March 14, 2025 • 19 mins
An interview on diabetes and genetics with Liana Billings, MD, Vice Chair of Research for the Department of Medicine at Endeavor Health; Director, Clinical and Genetics Research in Diabetes and Cardiometabolic Disease.
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David Klonoff (00:13):
Hello, welcome to Diabetes Technology Report.
I'm David Klonoff, I'm atSutter Health and we have a very
special guest today Health andwe have a very special guest
today.
I'm going to introduce myco-host, dr David Kerr, and he
will introduce her and start theinterview.
David Kerr (00:30):
David, Thanks very much, david, and welcome to
everyone.
I'm David Kerr.
As usual, I'm speaking to youfrom Santa Barbara, california,
and it's great we have LeannaBillings on today, who is an
authority, an expert, on certainaspects of diabetes.
So come to that.
So, leanna, welcome, it'sfantastic to have you on board
(00:51):
today.
One of the things we like toask to set the scene really is
how did you end up beinginterested in diabetes?
Our audience is very curiousabout that.
Liana Billings (01:03):
Yeah, well, it's been an evolution, Fortunately,
when I was in undergrad I hadthe experience in working in an
epidemiology lab at Universityof Illinois in Chicago and we
were interested in looking atsome of the social and economic
factors that impacted type 1diabetes control in kids in
(01:27):
Chicago.
It was very eye-opening to me.
At that point I was a lowly labmember and I did a lot of data
collection that were based offof interviews with families, but
I was really able to kind ofsee right into the homes and
into the life of people livingwith type 1 diabetes and
realizing, you know really, thesignificant challenges that they
(01:49):
face every day in trying tocontrol blood sugar but also
trying to deal with gettingmedical supplies and medical
care and other things related tothe condition.
So that piqued my interest andthen I went on to continue to do
research, be interested in type2 diabetes because it's
affected my family members.
(02:10):
And then, when I was anendocrine fellow at Mass General
, I was fortunate to work in adiabetes genetics lab where I
was further excited about reallykind of, you know, honing in on
the field of diabetes and that,yeah, now it's evolved into a
field that I feel reallypassionate about and I feel when
(02:33):
I'm with my patients who havetype 1 and type 2 and other
atypical forms of diabetes, Ifeel really inspired by them and
the medical condition and whatthey actually fight through
every day to be able to live afull life with this condition.
David Kerr (02:50):
Excellent.
So you're driven, you have apassion, so can you give us,
like a thumbnail, sketch of thecore research that you're
involved in at the moment?
Liana Billings (03:01):
Yeah Well, our research is kind of two-sided.
One side is runningindustry-sponsored clinical
trials and we run clinicaltrials in type 1 diabetes, type
2, and other cardiometabolicconditions, particularly in type
2 and type 1,.
We're investigating newpharmaceutical medications that
can be used for treatment and weare also using new pumps and
(03:25):
monitoring devices, exploringthose and research to try to
find, you know, really gettingbetter and better at treating
and managing diabetes.
And the other side the otherhat I wear is running a genetics
research lab where we're veryinterested in using genetics to
help differentiate diabetes typeand exploring how do we
(03:47):
implement that into the clinicalsetting.
David Klonoff (03:51):
Liena.
Where do you think is thegreatest value in genetics for
people with diabetes?
Why would a person withdiabetes want to know about
their genetics?
Liana Billings (04:02):
Yeah, that's a good question.
I think lots of reasons.
I don't think there's just oneanswer.
I think genetics can be usedfor preventative efforts, so if
people know their risk, they canintervene early with prevention
.
As far as diagnosis, I think andthis is what we're exploring a
lot is we believe we can reallyuse genetics to help make a more
(04:26):
accurate diagnosis.
So, whether that's monogenicdiabetes, whether that's type 1
diabetes or type 2 diabetes,there are tools that we can use
with genetics that can helprefine the diagnosis and make
sure it's right from the start,and then you know.
Lastly, it can inform therapy.
So, lastly, it can informtherapy.
