July 17, 2024 • 22 mins
A conversation on pediatric diabetes care, AI innovations, and access to technology with Eda Cengiz, MD, MHS, UCSF Benioff Professor in Children's Health, Director of the Pediatric Diabetes Program.
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Episode Transcript
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David Klonoff (00:14):
Welcome to Diabetes Technology Report.
I'm David Klonoff, I'm anendocrinologist and I'm going to
be co-hosting this interviewtoday with a special guest.
Co-host is Dr David Kerr.
David Kerr (00:29):
Thanks, david, and hello to everyone.
I'm David Kerr.
I'm speaking to you from SantaBarbara, california.
I work as a researcher atSutter Health.
Today we have, I think, ourfirst pediatrician on the
reports.
So, ida Senge, it's great tosee you Looking forward to the
(00:50):
conversation, and one of thethings that we like to do to set
the scene is to really ask youa very simple question, but it's
usually quite complicated howdid you end up where you are and
why are you interested indiabetes in children?
Eda Cengiz (01:08):
Hi, david, and both Davids.
Actually we have Dr DavidKlonoff and Dr David Kerr.
Thank you for inviting me andyes, indeed, it's a simple
question.
However, it could be a bitcomplicated question.
(01:29):
However, it could be a bitcomplicated.
So I've been trained as apediatrician and I wanted to do
pediatric subspecialty andduring my pediatric training I
was involved in some diabetesresearch.
I was taking care of kids withdiabetes and since then I've
been interested in becoming adiabetologist.
So that's why I went totraining in diabetes, pediatric
(01:53):
endocrinology, metabolism anddiabetes.
There's also a little backgroundstory.
One of my childhood friends shewas diagnosed with diabetes.
So I was six or seven when myfriend was diagnosed and that
was the first time I wasintroduced to like insulin
(02:15):
syringes and vials and therewere no sensors, pumps were not
as common.
So I observed her going throughlike the diagnosis treatment
challenges.
She was a little kid, shedidn't understand what was going
on and I was a close friend.
(02:35):
So you know, I kind of had thefirst hand experience in a way,
like how diabetes is.
So that's the story about mypediatric diabetes training and
then I got involved in diabetestechnology research and I love
technology.
I'm like my family background.
(02:57):
I have family of engineers.
I'm the only physician, theblack sheep in the family, so I
had that technology connectiontoo, I guess.
Yeah, all the stars aligned,and here I am.
David Kerr (03:10):
Excellent.
I mean just thinking about yourfriend.
Clearly, what's available forchildren with type 1 diabetes
has changed dramatically.
Where do you think we stillneed to go?
What's the next frontier in thearea that you're interested in?
Eda Cengiz (03:29):
Well, diabetes technology has made significant
strides in improving lives ofchildren with diabetes.
As you're aware, diabetes isnot an easy disease and it's
even more challenging forchildren with diabetes
adolescents.
More challenging for childrenwith diabetes adolescents.
(03:50):
Back when I started diabetestechnology research, we had
pumps, we didn't have sensors.
So most of the parents of mypatients, they used to sleep in
the same bedroom, their kid'sbedroom, right next to their bed
, because they were afraid ofmissing low blood sugars in the
middle of the night and thosekids were not going to camps,
you know, field trips they werenot going to sleepovers.
(04:13):
So now, with, you know,continuous glucose monitors,
they can monitor their kids'blood sugars from their phone
and, you know, those kids nowcan go to school trips, field
trips.
It's easier to be molded insports because they're not
nervous about, you know, lowblood sugars while they are at a
(04:38):
game or practice.
So that's why it made diabetestechnology.
Continuous glucose sensors andnow AID systems made things easy
for them.
However, there's still room forimprovement.
So what's next?
We want precision medicine.
We want treatments that aretailored for children, for
(05:02):
adolescents.
I do research in women's health.
We're working on designingalgorithms, insulin delivery
algorithms for women withdiabetes.
We've done some research inthat field.
We need smaller devices, moreaccurate devices, and our dream
has been a fully automatedinsulin delivery system, and we
(05:26):
actually tested the firstversion in February.
