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Steve Freed: This is Steve Freed with Diabetes in Control and we’re here at the American Diabetes Association 77th scientific session 2017. We’re here to present you some really exciting interviews with some of the top endos from all across the world. And we have a special guest with us. Aaron Kowalski, PhD who has a very unique job. Maybe you can start off with, tell us a little bit about yourself and just a little bit about your background.
Aaron Kowalski: Sure, well thanks for having me. This is another great ADA scientific sessions and I’m JDRF’s Chief Mission Officer. I joined JDRF as a scientist working in our diabetes complications portfolio and now have the pleasure and honor of working with our research team on our funding. I also oversee our policy efforts because ultimately JDRF is about curing type 1 diabetes and keeping people healthy and happy until we get to a cure. And to do that we need research, but research needs to be translated through regulatory approvals. It needs to be accessible and affordable. Doctors need to prescribe advances before people benefit and my title of Chief Mission Officer, the mission is people doing better until we drive and cure this disease and that’s what I focus on at JDRF.
Steve Freed: And that’s pretty important. How many studies are you supporting from JDRF?
Aaron Kowalski: I’m really proud of the amount of type 1 diabetes research JDRF funds. We will fund over 80 million dollars in research this year and have many abstracts and oral presentations at the scientific sessions, which is really exciting to see the research get reported out.
Steve Freed: What’s the most exciting presentation, if you have to pick one?
Aaron Kowalski: Well, I can’t just pick one. I mean that’s unfair because we fund across a variety of different programs. In the nearest term, we are going to see devices really helping people with diabetes and I think of the artificial pancreas work that JDRF supported. I have been fortunate to work on that program for a number of years now. This meeting was super exciting because we are seeing the launch of the first hybrid close loop system and that’s really amazing.
Steve Freed: The technology and drugs have changed so dramatically over such a short period of time. If you look at what we’ve done from 1950 to 1995, 50 years approximately, we had one oral drug for diabetes, we had two insulins, and now there’s just so many choices, which even makes it more difficult for the medical professional to decide what’s best for what individual. But the one thing that I’ve noticed of the people that are here today, that people that are involved with diabetes, are passionate about what they do.
Aaron Kowalski: Yeah, oh yeah.
Steve Freed: I talk to people with new technologies and a lot of people involved with diabetes have diabetes. Usually it’s type 1 diabetes. So I’ll ask you a personal question. You work for JDRF. Do you have diabetes?
Aaron Kowalski: I have had diabetes since 1984 and I have a younger brother who’s had diabetes since 1977. And when we come to scientific sessions like this, I think one of the key things that we want to see is progress. And you’ve talked about progress that has happened over the decades and now we seem to see a tremendous acceleration. I think of my brother when he was diagnosed, we did urine glucose testing. Now you would be hard pressed to convince somebody that CGM wasn’t the standard of care for people with type 1. It’s been a transformational technology. The different drugs that can help people with type 1 and type 2 diabetes. Ultimately this disease is really hard. I mean that’s a theme in my talk at the sessions, was even with these advanced tools and technologies, we still have a lot of room for improvement. So the progress is amazing. I’m thrilled. My family has been doing it for 40 years but we still need to do more and I’m really proud of the work that JDRF is funding to try to help us drive towards a cure eventually.
Steve Freed: Well, you know over the years, over the many years, okay, when someone says “when are we going to have a cure for type 1 diabetes?” Type 2 is a whole other ball game. And the standard answer “we’ll have a cure in 5 years” and that goes back maybe 50 years, they’ve been saying that you know for a long time and I would love to ask you when are we going to have a cure for diabetes? And obviously you’re not going to say 5 years. What would you say?
Aaron Kowalski: I absolutely won’t say 5 years and I would say I don’t know when we’ll have a cure, but I can guarantee you we’re going to push as hard as we can to be as fast as we can. You know the other interesting thing if you talk to folks with diabetes, and I’m sure you know this, is what does a cure mean? If you asked what the Holy Grail, you walk away from the diabetes, everybody will agree upon that. But JDRF is funding a number of different approaches that would be maybe close such as cell replacement therapy. So we have a number of reports on advances of cell replacement therapy. At the session I spoke at we heard about advances in stem cell therapy which would be implantable and maybe last a couple years in your body. Is that a cure if it has to come out and be topped up every 2 years? Well, if I’m not dealing with diabetes for 2 years at a time, for me that I think would meet the definition. Glucose response of insulins are another really exciting area. My colleague, Dr. Julia Greenstein, will talk about advances in immunotherapies which are going to be what is critical to getting to the end goal. So, the cure, I don’t know because we don’t have all the answers but we’re funding a significant amount of research to try to drive us there as soon as possible.
Steve Freed: So, we’re here at ADA, the scientific sessions. So, let me ask you what are some of the JDRF-supported studies that presented results here at ADA this week? And you may have answered already, what results were the most exciting to you and to healthcare professionals?
