March 25, 2024 • 15 mins
An interview on diabetes management and emerging technologies with Robert A. Gabbay, MD, PhD, Chief Scientific and Medical Officer of the American Diabetes Association.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
David Klonoff (00:15):
Welcome to Diabetes Technology Report.
I'm Dr David Klonoff.
I'm an endocrinologist at UCSFand Sutter Health.
We have a very special guesttoday.
My co-host, Dr David Kerr, willintroduce our guest.
David Kerr (00:31):
Hello everyone.
I'm David Kerr.
I'm also at Sutter Health andbased in Santa Barbara,
california.
We have a very special guest,no doubt about it Bob Gabay.
I see you almost every day onLinkedIn and you're all over the
place.
You're the face of Diabetes forthe American Diabetes
Association.
How did you end up there?
(00:52):
What made you become interestedin diabetes?
Bob Gabbay (00:57):
Wow, david, that's a great question.
Thank you for that.
I do get around and it turnsout I like traveling.
This is a perfect role for me.
I started as a basic scientistlooking at the mechanisms of
insulin action in cells.
(01:19):
At the time I actually was sobasically focused Somehow I
didn't even really know that itwas connected to this big
disease.
As I went through my PhD, Irealized I wanted to impact
people more than just doingbasic science work.
(01:40):
I went to medical school withthe intention of just going back
to the lab and not treatingpatients and ended up finding
wow, I really enjoy caring forpeople.
I kept re-enlisting and throughthat whole process would
oscillate between research andresearch.
I started to oscillate betweenresearch now in diabetes and
(02:05):
clinical care.
That just opened so many doors.
I think one of the excitingthings about the world of
diabetes is in the old days theyused to teach knowing
tuberculosis is to know medicine.
I think this was one of thegreat.
(02:27):
I think in modern times it'sknowing diabetes is to know all
of medicine, because diabetestouches really everything.
My journey has allowed me tonot only learn about many
different organ systems anddisease states associated with
diabetes or potentially, butalso then getting into other
(02:50):
areas of how care is deliveredand organized, how to deliver
better care, what chronic carelooks like, what population
health might be.
All of these often apply todiabetes for a variety of
different reasons.
The journey has taken me thereand behavior change and the
(03:11):
importance of that Over the lastfew years.
I think we share a passionaround digital health and
technology that's transformingdiabetes care.
David Kerr (03:25):
Thank you.
I'm just wondering where yousee the next frontier is in
diabetes care.
Is it just a naturalprogression or do you see a big
topic on the horizon?
Bob Gabbay (03:41):
Yeah, that's a good one.
There are probably a few thingsthat I would think.
One there's all that we knowand have figured out and tools
that we have, and yet they'reonly a minority of people, in
many cases, that are benefitingfrom them either because of
(04:02):
access issues and inequitiesthat exist there.
Also, I think solving thefundamental problem of knowledge
to action it's like one thingto know, but it doesn't
necessarily translate to action.
That's true for people withdiabetes, but it's very much
(04:25):
true for healthcare and thehealthcare system.
If you were to ask mostclinicians how often should
someone with diabetes get an eyeexam, they would know that it's
yearly for most people and yetmaybe 60% of the time that
happens across the US.
(04:46):
It's not just knowledge, it'sknowledge to action.
David Klonoff (04:51):
Bob, I'd like to ask you, in your role at ADA,
what are your goals?
What would you like to seehappen at ADA and in the world?
Bob Gabbay (05:01):
Yeah, that's a great one.
I think fundamentally, it'sabout improving the lives of
people affected by diabetes in avariety of different ways and
preventing the complicationsthat they can occur, and then
also going upstream to honestlybend the curve on the number of
(05:26):
people that are developingdiabetes.
So I think those are really thebig focus and mindful that we
want to make sure that peoplehave access to the treatments
that we know are effective,because we've made incredible
progress over the last years andyet, as they say, the future is
(05:49):
here, but it's not evenlydistributed.
David Klonoff (05:53):
Since this is the technology report, what do you
see as the role of technologyfor people with diabetes?
Oh, huge.