Now we're doing a follow-onstudy in September, so that
would be the ultimate dream, butyou know, sky's the limit.
There's a lot more we need todo in that field.
I've also done some work inultra-fast acting insulins.
I've also done some work inultra fast acting insulins we're
(06:02):
using, you know, still firstgeneration, or maybe we can call
it second generation, but weneed like third, fourth, fifth
generation insulins that worknear future that will be
incorporated into AID systems toimprove those systems.
David Klonoff (06:12):
At UCSF.
We're very fortunate that youcame out and joined us.
How did you end up deciding tocome to UCSF?
Eda Cengiz (06:23):
It was an easy decision.
In a way, ucsf is a veryprogressive place and I'm an
endowed chair from BaniyovChildren's Hospital and that
gives me many opportunities toadvance the field for improving
diabetes care.
So I was actually collaboratingwith people from the Bay Area
(06:46):
because I do diabetes technologywork and then, given that UCSF
is an amazing center, I said,okay, why not, let's go there
and do more diabetes technologystudies.
Another advantage is I'm theprogram director for pediatric
diabetes program for UCSF andit's cross-bay, meaning we have
(07:09):
clinics on the San Franciscoside.
We also have clinics in theOakland side and patient
population is significantlydifferent.
We have people withdisadvantaged backgrounds on the
Oakland side and one of thefirst things we tried to do
(07:31):
after we built our Center ofExcellence for Diabetes
Technology at UCSF was tobroaden our patient population
that are treated with diabetestechnology devices, because it's
not easy to get approvals fordiabetes technology devices and
you need a lot of handholding,especially if you're coming from
(07:55):
disadvantaged backgrounds.
So we were able to reach out tothat population and started them
on automated insulin deliverydevices and we are now seeing
amazing outcomes.
Their A1Cs are better, wereduce the burden and we're
(08:17):
actually reducing diabetes,diabetic ketoacidosis or other
diabetes-related inpatientadmissions.
So it's been an amazingexperience for me and I'm so
close to all the technology.
You know software engineersbest software engineers in the
United States so it's soexciting to collaborate with
(08:38):
them and it's easier to you know, set up meetings, just meet for
coffee and brainstorm ideas.
Set up meetings, just meet forcoffee and brainstorm ideas.
And, on top of it, sanFrancisco is a beautiful city.
That's another big factor, Iguess.
And I'm so happy that I'm closeto Diabetes Technology Society
too.
We've collaborated in so manyareas when I was in Connecticut
(08:58):
and now it's easier to connectSame time zone and we're just 20
minutes away from each other.
David Klonoff (09:06):
Ed, speaking of collaborations, you and I are
collaborating on a project nowinvolving occlusions of insulin
pumps.
Could you explain what is anocclusion and what's wrong with
having an occlusion?
Eda Cengiz (09:22):
You know, for insulin pumps they inject
infused insulin from.
It starts from the you know thecartridge, then you have the
tubing and then there is thecatheter, so it's insulin is
infused in the subcutaneoustissue and then it goes into
your circulation.
So you know, we have theseamazing algorithms, we have the
(09:45):
sensor talking to the pump.
However, if your insulin is notdelivered into your circulation
, none of that is going to work.
So that's one of the crucialsteps delivering insulin without
interruption.
And it has to be accurate tothe circulation so that you can
regulate blood sugars, to thecirculation, so that you can
(10:10):
regulate blood sugars.
So occlusion can occur at manysteps.
I mean it can be even at thecartridge level.
What's going on in insulin inthe cartridge?
Is there a bubble there?
What's going on with theinfusion tube?
Is there a you know blockagethere?
And what's happening at thesite of infusion?
What's going on rightunderneath the skin and
interstitial area?
Is there a reaction that's, youknow, or like some sort of a
clot that's causing theocclusion?
(10:33):
Of course, another thing isthere could be a pump issue.
Maybe the pump is notdelivering enough, so that can
cause an occlusion too.
So that's why that's one of thecrucial steps we need to.
That's why that's one of thecrucial steps we need to prevent
.
If we can prevent occlusion,then we know that we can keep
(10:58):
blood sugars in range and we canprevent ketosis.
