . We end with a bright idea. It's
improving health a nd wellbeing in everyday lives.

If you have comments, please e - mail us at [email protected] or find
us on Facebook, Twitter, or wherever you listen to podcast. You can
also ask Alexa to play the program Conversations on Health Care .

Now stay tuned for our interview with Dr. Louis P hilipson on
Conversations on Health Care .

Mark Masselli: We're speaking today with Dr. Louis Philipson, President of Medicine and Science for the American Diabetes Association , an organization
dedicated to improving the health and lives of 30 million Ameri cans living with diabetes.

Dr. Philipson is the Director of the Kovler Diabetes Center and the
James C. Tyree, Professor of Diabetes Research at the University of
Chicago, a noted researcher in beta cell biology and genetics of
diabetes.

Dr. Philipson has published over 180 peer review publications. He's
earned his BA from Harvard, completing his MD and fellowship in
endocrinology at the University of Chicago.

Dr. Ph ilipson , welcome to Conversations on He alth Care.

Dr. Philipson: Well, good morning, and I b ring you greetings from all my colleagues
at the American Diabetes Association.

Mark Masselli: That's great. We are in the midst of the National Diabetes month.
These numbers , I think, for the public are staggering 30 million
Americans currently have diabe tes. I wonder , if you can just help our
listeners understand the economic health and emotional impact of

Dr. Louis Phillipson – American Diabetes Association

this enormous burden of disease on the overall population health in
this country and what do the numbers tell us?

Dr. Philipson: Well, it is very amazi ng, I mean, the cost -- firstly , the economic cost is
in the many billions of dollars , but even more than that is the personal
cost , no only the person who has diabetes, but to their entire family,
depending on when you get diabetes and certainly there ’s m any kinds
of diabetes. Most people think about Type 1 and Type 2 , but the
number is just are as you say amazing. We say about 3 0 million
people actually have diabetes , several million of them don't know it
yet ; but we also th ink another 60 million have pre - diabetes 60 to 70
million. That me ans about a third of the country either has diabetes or
is at high risk. I t is an amazing, sad situation.

Margaret Flinter: Well, Dr. Ph ilipson, as we have learned with most chronic diseases,
there are so many co - morbidit ies that go along with the disease,
certainly the increased risk for heart disease, for damage to the eye
and ultimately blindness , for impact on the kidneys. Maybe you could
help our audience better understand the complexities of this disease
and why gett ing diabetes under control and manage is both such a
great challenge , but why that' s really the great opportunity.

Dr. Philipson: I think the complexity start out with how do you even know you have
diabetes or whether you are at risk? I think many primary care
doctors and internists around the country are getting the word out
that their patients even in early adulthood need to start thinking
about it.

I teach my students doctors that they need to take a family history
that you can save a lot of lives by jus t understanding who has diabetes
and as you mention ed, some of it is genetic risk.

There are two main kinds of diabetes th at kind that might strike
children first and now we know that that blends , so that you can have
either kind of diabetes at any age . A doctor can't tell if or what kind of
diabetes you have just by looking at you , so tests are necessary.

Then beyond t hat, sadly, if control is poor, it's incredibly hard. I tell
my patients , I say you have to walk that lonely v alley yourself. Then as
they s ay, unfortunately complications arise and diabetes remains one
of the top leading causes of blindness, as you said, sadly, of kidney
disease lea ding to dialysis and transplant, of heart disease, and then
things like ne uropathies and amputations , so that pa ints a very grim
picture and what we try to figure out is how do we mitigate the risk ,
how can we get out of this sort of debacle which continues to grow?

Mark Masselli: Dr. Philipson, let's talk about the work you do at the American
Diabetes Association a s President for Medicine and Science . You see
this huge network out there of 20,000 clinicians and researchers

Dr. Louis Phillipson – American Diabetes Association

working in this space and c lose to 600,000 diabetes patients and their
families are also actively involved in sharing t heir data with this
resear ch community.

One thing that we're very prou d of is that we joined early on, we were
asked by NIH to participate in t he all of us research project to look
longitudinally at lots of bits of data and how they might impact
chronic and complex diseases.

I wond er , if you c ould tell us about some of your current research that
you're focused in and how you'll be able to collaborate across such
large populations.

