June 21, 2024 • 17 mins
A conversation on the future of diabetes care with Eyal Dassau, PhD, Vice President of Innovation and Connected Care at Lilly,
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
David Klonoff (00:14):
Welcome to Diabetes Technology Report.
This is the podcast that coversdiabetes technology.
I'm Dr David Klonoff.
I'm an endocrinologist atSutter Health and UCSF.
David Kerr (00:26):
We have a very special guest today and my
co-interviewer, dr David Kerr,will introduce him pleasure in
welcoming one of the giants ofthe artificial pancreas
development, eyal Diso, who'scurrently Vice President of
(00:54):
Innovation and Connected Care atLilly Eyal.
It's great to catch up with youonce more.
I think a lot of our listenerswant to know how did you end up
being interested in diabetes anddiabetes technology
specifically?
Eyal Dassau (01:06):
First of all, thank you, dr Kiran and Dr Khlona for
having me here.
Why I'm in diabetes or diabetestechnology?
I think that for me it's, likemany others, motivated by a
personal experience withdiabetes not myself.
My dad has type 1 diabetes foras far as I remember him.
(01:28):
So as a young boy I learned howto identify hypoglycemia by
just looking at him, how to doseinsulin and to inject.
Later on I had to apply evenemergency treatments, including
to him emergency treatments,including to him.
So I was very motivated to kindof okay, what do we do with
(01:51):
that?
How do we improve the care forpeople with diabetes?
And when the artificialpancreas program started, I was
lucky enough to move to SantaBarbara to be part of that
program and to be part of thatinitiative that all of you guys
were part of it, to generate anew treatment modality for
(02:14):
people with diabetes.
David Kerr (02:17):
I mean, the artificial pancreas has come a
very, very long way and it'schanged lives around the world.
Where does it go from here?
Do you think?
What are the great barriersthat we still need or the
questions we need to solve whenit comes to artificial pancreas
systems?
Eyal Dassau (02:36):
So I think that, as you mentioned, there was great
strides.
I think that we have the firstor second generations of systems
out there.
I think that we have the firstor second generations of systems
out there and to me it's justthe starting point of what we
can do with information, withdata and with what we call
Internet of Things.
So we are living in a connectedenvironment, we are living
(03:01):
where information is flowing andthe question is how we can
nourish that information towardhelping people with diabetes to
reduce the burden of diabetes,improving the care and enjoying
life.
So spending less time ondiabetes, worried about diabetes
, and more time about otheractivities about other
(03:24):
activities, eyal.
David Klonoff (03:28):
many people will say that the three areas where
we could stand to seeimprovements in artificial
pancreas are faster-actinginsulin, better algorithms and
better sensors.
Which of those do you thinkcould be improved the most?
Where should we be puttingefforts?
Eyal Dassau (03:47):
You just mentioned the three big ones.
The question is what we'relooking for from an improvement
perspective, and it's maybe morepersonalized medicine.
So when we speak about sensorsand algorithms, it's how you
tailor and algorithms is how youtailor modern algorithms to
improve the life, but extendthat even beyond what we call
(04:10):
the artificial pancreas or AADsystems.
Many are using injections, mditherapy and other modalities.
David Klonoff (04:28):
How we can use information to better inform
insulin management across theboard.
You know you've done work on anartificial pancreas that
delivers glucagon.
Eyal Dassau (04:39):
Could you say something about that?
It wasn't really an artificialpancreas.
My work on the AAD space wasmore insulin-centric.
We've done some work aboutusing glucagon as a modality in
hypoglycemia for patients thatwere under bariatric surgery,
(05:00):
for post-bariatric surgerycomplications, and I think
that's another example of how wecan utilize technology to
improve a certain group ofindividuals that needs that help
and that, where automation cancome to play and, reducing that
fear of hypoglycemia, normalizelife by utilizing a different
(05:23):
drug, in this case glucagon andnot insulin.