So it's an important factor tokeep our patients safe and to
keep blood sugars in range tokeep our patients safe and to
keep blood sugars in range.
David Kerr (11:13):
Ida, just to change subject, when I go on social
media and the news, there's alot of talk about prevention of
type 1 diabetes in children andadults, and what's your sense of
where we are with that and whatstill needs to be done?
Eda Cengiz (11:28):
What's your sense of where we are with that and what
still needs to be done?
Obviously, our ultimate goal isto cure diabetes and to prevent
diabetes.
I've been doing diabetestechnology work to actually keep
people with diabetes safe andhealthy until we find a cure and
prevention.
I've done some prevention work.
I was part of like this was 15years ago.
(11:50):
I was part of the, you know,teplizumab treatment group and
we back then we were infusingteplizumab within the first 90
days of diagnosis.
And now we have an indicationit's T-Zil, that's teplizumab,
(12:12):
but we're using it in stage twodiabetes to, in a way, prolong
honeymoon phase.
So it's not a cure yet, but atleast that's one of the first
steps.
So we were able to achieve that.
And now there's so much ongoingwork regarding, you know, immune
modulation treatment to preventdiabetes.
(12:33):
Also, there's stem cellresearch.
I wish I can say, hey, you know, we're going to have a cure
within the next couple of years.
We're not there yet.
Having said that, there'ssignificant progress.
So there's still ongoingresearch.
I believe in the cure.
I know we'll get there.
I believe in the prevention.
I know we'll get there.
(12:54):
It's just it's going to take awhile and it's going to take a
lot of work.
David Kerr (12:59):
Yeah, so it's early stages, early days in that
particular journey.
The other question I alwayslike to ask our guests on
Diabetes Technology Reports ishow is artificial intelligence
going to change what you do on aday-to-day basis?
Have you got any thoughts onthat?
I mean perhaps now and maybe ina few years time.
Eda Cengiz (13:21):
Oh yeah, it started already changing things for us.
You know we have been usinginsulin delivery algorithms and
now the next step is using AI.
How can we make these systemssmarter?
I've been doing insulin actionstudies for again over a decade
now and what I know for sure isone size does not fit all.
(13:43):
There's so much variabilitywhen it comes to insulin action,
so you need smarter systemsthat will account for that.
And AI is going to be againlike a game changer for diabetes
management.
And CHAT-GPT is a block awayfrom me.
That's super exciting is ablock away from me.
(14:08):
That's super exciting.
And UCSF is already actuallycollaborating with CHATGPT for
improving medicine.
We haven't collaborated withthem yet for any type of
diabetes research yet, but AI isgoing to be a big part of
diabetes technology automatedinsulin delivery devices and
(14:28):
it's the future for precisionmedicine to improve diabetes
care and we are alreadycollaborating with some of the
algorithm experts to incorporateAI into our medical decision
system.
I'm collaborating withUniversity of Virginia to design
(14:49):
algorithms to improve again youknow insulin delivery system
for women with diabetes.
So AI is going to be a hugepart of it.
Another thing we've been doingwas to use e-learning AI both
for patients, people withdiabetes and for providers, and
(15:12):
I'm collaborating withChildren's Hospital of
Philadelphia, dr Marks.
She's been working one-learning and her actually
training modules for providers.
They already use some sort ofAI so that, if you need to, if
there are like certain gaps inknowledge, that AI detects that
and sends you questions, morequestions, regarding that field.
David Klonoff (15:35):
So we're doing little bits and pieces, but I
think the future is going to bebright and exciting for AI for
diabetes care, for diabetes careand you have some amazing tools
to offer your patients, but weknow that there are many
patients who cannot, will not,are not using them.
What do you see as a way ofincreasing the reach of these
(16:00):
tools, products, AIDs, so thateveryone will benefit from them?
Eda Cengiz (16:06):
Excellent question.
We have been working to broadenour reach for a while now.
One key issue has beeninsurance coverage and we're
trying to make the case toinsurance companies so that we
have insurance coverage fordiabetes technology devices.