So a very kind of clear exampleis where we can use certain
(04:49):
medications, such as in MODYmonogenic or maturity-onset
diabetes of the young wherecertain genetic forms of that
MODY, like HNF1A or HNF4A MODY,can be treated with
sulfonylureas, which can be veryeffective in many people.
And I have stories where I'vetaken people off of insulin
who've been on insulin years andyears and years and now can
(05:11):
actually take a pill.
So these are life-changingdiagnoses that use genetics to
make that impact.
David Klonoff (05:19):
Leanna, do you keep track of your patients in a
large database and do you workwith others in building the
database?
Liana Billings (05:29):
Yeah, so we have a couple of different data sets
.
So we do have a database whereit's linked to a clinical effort
that I started about 10 yearsago.
So we at Endeavor started thediabetes consultation or
personalized medicine anddiabetes consultation clinic
(05:49):
here.
It's aimed to have a placewhere people can get genetic
testing because historicallythis has been kind of a barrier
there.
So we have streamlined theprocess to where people come in
with atypical diabetes.
I evaluate them, we discusswhether genetic testing would be
appropriate.
(06:10):
I've pretty much been able toget everyone genetic testing
because you know, we know how towork with insurance.
We also have a reasonableout-of-pocket price and we
actually have kind of homegrownour own genetic panel with
monogenic genes, type 1 and type2 diabetes polygenic risk
scores and a genetic probabilityrisk that we assess using the
(06:34):
T1D and T2D polygenic riskscores, so that patient
population I've accrued over theyears is actually part of a
bigger data set.
And then we also have here atEndeavor something called the
Genomics Health Initiative,which is a biorepository where
anyone coming to our healthsystem can enroll in the
(06:56):
Genomics Health Initiative andwe are able to examine how
genetic factors are associatedwith their disease conditions or
their prospectively how they doas far as their risk of disease
and so on.
So those are a couple of datasets that we have locally at
Endeavor.
David Kerr (07:16):
Diana, I'm intrigued here.
Are you finding that people arewilling and able and really up
for having their geneticsmeasured, or are there still a
group of people who are kind ofgoing well, I'm not quite sure
about this because there'snothing I can do about my
genetics.
And what's your generalperception?
Liana Billings (07:33):
I think it's a mix, you know it's interesting.
I would say that, at least frommy experience, people are more
enthusiastic than not.
There definitely are those thatare more scared.
I guess they're more hesitantto kind of know that risk.
But most are really curious.
They want to know more aboutthemselves.
They want to know how the bookwas written and why they're
(07:55):
seeing things.
So I would say the uptake isthey're pretty enthusiastic.
Also, I tend to see a lot ofpeople with atypical diabetes
who've had this confusingdiagnosis, not able to be given
one or the other, and so to themto get a genetic diagnosis that
is much more definitive andactually helps them understand
(08:16):
what's going on and thetreatment that they would be
right for is really sosatisfying and they're happy to
have that information.
David Kerr (08:27):
And what about people who think they're at risk
of that, who haven't actuallydeveloped diabetes yet?
Are you recruiting orinterested in seeing those
people as well?
Liana Billings (08:37):
Yeah, so another thing that we've done here at
Endeavor is we've worked with agenetic testing company to
develop a polygenic risk panelfor multiple diseases.
So one of the ones that I'vebeen working on is the
cardiometabolic panel, and whatit has is a type 1 diabetes, a
type 2 diabetes, chronic kidneydisease, obesity and coronary
(09:01):
artery disease polygenic riskscore, and this is available to
anyone who comes to see a doctorat Endeavor.
We order it and they may or maynot have any of those
conditions, but they can seetheir risk.
We've seen that.
You know, knowing that theyhave higher risk can change
behavior Right now.
(09:23):
It's just launched last year,so this is on a smaller scale.
But my own patients I've seen,for example of a high type 2
diabetes risk score, want acontinuous glucose monitor to
see if you know what's going onin between.
