Julia Mader on Advancements in Diabetes Technology and Patient Experience in Austria

Interview on diabetes technology and patient experience in Austria with Julia Mader, MD, Associate Professor at Medical University of Graz and the new managing editor of Journal of Diabetes Science and Technology.

Episode Transcript

David Klonoff (00:12):
Welcome to Diabetes Technology Report.
I'm Dr David Klonoff.
I'm an endocrinologist at MillsPeninsula Medical Center in San
Mateo, California.
We have a special guest todayfrom Europe my co-host.

David Kerr (00:32):
Dr David Kerr will introduce her.
Hello everyone.
Yes, this is David Kerr.
I'm speaking to you from SantaBarbara, california, and it's a
real pleasure to welcome the newmanaging editor of the Journal
of Diabetes Science andTechnology, dr Julia Mehta.
Welcome, julia.

Julia Mader (00:43):
Hi, nice to meet you guys.

David Kerr (00:45):
And what we like to do with these is get a little
bit of background.
Try, you know, set the scene.
So how did you end up beinginterested in diabetes and
diabetes and technology?
Specifically, what were thedrivers of this?

Julia Mader (01:02):
Well, so interestingly, already quite
early during my career, I endedup in diabetes technology.
I have to admit so when I wasfinalizing my last year in
medical school, I ended up indiabetes for doing my thesis
there, diabetes for doing mythesis there.

(01:24):
And my first project alreadybrought me to the field of
diabetes technology.
That was about glucose sensingin the intensive care unit.
At that time it was a bit of ahow do you say awkward theme
that no one was believing in.
And that's been nearly 20 yearsago and fortunately I managed
to stay on the bloodstream.

David Kerr (01:46):
And what are you up to at the moment?

Julia Mader (01:54):
What sort of keeps you up at night thinking about
diabetes and technology?
So what really keeps me up atnight is I want to make the
lives of people living withdiabetes more easy.
So, for example, I just cameback from a diabetes camp with
kids with diabetes, and then yousee all the hassle and all the
difficulties that they stillendure, even if they now have
probably way much bettertherapies than we had 10 or 15

(02:17):
or 20 years back.
It is still for them an ongoingchallenge and I hope at some
point in time we can make it somuch easier that they don't
notice that they have anychronic condition to pick out.

David Klonoff (02:33):
Julia, what would you say are the differences you
see in the types of problemsyou have to address for type 1
people versus type 2 people?

Julia Mader (02:42):
So I think for type 1, it's still more complex.
Even if you're well trained andknow what to do in different
situations, you still have totake into account so much about
exercise, so much about food,specifically, let's say, when
you are on vacation.
So I was on vacation with a goodfriend of mine who has type 1

(03:03):
diabetes and he made kind of achallenge out of it to go for
the food that all of us had andwe were doing a report for the
Austrian society there and hetook pictures of the food and
then how we ended up needingglucose and he said, even if he
was trying his very, very best,he ended up either in hype or

(03:24):
hypoglycemia because he neverwas sure about what in that
group.
Specifically, he was notfamiliar with the kind of food
in the workplace.
And so type 1 is probably waymore challenging if you compare
it to xenocorpus tutoribus and Ithink for type 2 tutoribus the
advances have been reallyongoing.

(03:44):
We have observed a lot of newmedication, drugs that make
light and walk in the air, sothat people with type 2 diabetes
nowadays don't need to go forcomplex count counting, for
complex monitoring or advice byus, but with all the new drugs

(04:07):
that we have available.
In many countries, insulin isthe last line of defense.
It's not complex, it's justsome new stuff.

David Klonoff (04:20):
Julia, you live in Austria.
Is the Austrian governmentinterested in helping people
with diabetes?
Do they have any programs thatyou work with?

