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On July 24, CHI partnered with the Congressional Diabetes Caucus to bring together a panel of experts to discuss the key issues surrounding the diabetes epidemic. With diabetes affecting 25.8 million people, and ethnic minorities sharing a disproportionate burden, it is important now more than ever that we fund research and education efforts to understand and combat this disease for which there is no cure. During the event, Rep. Xavier Becerra (D-Los Angeles) acknowledged the prevalence of diabetes in his home district and reiterated the importance of combating the disease. In Los Angeles alone, the consequences of the diabetes pandemic are especially evident, where diabetes has been the 6th leading cause of death since 1997. Diabetes costs Los Angeles County an estimated $6.4 billion a year, according to the Los Angeles County Department of Public Health.
Panelists at the briefing included physicians, researchers, innovators and patient advocates. Speakers highlighted differences between diabetes types 1 and 2 and their variations in diagnosis, prevention and known causes. Type 1 diabetes, previously known as juvenile diabetes, is an autoimmune disease in which the body does not produce the hormone insulin. There is no known way to prevent type 1 diabetes. Type 2 diabetes, previously known as adult-onset diabetes, is a metabolic disease in which the body does not make enough insulin or use it effectively. Type 2 diabetes can be prevented or delayed by maintaining a healthy weight and exercising regularly.
Dr. Richard Bergman of Cedars Sinai noted that there are two categories of treatment: medical and behavioral. Type 2 diabetes is much less understood and, therefore, treatments are less developed. Researchers have discovered, however, that along with obesity, environmental factors including toxin exposure increase the risk of developing type 2 diabetes. Bergman also stressed the importance of NIH funding for diabetes research. Specifically, he noted the lack of incentives for intelligent, young researchers to enter the field where funding lags.
Panelists from the City of Hope and Medtronic spoke about their joint effort to create an automated insulin pump that assesses a patient’s blood-sugar levels systematically and releases or stops insulin injections accordingly. Essentially, this device would function as an artificial pancreas. For patients, this could dramatically improve the lives of those with type 1 diabetes by reducing their reliance on finger pricks and self-administered insulin injections.
Dr. Francine R. Kaufman, chief medical officer of Medtronic Diabetes, and author of "Diabesity: The Obesity-Diabetes Epidemic That Threatens America And What We Must Do to Stop It," presented Medtronic’s project, The Environmental Determinants of Diabetes in the Young, or TEDDY. The project aims to identify the triggers that cause children to get type 1 diabetes and to establish a central repository of data and biological samples. Highlights of Medtronic’s TEDDY diabetes program include:
- Discovery of new genes, potential targets for prevention and treatment
- Reprogramming adult pancreas cells to insulin-producing beta cells in mice
- Standardizing improved patient care for both type 1 and 2 diabetes
- Developing new glucose monitoring tools
- Developing and testing of novel drugs for treating diabetes complications
- Islet transplantation advances
- Promising therapies targeting immune cells to prevent and reverse type 1 diabetes
- Testing of novel type 1 diabetes prevention strategies
Michelle Mundt, a Juvenile Diabetes Research Foundation volunteer who has family members with type 1 diabetes, illustrated her daily life and the effects of diabetes. About 700,000 Americans suffer from type 1 diabetes, the most common chronic metabolic disorder to affect children. Mundt shared dramatic lifestyle changes post-diagnosis including the daily vigilance required to manage the disease. She and her husband have taught their children to check their insulin levels, count carbohydrates and account for exercise and sleep. Preparation, she said, is key to daily activities. She said her family always has juice boxes and snacks on hand in case blood-sugar levels drop too low.
CHI extends a warm thank you to the panelists for their participation as well as congressional staffers, and individuals from organizations like FasterCures, the American Diabetes Association, JDRF, the National Council on Aging, the American Podiatric Medical Association, and the California Hospital Association for attending.
For more information on what CHI member companies and other organizations are doing in the diabetes arena, click here.
