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Dr. Jeffrey Mechanick Part 9, Determining Best Treatment

Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 9 of this Exclusive Interview, Dr. Mechanick reiterates his call for the individualization of diabetes care.

Dr. Jeffrey Mechanick, MD, FACP, FACE, FNLA is the Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, NY. Dr. Mechanick was chosen president of the American College of Endocrinology (ACE) in May 2016, an office he will hold for one year. His current research interests are in nutrition and metabolic support, lifestyle and obesity medicine, and network analysis of complex systems.

Transcript of this video segment:

Steve Freed: So, my last question is an interesting one. I imagine different endocrinologists have different ideas about it and how they treat patients. There’s been a great paradigm shift in the treatment of diabetes. Just going back a couple of years, it was always focused on blood sugars, on A1C, that’s all you had to worry about besides hypertension and hyperlipidemia, those were included also. But the real focus was preventing the complications from diabetes and dropping the A1C, that was important. In fact, even today I think physicians get paid according to how low the A1C is, if you can normalize it. About 3 years ago, they came out with a couple of drugs that actually prevent dying from heart disease. Now, since most patients, at least 70% of diabetes patients, are going to die from heart disease, strokes, and heart attacks… Now we have a drug that actually can prevent it in a certain way. So now we have to realize, do we treat the blood sugars as importantly, do we give a patient these new drugs, the SGLT-2 drugs that have benefits of not only lowering blood sugar but preventing death? Now we have two ways to treat patients. What are your thoughts on that?

Dr. Mechanick: It comes back to the point I was making before, what’s more important, treating a number or treating the person. Although the mainstay of diabetes care has and will still continue to be, treating that number, treating to target, using the A1C, really it has to be within the context of the biological marker of the clinical marker, of the clinical relevance, which is decreasing the risk for what patients with diabetes are really at risk for, which is cardiovascular disease, cerebrovascular disease, peripheral vascular disease. I think the fact that there’s only a small number of medications that have as yet to have been shown to do that, that doesn’t mean that others won’t enjoy that same benefit, once the proper studies are conducted. Whether an algorithm should favor some of those drugs that have already shown an effect in preventing cardiovascular disease over drugs that have not yet shown that effect, we’ve included that in our discussions, when we formulate our diabetes algorithm, and that’s one of the reasons why our algorithm is going to be refreshed and revised and vetted every single year to incorporate some of this new information. So it’s important, but it still needs to be thought about. There still needs to be deliberation, it’s not black and white, just because one particular medicine is showing a benefit in terms of cardiovascular risk, that that medicine should be used for everybody. It still needs to be incorporated in a lot of clinical judgment for individualization of care. This is an argument for the thinking clinical endocrinologist, as opposed to a robotic, computer-assisted decision tree for the care of diabetes.

Steve Freed:  Well, you just destroyed my idea of putting statin in our drinking waters. I want to thank you for your time, I know you are busy. Enjoy the rest of your time here and thank you very much.


To view this video in full, click here.

To view other segments in this video series:

Part 1: Nutrition and Lifestyle
Part 2: Effective Diet Discussions
Part 3: Simplifying Aspects of Diabetes Care
Part 4: Influx of Prediabetes Patients
Part 5: Tips to Alter Lifestyle
Part 6: Bariatric Surgery and Obesity Treatment
Part 7: Government Assistance
Part 8: Joint A1C Recommendations