Maybe their A1C looks fine andthey probably haven't done a
two-hour glucose test, you know,because maybe it wasn't
appropriate and so they want todo a continuous glucose monitor.
(09:46):
They're more motivated to, youknow, have weight loss or
consider weight loss therapies.
In type 1 diabetes.
High polygenic risk score,we've been screening for
antibodies just to make surethat you know we're identifying
people early.
So, yeah, so it does seem tomake an impact.
It also increases the number ofreferrals and some you know
some intensification oftherapies by doctors if they
(10:08):
know the higher genetic risk.
David Kerr (10:10):
Can I just ask you one more about this?
What about everyone's worriedabout the cost of GLP-1s and
treating obesity.
Do you think, going forward, wemight get to a place where, if
someone has obesity and theyhave the, the smart thing would
be to have a polygenic riskscore assessment, because that
will lower the barrier toaccessing, perhaps, these kinds
(10:32):
of therapies?
Liana Billings (10:34):
Well, you bring up a good point.
I mean, I think with GLP-1s andthe incartan-based therapies
they're trying to find differentcategories, I guess, of people.
That where you're going to getthe most benefit.
So, for example, you knowtrisapidides approved with
obstructive sleep apnea, with orwithout diabetes, the chronic
(10:58):
kidney disease indications withsemaglutide.
You know the heart diseaseindications with multiple GLP-1.
So these other kind of benefitsthat maybe can be within people
with type 2 diabetes or withinpeople with obesity, I think the
same as with genetics.
I think we're still reallyearly but we do have data sets
with randomized clinical trialsthat if you know there were
(11:22):
biobank samples we couldactually look to see how does
that genetic risk actuallyimpact the response?
And if you know, for example,you have a very high polygenic
risk for obesity and you respondgreat, you know they can
counter your weight gain, thenthat's actually a population we
can really focus in on.
(11:42):
Or if you do not have obesityand you have a high polygenic
risk, maybe you're the person weneed to intervene on earlier.
So I think that's where we'rethinking that some of the
utility of these polygenic riskscores and knowing that genetic
risk will be.
David Klonoff (11:59):
Leanna, as you use your risk scores, do you
think it still makes sense totalk about diabetes as just
there's type 1 and there's type2 and maybe everything else is
lumped together as atypical?
Or do you think it makes moresense to start dividing up 1 and
2 and atypical into smallersubgroups and have many types of
(12:19):
diabetes that we tell ourpatients about?
Liana Billings (12:21):
Yeah, I think that brings up a really good
point and definitely a very hotarea of interest in the field.
I think anyone practicingclinical diabetes knows that
there's more than two types,which is sometimes referred to
(12:47):
as the wastebasket diagnosis,because if you don't have type 1
and you don't have monogenic,you're in the type 2 category.
But we see people who are somany different phenotypes within
type 2 diabetes responddifferently to therapies, have
different rates of complications.
So there's all sorts of effortsto cluster people into
different subtypes at least oftype 2, based on phenotype,
(13:09):
based on their genetic risk.
You know there will be moreadvanced things like proteomics
and metabolomics and otherthings that we can kind of use
to help distinguish certainsubtypes that may respond
differently to therapy and havedifferent prognoses.
So I definitely don't thinkthat there's only two types and
there are efforts.
You know, if we want to go intosome of the research efforts,
(13:29):
there's a study called RADIANTwhich is a multi-center effort
across the US that is recruitingpeople with atypical diabetes
so not clearly type 1 and notclearly type 2.
They don't fit into theclassical category and recruits
them for further evaluation tosee if there's a genetic cause
or to understand the physiologyof their diabetes better.
David Klonoff (13:53):
Leona, we are a diabetes technology society, so
I'll ask you a question abouttechnology.
How do you think thattechnology is affecting people
with diabetes?
How useful is it?
Where do you think it's going?
Liana Billings (14:08):
Well, I think continuous glucose monitors have
really revolutionized the field.
It's almost gotten to the pointwhere it's hard to practice
without one.