(16:27):
They just see the cost of a CGMor pump, but they forget to see
the big cost of one admissionto hospital.
You know, if you can preventone diabetic ketoacidosis, you
are, you know.
One, it's improving patientsafety.
Two, you are saving, you know,safety too.
(16:54):
You are saving, you know, 40,50,000, maybe a hundred thousand
dollars per admission just byspending like minuscule amount
of money, little amount of moneyfor sensor and pump.
Now we're going to havehopefully soon, you know, ketone
sensors so we can preventketosis with that.
We have sensors that alert youfor, you know, for potential low
blood sugars, so you don't haveto again.
(17:14):
It's number one is patientsafety.
But the other thing is you'repreventing an admission to the
hospital for severe hypoglycemicreaction or an emergency room
admission for severehypoglycemic reaction.
So one key issue is um isinsurance coverage.
The other thing is obviously umbroadening provider care for
(17:39):
diabetes, for like provider,like educating people with
diabetes, and also providers fordiabetes technology devices.
I give talks to primary carephysicians, pediatricians,
pediatric endocrinologists inthe country and we had some
(17:59):
resistance even from pediatricendocrinologists to prescribe
diabetes technology devicesbecause they didn't know how to
use it.
They didn't know how to insert,they didn't know how to
troubleshoot.
It was quite challenging tointerpret those reports.
But now, if we make it easy forpeople with diabetes, for
(18:22):
providers, I think that waywe'll have more and more people
using these devices, benefitingfrom these devices.
And look what happened duringCOVID Many people, many
providers, were not able to seetheir patients, were not able to
provide care to their patientsbecause clinics shut down.
(18:43):
But for our people, for ourpeople with diabetes who were
using diabetes technology, theircare was not interrupted during
that period of time becausethey were using diabetes
technology devices.
So we need again you know, somany other things to reach out
(19:04):
to people, especially, you know,people from disadvantaged
populations.
As I noted before, they needmore hand-holding.
We need multilingual guides,online resources, better
education and more people tokind of help them, at least at
the beginning, and remotemonitoring support.
David Klonoff (19:34):
I have one last question for you.
In adults, we're seeing CGMsbeing used by people who don't
have diabetes to see if theyhave prediabetes or they're
actually developing type 2diabetes.
My question for you is do youthink we're going to see this in
children wearing CGMs to see ifthey're going to be developing
type 1 diabetes going?
Eda Cengiz (19:48):
to be developing type 1 diabetes.
That's an excellent questionand I think it kind of, you know
, it's also relevant for yourquestion about prevention
studies, david.
We now we're seeing more andmore kids.
They were diagnosed with, likeyou know, some high blood sugars
(20:09):
here and there at the clinic,you know, during like sports
physical, and then you know,families are, you know, they
don't know what to do, and inthe past we were like, hey, we
don't have anything, anyprevention method, treatment for
you.
So sometimes we're thinking likewhat's the point in you know,
checking, like monitoring thosekids?
(20:31):
To be honest with you, there isa point actually, because you
know we still have 30% of kidsdiagnosed in diabetic
ketoacidosis.
They're coming in a coma to thehospital when they're newly
diagnosed.
So if there's any suspicion, Istill see the value, significant
value, of monitoring them witha CGM.
But on the other hand, now wehave this prevention drugs TZL
(20:55):
and if we can diagnose themsooner with stage two diabetes
and, you know, start thetreatment, this gives them a
huge opportunity and we can, youknow, prolong their beta cell
life, reduce complications ofdiabetes.
So I see CGM as a veryimportant tool to monitor those
(21:17):
kids too.
But we need to make it easierfor them.
We need to have you know, weneed to reduce the burden.
So if we're going to do CGMmonitoring for those kids, it
shouldn't add any burden orstress to the kid or the family.
David Klonoff (21:31):
Edda, thank you for answering these questions.
You know so much about diabetes.
I've learned a lot talking withyou today.
So I want to say, on behalf ofDr David Kerr and myself, thank
you for appearing on DiabetesTechnology Report.
This podcast is available atthe Apple Store and Spotify and
the Diabetes Technology Societywebsite.
