Dr. Ralph Defronzo talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the major changes he has seen in diabetes treatment in the past 50 years.
Dr. Ralph Defronzo, MD is Professor of Medicine and Chief of the Diabetes Division at the University of Texas Health Diabetes Center in San Antonia, Texas. Dr. Defronzo is also Deputy Director of the Texas Diabetes Institute.
Transcript of this video segment:
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. We’re going to start off with a very special guest. A gentleman, a doctor, who if you don’t know who he is, then you shouldn’t be involved in diabetes. Dr. Ralph Defronzo. I have to say it’s a real pleasure to have you here today.
Dr. Defronzo: My pleasure.
Steve Freed: It’s exciting for me just to be able to sit across from you and pick up your knowledge to make me a better diabetes educator.
Dr. Defronzo: This will be a fun interaction, I’m sure.
Steve Freed: Maybe we can start with, tell us a little bit about yourself.
Dr. Defronzo: I’m a professor of medicine and chief of the diabetes division at the University of Texas, Health Science Center in San Antonio. I also serve as the Deputy Director of the Texas Diabetes Institute, which is the largest center in the U.S. for taking care of people with type 2 diabetes. We see about 10,000 unduplicated patients every year. It’s a largely Hispanic community. It’s an underserved community. Our center is in the heart of the Hispanic community. We do a lot of community work in addition to just taking care of our diabetic patients. We have a lot of outreach programs to improve quality of life, make it healthier for them. It’s a pretty well-integrated, academic, clinical community.
Steve Freed: How many papers have you been part of?
Dr. Defronzo: I think I passed 750 publications this month.
Steve Freed: It seems like everybody wants your name on their studies. You’ve been involved with so much, the knowledge that you’ve gained. Going off of script a little bit, if we go back 50 years, and we bring it up to today, what has been the major change that you’ve seen?
Dr. Defronzo: When I first started, even if you think back to 1995, we had two drugs. We had sulfonylureas, which now we consider them pretty barbaric, and insulin, and that was it. I actually was the person who was responsible, to get Metformin approved by the FDA. That happened in 1995. We thought, “man, we’re in heaven now, we have two drugs. We have Metformin and sulfonylureas.” Then you think about all the drugs that we have now, how much better off patients’ lives are and how much easier it is for doctors to get people under control. The big problem now as I see it is affordability of many of the newer medications, which work really quite well compared to the older medications but are also quite expensive. This is an issue that we all have to deal with as physicians.
Steve Freed: One of my major questions for you is they’re going to present a lot of new information here. What, is the most exciting information that you believe is going to be coming out of this meeting?
Dr. Defronzo: Well, I think we’re going to see a lot more about the cardiovascular outcome trials. I think that this has now made in my opinion a significant change that I hope we’ll force HMOs, insurance companies, now to move the newer drugs up. So we’ll hear a lot more about the EMPA-REG Outcome Study. If we have a medication that decreases significantly the MACE endpoint and particularly decreases mortality by some 38% to 40%. I think we need to think more seriously about putting these drugs up as first line therapy. We have a lot more that we’re going to hear from the LEADER trial and from SUSTAIN-6. Again, the GLP-1 receptor class showing a decrease in cardiovascular events. We’ll hear a lot about another SGLT-2 inhibitor from the CANVAS study, canagliflozin. I anticipate that it will be positive as will be EMPA-REG, which will lend credence to the SGLT-2 class, not only as a very important drug for lowering glucose, but a drug that decrease cardiovascular events. To me, there are two big problems that diabetics have, the microvascular complications, eye, kidney, and nerve damage of course more are related to glycemic control, but the cardiovascular complications are what kill our patients, mortality. So if we have drugs that both effectively reduce glucose and decrease cardiovascular events. To me, those are the drugs that should be the front line drugs.