Marie E. McDonnell, MD
Director, Diabetes Program, Brigham and Women’s Hospital
Diabetes is an increasingly common disease. And right now, we’re seeing prevalences around nine percent in the American population. And over the age of 65, there's a prevalence of 25 percent. This is rising over time. So, for example, in 2010, it was just eight percent. So we see this steady rise.
Developing more precise medications in diabetes is a significant priority. The reason why is because there are many side effects that patients experience firsthand from their diabetes medicines. And this is a disease that affects the body over many, many years, often decades. And I often say to patients, it’s like putting money in the bank when you are taking care of your diabetes today, because it’s going to pay off when you're 75, and you have normal vision, your kidneys are working, your heart is healthy. So what can we do to motivate patients to take medicines early? It’s very difficult to do that when the drug itself has side effects. Some of the side effects we know about include heart failure or exacerbation of heart failure. And many of our patients have heart defects, heart problems. So we need to be sensitive to that and protect patients from that.
Then we have simple effects that are pretty common, GI side effects that are common and really are related to the drug not being precise enough. The other side effect that I think is the most important and prevalent is hypoglycemia, which is low blood glucose. This is a side effect that can-- that really stops patients in their tracks. It makes them feel tired, uncomfortable. And sometimes they can have a serious event where they get confused.
I think providers and patients struggle sometimes when they read the literature, and they see a paper that says "Drug A is better than Drug B." And they ask themselves, "Well, is this definitely going to apply to me?" And providers have the same struggle. They talk about generalizability. “Well this study isn't quite fitting my patient.” So what if we could take the - the trial participants and look at all of their characteristics, and see, well actually, patients with this cluster of characteristics did much better on Drug C.
So it’s like taking the data from a large clinical trial, which has a specific result, and applying it more precisely to unique patients. And Dr. Don Simonson did that just exact thing, along with Dr. Alex Turchin, where in this example, you’ll see a patient, really, when all of his characteristics were taken into account, Drug C was much more effective. And if we could compile that data, and have it be accessible even on a platform, for example in an electronic health record, patients could walk in, be diagnosed with even classical type 2 diabetes. But, because of a certain feature of their diabetes, they’ll be placed on a unique pathway outside of an algorithm.
I think one of the new frontiers in diabetes is beta cell restoration. So this is the idea in both type 1 diabetes and type 2 that we can restore that dying beta cell population. We have a large transplant program here at Brigham and Women's Hospital. There are also islet cell transplants going on at Brigham and Women's Hospital. Both of those therapies will see substantial improvements in the next 10 to 20 years. And patients will need to access them.
There is new technology being developed in insulin delivery to make it easier. It’s challenging to dose insulin with multiple injections a day. Some patients can use equipment like an insulin pump delivery system. But newer products will arrive onto the market in the next five years, which will measure the glucose at the same time a dose is being delivered, so that, in real time, a patient can receive insulin appropriate for their glucose level without them being involved in that decision. This is called the bionic pancreas. And many models are being tested right now. And I think that the FDA is ready to see one come on the market in the next five years.
Given what's often called the armamentarium, which is really the toolbox of medications and other treatments that we have for diabetes, we can be more aggressive earlier in the management of both type 2 and type 1 diabetes, and the subtypes. It’s really about selecting the therapies well, at the right time, and for the right patients.
Given that diabetes is rising, we’re seeing more patients especially in our population over the age of 65, it’s our passion in the Brigham and Women's Diabetes Program to develop personalized, individualized treatment programs, and also research programs, that will hopefully help us and help our broader community treat our patients as they become more complex.
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