Hopefully, what we envision issomething like a patch that has
a glucagon with a smartalgorithm that will release it
at the right time at the rightmoment.
David Kerr (05:38):
Going back to management of the needs, you
know, in your title title it'sgot connected care.
If I'm a person with diabetes,type 1, type 2, what does that
mean to them?
What can they look forward to?
Eyal Dassau (05:58):
So connected care is the ability basically to take
the information that we havewhether it's from an insulin
modality, in this case,connected insulin pen glucose
information and improve the waythat we manage treatments,
(06:20):
Improve them, Make them betterand personalize that to the
user's needs, Because each of usare very different.
We have different objectives.
We need to meet the users wherethey are by using technology,
Making insightful insight fromthe data.
David Kerr (06:42):
So does that move into?
It's not simply insulin.
Look at the change in glucoseyou're getting into, looking at
other lifestyle orpatient-centered factor so you
can really fine-tune the system.
Eyal Dassau (07:00):
I think that we need to consider not just
glucose there's glucose, there'sthe insulin, there's the type
of insulin that you're taking,the other contextual information
that we are sharing or can beutilized via connected devices,
again to improve management ofdiabetes, in this case,
(07:23):
management of insulin delivery.
David Klonoff (07:26):
You know, there's a lot of interest now in
classifying people with type 2and even type 1 diabetes into
subtypes.
People in this area feel thatthere's not just type 1 and type
2, but there are many subtypes.
Presumably, each of thosesubtypes would require or
benefit from a differenttreatment.
(07:47):
What do you think about that,and do you think that this
movement of splitting the typesof diabetes is compatible with
artificial pancreas?
Eyal Dassau (07:59):
You know I can share probably my opinion here.
We've seen throughout life thename, you know the definition of
diabetes being modifiedmultiple times with multiple
names.
So it might be a part of thatcycle when I see technology and
(08:20):
ability.
I would tailor that topersonalized medicine In that we
, the first or second generationof AAD system, are designed for
populations and now there'sopportunity down the road to
further personalize the systemstoward the needs of the
(08:42):
individuals.
And that's maybe alluded towhat you know, whether the type
or subtype of you know that,where more advanced algorithms
can come to play, learning thedata and understanding how it
can further modify the system tobe tailored to the individual.
So it's like a tailored suit,the system to be tailored to the
individual.
(09:03):
So it's like a tailored suit,it's not off the rack.
It would fit to you Now easy tosay lots of work needs to
happen in that in order to getit into something that people
can use, especially in aregulated environment.
David Klonoff (09:19):
Do you think that we're going to be seeing the
use of GLP-1 receptor agonistsincreasing in type 2 and
possibly even entering theapproval group for type 1?
What do you think is the futureof those drugs?
Eyal Dassau (09:40):
It might be, I don't know.
That's toward the clinicians inthe room here and potentially
other users would need tonavigate that space and see how
the utilization of GLPs willcome in the future.
I really can't comment on that.
(10:00):
Okay, you're an engineer bybackground.
David Kerr (10:01):
I really can't comment on that.
Okay, You're an engineer bybackground AI I happen to know
that, and our listeners arereally intrigued as to your
vision of AI and diabetes.
And when are we going to startnoticing benefits from AI and
(10:21):
what are your concerns about AI?
Is it all hype at the moment orwhat's your thoughts on this?
Eyal Dassau (10:30):
I think that you know whether we're using right
now AI, depending on what systemyou're using or where there's
some elements of AI that arebeing used right now.
When you look at artificialpancreas, you know predictions,
learning elements there are.
My assumption that we'll seemore and more as time comes and
(10:54):
we have more data going back totailoring the algorithms to the
individuals and how we canfurther predict lifestyle and
ability to change with moreinformation or make faster
decisions.
There is a it's not an easytask.
There is challenges you mayhave you know mentioning, you
(11:16):
know hallucinations or how youcan trust the system, how you
can verify and validate thesystem.
So there'll be some work thatwill need to be done there.