Very few patients I have whodon't use continuous glucose
monitors at this point, and onlya very small substance where
the glucose monitor actuallycauses more anxiety than benefit
(14:28):
, but I could think of twopeople off the top of my head
Most of the time.
These are just suchlife-changing therapies, not
only for the patient to be ableto have a safety kind of benefit
, knowing what their blood sugaris at any point in the day.
Also letting us move into theoptions of having these hybrid
(14:50):
closed-loop insulin pumps thatcan help dramatically improve
blood sugar and lower the riskof hypoglycemia, allow people to
sleep through the night,finally.
So yeah, these genetic toolsare sorry.
These technological tools arephenomenal and I'm excited to
see where they're going.
David Klonoff (15:14):
Liana, is there anything that you'd like to tell
our listeners about the futureof diabetes, where you think
this is going?
Liana Billings (15:23):
Well, I mean, I think there's.
It's actually this field is isjust growing so fast.
I mean I feel really fortunateto be a part of the diabetes
effort and initiative.
I think about 20 years ago itwas just a different story.
20, 25 years ago we had so farfewer pharmaceutical medications
(15:47):
.
Now we have a whole menu tochoose from, with benefits
beyond glycemic control, likeimproving heart disease and
chronic kidney disease andobesity and obstructive sleep
apnea, and the list will go onand on, you know eventually.
So I think that I'm so excitedto be a part of this field and
(16:10):
also looking forward in type 1diabetes to see what we can do
to help provide diseasemodifying agents that slow the
disease or prevent the disease.
I think that's definitely onthe horizon and I'm looking
forward to seeing that happen inmy career.
David Kerr (16:24):
Rihanna, I just wanted to ask you.
It struck me that when you weredescribing your work which I
think is absolutely fascinatingwe're seeing growth of type 2
diabetes, as it's called, inchildren and young people.
Now, type 2 diabetes isprobably the wrong name for it,
given what you're saying.
So I'm wondering are youinvolved?
(16:44):
I do think there's a place forthe kind of work that you're
involved in to better understandwhy we're seeing this explosion
, this terrible disease inchildren and young people, which
previously was only seen inadults terrible disease in
children and young people whichpreviously was only seen in
adults.
Liana Billings (17:07):
Yeah, I think the explosion and increase of
type 2 diabetes or, you know,non-type 1 diabetes in kids for
whatever, whatever we decide tocall it eventually but type 2
diabetes in kids ismultifactorial.
I think it has to do with,obviously, the rising rates of
obesity, the food quality thatthe kids have and whether in
schools and their homes I mean,it's so complicated why we are
(17:29):
having this increase increasedsedentary activities, video
games and TV and all that.
So TV is not even the is reallynot even the problem anymore.
So iPhones or smartphones.
So I think the cause ismultifactorial.
I think, as far as I'm concerned, my research in kids with
(17:50):
diabetes can be impactfulbecause now that we have more
than just type 1 diabetes inkids, now that we're seeing
these other forms of diabetes,it can be extremely confusing in
kids knowing what they have,especially because you might
have someone with type 1diabetes with obesity, or you
might have someone who has type2 with obesity, these other kind
(18:10):
of metabolic disturbances thatmake you think type 2, but they
may in actuality, have adifferent form of diabetes.
So I think we can employgenetics in kids.
I've actually seen children inmy personalized medicine clinic
who have these kind of ambiguousdiagnoses.
They're not sure if they havemonogenic diabetes, type one or
type two, and so we're usingthese genetic risk scores and
(18:35):
genetic testing in order tobetter define the types in
childhood, because we have tohave a diagnosis right away to
make sure that they have thebest therapy.
They'll be living with this fora long time, so it's so
important in childhood.
David Klonoff (18:50):
Well, hannah, your research is helping many
people with diabetes and, onbehalf of David and myself, we
would like to thank you fortaking the time out of your
research work so that we couldinterview you.
This interview will beavailable at the Apple podcast
and on Spotify and at theDiabetes Technology Society
website For our listeners.
(19:11):
Stay tuned for our next podcastand it's now time to say
goodbye and we will talk to youlater.
