In part 3 of this Exclusive Interview, Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about gaps in current knowledge of how medications impact different ethnic populations, and how AACE is working to educate providers on these gaps.
Dr. Jeffrey Mechanick, MD, FACE, FACR, FACN, ECNU 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.
Transcript of this video segment:
Freed: We’re getting a little bit off track. I know that there have only been a couple of studies where they look at a particular drug for a particular race and obviously that is very important. We know that if metformin doesn’t work for African Americans why are we prescribing it? How does this all get into play?
Mechanick: Well, right now we don’t have enough data to actually answer the question for the ideal cocktail, the ideal algorithm, the ideal way to structure lifestyle for the different ethnicities and the different cultures. There are a lot of variables. But let’s stipulate that, that uncertainty and that incompleteness exists – how is that actionable? It’s actionable now through education and research. So, AACE is now endeavoring to build-up this educational arm, to start training our clinical endocrinologists, having more activities like that lecture forthcoming, so that we’re aware of these transcultural problems – aware of the shortcomings of generalizing from these studies. From a research standpoint, also, a lot of the principle investigators when they design these studies are going to need to capture a more representative population in their studies and also make these studies robust enough so that any post hoc analysis to look at a particular subset is going to be powered sufficiently.
Freed: If you look at the bigger picture, obviously, you have to deal with the American Diabetes Association (ADA) because that is where the protocols stem from, especially for type 2 patients – 90 percent do not go to endocrinologists, they go to family practitioners and internists. How do you get the information? What is the process for what you have today and moving it over so that it hits the general population, and mostly, the family practitioners because that is really where it starts.
Mechanick: Well the first part is how do we deal with the sister societies? A lot of the transcultural program predated incorporating it in AACE activates. When we set up this global network, of colleagues and thought leaders who were experts in diabetes care, the majority were really members of the American Diabetes Association. So, they’re already situated there in the ADA. ADA, Endocrine Society, EASD (European Association for the Study of Diabetes), and IDF (International Diabetes Federation), already have representation of experts in the transculturalization process, it’s just a matter of it bubbling up internally within those societies so it becomes a priority. As far as primary care goes, you’re absolutely right, and one of AACE’s objectives is to work more closely with the primary care community and it’s not just for the transculturalization; it’s really for the larger picture of optimizing diabetes care and obesity for the general population. There are not enough endocrinologists to be able to do it so we need to work hand in hand with primary care.