Dr. Philipson: There is a network , I mean , unfortunately , they're just not that many
endocrinologists i n the country . I did a PhD in biochemistry, and then I
went to medical school, and then I went through internship in
residency, then I became an endocrinologist ---

Mark Masselli: Then it just started.

Dr. Philipson: -- right. It takes a long time for that sort of training. I consider the sort
of the front line are really the primary care folks , who far outnumber
the diabetes oriented endocrinologist , so that the cohort taking care
of people, the docs taking care of folks with diabetes is much larger.
The A merican Diabetes Association by hosting, say the annual
meetings which usually gathers about 16,000, attendees, those sorts
of platforms help bring people together from all over the world.

My colleagues really in the science are in Europe, in Asia, they're in
South America , and a growing number of them are in Africa, because
diabetes is an amazing international problem as well.

My own research, which, as you say, has some similarities to what all
of us is trying to do is really based on genetics, families w ith diabetes,
individuals who might have unusual forms of diabetes, part of the
initiative , say from the American Diabetes Association and the EA SD ,
which is the European Association is to understand how to make
diabetes precision medicine.

That's one of t he most exciting initiatives we've been talking about in
a long time , so we're borrowing from the cancer doctors who now can
tell you something about your tumor and this proteins and things that
might be attacked. How can we take those principles and put t hem
in to diabetes, trying to so rt of wrap everything together , this
precision medicine idea , includes things like measuring blood tests,
we have things called biomarkers, which are say the presence of
antibodies, which tell us that you might have a certain kind of
diabetes all the way through ideal therapies, developing new
therapies that are co st effective.

Dr. Louis Phillipson – American Diabetes Association

The third part is, in f act, the person with diabetes, have to say we're
not diabetic, we are people with diabetes, we need to understand all
the factor s that allow pe ople to thrive, how can they do better with
the right choice of drugs , so this is one of the great new initiatives
that I'm pleased to be a part of with the American Diabetes
Association.

Margaret Flinter: We come from the world of the commu nity health center is t he
largest primary care system in the country. 28 million people ,
disproport ionately people who are low income, very diverse on all
measures, and over the years have noted differences in racial ethnic
incidences of diabetes and of co urse, all the social determinants of
health.

When we begin to think about the larger groups, our Hispanic
population , our Native American population, African - American
population, what's the conversation going on in the field about how
we train a generation of people to care for th ese individuals most
effectively, and wh o else needs to be on the team?

Dr. Philipson: Every year, the call center fields over 100,000 phone calls from people
who want to know more about diabetes , feel they’re not getting, as
you s ay, the who is the team. Most people don't have a doctoring
team, they see a primary care doctor and they say something well,
meaning you know, lose weight , exercise and take your medicine and
check your blood sugar and that really doesn't actually get mos t
people anywhere. The number one question at this huge call center is
what should I eat?

I mean, your question resonates with me in that way is that we know
so much about medicine and cells and DNA . Some kinds of diabetes
can be prevented , certainly not T ype 1, not yet. We're getting closer.
Some people who have a tendency to Type 2 diabetes might avert the
severe decree with lifestyle changes , it doesn't work for everyone.

In the United States , we are other minority groups elsewhere, they're
the majority group; but why is it that we think about non - Hispanic
whites, we think about African - American people, and very
importantly, Asian peopl e , so it’s not well understood that more
people in the world who have diab etes are in fact, Asian people.

There are myste ries here, some of which have to do with how much
insulin an individual person can make. Someone from So uth Asia, for
example, may not look large to Western eyes ; but in fact , they're
already overweight. W hen we get into this notion of anything that
gives you more calories , it doesn't have to be an American fast food
restaurant, those extra calories combined with decreased calorie
expenditure , in other words, [Inaudible 00: 09:55] , so all of those
things together make more calories in , b ecause of better agri culture

Dr. Louis Phillipson – American Diabetes Association

and supply and fewer calories out, and for a lot of folks that can spell
a predilection to Type 2 diabetes, and all of us will help us gather folks
from all different backgrounds and that could be a gold mine to
understand why this person from Sout h Asia has diabetes and they
weigh, you know, 135 pounds.