Bye, bye, thank you very much,bye, bye.
Liana Billings (19:23):
Thank you.
Thank you for having me.
Hello, welcome to Diabetes Technology Report.
I'm David Klonoff, I'm atSutter Health and we have a very
special guest today Health andwe have a very special guest
today.
I'm going to introduce myco-host, dr David Kerr, and he
will introduce her and start theinterview.
David Kerr (00:30):
David, Thanks very much, david, and welcome to
everyone.
I'm David Kerr.
As usual, I'm speaking to youfrom Santa Barbara, california,
and it's great we have LeannaBillings on today, who is an
authority, an expert, on certainaspects of diabetes.
So come to that.
So, leanna, welcome, it'sfantastic to have you on board
(00:51):
today.
One of the things we like toask to set the scene really is
how did you end up beinginterested in diabetes?
Our audience is very curiousabout that.
Liana Billings (01:03):
Yeah, well, it's been an evolution, Fortunately,
when I was in undergrad I hadthe experience in working in an
epidemiology lab at Universityof Illinois in Chicago and we
were interested in looking atsome of the social and economic
factors that impacted type 1diabetes control in kids in
(01:27):
Chicago.
It was very eye-opening to me.
At that point I was a lowly labmember and I did a lot of data
collection that were based offof interviews with families, but
I was really able to kind ofsee right into the homes and
into the life of people livingwith type 1 diabetes and
realizing, you know really, thesignificant challenges that they
(01:49):
face every day in trying tocontrol blood sugar but also
trying to deal with gettingmedical supplies and medical
care and other things related tothe condition.
So that piqued my interest andthen I went on to continue to do
research, be interested in type2 diabetes because it's
affected my family members.
(02:10):
And then, when I was anendocrine fellow at Mass General
, I was fortunate to work in adiabetes genetics lab where I
was further excited about reallykind of, you know, honing in on
the field of diabetes and that,yeah, now it's evolved into a
field that I feel reallypassionate about and I feel when
(02:33):
I'm with my patients who havetype 1 and type 2 and other
atypical forms of diabetes, Ifeel really inspired by them and
the medical condition and whatthey actually fight through
every day to be able to live afull life with this condition.
David Kerr (02:50):
Excellent.
So you're driven, you have apassion, so can you give us,
like a thumbnail, sketch of thecore research that you're
involved in at the moment?
Liana Billings (03:01):
Yeah Well, our research is kind of two-sided.
One side is runningindustry-sponsored clinical
trials and we run clinicaltrials in type 1 diabetes, type
2, and other cardiometabolicconditions, particularly in type
2 and type 1,.
We're investigating newpharmaceutical medications that
can be used for treatment and weare also using new pumps and
(03:25):
monitoring devices, exploringthose and research to try to
find, you know, really gettingbetter and better at treating
and managing diabetes.
And the other side the otherhat I wear is running a genetics
research lab where we're veryinterested in using genetics to
help differentiate diabetes typeand exploring how do we
(03:47):
implement that into the clinicalsetting.
David Klonoff (03:51):
Liena.
Where do you think is thegreatest value in genetics for
people with diabetes?
Why would a person withdiabetes want to know about
their genetics?
Liana Billings (04:02):
Yeah, that's a good question.
I think lots of reasons.
I don't think there's just oneanswer.
I think genetics can be usedfor preventative efforts, so if
people know their risk, they canintervene early with prevention
.
As far as diagnosis, I think andthis is what we're exploring a
lot is we believe we can reallyuse genetics to help make a more
(04:26):
accurate diagnosis.
So, whether that's monogenicdiabetes, whether that's type 1
diabetes or type 2 diabetes,there are tools that we can use
with genetics that can helprefine the diagnosis and make
sure it's right from the start,and then you know.
Lastly, it can inform therapy.
So, lastly, it can informtherapy.
So a very kind of clear exampleis where we can use certain
(04:49):
medications, such as in MODYmonogenic or maturity-onset
diabetes of the young wherecertain genetic forms of that
MODY, like HNF1A or HNF4A MODY,can be treated with
sulfonylureas, which can be veryeffective in many people.