Bob Gabbay (06:02):
I think it's revolutionized care, from just
continuous glucose monitoring Imean, you ask anybody living
with diabetes it has one andthey will tell you it has
changed their life, so that'samongst the most obvious you
take that a step further, andautomated insulin delivery for
(06:24):
those that are using it has alsobeen a big opportunity.
I think the pandemic has gotteneveryone to embrace
telemedicine and telehealth andwhat that can offer, and then I
think the area where there'sstill more to happen is in terms
(06:45):
of digital health solutions andgreater adoption and refinement
of that, and then figuring outwhat is the role of AI in all of
this.
David Kerr (06:58):
Can I just follow up on that, because I'm intrigued
by your personal and also theADA's perspective on AI.
Are they fearful or are theywelcoming, or what's the view
from the top?
Bob Gabbay (07:13):
I think both.
In both cases, I think we'reexcited and there is some
trepidation.
On the one hand, we know we'vealready endorsed, through the
standards of care, retinalimaging that can be read by AI
and is FDA approved, and so thatis a solution that is working
(07:37):
and great.
On the other side, and thenthere are a variety of AI-driven
digital tools that can helpcoach patients and guide them,
and so I think there's realvalue there.
And then there's this newerarea of synthesizing information
(08:02):
and either making clinicaldecisions, where there's maybe a
little bit more trepidation,because at least the tools that
I've seen are good, but they'renot always great, and so how do
you navigate all of that?
But it's a fast-moving areathat certainly needs to be
(08:25):
monitored.
David Kerr (08:26):
Just just exploring a little bit more.
I mean, you get to see a lot ofthings really early.
I'm sure all sorts ofInnovators and entrepreneurs are
wanting to meet you.
Is there an area where we aremissing something, where you
think more Technological,technological innovation needs
to take place?
Bob Gabbay (08:47):
Yeah, that's an interesting one.
One of the, I think the thewell, I'll say two pet peeves
that I would point out.
One is most of the solutionslive in this universe, really
separate from the traditionalhealthcare system, and and they
(09:10):
run the risk of reallyfragmenting care.
Whatever is happening in thatother world is not transmitted
to whoever might be theirprimary care provider, and I
think that's a.
That's a missed opportunity,and Figuring out how to do that
and have those two efforts workin concert can make a huge
(09:32):
difference and I think wouldreally Move things forward in a
really big way.
The the other is the challengeof having so many solutions out
there and most stakeholders havereally no great way of knowing
(09:53):
Whether these are good or bad.
Like anything there, they'regood ones and bad ones.
Right For things that are FDAapproved, there's been a process
and, sure, for digitaltherapeutics, you have a way of
knowing that.
But for many of the othersolutions, it's hard to judge,
and so if you're, if you're aprovider and you're asked, hi,
(10:13):
you know you may know a few ofthem and you could recommend,
but most of them you wouldn'tknow.
If you're a person living withdiabetes, you really would have
very little way to knowing, andand payers Are also wanting to
know what what to do, and sowe've been working with NC QA,
the National Center for QualityAssurance, see if can establish
(10:34):
some kind of certificationprogram.
That may not be the onlysolution, but I think there
needs to be some way to sort outthe the, the, the good from not
quite as good.
David Klonoff (10:45):
Bob, many people with diabetes Either are unable
or unwilling to follow some ofthe treatments from their
doctors.
How important is behavior andor a lifestyle in managing
diabetes?
Bob Gabbay (11:01):
Probably one of the most important things, and I I
think it's understanding thelayer below that right.
So you know, some clinicianswill say, well, my patients just
don't.
They don't do what I tell themto do, and that's a little bit
of a cop out in my mind, rightlike our job is to help guide
(11:23):
them to what and figure out why.
I mean, people typically havereasons and and you've got to
approach them in a way wherethey're open to sharing that
could be they can't afford it.
It, you know, could be avariety of things, could be
what's happening in life rightnow, which is Eclipse, is the
importance of diabetes.
So I Think solving thatbehavior piece is really
(11:46):
critical and I think that'sanother place where technology
could really help because itallows the frequent touch that
is needed.
Because you know, typicallythese clinicians, we see our
patients, you know onlyepisodically and and behavior
changes about what happens dayafter day, not every three
(12:07):
months.
David Kerr (12:10):
Bob, I've got to ask you this because we've got you
here.