This person from Germany, you know, is a solid 250 pounds and
doesn't have diabetes. I think fo r the -- the FQHC , the Federally
Qualified Health Centers are trying to fill that gap , but there's a hu ge
gap between what we know how to do as doctors and teams and
what we actually are doing. I mean, we need to keep the science
going. There is a growing understanding that healthcare delivery and
behavioral medicine and understanding how people relate to d octors
and their teams like this is as critical as the next cellular therapy for
diabetes.

Mark Masselli: We're speaking today with Dr. Louis Philipson , the President of
Medicine and Science f or the American Diabetes Association .

You were talking about the work that you're doing in the genetic area
and obviously we're all keeping an eye on all the excitement that's
happening in the gene editing world with CRISPR technology and the
like ; but it's also true that there's incredible w ork going on as a result
of members of the diabetes community sort of hacking the science, if
you will.

There's one case of a n engineer whose son had Type 1 diabetes and it
led to the development of an artificial pancreas. Families are
impacted. They're very motivated community. I'm wondering if you
could talk a little bit abou t how this no n traditional way is impacting
some of the tradit ional research that's going on.

Dr. Philipson: I know exactly the story you're talking about ; but way before that,
there were many groups, many comp anies working on exactly how to
do this. I think artificial pancreas is actually a misnomer. I mean, it's
not pancreas. It's simply that in many cases, just the cells that give
insulin. There's a group in Boston that's working on the concept of
giving in su lin at times and glucagon at another time.

One company does have a product tha t has a glucose sensor, which
by themselves are revolutionizing high insights into diabetes. There
sometimes some days, I feel like I couldn't practice medicine
anymore , if not f or continuous glucose monitors, it haven't even been
on the market for more than --

The marriage of continuous glucose monitors with insulin pumps has
been going on for now quite a few years. These are for people who
have essentially no insulin, or very li ttle insulin for the most part,
there are some other examples ; but people with Type 1 diabetes , who

Dr. Louis Phillipson – American Diabetes Association

make very little insulin can benefit tremendously from these
automatic systems.

The company you mentioned started with a father and a son and are
coming alo ng. None of those are in market , so there's a whole
population of people who are you know, sort of we are not waiting
kinds of banners, who are developing their own closed loop system.
Using basically hacked devices with a cell phone controller and a
pump and a sensor and of course peop le are rushing ahead .

All the manufacturers admit that they are not where they want to be
and so to have individuals sort of drive the system to have more
competition, 2020 is going to be an amazing year for that.

Just a minu te or two on the genetics part, my grou p at the University
of Chicago , there is a professor here, Graeme Bell , an d our current
Dean Ken Polonsky, around 1995 started working on genetics of
diabetes in a different way. Th ey were looking to see whether there
were single genes , so they did find that we could identify a handful of
genes when there was one small mutation in that gene each child had
a 50 / 50 chance of having diabetes.

Mark Masselli: Wow.

Dr. Philipson: That's been the cornerstone of my work for th e last decade or so. We
picked up on that , it kind of went away for a while , big excitement
that it was discovered and then it was thought , w ell, you know, it's
like 1% of the population , why should we care ; but once you start
looking for them maybe it's 2 % , but now we're talking 2% of 30
million. That's a lot of folks. Every doctor who sees enough patients
with diabetes is seeing these atypical .

We usually think of people with Type 2 diabetes wrongly as being
larger folks and people with Type 1 diabetes as being thinner folks,
that's wrong. In this case, they're mostly thin , they're mostly young ,
so they were unusual and oftentimes extende d families.

The big win here is, in fact, precision medicine , that the other name
for these is called Mod y M - O - D - Y , whic h stands for Maturity Onset
Diabetes of Young people ; so far in our clinic , we've already
accumulated about 1 , 000 people who have one of several different
genes .

As I said, the beauty is that if you have a specific gene, sometimes we
can have a specific t reatment. In m any cases, specific treatment is
something inexpensive, well known, but we didn't know that it exactly
fixes this defect over here.

Mark Masselli: That's exciting. Single -- it's a single gene variation that --- [Overlap]
sickle cell anemia h as a single gene .