Julia Mader (04:31):
So it's not so much the government that defines the
programs, it's more thesocieties and also the hospital
center people caring for peoplewith diabetes who enable that.
But what we have to definitelyadmit is that in many of the
European countries, includingAustria, access to medication is

(04:52):
very good, so that peoplereally pay a low amount of money
compared to what I've heard atleast people in other places of
the world need to put in termsof money on the table.
So, for example, in my country,if you have no special other
insurance, usually you pay seveneuros per package of medication

(05:14):
.
You're respective of what thecosts are if you have it
approved for your condition, butotherwise you pay seven euros a
bed for whatever the cost ofthe medication is itself.

David Kerr (05:30):
Julia, I'm just interested in comparing the US
with Europe.
What do you think is the rateof type 1 diabetes?
The proportion of people usingclosed-loop or artificial
pancreas systems?
How much penetration is there?

Julia Mader (05:46):
That's a very good question.
I think that depends a littlebit on the age of the people, so
it's fully covered for everyonewho wants to go for it.
The obstacle is more into whowants to go for it.
So I guess in the pediatricfield we are at 70% to 80% to

(06:12):
90%, depending on the clinicthat people are taking care of.
In the adult population I guessit's roughly around 60 percent,
50 to 60 percent again,depending a lot where you are in
uh in care.
So it might be that the gptakes care of you and that they
are not familiar with thattechnology and then you don't
end up using it.
But in general the uptake isincreasing with better systems

(06:34):
becoming available.
Only drawback that we stillhave in my country we only have
two systems available and noneof that includes a patch plant.

David Kerr (06:44):
Interesting.
I mean our own data here inCalifornia suggests that the use
of AP is actually a lot lowerthan that.
So we're very jealous.
What about the use of wearabletechnologies such as CGM in
people who are not on insulin?
Is that becoming a big deal inEurope?

Julia Mader (07:02):
Not yet because that's not reimbursed and, in
contrast to the US, people arenot really used to pay out of
the pocket for anyhealthcare-related expenses.
Well, nearly not so for peoplewithout insulin.
They might be really a minorityin the one-digit area.

(07:23):
So I don't even have one singlepatient who is using CGM
without insulin at present.
You see a slight uptake, evenif it's not funded, in terms of
those double agonists regardingobesity.
So that's maybe something newthat they did not have in the

(07:43):
past before, because there theytruly have the need on their own
perspective.
But for CGM in those withoutinsulin, I don't see really a
big uptake.
The only group that uses it butthose are keeping without
diabetes are people in trainingin the sense that who are

(08:07):
training maybe, let's say, formarathon or long-distance runs
or cycling, because they want tounderstand better their
refueling procedures duringexercise.
But for type 2 and oral agentsI would not see that.
There is maybe a small nichewhere how I can still request

(08:31):
reimbursement for people withoutbasal bolus therapy If I
indicate okay, people are usingbasal insulin with bolus on
demand and the insurancecompanies don't ask how much the
demand of bolus insulin is.
So that's kind of a little wayhow to get around the
reimbursement.
Slotted genes, but only forthose who are insulin-model.

David Klonoff (08:53):
Julie, you mentioned these new GLP-1
receptor agonists.
In the US they're becoming verypopular.
Some people think that that'sgoing to become first-line
treatment, even ahead ofmetformin.
These drugs are very effective.
Are they used much where youare, and what do you think about
them for type 2?

Julia Mader (09:14):
I think they are becoming more and more wide and
loose and they will become forsure a game changer.
If they will end up beforemetformin I do not yet know, but
I think they are at a verystrong position at least in
coming in a second in those I donot yet know, but I think they
are at a very strong position atleast in coming in a second in
those who do not meet thetargets.
Before it was only people whohad either HbA1c above 8.5%,

(09:39):
preferentially in those who hadalso a BMI above 30.
But the insurance companiesnowadays at least recognize
advantages and allow us to usethem in a broader clinical cycle
so that meta-OR should bepresent and even in type 1
diabetes they are becomingreimbursed nowadays consensus

(10:04):
panel that advocated the use ofmaking GLP-1 RAs available for
T1D patients using automatedinsulin delivery systems.

David Klonoff (10:13):
We worked on that together, and David Kerr is as
well aware of that.
So, Julia, what types oftechnologies do you see now that
look very promising?