(21:53):
So we will see you again at thenext Diabetes Technology Report
podcast.
Goodbye everybody, thank you.
Eda Cengiz (22:02):
Thank you.
Welcome to Diabetes Technology Report.
I'm David Klonoff, I'm anendocrinologist and I'm going to
be co-hosting this interviewtoday with a special guest.
Co-host is Dr David Kerr.
David Kerr (00:29):
Thanks, david, and hello to everyone.
I'm David Kerr.
I'm speaking to you from SantaBarbara, california.
I work as a researcher atSutter Health.
Today we have, I think, ourfirst pediatrician on the
reports.
So, ida Senge, it's great tosee you Looking forward to the
(00:50):
conversation, and one of thethings that we like to do to set
the scene is to really ask youa very simple question, but it's
usually quite complicated howdid you end up where you are and
why are you interested indiabetes in children?
Eda Cengiz (01:08):
Hi, david, and both Davids.
Actually we have Dr DavidKlonoff and Dr David Kerr.
Thank you for inviting me andyes, indeed, it's a simple
question.
However, it could be a bitcomplicated question.
(01:29):
However, it could be a bitcomplicated.
So I've been trained as apediatrician and I wanted to do
pediatric subspecialty andduring my pediatric training I
was involved in some diabetesresearch.
I was taking care of kids withdiabetes and since then I've
been interested in becoming adiabetologist.
So that's why I went totraining in diabetes, pediatric
(01:53):
endocrinology, metabolism anddiabetes.
There's also a little backgroundstory.
One of my childhood friends shewas diagnosed with diabetes.
So I was six or seven when myfriend was diagnosed and that
was the first time I wasintroduced to like insulin
(02:15):
syringes and vials and therewere no sensors, pumps were not
as common.
So I observed her going throughlike the diagnosis treatment
challenges.
She was a little kid, shedidn't understand what was going
on and I was a close friend.
(02:35):
So you know, I kind of had thefirst hand experience in a way,
like how diabetes is.
So that's the story about mypediatric diabetes training and
then I got involved in diabetestechnology research and I love
technology.
I'm like my family background.
(02:57):
I have family of engineers.
I'm the only physician, theblack sheep in the family, so I
had that technology connectiontoo, I guess.
Yeah, all the stars aligned,and here I am.
David Kerr (03:10):
Excellent.
I mean just thinking about yourfriend.
Clearly, what's available forchildren with type 1 diabetes
has changed dramatically.
Where do you think we stillneed to go?
What's the next frontier in thearea that you're interested in?
Eda Cengiz (03:29):
Well, diabetes technology has made significant
strides in improving lives ofchildren with diabetes.
As you're aware, diabetes isnot an easy disease and it's
even more challenging forchildren with diabetes
adolescents.
More challenging for childrenwith diabetes adolescents.
(03:50):
Back when I started diabetestechnology research, we had
pumps, we didn't have sensors.
So most of the parents of mypatients, they used to sleep in
the same bedroom, their kid'sbedroom, right next to their bed
, because they were afraid ofmissing low blood sugars in the
middle of the night and thosekids were not going to camps,
you know, field trips they werenot going to sleepovers.
(04:13):
So now, with, you know,continuous glucose monitors,
they can monitor their kids'blood sugars from their phone
and, you know, those kids nowcan go to school trips, field
trips.
It's easier to be molded insports because they're not
nervous about, you know, lowblood sugars while they are at a
(04:38):
game or practice.
So that's why it made diabetestechnology.
Continuous glucose sensors andnow AID systems made things easy
for them.
However, there's still room forimprovement.
So what's next?
We want precision medicine.
We want treatments that aretailored for children, for
(05:02):
adolescents.
I do research in women's health.
We're working on designingalgorithms, insulin delivery
algorithms for women withdiabetes.
We've done some research inthat field.
We need smaller devices, moreaccurate devices, and our dream
has been a fully automatedinsulin delivery system, and we
(05:26):
actually tested the firstversion in February.
Now we're doing a follow-onstudy in September, so that
would be the ultimate dream, butyou know, sky's the limit.
There's a lot more we need todo in that field.