Do you think we're doing a goodjob with diabetes education,
particularly in the area oftechnology?
Bob Gabbay (12:20):
I think we could do better.
I think one of the challenges Ifind is for people with
diabetes.
The word diabetes education isnot helpful in my mind.
I've had patients tell me thisI don't need to be educated.
(12:41):
I've had diabetes for 20 years.
What you might want is to learnhow to problem solve around
your diabetes and have someoneguide you on how to navigate.
Some is the terminology and Iknow that that's complicated to
change and all that and how youframe it.
We also know that maybe only10% of people actually see a
(13:06):
diabetes education specialist.
What about the other 90%?
An area that we're trying tolean into is if you look where
these people are practicing andyou look where the patients are,
there's a huge mismatch.
(13:26):
These educators are either inhospitals or within a
chronologist and, of course, 90%of patients are in primary care
.
I think we need to move themtogether somehow.
David Klonoff (13:41):
Bob, there are several new types of medications
that are becoming available.
There's the GLP1 receptoragonists for diabetes and
obesity.
There's SGLT2 inhibitors.
There's new kinds of insulin.
What do you think about theseor some other types of new drugs
?
Bob Gabbay (14:01):
Also a big step forward Our ability to treat
obesity in some ways for thefirst time like we've had
bariatric surgery but lifestylehas been somewhat effective, but
not as effective as we wouldlike.
Now there are treatments thatreally can pharmacological
(14:21):
therapy that can make a hugedifference.
I think that has been really anextraordinary change.
I think all of these advancesare steps in the right direction
.
Again, the access andubiquitous availability of them
to all people that could usethem is a challenge we still
(14:43):
have to overcome.
David Klonoff (14:46):
Bob, I'd like to thank you for taking time out of
your job and your research towork with us.
This has been very interestingfor me.
On behalf of both David and I,I would like to thank you, thank
the audience, remind everyonethat Diabetes Technology Report
is available at Spotify and atthe Apple Store and at the
(15:08):
Diabetes Technology Societywebsite.
Once again, bob, thank you.
We look forward to connectingwith you and the audience at the
next Diabetes Technology Report.
Goodbye everybody.
David Kerr (15:20):
Thank you, Bob.
Bob Gabbay (15:21):
Thank you Bye.
Welcome to Diabetes Technology Report.
I'm Dr David Klonoff.
I'm an endocrinologist at UCSFand Sutter Health.
We have a very special guesttoday.
My co-host, Dr David Kerr, willintroduce our guest.
David Kerr (00:31):
Hello everyone.
I'm David Kerr.
I'm also at Sutter Health andbased in Santa Barbara,
california.
We have a very special guest,no doubt about it Bob Gabay.
I see you almost every day onLinkedIn and you're all over the
place.
You're the face of Diabetes forthe American Diabetes
Association.
How did you end up there?
(00:52):
What made you become interestedin diabetes?
Bob Gabbay (00:57):
Wow, david, that's a great question.
Thank you for that.
I do get around and it turnsout I like traveling.
This is a perfect role for me.
I started as a basic scientistlooking at the mechanisms of
insulin action in cells.
(01:19):
At the time I actually was sobasically focused Somehow I
didn't even really know that itwas connected to this big
disease.
As I went through my PhD, Irealized I wanted to impact
people more than just doingbasic science work.
(01:40):
I went to medical school withthe intention of just going back
to the lab and not treatingpatients and ended up finding
wow, I really enjoy caring forpeople.
I kept re-enlisting and throughthat whole process would
oscillate between research andresearch.
I started to oscillate betweenresearch now in diabetes and
(02:05):
clinical care.
That just opened so many doors.
I think one of the excitingthings about the world of
diabetes is in the old days theyused to teach knowing
tuberculosis is to know medicine.
I think this was one of thegreat.
(02:27):
I think in modern times it'sknowing diabetes is to know all
of medicine, because diabetestouches really everything.
My journey has allowed me tonot only learn about many
different organ systems anddisease states associated with
diabetes or potentially, butalso then getting into other
(02:50):
areas of how care is deliveredand organized, how to deliver
better care, what chronic carelooks like, what population
health might be.
All of these often apply todiabetes for a variety of
different reasons.
The journey has taken me thereand behavior change and the
(03:11):
importance of that Over the lastfew years.