I think that's part of thediscovery process.
There's always challenges and Ithink that, if I reflect back
to the AID path, was it an easytask?
(11:36):
No, it took multiple iterationsand multiple steps by industry,
academia collaborations to moveit forward.
So I would assume that we'llsee some progress around the
utilization of AI and differenttype of AI in the future of
(11:57):
diabetes technology.
David Kerr (12:00):
I mean, I think that's a fair assumption at this
stage.
The other question, which is apractical question that people
with diabetes constantly ask me,is the AP systems at the moment
are not objects of beauty inthe sense that they have a
certain size and they'reseparate pieces.
Do you see any change bringingeverything to one device, much
(12:25):
smaller, lasting longer?
I'm just wondering what thevision for this is in the future
, without giving us any industrysecrets.
Eyal Dassau (12:39):
As a former designer in this space, I played
or toyed with the idea of anall-in-one device.
Going back many years ago I didsome simulations of an
all-in-one device.
Can it be used or are there anyinterferences or not?
This goes back to we need toserve the users, so we need the
(13:04):
voice of the users, and I thinkthat we see devices these days
that are less medical devices,but they're still not so small,
they're not so discrete.
Can we make them smaller?
Potentially, yes.
Technology improved.
(13:25):
We are seeing some use of thingsthat we didn't believe that
would be reality using yourphone as your screen, and that's
minimized the footprint of yourpump.
So we see now more pumps thatkind of found a, what I call a
patch or semi patch pumps thatare smaller, maybe even smaller
in the future.
Can they be integrated with asensor?
Might be.
Hopefully.
(13:45):
Somebody is working on it rightnow as we speak.
There's the other opportunityand we've done some work on that
in previous life at Harvard andUC Santa Barbara with
implantable system, and I knowthat currently there's some work
around that.
There are definitely challengesthere, but that's become kind
(14:07):
of a really interestingproposition of an implanted
system that you wouldn't see,provide the full benefit of an
AAD system, but nothing isvisible on your body, so body
image is very important.
David Klonoff (14:27):
Hey Al, as we see more connected care, many
people would likeinteroperability so that
whatever device they use cansend information to many
platforms and their doctor canhave access to many types of
devices.
And then we also see peopleconcerned about cybersecurity,
the more information that getstransmitted wirelessly.
(14:49):
What do you think about thosetwo areas?
Eyal Dassau (14:53):
You just mentioned.
You know two big areas that areinvestigated how much you can
enable interoperability ofsystems and across systems.
Again, meeting the users wherethey are, as you mentioned, one
of the users is the healthcaresystems or the users themselves
(15:17):
as patients, people withdiabetes, and cybersecurity is
around us across the board.
So how do we make the systemrobust enough but also enable
interoperability there?
There are different approachesthat are being utilized there
and following guidance from theregulators to enable it, the
(15:41):
regulators to enable it.
David Klonoff (15:42):
And one last question when do you think we'll
be in 10 years or 20 years or30 years Any of those based on
how things are progressing indiabetes technology?
Eyal Dassau (15:56):
It's a good question.
I think that we'll have an AADsystems that will be much
smarter, much more predictive,as well as tailored toward
personalization of needs.
So what we probably initiallydreamed and but had to propose
(16:19):
on that more kind of ability,whether it's interface or the
system will learn by itself viaAI what is your true goals and
what are your true needs anddrive it toward that.
I think that it's doable downthe road, especially in 10 years
from now.
David Klonoff (16:41):
Well, thank you for being interviewed and
answering our questions.
This completes today'sinterview for Diabetes
Technology Report.
You can find this report it'savailable on Spotify, the Apple
Store and the DiabetesTechnology Society website, so
we look forward to you joiningus for the next Diabetes
(17:02):
Technology Report.
I'm going to now say goodbye,Dr Kerr.
David Kerr (17:07):
Thank you very much, Eyal.
That was really positive andthoughtful.
Thank you very much.
Thank you, Eyal.
