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Mark Molitch Part 2, The Future of Diabetes Treatment

Oct 6, 2017

In part 2 of this Exclusive Interview, Dr. Mark Molitch shares his thoughts about technology, the latest meds, and what’s coming down the pike in a conversation with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California.

Dr. Mark Molitch is the Martha Leland Sherwin Professor of Medicine at Northwestern in the
Division of Endocrinology, Metabolism and Molecular Medicine. He has been active in clinical research in diabetes, focusing on diabetic nephropathy, and other areas of endocrinology.

Transcript of this video segment:

Steve Freed: You know, I tell people we should all live like we have diabetes and it’s healthy for everyone. I really think it has to come from the doctors and the education process. Diabetes has changed dramatically over the years and the knowledge we gained in the last 5 years is equal to the knowledge we have gained in the last 50 years. God only knows what it’s going to be over the next five years.

Mark Molitch: We only hope it will continues that progress.

Steve Freed: I always ask the question when you leave here today, if you called Uber to take you to the airport, and a car pulls up and there’s no driver in it and a voice comes up and it says, “Dr. Molitch, Great to have you. Where would you like to go?” Would you get in the car today?

Mark Molitch: Yes, it’s not gonna be far away from that.

Steve Freed: So, technology is really changing. It is changing in medicine. With the CGM systems that we now have and the new ones that will be coming out. Number one, what do you think in the advancement of technology is going to be able to help you take care of your patients with diabetes?

Mark Molitch: We are getting close to a true artificial pancreas, certainly with the integrated pumps in the CGMs that now can sorta semi-automate the basal rates and clearly there’s experimental data showing that you can automate the boluses as well. It hasn’t gotten to the market yet, but it is coming soon. Although I must say that I thought everything was in place 25 years ago to do all that and we’re just kind of now getting to that point, so I see a completely automated, integrated insulin pump continuous glucose monitoring system in the next 5 years on the market and that will really revolutionize care.

Steve Freed: That’s really change dramatically when you were in school. When you were in school, and I presume you remember the days when people had urine strips and they had to pee on a strip and we only had one drug for diabetes, sulfonylureas, and it was a pretty simple, easy decision…

Mark Molitch: We even had a second drugthen, a biguanide, phenformin. That’s since gone by-bye.

Steve Freed: That came 50 years later.

Mark Molitch: No, phenformin, not metformin.

Steve Freed: So, we had 2 drugs.

Mark Molitch: Right, but that one caused too much lactic acidosis.

Steve Freed: So, when you were in school it was easy. What do you do today to teach these students? We have over a couple million possible combinations if you add insulin into it. Single, double, triple, quadruple therapy. It’s gets a little confusing. So how do you teach that to the new people?

Mark Molitch: We do the stepwise approach that you know the ADA has certainly advocated and others as well. Since you started with lifestyle change and then metformin is the first drug and then once you get to the second and third drugs, it becomes more difficult but I think one of the things in fact it was emphasized today is that we need to start thinking about things other than just glucose-lowering when picking that second and third drug. Picking drugs that have cardiovascular benefits or adverse effects of weight gain and hypoglycemia, trying to put all that together when you started picking the second and third drug.

Steve Freed: You heard ADA announced some breakthrough studies possibly. What do you think is the most exciting thing coming out of this conference?

Mark Molitch: I’m waiting to hear about tomorrow. I think tomorrow is going to be most important study from a clinical perspective, which is the CANVA study to see if that duplicates what EMPA-REG did for canagliflozin versus empagliflozin or if it doesn’t, and if it doesn’t then this is a unique drug effect verus a class effect and I think that would be a very important to see the results of.

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