I think we share a passionaround digital health and
technology that's transformingdiabetes care.
David Kerr (03:25):
Thank you.
I'm just wondering where yousee the next frontier is in
diabetes care.
Is it just a naturalprogression or do you see a big
topic on the horizon?
Bob Gabbay (03:41):
Yeah, that's a good one.
There are probably a few thingsthat I would think.
One there's all that we knowand have figured out and tools
that we have, and yet they'reonly a minority of people, in
many cases, that are benefitingfrom them either because of
(04:02):
access issues and inequitiesthat exist there.
Also, I think solving thefundamental problem of knowledge
to action it's like one thingto know, but it doesn't
necessarily translate to action.
That's true for people withdiabetes, but it's very much
(04:25):
true for healthcare and thehealthcare system.
If you were to ask mostclinicians how often should
someone with diabetes get an eyeexam, they would know that it's
yearly for most people and yetmaybe 60% of the time that
happens across the US.
(04:46):
It's not just knowledge, it'sknowledge to action.
David Klonoff (04:51):
Bob, I'd like to ask you, in your role at ADA,
what are your goals?
What would you like to seehappen at ADA and in the world?
Bob Gabbay (05:01):
Yeah, that's a great one.
I think fundamentally, it'sabout improving the lives of
people affected by diabetes in avariety of different ways and
preventing the complicationsthat they can occur, and then
also going upstream to honestlybend the curve on the number of
(05:26):
people that are developingdiabetes.
So I think those are really thebig focus and mindful that we
want to make sure that peoplehave access to the treatments
that we know are effective,because we've made incredible
progress over the last years andyet, as they say, the future is
(05:49):
here, but it's not evenlydistributed.
David Klonoff (05:53):
Since this is the technology report, what do you
see as the role of technologyfor people with diabetes?
Oh, huge.
Bob Gabbay (06:02):
I think it's revolutionized care, from just
continuous glucose monitoring Imean, you ask anybody living
with diabetes it has one andthey will tell you it has
changed their life, so that'samongst the most obvious you
take that a step further, andautomated insulin delivery for
(06:24):
those that are using it has alsobeen a big opportunity.
I think the pandemic has gotteneveryone to embrace
telemedicine and telehealth andwhat that can offer, and then I
think the area where there'sstill more to happen is in terms
(06:45):
of digital health solutions andgreater adoption and refinement
of that, and then figuring outwhat is the role of AI in all of
this.
David Kerr (06:58):
Can I just follow up on that, because I'm intrigued
by your personal and also theADA's perspective on AI.
Are they fearful or are theywelcoming, or what's the view
from the top?
Bob Gabbay (07:13):
I think both.
In both cases, I think we'reexcited and there is some
trepidation.
On the one hand, we know we'vealready endorsed, through the
standards of care, retinalimaging that can be read by AI
and is FDA approved, and so thatis a solution that is working
(07:37):
and great.
On the other side, and thenthere are a variety of AI-driven
digital tools that can helpcoach patients and guide them,
and so I think there's realvalue there.
And then there's this newerarea of synthesizing information
(08:02):
and either making clinicaldecisions, where there's maybe a
little bit more trepidation,because at least the tools that
I've seen are good, but they'renot always great, and so how do
you navigate all of that?
But it's a fast-moving areathat certainly needs to be
(08:25):
monitored.
David Kerr (08:26):
Just just exploring a little bit more.
I mean, you get to see a lot ofthings really early.
I'm sure all sorts ofInnovators and entrepreneurs are
wanting to meet you.
Is there an area where we aremissing something, where you
think more Technological,technological innovation needs
to take place?
Bob Gabbay (08:47):
Yeah, that's an interesting one.
One of the, I think the thewell, I'll say two pet peeves
that I would point out.
One is most of the solutionslive in this universe, really
separate from the traditionalhealthcare system, and and they
(09:10):
run the risk of reallyfragmenting care.
Whatever is happening in thatother world is not transmitted
to whoever might be theirprimary care provider, and I
think that's a.
That's a missed opportunity,and Figuring out how to do that
and have those two efforts workin concert can make a huge
(09:32):
difference and I think wouldreally Move things forward in a
really big way.