I've also done some work inultra-fast acting insulins.
I've also done some work inultra fast acting insulins we're
(06:02):
using, you know, still firstgeneration, or maybe we can call
it second generation, but weneed like third, fourth, fifth
generation insulins that worknear future that will be
incorporated into AID systems toimprove those systems.
David Klonoff (06:12):
At UCSF.
We're very fortunate that youcame out and joined us.
How did you end up deciding tocome to UCSF?
Eda Cengiz (06:23):
It was an easy decision.
In a way, ucsf is a veryprogressive place and I'm an
endowed chair from BaniyovChildren's Hospital and that
gives me many opportunities toadvance the field for improving
diabetes care.
So I was actually collaboratingwith people from the Bay Area
(06:46):
because I do diabetes technologywork and then, given that UCSF
is an amazing center, I said,okay, why not, let's go there
and do more diabetes technologystudies.
Another advantage is I'm theprogram director for pediatric
diabetes program for UCSF andit's cross-bay, meaning we have
(07:09):
clinics on the San Franciscoside.
We also have clinics in theOakland side and patient
population is significantlydifferent.
We have people withdisadvantaged backgrounds on the
Oakland side and one of thefirst things we tried to do
(07:31):
after we built our Center ofExcellence for Diabetes
Technology at UCSF was tobroaden our patient population
that are treated with diabetestechnology devices, because it's
not easy to get approvals fordiabetes technology devices and
you need a lot of handholding,especially if you're coming from
(07:55):
disadvantaged backgrounds.
So we were able to reach out tothat population and started them
on automated insulin deliverydevices and we are now seeing
amazing outcomes.
Their A1Cs are better, wereduce the burden and we're
(08:17):
actually reducing diabetes,diabetic ketoacidosis or other
diabetes-related inpatientadmissions.
So it's been an amazingexperience for me and I'm so
close to all the technology.
You know software engineersbest software engineers in the
United States so it's soexciting to collaborate with
(08:38):
them and it's easier to you know, set up meetings, just meet for
coffee and brainstorm ideas.
Set up meetings, just meet forcoffee and brainstorm ideas.
And, on top of it, sanFrancisco is a beautiful city.
That's another big factor, Iguess.
And I'm so happy that I'm closeto Diabetes Technology Society
too.
We've collaborated in so manyareas when I was in Connecticut
(08:58):
and now it's easier to connectSame time zone and we're just 20
minutes away from each other.
David Klonoff (09:06):
Ed, speaking of collaborations, you and I are
collaborating on a project nowinvolving occlusions of insulin
pumps.
Could you explain what is anocclusion and what's wrong with
having an occlusion?
Eda Cengiz (09:22):
You know, for insulin pumps they inject
infused insulin from.
It starts from the you know thecartridge, then you have the
tubing and then there is thecatheter, so it's insulin is
infused in the subcutaneoustissue and then it goes into
your circulation.
So you know, we have theseamazing algorithms, we have the
(09:45):
sensor talking to the pump.
However, if your insulin is notdelivered into your circulation
, none of that is going to work.
So that's one of the crucialsteps delivering insulin without
interruption.
And it has to be accurate tothe circulation so that you can
regulate blood sugars, to thecirculation, so that you can
(10:10):
regulate blood sugars.
So occlusion can occur at manysteps.
I mean it can be even at thecartridge level.
What's going on in insulin inthe cartridge?
Is there a bubble there?
What's going on with theinfusion tube?
Is there a you know blockagethere?
And what's happening at thesite of infusion?
What's going on rightunderneath the skin and
interstitial area?
Is there a reaction that's, youknow, or like some sort of a
clot that's causing theocclusion?
(10:33):
Of course, another thing isthere could be a pump issue.
Maybe the pump is notdelivering enough, so that can
cause an occlusion too.
So that's why that's one of thecrucial steps we need to.
That's why that's one of thecrucial steps we need to prevent
.
If we can prevent occlusion,then we know that we can keep
(10:58):
blood sugars in range and we canprevent ketosis.
So it's an important factor tokeep our patients safe and to
keep blood sugars in range tokeep our patients safe and to
keep blood sugars in range.