And I have stories where I'vetaken people off of insulin
who've been on insulin years andyears and years and now can
(05:11):
actually take a pill.
So these are life-changingdiagnoses that use genetics to
make that impact.
David Klonoff (05:19):
Leanna, do you keep track of your patients in a
large database and do you workwith others in building the
database?
Liana Billings (05:29):
Yeah, so we have a couple of different data sets
.
So we do have a database whereit's linked to a clinical effort
that I started about 10 yearsago.
So we at Endeavor started thediabetes consultation or
personalized medicine anddiabetes consultation clinic
(05:49):
here.
It's aimed to have a placewhere people can get genetic
testing because historicallythis has been kind of a barrier
there.
So we have streamlined theprocess to where people come in
with atypical diabetes.
I evaluate them, we discusswhether genetic testing would be
appropriate.
(06:10):
I've pretty much been able toget everyone genetic testing
because you know, we know how towork with insurance.
We also have a reasonableout-of-pocket price and we
actually have kind of homegrownour own genetic panel with
monogenic genes, type 1 and type2 diabetes polygenic risk
scores and a genetic probabilityrisk that we assess using the
(06:34):
T1D and T2D polygenic riskscores, so that patient
population I've accrued over theyears is actually part of a
bigger data set.
And then we also have here atEndeavor something called the
Genomics Health Initiative,which is a biorepository where
anyone coming to our healthsystem can enroll in the
(06:56):
Genomics Health Initiative andwe are able to examine how
genetic factors are associatedwith their disease conditions or
their prospectively how they doas far as their risk of disease
and so on.
So those are a couple of datasets that we have locally at
Endeavor.
David Kerr (07:16):
Diana, I'm intrigued here.
Are you finding that people arewilling and able and really up
for having their geneticsmeasured, or are there still a
group of people who are kind ofgoing well, I'm not quite sure
about this because there'snothing I can do about my
genetics.
And what's your generalperception?
Liana Billings (07:33):
I think it's a mix, you know it's interesting.
I would say that, at least frommy experience, people are more
enthusiastic than not.
There definitely are those thatare more scared.
I guess they're more hesitantto kind of know that risk.
But most are really curious.
They want to know more aboutthemselves.
They want to know how the bookwas written and why they're
(07:55):
seeing things.
So I would say the uptake isthey're pretty enthusiastic.
Also, I tend to see a lot ofpeople with atypical diabetes
who've had this confusingdiagnosis, not able to be given
one or the other, and so to themto get a genetic diagnosis that
is much more definitive andactually helps them understand
(08:16):
what's going on and thetreatment that they would be
right for is really sosatisfying and they're happy to
have that information.
David Kerr (08:27):
And what about people who think they're at risk
of that, who haven't actuallydeveloped diabetes yet?
Are you recruiting orinterested in seeing those
people as well?
Liana Billings (08:37):
Yeah, so another thing that we've done here at
Endeavor is we've worked with agenetic testing company to
develop a polygenic risk panelfor multiple diseases.
So one of the ones that I'vebeen working on is the
cardiometabolic panel, and whatit has is a type 1 diabetes, a
type 2 diabetes, chronic kidneydisease, obesity and coronary
(09:01):
artery disease polygenic riskscore, and this is available to
anyone who comes to see a doctorat Endeavor.
We order it and they may or maynot have any of those
conditions, but they can seetheir risk.
We've seen that.
You know, knowing that theyhave higher risk can change
behavior Right now.
(09:23):
It's just launched last year,so this is on a smaller scale.
But my own patients I've seen,for example of a high type 2
diabetes risk score, want acontinuous glucose monitor to
see if you know what's going onin between.
Maybe their A1C looks fine andthey probably haven't done a
two-hour glucose test, you know,because maybe it wasn't
appropriate and so they want todo a continuous glucose monitor.
(09:46):
They're more motivated to, youknow, have weight loss or
consider weight loss therapies.