Eyal Dassau (17:13):
Thank you guys.
Thank you Dr Kerr and DrKlonoff.
Welcome to Diabetes Technology Report.
This is the podcast that coversdiabetes technology.
I'm Dr David Klonoff.
I'm an endocrinologist atSutter Health and UCSF.
David Kerr (00:26):
We have a very special guest today and my
co-interviewer, dr David Kerr,will introduce him pleasure in
welcoming one of the giants ofthe artificial pancreas
development, eyal Diso, who'scurrently Vice President of
(00:54):
Innovation and Connected Care atLilly Eyal.
It's great to catch up with youonce more.
I think a lot of our listenerswant to know how did you end up
being interested in diabetes anddiabetes technology
specifically?
Eyal Dassau (01:06):
First of all, thank you, dr Kiran and Dr Khlona for
having me here.
Why I'm in diabetes or diabetestechnology?
I think that for me it's, likemany others, motivated by a
personal experience withdiabetes not myself.
My dad has type 1 diabetes foras far as I remember him.
(01:28):
So as a young boy I learned howto identify hypoglycemia by
just looking at him, how to doseinsulin and to inject.
Later on I had to apply evenemergency treatments, including
to him emergency treatments,including to him.
So I was very motivated to kindof okay, what do we do with
(01:51):
that?
How do we improve the care forpeople with diabetes?
And when the artificialpancreas program started, I was
lucky enough to move to SantaBarbara to be part of that
program and to be part of thatinitiative that all of you guys
were part of it, to generate anew treatment modality for
(02:14):
people with diabetes.
David Kerr (02:17):
I mean, the artificial pancreas has come a
very, very long way and it'schanged lives around the world.
Where does it go from here?
Do you think?
What are the great barriersthat we still need or the
questions we need to solve whenit comes to artificial pancreas
systems?
Eyal Dassau (02:36):
So I think that, as you mentioned, there was great
strides.
I think that we have the firstor second generations of systems
out there.
I think that we have the firstor second generations of systems
out there and to me it's justthe starting point of what we
can do with information, withdata and with what we call
Internet of Things.
So we are living in a connectedenvironment, we are living
(03:01):
where information is flowing andthe question is how we can
nourish that information towardhelping people with diabetes to
reduce the burden of diabetes,improving the care and enjoying
life.
So spending less time ondiabetes, worried about diabetes
, and more time about otheractivities about other
(03:24):
activities, eyal.
David Klonoff (03:28):
many people will say that the three areas where
we could stand to seeimprovements in artificial
pancreas are faster-actinginsulin, better algorithms and
better sensors.
Which of those do you thinkcould be improved the most?
Where should we be puttingefforts?
Eyal Dassau (03:47):
You just mentioned the three big ones.
The question is what we'relooking for from an improvement
perspective, and it's maybe morepersonalized medicine.
So when we speak about sensorsand algorithms, it's how you
tailor and algorithms is how youtailor modern algorithms to
improve the life, but extendthat even beyond what we call
(04:10):
the artificial pancreas or AADsystems.
Many are using injections, mditherapy and other modalities.
David Klonoff (04:28):
How we can use information to better inform
insulin management across theboard.
You know you've done work on anartificial pancreas that
delivers glucagon.
Eyal Dassau (04:39):
Could you say something about that?
It wasn't really an artificialpancreas.
My work on the AAD space wasmore insulin-centric.
We've done some work aboutusing glucagon as a modality in
hypoglycemia for patients thatwere under bariatric surgery,
(05:00):
for post-bariatric surgerycomplications, and I think
that's another example of how wecan utilize technology to
improve a certain group ofindividuals that needs that help
and that, where automation cancome to play and, reducing that
fear of hypoglycemia, normalizelife by utilizing a different
(05:23):
drug, in this case glucagon andnot insulin.
Hopefully, what we envision issomething like a patch that has
a glucagon with a smartalgorithm that will release it
at the right time at the rightmoment.