Aaron Kowalski: We’ve funded research across the spectrum and again I think the nearest term studies that are reporting out that are going to be applicable to healthcare professionals are the device-based studies. Medtronic’s 670G system launching to the market. JDRF doesn’t fund commercial development of these systems, but we did fund a lot of the research that went into the building of the AP systems. Medtronic’s is coming to the market and a number of other companies that are following. People who have type 1 diabetes and are wearing pumps are going to migrate very soon, and in fact it’s happening right now, to hybrid closed loop control and it’s transformational. We’ve heard a number of reports. Overnight glucose levels normalized. Much less variability. Less time hypoglycemic. So that’s great. Another study that was reported out that JDRF funded that I’m excited about is what’s called the “REMOVAL Study” and this was looking at using metformin in type 1 diabetes and trying to reduce the risk of cardiovascular outcomes and the results were very positive. So, if you think of an application when you have type 1 adults who may be at risk, we know of course both forms of diabetes have increased cardiovascular risk, here’s another potential means to reduce risk and that will have direct clinical impact. You’ll hear from Dr. Greenstein about some of the more advanced immuno work that we’re doing, which is going to take time. These are first very important read-outs that we’re getting and I think its super exciting.
Steve Freed: So, let me ask you about one of the items you just mentioned, the artificial pancreas. What are some of the takeaways from your presentation on the artificial pancreas technology that could be useful to healthcare professionals? And we keep talking about an artificial pancreas. It’s not an artificial pancreas. I don’t know why we even use that term. It’s the first step toward an artificial pancreas.
Aaron Kowalski: I wrote a paper about this and I catch some flak so if you want to blame somebody you can blame me. But the short version is the artificial pancreas, a machine that replaces what your pancreas did before you have diabetes is kind of the goal. Along the way, what we’re trying to do is take the tools we have now and make them work better. Much better. So I think we kind of inherited the term artificial pancreas. I always say there’s no single artificial pancreas. There are going to be iterations of more advanced insulin pumps that will reduce highs and lows and reduce user burden. Meaning the decisions you have to make. It’s closing the loop is the other term that you often hear. It’s not completely closed but it is going to work. The data is unbelievable. The data that’s been reported out. JDRF has funded over 100 million dollars in this field and I’m now hearing people wearing these pumps at these scientific sessions. Overnight glucose normalized. Hypoglycemia reduced by almost two thirds. Hyperglycemia reduced. Significantly more time and range. So the artificial pancreas or hybrid closed loop systems are coming to the market and this is the first meeting where we have a system that’s out on the market dosing insulin automatically. The other thing that we’ve talked about, and you heard a number of presentation, is okay well how would you make it more like the functioning islet? We know that we need faster acting insulin. That’s another gap. The reason we call it hybrid is you need the bolus at meal time because the insulin doesn’t work fast enough. It doesn’t work like a pancreas’ insulin works. We heard that people don’t want to wear devices. So I always joke that people without diabetes don’t wear insulin pumps. So when you wear an insulin pump what you want to get is some return on that investment, but the other side is if we can make these devices smaller and easier to wear I think it would be better and you might see more people adopting some of the advances here. So I’m really excited about this year. I think it’s a seminal year in terms of technology because it’s the first year that we can talk about people actually out in the audience wearing hybrid closed loop systems.
Steve Freed: So, for my last question. It’s one of my favorite questions to ask everybody. I can stop people on the street and ask them the question. You go downstairs in the exhibit hall and they’re offering free A1C tests and they stick your finger and give you a little piece of paper in about 5 to 10 minutes and on there is a number. Doesn’t say it’s below 6, doesn’t say it’s between 8 and 5. It just gives you a number. An exact number with a decimal place. So, if you can have any A1C for yourself forgetting you have diabetes okay, if you can have any number that you want for your health, what number would you like that to be?
Aaron Kowalski: I would like it to be a normal number. I mean a non-diabetes level.
Steve Freed: But it doesn’t say normal on the piece of paper. There’s a number.
Aaron Kowalski: So, I would say 5.5%. We know that the general population of people who don’t have diabetes are in the mid-5 range. Now of course that is a cure. How you get there as you know, to drive the A1C down to 5.5% right now for me would mean a tremendous amount of hypoglycemia. We need to get to an A1C that is attainable in your real life. And the other thing that I say when people ask me about A1C is diabetes is not just about A1C. When I hear the reports out of the first hybrid closed loop systems, one of the key things, the number one thing, what do you think the number one benefit that people report out?
Steve Freed: Well hopefully less time taking care of their diabetes.
Aaron Kowalski: Well that’s one. The number one, and this is part of that, is sleep. They sleep better. That people don’t appreciate how much diabetes interferes with sleep. And of course I would love to have a normal A1C, but the A1C needs to come with the quality of life that is not overburdensome. I could poke my fingers 50 times a day and eat celery and fast and maybe get my A1C down to 5.5%, but that’s not the quality of life that I want. So, that’s why we do research. That’s why I’m really proud of the research that JDRF is doing because we’re looking at the glucose control but also what it takes to get there and to me you have to balance both of those. So that’s a longwinded way of having an A1C that my wife has who doesn’t have diabetes would be great but I want to get there the way she gets there without thinking about it.
Steve Freed: My license plate says HbA1C 5.
Aaron Kowalski: Nice. Alright.
Steve Freed: So, if you see that license plate, it’s me.
Aaron Kowalski: I’ll know it’s you. I’ll try riding that slipstream.