In type 1 diabetes.
High polygenic risk score,we've been screening for
antibodies just to make surethat you know we're identifying
people early.
So, yeah, so it does seem tomake an impact.
It also increases the number ofreferrals and some you know
some intensification oftherapies by doctors if they
(10:08):
know the higher genetic risk.
David Kerr (10:10):
Can I just ask you one more about this?
What about everyone's worriedabout the cost of GLP-1s and
treating obesity.
Do you think, going forward, wemight get to a place where, if
someone has obesity and theyhave the, the smart thing would
be to have a polygenic riskscore assessment, because that
will lower the barrier toaccessing, perhaps, these kinds
(10:32):
of therapies?
Liana Billings (10:34):
Well, you bring up a good point.
I mean, I think with GLP-1s andthe incartan-based therapies
they're trying to find differentcategories, I guess, of people.
That where you're going to getthe most benefit.
So, for example, you knowtrisapidides approved with
obstructive sleep apnea, with orwithout diabetes, the chronic
(10:58):
kidney disease indications withsemaglutide.
You know the heart diseaseindications with multiple GLP-1.
So these other kind of benefitsthat maybe can be within people
with type 2 diabetes or withinpeople with obesity, I think the
same as with genetics.
I think we're still reallyearly but we do have data sets
with randomized clinical trialsthat if you know there were
(11:22):
biobank samples we couldactually look to see how does
that genetic risk actuallyimpact the response?
And if you know, for example,you have a very high polygenic
risk for obesity and you respondgreat, you know they can
counter your weight gain, thenthat's actually a population we
can really focus in on.
(11:42):
Or if you do not have obesityand you have a high polygenic
risk, maybe you're the person weneed to intervene on earlier.
So I think that's where we'rethinking that some of the
utility of these polygenic riskscores and knowing that genetic
risk will be.
David Klonoff (11:59):
Leanna, as you use your risk scores, do you
think it still makes sense totalk about diabetes as just
there's type 1 and there's type2 and maybe everything else is
lumped together as atypical?
Or do you think it makes moresense to start dividing up 1 and
2 and atypical into smallersubgroups and have many types of
(12:19):
diabetes that we tell ourpatients about?
Liana Billings (12:21):
Yeah, I think that brings up a really good
point and definitely a very hotarea of interest in the field.
I think anyone practicingclinical diabetes knows that
there's more than two types,which is sometimes referred to
(12:47):
as the wastebasket diagnosis,because if you don't have type 1
and you don't have monogenic,you're in the type 2 category.
But we see people who are somany different phenotypes within
type 2 diabetes responddifferently to therapies, have
different rates of complications.
So there's all sorts of effortsto cluster people into
different subtypes at least oftype 2, based on phenotype,
(13:09):
based on their genetic risk.
You know there will be moreadvanced things like proteomics
and metabolomics and otherthings that we can kind of use
to help distinguish certainsubtypes that may respond
differently to therapy and havedifferent prognoses.
So I definitely don't thinkthat there's only two types and
there are efforts.
You know, if we want to go intosome of the research efforts,
(13:29):
there's a study called RADIANTwhich is a multi-center effort
across the US that is recruitingpeople with atypical diabetes
so not clearly type 1 and notclearly type 2.
They don't fit into theclassical category and recruits
them for further evaluation tosee if there's a genetic cause
or to understand the physiologyof their diabetes better.
David Klonoff (13:53):
Leona, we are a diabetes technology society, so
I'll ask you a question abouttechnology.
How do you think thattechnology is affecting people
with diabetes?
How useful is it?
Where do you think it's going?
Liana Billings (14:08):
Well, I think continuous glucose monitors have
really revolutionized the field.
It's almost gotten to the pointwhere it's hard to practice
without one.
Very few patients I have whodon't use continuous glucose
monitors at this point, and onlya very small substance where
the glucose monitor actuallycauses more anxiety than benefit
(14:28):
, but I could think of twopeople off the top of my head
Most of the time.