Dr. Louis Phillipson – American Diabetes Association

Dr. Philipson: That's been amazing and so it has taken over our lives and every day
we're talking to families and doctors about atypical cases they’re
seeing , so that’s been an amazing , you kno w, I feel something like
Moses, you know, I c an see the Promise d L and , but it's like when you
can have targeted therapy for specific genetic c auses of diabetes .

I think one small example is something called MODY2 , which is a
mutation in important enzy me called gluco kinase. This enzyme
controls actual ly how blood sugar gets into the liver or the insulin
secreting cells. The important thing here is that if you have such a
mutation, your blood sugars little bit elevated your entire life, they
don't progress.

Right now, the evidence is that these folks do n't need any treatment
at all, except maybe in pregnancy. That sort of insight is amazin g . We
can tell our families, you're not going to get complications of diabetes
and that is to me one o f the most rewarding we can do.

Margaret Flinter: I was thinking w e take care of about 100,000 people a year , 6 , 000 of
them have diabetes, and we're charged really with the health of our
whole community, not just the health of the people sitting in front of
us.

The policy implications of trying to keep people fit, trying to keep
people active seems like the biggest net that we can throw out there
and the prevention of things moving forward. I'm sure yo u have a
position on what is important from a policy perspective to slow this
p rogression from pre - diabetes to diabetes . w e'd l ove for you to
comment on that.

Dr. Philipson: One of the biggest studies that was sponso red by the National
Institutes of Health and the NIDDK , which is the National Institute of
Diabetes and Digestive and Kidney disease, which funds a great deal
of diabetes research along with the CDC, the Center for Disease
Control, which also has a diabetes translation desk . Including the
American Diabetes Association , have been doing a program called the
Diabetes Prevention Program now for decades. This pr ogram, i t's an
absolutely a win, so ident ifying people with not only pre - diabetes, but
the hig hest risk group to go on to pre - diabetes , usi ng a team
approach for exercise, nutrition, cooking at home, often without any
kind of drugs at all .

The results ha ve been as tounding that the fact people can delay or
prevent Type 2 diabetes. The problem is, is that it's expensive , so the
economics of our healthcare system kin d of work against us . That we
know these things work , we know that diabetes centers even work ,
but the expense has been a big barrier.

Of course, there ’s all sorts of lifestyle issues , if you're working two

Dr. Louis Phillipson – American Diabetes Association

jobs, if you are also taking care of three children , where do you find
time to walk 10,000 steps a day . We don't know how to do that. We
know what to te ll people. We don't necessarily know how to help
them do the thing.

That's why I say the health care delivery aspect , how do you help
peo ple with lifestyle intervention. In several centers , they really had
some amazing ability to incorporate and exercise f acility. We certainly
offer classes on cooking on lifestyle modification basically.

Two small examples , there’s a great film right now fro m the American
Diabetes Association and a pharmaceutical compan y narrated by Viola
Davis, the noted actress of stage a nd screen .

Viola talks about her pre - diabetes diagnosis and narrates this very
beautiful film , really intro ducing the concept of diabetes in all sorts of
people , so that outreach is very important.

The other outreach we do is that is legislative. I have be en on the Hill
twice this year, advocating for funding for diabetes research, but also
for Diabetes Prevention Program , so there’s lot going on.

Mark Masselli: We've been speaking today with Dr. Louis Philipson , President of
Medicin e and Science for the Am erican Diabetes Association and the
director of the Kovler Diabetes Center at the University of Chicago.
You can learn more about his important work by going to diabetes.org
or follow them on Twitter.

Thank you so much for the contributions that you're mak ing, the
research that you're doing, and the impact that it's having on so many
families and individuals with diabetes. Thank you for joining us on
Conversations on He alth Care.

Dr. Philipson: Thank you so much. It's great to be here.

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Mark Masselli : At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy , Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit cons umer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what have you got for us this week?

Lori Robertson: In his campaign rally speeches, President Donald Trump often boast s
of his administration's plan to end the AIDS epidemic in the U . S . in 10
years. It's true he has proposed funding for that initiative , but he's
wrong to say that the Obama administration “ spent no money ” on
such efforts.