The the other is the challengeof having so many solutions out
there and most stakeholders havereally no great way of knowing
(09:53):
Whether these are good or bad.
Like anything there, they'regood ones and bad ones.
Right For things that are FDAapproved, there's been a process
and, sure, for digitaltherapeutics, you have a way of
knowing that.
But for many of the othersolutions, it's hard to judge,
and so if you're, if you're aprovider and you're asked, hi,
(10:13):
you know you may know a few ofthem and you could recommend,
but most of them you wouldn'tknow.
If you're a person living withdiabetes, you really would have
very little way to knowing, andand payers Are also wanting to
know what what to do, and sowe've been working with NC QA,
the National Center for QualityAssurance, see if can establish
(10:34):
some kind of certificationprogram.
That may not be the onlysolution, but I think there
needs to be some way to sort outthe the, the, the good from not
quite as good.
David Klonoff (10:45):
Bob, many people with diabetes Either are unable
or unwilling to follow some ofthe treatments from their
doctors.
How important is behavior andor a lifestyle in managing
diabetes?
Bob Gabbay (11:01):
Probably one of the most important things, and I I
think it's understanding thelayer below that right.
So you know, some clinicianswill say, well, my patients just
don't.
They don't do what I tell themto do, and that's a little bit
of a cop out in my mind, rightlike our job is to help guide
(11:23):
them to what and figure out why.
I mean, people typically havereasons and and you've got to
approach them in a way wherethey're open to sharing that
could be they can't afford it.
It, you know, could be avariety of things, could be
what's happening in life rightnow, which is Eclipse, is the
importance of diabetes.
So I Think solving thatbehavior piece is really
(11:46):
critical and I think that'sanother place where technology
could really help because itallows the frequent touch that
is needed.
Because you know, typicallythese clinicians, we see our
patients, you know onlyepisodically and and behavior
changes about what happens dayafter day, not every three
(12:07):
months.
David Kerr (12:10):
Bob, I've got to ask you this because we've got you
here.
Do you think we're doing a goodjob with diabetes education,
particularly in the area oftechnology?
Bob Gabbay (12:20):
I think we could do better.
I think one of the challenges Ifind is for people with
diabetes.
The word diabetes education isnot helpful in my mind.
I've had patients tell me thisI don't need to be educated.
(12:41):
I've had diabetes for 20 years.
What you might want is to learnhow to problem solve around
your diabetes and have someoneguide you on how to navigate.
Some is the terminology and Iknow that that's complicated to
change and all that and how youframe it.
We also know that maybe only10% of people actually see a
(13:06):
diabetes education specialist.
What about the other 90%?
An area that we're trying tolean into is if you look where
these people are practicing andyou look where the patients are,
there's a huge mismatch.
(13:26):
These educators are either inhospitals or within a
chronologist and, of course, 90%of patients are in primary care
.
I think we need to move themtogether somehow.
David Klonoff (13:41):
Bob, there are several new types of medications
that are becoming available.
There's the GLP1 receptoragonists for diabetes and
obesity.
There's SGLT2 inhibitors.
There's new kinds of insulin.
What do you think about theseor some other types of new drugs
?
Bob Gabbay (14:01):
Also a big step forward Our ability to treat
obesity in some ways for thefirst time like we've had
bariatric surgery but lifestylehas been somewhat effective, but
not as effective as we wouldlike.
Now there are treatments thatreally can pharmacological
(14:21):
therapy that can make a hugedifference.
I think that has been really anextraordinary change.
I think all of these advancesare steps in the right direction
.
Again, the access andubiquitous availability of them
to all people that could usethem is a challenge we still
(14:43):
have to overcome.
David Klonoff (14:46):
Bob, I'd like to thank you for taking time out of
your job and your research towork with us.
This has been very interestingfor me.
On behalf of both David and I,I would like to thank you, thank
the audience, remind everyonethat Diabetes Technology Report
is available at Spotify and atthe Apple Store and at the
(15:08):
Diabetes Technology Societywebsite.
Once again, bob, thank you.
We look forward to connectingwith you and the audience at the
next Diabetes Technology Report.
Goodbye everybody.
David Kerr (15:20):
Thank you, Bob.
Bob Gabbay (15:21):
Thank you Bye.
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