David Kerr (05:38):
Going back to management of the needs, you
know, in your title title it'sgot connected care.
If I'm a person with diabetes,type 1, type 2, what does that
mean to them?
What can they look forward to?
Eyal Dassau (05:58):
So connected care is the ability basically to take
the information that we havewhether it's from an insulin
modality, in this case,connected insulin pen glucose
information and improve the waythat we manage treatments,
(06:20):
Improve them, Make them betterand personalize that to the
user's needs, Because each of usare very different.
We have different objectives.
We need to meet the users wherethey are by using technology,
Making insightful insight fromthe data.
David Kerr (06:42):
So does that move into?
It's not simply insulin.
Look at the change in glucoseyou're getting into, looking at
other lifestyle orpatient-centered factor so you
can really fine-tune the system.
Eyal Dassau (07:00):
I think that we need to consider not just
glucose there's glucose, there'sthe insulin, there's the type
of insulin that you're taking,the other contextual information
that we are sharing or can beutilized via connected devices,
again to improve management ofdiabetes, in this case,
(07:23):
management of insulin delivery.
David Klonoff (07:26):
You know, there's a lot of interest now in
classifying people with type 2and even type 1 diabetes into
subtypes.
People in this area feel thatthere's not just type 1 and type
2, but there are many subtypes.
Presumably, each of thosesubtypes would require or
benefit from a differenttreatment.
(07:47):
What do you think about that,and do you think that this
movement of splitting the typesof diabetes is compatible with
artificial pancreas?
Eyal Dassau (07:59):
You know I can share probably my opinion here.
We've seen throughout life thename, you know the definition of
diabetes being modifiedmultiple times with multiple
names.
So it might be a part of thatcycle when I see technology and
(08:20):
ability.
I would tailor that topersonalized medicine In that we
, the first or second generationof AAD system, are designed for
populations and now there'sopportunity down the road to
further personalize the systemstoward the needs of the
(08:42):
individuals.
And that's maybe alluded towhat you know, whether the type
or subtype of you know that,where more advanced algorithms
can come to play, learning thedata and understanding how it
can further modify the system tobe tailored to the individual.
So it's like a tailored suit,the system to be tailored to the
individual.
(09:03):
So it's like a tailored suit,it's not off the rack.
It would fit to you Now easy tosay lots of work needs to
happen in that in order to getit into something that people
can use, especially in aregulated environment.
David Klonoff (09:19):
Do you think that we're going to be seeing the
use of GLP-1 receptor agonistsincreasing in type 2 and
possibly even entering theapproval group for type 1?
What do you think is the futureof those drugs?
Eyal Dassau (09:40):
It might be, I don't know.
That's toward the clinicians inthe room here and potentially
other users would need tonavigate that space and see how
the utilization of GLPs willcome in the future.
I really can't comment on that.
(10:00):
Okay, you're an engineer bybackground.
David Kerr (10:01):
I really can't comment on that.
Okay, You're an engineer bybackground AI I happen to know
that, and our listeners arereally intrigued as to your
vision of AI and diabetes.
And when are we going to startnoticing benefits from AI and
(10:21):
what are your concerns about AI?
Is it all hype at the moment orwhat's your thoughts on this?
Eyal Dassau (10:30):
I think that you know whether we're using right
now AI, depending on what systemyou're using or where there's
some elements of AI that arebeing used right now.
When you look at artificialpancreas, you know predictions,
learning elements there are.
My assumption that we'll seemore and more as time comes and
(10:54):
we have more data going back totailoring the algorithms to the
individuals and how we canfurther predict lifestyle and
ability to change with moreinformation or make faster
decisions.
There is a it's not an easytask.
There is challenges you mayhave you know mentioning, you
(11:16):
know hallucinations or how youcan trust the system, how you
can verify and validate thesystem.
So there'll be some work thatwill need to be done there.
I think that's part of thediscovery process.
There's always challenges and Ithink that, if I reflect back
to the AID path, was it an easytask?