CHI-Advancing California biomedical research and innovation
Goldman is a nationally-recognized health economist influential in both academic and policy circles. He is the author of more than 100 articles and book chapters, including articles in some of the most prestigious medical, economic, health policy, and statistics journals. He is a health policy advisor to the Congressional Budget Office, and is a frequent speaker on healthcare issues. He joins us July 12 at UCLA for “California: Uniting Science and Policy to Advance Cancer Care.” It’s not too late to register for the event – contact Marisa Reinoso at reinoso@chi.org.
Q: What policies have greatly impacted cancer care in your opinion?
A: I think what people don’t realize is just how important reimbursement and other health policies are in terms of changing the way treatment gets delivered. For example, if you look at the rules for Medicare reimbursement, most of the reimbursement has been generous, historically, for infused therapies. And the result is that we have many infused therapies for cancer. And the question is whether that generous reimbursement is going to continue. Even more important is the relationship between reimbursement and future innovation.
The idea is that we have the luxury in the United States because we have reimbursed, historically, at generous levels that, for our conditions, we’ve actually made progress. We’re actually winning the war on cancer and we’re doing it through treatment, as well as diagnosis. The issue is whether that type of progress will continue.
Q: You talk a lot about the importance, both from a health standpoint and an economic one, of prevention and preventive care. How much of this will rely on medical diagnostics and advanced technologies and how much is it reliant on an individual to change his or her behavior?
A: What we found is the change in behavior is notoriously difficult. If you roll the clock back 50 years and you think about hypertension, it has always been a serious health dilemma in this country. But we know there are behavioral modifications that will help people – they can change their diet, reduce their salt intake and exercise more. But what we found is that very few people comply.
Actually, the introduction of drugs, mainly beta blockers, diuretics, calcium channel blockers, and a whole host of therapies, have actually resulted in incredible improvements in cardiovascular-related mortality in the United States. These classes of drugs have been a huge success and they have been able to substitute where previously we had to rely on behavioral change. There is an important lesson here. Yes, we’d like to modify behavior. And, yes, behavior change has value. But it is also important that we continue to innovate to find ways where biomedicine can fill those gaps.
Q: How do you see California leading the way in terms of healthcare following the Affordable Care Act, with so many uninsured?
A: As in so many areas, California is one of those states that defines the way other states will react to policies. As you know, we face a severe fiscal and economic crisis in the state. It is easy to say one of the reasons for this is healthcare, so we should be working hard to reduce reimbursement in many areas. But it is important to realize that California is also the engine for biotechnology and biomedicine is one of the engines of growth in this state.
California has a reasonably competitive health insurance market. In the private sector, they have been initiating reforms that will drive reimbursement down where it needs to be driven down. And it will drive up where we need to reward value. We should be careful to make sure that we encourage those markets to work as efficiently as possible. And that may mean even raising reimbursement in some areas.
Q: What’s been consuming the majority of your time these days?
A: I have been spending my time trying to think about other ways that we can 1) reimburse high-value therapy and 2) come up with better models to try and understand the short- and long-implications of disease. For example, if you think about a country’s progress generally, and we tend to look at gross national product or gross domestic product, but we don’t take into account the health benefits that countries might get from various interventions. And that is an important part of progress. We need to find ways to promote not only longevity but also better quality of life when people get older.
There’s been a lot of focus on the ACA and its short-term implications. We are the only center that I know of that is actually thinking about how will this affect innovation in the long-term.
Q: What are you most looking forward to hearing about at “California: Uniting Science and Policy to Advance Cancer Care” on Thursday?
A: I’m looking forward to “The State of Cancer Research in the Golden State” and “Improving Access to Advanced Treatment” panels.
I think it is important we promote access to therapy and we do not end up with a world where we have large disparities in access because only the wealthy can get access to these therapies. At the same time, we have to make sure we can reimburse them appropriately.
Really, access to care is going to be a key issue going forward.
CHI-Advancing California biomedical research and innovation