David Kerr (11:13):
Ida, just to change subject, when I go on social
media and the news, there's alot of talk about prevention of
type 1 diabetes in children andadults, and what's your sense of
where we are with that and whatstill needs to be done?
Eda Cengiz (11:28):
What's your sense of where we are with that and what
still needs to be done?
Obviously, our ultimate goal isto cure diabetes and to prevent
diabetes.
I've been doing diabetestechnology work to actually keep
people with diabetes safe andhealthy until we find a cure and
prevention.
I've done some prevention work.
I was part of like this was 15years ago.
(11:50):
I was part of the, you know,teplizumab treatment group and
we back then we were infusingteplizumab within the first 90
days of diagnosis.
And now we have an indicationit's T-Zil, that's teplizumab,
(12:12):
but we're using it in stage twodiabetes to, in a way, prolong
honeymoon phase.
So it's not a cure yet, but atleast that's one of the first
steps.
So we were able to achieve that.
And now there's so much ongoingwork regarding, you know, immune
modulation treatment to preventdiabetes.
(12:33):
Also, there's stem cellresearch.
I wish I can say, hey, you know, we're going to have a cure
within the next couple of years.
We're not there yet.
Having said that, there'ssignificant progress.
So there's still ongoingresearch.
I believe in the cure.
I know we'll get there.
I believe in the prevention.
I know we'll get there.
(12:54):
It's just it's going to take awhile and it's going to take a
lot of work.
David Kerr (12:59):
Yeah, so it's early stages, early days in that
particular journey.
The other question I alwayslike to ask our guests on
Diabetes Technology Reports ishow is artificial intelligence
going to change what you do on aday-to-day basis?
Have you got any thoughts onthat?
I mean perhaps now and maybe ina few years time.
Eda Cengiz (13:21):
Oh yeah, it started already changing things for us.
You know we have been usinginsulin delivery algorithms and
now the next step is using AI.
How can we make these systemssmarter?
I've been doing insulin actionstudies for again over a decade
now and what I know for sure isone size does not fit all.
(13:43):
There's so much variabilitywhen it comes to insulin action,
so you need smarter systemsthat will account for that.
And AI is going to be againlike a game changer for diabetes
management.
And CHAT-GPT is a block awayfrom me.
That's super exciting is ablock away from me.
(14:08):
That's super exciting.
And UCSF is already actuallycollaborating with CHATGPT for
improving medicine.
We haven't collaborated withthem yet for any type of
diabetes research yet, but AI isgoing to be a big part of
diabetes technology automatedinsulin delivery devices and
(14:28):
it's the future for precisionmedicine to improve diabetes
care and we are alreadycollaborating with some of the
algorithm experts to incorporateAI into our medical decision
system.
I'm collaborating withUniversity of Virginia to design
(14:49):
algorithms to improve again youknow insulin delivery system
for women with diabetes.
So AI is going to be a hugepart of it.
Another thing we've been doingwas to use e-learning AI both
for patients, people withdiabetes and for providers, and
(15:12):
I'm collaborating withChildren's Hospital of
Philadelphia, dr Marks.
She's been working one-learning and her actually
training modules for providers.
They already use some sort ofAI so that, if you need to, if
there are like certain gaps inknowledge, that AI detects that
and sends you questions, morequestions, regarding that field.
David Klonoff (15:35):
So we're doing little bits and pieces, but I
think the future is going to bebright and exciting for AI for
diabetes care, for diabetes careand you have some amazing tools
to offer your patients, but weknow that there are many
patients who cannot, will not,are not using them.
What do you see as a way ofincreasing the reach of these
(16:00):
tools, products, AIDs, so thateveryone will benefit from them?
Eda Cengiz (16:06):
Excellent question.
We have been working to broadenour reach for a while now.
One key issue has beeninsurance coverage and we're
trying to make the case toinsurance companies so that we
have insurance coverage fordiabetes technology devices.
(16:27):
They just see the cost of a CGMor pump, but they forget to see
the big cost of one admissionto hospital.
You know, if you can preventone diabetic ketoacidosis, you
are, you know.
