Dr. Steven Edelman talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the state of control – or lack thereof – within the diabetes community.
Dr. Steven Edelman, Founder, Director, and Chairman of the Board of the nonprofit organization Taking Control of Your Diabetes, is a Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at the University of California, San Diego and the Veterans Affairs Healthcare System of San Diego. He is also a 10-time winner of the San Diego Magazine Top Doctors in San Diego Award.
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 with 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: Dr. Steven Edelman, Professor of Medicine University of California-San Diego, Veteran’s Affairs Medical Center, Founder and Director of “Taking Control of your Diabetes” TCOYD. He’s been doing that for many years. Maybe we can just start off and tell us a little bit about what kind of practice you have.
Dr. Edelman: Well, I’ve been doing “Taking Control of Diabetes” for 22 years, but it all started off when I got diabetes when I was 15 years old. I wanted to become a diabetes specialist, so I became an endocrinologist and I work at the University of California-San Diego and the Veteran’s Affairs Medical Center. So I have a university based practice and I run a big clinic at the VA, mostly type 2s, but still a lot of type 1s these days. When I run “Taking Control of your Diabetes” putting on conferences around the country. I really have interaction with 1,000s of people every year. type 2 and type 1.
Steve Freed: Because you’ve seen so many patients throughout the country. Probably throughout the world. What do you think is the major issue? Why is it that most people are out of control?
Dr. Edelman: Well, we should put it in two buckets. The type 2 and type 1. Primarily in the States. type 1, you know Steve, it’s tough to control. SubQ insulin just acts too slow, it hangs around too long. It really shocks me that a minority of type 1s are wearing a continuous glucose monitor, which I think is one of the most important advances in type 1 diabetes since the discovery of insulin. Over 100 years ago. A device that tells your blood sugar every 5 minutes, trend arrows up and down, and warns you, then going to your phone to the cloud to help loved ones follow along. Why is it that so few people are on the continuous glucose monitor? We’ll get into that later. Type 1 is tough. They’re totally dependent on injectable insulin and there’s a lot of unpredictable fluctuations. You take type 1 diabetes exchange data, that’s the snapshot of 27,000 type 1s in the United States and they’re followed at major medical centers with good diabetes clinics. Only 30% have an A1C at goal. So it tells you that there is really, it’s hard to control type 1. Type 2, I can summarize it for you. There’s a lack of a sense of urgency. It’s a polypharmacy condition. Doctors don’t have time to talk to patients about why they’re prescribing multiple drugs. People don’t take them. I have data I’m presenting here at this meeting on adherence and persistence in type 2 meds and it’s unbelievable how many, when you look at pharmacy benefit manager refill data in large databases, administrative claims data, that the adherence, defined as percent of days covered, is horrible. These are drugs, even like the DPP-4s, that have no side effects that are once a day. There’s a big disconnect between people with type 2, they don’t understand the urgency, doctors don’t have time to explain things with them, develop a relationship that has a lot of trust. People don’t do the refills. It’s shocking, very shocking.