(11:36):
No, it took multiple iterationsand multiple steps by industry,
academia collaborations to moveit forward.
So I would assume that we'llsee some progress around the
utilization of AI and differenttype of AI in the future of
(11:57):
diabetes technology.
David Kerr (12:00):
I mean, I think that's a fair assumption at this
stage.
The other question, which is apractical question that people
with diabetes constantly ask me,is the AP systems at the moment
are not objects of beauty inthe sense that they have a
certain size and they'reseparate pieces.
Do you see any change bringingeverything to one device, much
(12:25):
smaller, lasting longer?
I'm just wondering what thevision for this is in the future
, without giving us any industrysecrets.
Eyal Dassau (12:39):
As a former designer in this space, I played
or toyed with the idea of anall-in-one device.
Going back many years ago I didsome simulations of an
all-in-one device.
Can it be used or are there anyinterferences or not?
This goes back to we need toserve the users, so we need the
(13:04):
voice of the users, and I thinkthat we see devices these days
that are less medical devices,but they're still not so small,
they're not so discrete.
Can we make them smaller?
Potentially, yes.
Technology improved.
(13:25):
We are seeing some use of thingsthat we didn't believe that
would be reality using yourphone as your screen, and that's
minimized the footprint of yourpump.
So we see now more pumps thatkind of found a, what I call a
patch or semi patch pumps thatare smaller, maybe even smaller
in the future.
Can they be integrated with asensor?
Might be.
Hopefully.
(13:45):
Somebody is working on it rightnow as we speak.
There's the other opportunityand we've done some work on that
in previous life at Harvard andUC Santa Barbara with
implantable system, and I knowthat currently there's some work
around that.
There are definitely challengesthere, but that's become kind
(14:07):
of a really interestingproposition of an implanted
system that you wouldn't see,provide the full benefit of an
AAD system, but nothing isvisible on your body, so body
image is very important.
David Klonoff (14:27):
Hey Al, as we see more connected care, many
people would likeinteroperability so that
whatever device they use cansend information to many
platforms and their doctor canhave access to many types of
devices.
And then we also see peopleconcerned about cybersecurity,
the more information that getstransmitted wirelessly.
(14:49):
What do you think about thosetwo areas?
Eyal Dassau (14:53):
You just mentioned.
You know two big areas that areinvestigated how much you can
enable interoperability ofsystems and across systems.
Again, meeting the users wherethey are, as you mentioned, one
of the users is the healthcaresystems or the users themselves
(15:17):
as patients, people withdiabetes, and cybersecurity is
around us across the board.
So how do we make the systemrobust enough but also enable
interoperability there?
There are different approachesthat are being utilized there
and following guidance from theregulators to enable it, the
(15:41):
regulators to enable it.
David Klonoff (15:42):
And one last question when do you think we'll
be in 10 years or 20 years or30 years Any of those based on
how things are progressing indiabetes technology?
Eyal Dassau (15:56):
It's a good question.
I think that we'll have an AADsystems that will be much
smarter, much more predictive,as well as tailored toward
personalization of needs.
So what we probably initiallydreamed and but had to propose
(16:19):
on that more kind of ability,whether it's interface or the
system will learn by itself viaAI what is your true goals and
what are your true needs anddrive it toward that.
I think that it's doable downthe road, especially in 10 years
from now.
David Klonoff (16:41):
Well, thank you for being interviewed and
answering our questions.
This completes today'sinterview for Diabetes
Technology Report.
You can find this report it'savailable on Spotify, the Apple
Store and the DiabetesTechnology Society website, so
we look forward to you joiningus for the next Diabetes
(17:02):
Technology Report.
I'm going to now say goodbye,Dr Kerr.
David Kerr (17:07):
Thank you very much, Eyal.
That was really positive andthoughtful.
Thank you very much.
Thank you, Eyal.
Eyal Dassau (17:13):
Thank you guys.
Thank you Dr Kerr and DrKlonoff.
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