These are just suchlife-changing therapies, not
only for the patient to be ableto have a safety kind of benefit
, knowing what their blood sugaris at any point in the day.
Also letting us move into theoptions of having these hybrid
(14:50):
closed-loop insulin pumps thatcan help dramatically improve
blood sugar and lower the riskof hypoglycemia, allow people to
sleep through the night,finally.
So yeah, these genetic toolsare sorry.
These technological tools arephenomenal and I'm excited to
see where they're going.
David Klonoff (15:14):
Liana, is there anything that you'd like to tell
our listeners about the futureof diabetes, where you think
this is going?
Liana Billings (15:23):
Well, I mean, I think there's.
It's actually this field is isjust growing so fast.
I mean I feel really fortunateto be a part of the diabetes
effort and initiative.
I think about 20 years ago itwas just a different story.
20, 25 years ago we had so farfewer pharmaceutical medications
(15:47):
.
Now we have a whole menu tochoose from, with benefits
beyond glycemic control, likeimproving heart disease and
chronic kidney disease andobesity and obstructive sleep
apnea, and the list will go onand on, you know eventually.
So I think that I'm so excitedto be a part of this field and
(16:10):
also looking forward in type 1diabetes to see what we can do
to help provide diseasemodifying agents that slow the
disease or prevent the disease.
I think that's definitely onthe horizon and I'm looking
forward to seeing that happen inmy career.
David Kerr (16:24):
Rihanna, I just wanted to ask you.
It struck me that when you weredescribing your work which I
think is absolutely fascinatingwe're seeing growth of type 2
diabetes, as it's called, inchildren and young people.
Now, type 2 diabetes isprobably the wrong name for it,
given what you're saying.
So I'm wondering are youinvolved?
(16:44):
I do think there's a place forthe kind of work that you're
involved in to better understandwhy we're seeing this explosion
, this terrible disease inchildren and young people, which
previously was only seen inadults terrible disease in
children and young people whichpreviously was only seen in
adults.
Liana Billings (17:07):
Yeah, I think the explosion and increase of
type 2 diabetes or, you know,non-type 1 diabetes in kids for
whatever, whatever we decide tocall it eventually but type 2
diabetes in kids ismultifactorial.
I think it has to do with,obviously, the rising rates of
obesity, the food quality thatthe kids have and whether in
schools and their homes I mean,it's so complicated why we are
(17:29):
having this increase increasedsedentary activities, video
games and TV and all that.
So TV is not even the is reallynot even the problem anymore.
So iPhones or smartphones.
So I think the cause ismultifactorial.
I think, as far as I'm concerned, my research in kids with
(17:50):
diabetes can be impactfulbecause now that we have more
than just type 1 diabetes inkids, now that we're seeing
these other forms of diabetes,it can be extremely confusing in
kids knowing what they have,especially because you might
have someone with type 1diabetes with obesity, or you
might have someone who has type2 with obesity, these other kind
(18:10):
of metabolic disturbances thatmake you think type 2, but they
may in actuality, have adifferent form of diabetes.
So I think we can employgenetics in kids.
I've actually seen children inmy personalized medicine clinic
who have these kind of ambiguousdiagnoses.
They're not sure if they havemonogenic diabetes, type one or
type two, and so we're usingthese genetic risk scores and
(18:35):
genetic testing in order tobetter define the types in
childhood, because we have tohave a diagnosis right away to
make sure that they have thebest therapy.
They'll be living with this fora long time, so it's so
important in childhood.
David Klonoff (18:50):
Well, hannah, your research is helping many
people with diabetes and, onbehalf of David and myself, we
would like to thank you fortaking the time out of your
research work so that we couldinterview you.
This interview will beavailable at the Apple podcast
and on Spotify and at theDiabetes Technology Society
website For our listeners.
(19:11):
Stay tuned for our next podcastand it's now time to say
goodbye and we will talk to youlater.
Bye, bye, thank you very much,bye, bye.
Liana Billings (19:23):
Thank you.
Thank you for having me.
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