One, it's improving patientsafety.
Two, you are saving, you know,safety too.
(16:54):
You are saving, you know, 40,50,000, maybe a hundred thousand
dollars per admission just byspending like minuscule amount
of money, little amount of moneyfor sensor and pump.
Now we're going to havehopefully soon, you know, ketone
sensors so we can preventketosis with that.
We have sensors that alert youfor, you know, for potential low
blood sugars, so you don't haveto again.
(17:14):
It's number one is patientsafety.
But the other thing is you'repreventing an admission to the
hospital for severe hypoglycemicreaction or an emergency room
admission for severehypoglycemic reaction.
So one key issue is um isinsurance coverage.
The other thing is obviously umbroadening provider care for
(17:39):
diabetes, for like provider,like educating people with
diabetes, and also providers fordiabetes technology devices.
I give talks to primary carephysicians, pediatricians,
pediatric endocrinologists inthe country and we had some
(17:59):
resistance even from pediatricendocrinologists to prescribe
diabetes technology devicesbecause they didn't know how to
use it.
They didn't know how to insert,they didn't know how to
troubleshoot.
It was quite challenging tointerpret those reports.
But now, if we make it easy forpeople with diabetes, for
(18:22):
providers, I think that waywe'll have more and more people
using these devices, benefitingfrom these devices.
And look what happened duringCOVID Many people, many
providers, were not able to seetheir patients, were not able to
provide care to their patientsbecause clinics shut down.
(18:43):
But for our people, for ourpeople with diabetes who were
using diabetes technology, theircare was not interrupted during
that period of time becausethey were using diabetes
technology devices.
So we need again you know, somany other things to reach out
(19:04):
to people, especially, you know,people from disadvantaged
populations.
As I noted before, they needmore hand-holding.
We need multilingual guides,online resources, better
education and more people tokind of help them, at least at
the beginning, and remotemonitoring support.
David Klonoff (19:34):
I have one last question for you.
In adults, we're seeing CGMsbeing used by people who don't
have diabetes to see if theyhave prediabetes or they're
actually developing type 2diabetes.
My question for you is do youthink we're going to see this in
children wearing CGMs to see ifthey're going to be developing
type 1 diabetes going?
Eda Cengiz (19:48):
to be developing type 1 diabetes.
That's an excellent questionand I think it kind of, you know
, it's also relevant for yourquestion about prevention
studies, david.
We now we're seeing more andmore kids.
They were diagnosed with, likeyou know, some high blood sugars
(20:09):
here and there at the clinic,you know, during like sports
physical, and then you know,families are, you know, they
don't know what to do, and inthe past we were like, hey, we
don't have anything, anyprevention method, treatment for
you.
So sometimes we're thinking likewhat's the point in you know,
checking, like monitoring thosekids?
(20:31):
To be honest with you, there isa point actually, because you
know we still have 30% of kidsdiagnosed in diabetic
ketoacidosis.
They're coming in a coma to thehospital when they're newly
diagnosed.
So if there's any suspicion, Istill see the value, significant
value, of monitoring them witha CGM.
But on the other hand, now wehave this prevention drugs TZL
(20:55):
and if we can diagnose themsooner with stage two diabetes
and, you know, start thetreatment, this gives them a
huge opportunity and we can, youknow, prolong their beta cell
life, reduce complications ofdiabetes.
So I see CGM as a veryimportant tool to monitor those
(21:17):
kids too.
But we need to make it easierfor them.
We need to have you know, weneed to reduce the burden.
So if we're going to do CGMmonitoring for those kids, it
shouldn't add any burden orstress to the kid or the family.
David Klonoff (21:31):
Edda, thank you for answering these questions.
You know so much about diabetes.
I've learned a lot talking withyou today.
So I want to say, on behalf ofDr David Kerr and myself, thank
you for appearing on DiabetesTechnology Report.
This podcast is available atthe Apple Store and Spotify and
the Diabetes Technology Societywebsite.
(21:53):
So we will see you again at thenext Diabetes Technology Report
podcast.
Goodbye everybody, thank you.
Eda Cengiz (22:02):
Thank you.
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