In fact, the Obama administration spent about the same per year on

Dr. Louis Phillipson – American Diabetes Association

AIDS resear ch and prevention as the Trump administration has and
that's only be cause Congress actually writes the budget , because
while Obama routinely sought to i ncrease funding until this year,
Trump has proposed cutting it.

This year in his State of the Union address , Trump announced that his
2020 budget would “ make the needed commitment to eliminate the
HIV epidemic in the United States within 10 years ” , and that was
backed by Trump's budget with proposed $291 million in spending for
that initiative.

The President, h owever, has falsely stated that his plan would
“ eradica te AIDS in America once and for all . ” The Centers for Disease
Control and Prevention says the term epidemic refers to an increase
in the number of cases of a disease beyond what's normally expected
in a certain population and area. Ending an epidemic would mean
reduci ng cases below a certain level.

The goal in the administration's plan is to lower the number of new
HIV infections by 90% by 20 30. If that milestone were achieved, one
could argue that woul d end the HIV AIDS as an epidemic ; but that
does not mean HIV AIDS would be wiped out entirely.

One of the key strategies to reduce new diagnosis of HIV is to target
initial efforts on geographic hotspots and to provide pre - exposure
prophylaxis pills to pr otect people at the highest risk of getting HIV.
That biomedical prevention tool was approved by the FDA in 2012,
and helps reduce the risk of getting HIV.

That's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret F linter: F act C heck.org is committed to f actual accuracy from the country's
major political players and as a project of the Annenberg Public Policy
Center at the University of Pennsylvania.

If you have a fact that you'd like checked, e - mail us at chcradio.com .
We'll have FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

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Mark Masselli: Each week , Conversation s highlights a bright idea about how to make
wellness a part of o ur communities and everyday lives. Currently ,
some 30 million Americans have Type 2 diabetes and that number is
expected to climb substantially in the coming decades.

Patients who were newly diagnosed often find it difficult to process
the behavioral chang e required to keep their disease in check.
Amazon , the creator of the interactive voice technology known as

Dr. Louis Phillipson – American Diabetes Association

Alexa, and pharmaceutical entity, Merck teamed up to launch a
competition for developers to create a tool using existing technology
that would help folks better manage their diabetes . The winner
Sugar pod developed by Seattle based startup Wellpepper.

Anne Weiler: The challenge was how do you help someone newly diagnosed with
Type 2 diabetes and we already had interactive care plans for people
with Typ e 2 diabetes and then we thought, w ell, sure, w e can voice
enable those care plans , but isn't that what everyone's going to do .

What we thought that was the most interesting was the integrated
care plan that included a device w h ich is a voice powered scale and
foot scanner that looks for diabetic foot ulcers. We thought that the
scale was a nice way of fitting into a routine that s omeone already
had in their day.

Mark Masselli: CEO , Anne Weiler says they were intrigued by the opportunity to
incorporate Alex a’s voice technology for coaching purposes along
with some simple technologies that exists.

Anne Weiler: The three components are voice - enabled , scale and foot scanner, a
mobile care plan , because vo ice isn't always the best interface and
then a voice inte raction that could happe n with any sort of Alexa
device.

Mark Masselli: Chief Technology Officer , Mike Van Snellenberg said they got great
feedback from consumers who said they quickly adapted to the
Sugarpod interface.

Mike Snellenberg : Yes, but anytime y ou want to do interventions on pe ople, you need to
have very low touch lightweight interactions, things that don't
interfere with a person's life and can kind of gently nudge them in the
right direction. I think voice i s a great application for that.

Mark Masselli: Well , weights are measured in feet photographed. Alexa offers
suggestions for weight management , die t and exercise and other
behaviors that will empower patients to make lasting behavior
changes.

Sugar pod is simple constructed Alexa - enabled weigh t and foot ulcer
scanner , providing a flow of important clinical information for their
providers who can benefit from the real time monitoring of patient
health data. Now that's a bright idea.

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Mark Masselli: You've been listening to Conversations o n Health Care. I'm Mark
Masselli.

Margaret Flinter: I'm Margaret Flinter.

Dr. Louis Phillipson – American Diabetes Association
Mark Masselli: Peace in Health.
Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
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listen to podcasts.
If you have comments, please e - mail us at [email protected] , or
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