Julia Mader (10:25):
So I think for people who are not wanting to go
for an AID system, connectedpens and more of that, even
smart pens, are becoming reallyimportant because they help
people to really not only trackbetter their insulin doses but
also to help them to calculate,because calculation is a big

(10:46):
deal Hopefully also with sometechnology included that tells
them, as according to theglucose rise, how much insulin
they should inject, becausethat's still the largest burden.
I also think that glucosemonitors, even if they are not
combined with the ID system, assoon as they give better

(11:09):
insights and deeperunderstandings of how to
re-inject to glucose values,will become important.
I'm not so sure how soon we'regoing to see ketone meters or
combined meters on the market,but I guess that will also
facilitate some of the diabetesmanagement, because sometimes

(11:29):
you just simply don't know is itthe meeting of the eating room,
the fat content of the meal,because it's not going down, or
is it the catheter cooling?
In that sense we could do thebenefit also of a combined and
PCOS monitoring approach and wealso observe in some people and

(11:50):
some research that's ongoing,some technology to track other
conditions like that.
But it took disease, but that'sstill something very young, so
I've been involved in oneproject, but it's not so sure
how easily that's going to berealized on one side and we'll
get the better treatment that wehave.

(12:11):
Maybe we also see deep declinein those complications that we
don't need to monitor thoseconditions anymore.

David Kerr (12:18):
but I mean that would be another three the other
thing I would like to ask allof our contributors is about
artificial intelligence, becauseevery time you open social
media or the news, there'ssomething about artificial
intelligence.
What's your thoughts on howit's going to influence what we

(12:40):
do on a day-to-day basis in thenear future and in the longer
term?

Julia Mader (12:47):
That's a very good one.
So I think artificialintelligence will help us, at
least with data interpretation and musicas.
But it's maybe not as marked asall of us had thought it
already is, because it's justlearning from what is known in
many places.
So I think you can getsomething out of it, but you

(13:10):
need to be very sure that themodel is underlying it.
You need to find the face,otherwise you don't get
suggestions out of it.
If you just simply test and goand try to write up some simple
article, you might get very funfacts out of that, and the same
is happening, of course, forcertainly medical care, if the

(13:36):
underlying database is not good.
But on the other hand, we'veseen that clinical
interpretation of state or bymachine can be better than by
genome because they are not somuch influenced by the
individual sitting in front ofthem.
So because each person haseither dark or light errors in
my immune smart or not smart Imight have different approaches

(13:59):
to them and the computer wouldbe probably more neutral and not
taking into account my personalobservations.

David Klonoff (14:11):
Julie, I have one last question for you.
Now you're managing editor ofthe Diabetes Technology Society
Journal, which is the Journal ofDiabetes Science and Technology
.
What's it like?
How do you plan to handle thatnew position?

Julia Mader (14:27):
It's a really important position position and
thanks again, david, for havingme and for asking me for that
one, so I had very, verypositive responses to that.
A lot of people approached meto it, so obviously this is
something that doesn't gounnoticed.
That's one thing.

(14:48):
On the other hand side, ofcourse, I hope that we can
together further develop thejournal and really keep it as
successful as it is.
So it's really on a very, verygood track in my opinion, and
that's all your longstanding,sustained work in this trial

(15:11):
that's put into it and I thinkit's becoming, or it is, the
leading trial for noveltycolleges.
Also, when I see the articlesthat are submitted, they are of
high quality and people reallywant their data to be published
here.

David Klonoff (15:32):
Well, with you at the helm, we'll reach even
higher heights.
So, Julia, thank you for beinginterviewed today.
David, thank you forinterviewing.

David Kerr (15:41):
Pleasure.
Really welcome aboard.

Julia Mader (15:44):
Thank you so much.

David Klonoff (15:46):
This completes the podcast.
This podcast is available onSpotify, Apple Store and the
Diabetes Technology Societywebsite.
We look forward to seeingeveryone at our next podcast and
, until then, have a good day.
Bye-bye.