Osagie Ebekozien on Technology, Equity, and Collaboration in Type 1 Diabetes Care

An interview on technology, equity, and collaboration in type 1 diabetes care with Osagie Ebekozien, MD, MPH, CPHQ, Executive Vice President and Chief Medical Officer of T1D Exchange.

Episode Transcript

David Klonoff (00:03):
Welcome to Diabetes Technology Report,
co-hosted by endocrinologistDavid Klonoff from UCSF and
David Kerr from Sutter Health.
Welcome to Diabetes TechnologyReport.
This is the first DiabetesTechnology Podcast on this topic
.
I'm David Klonoff.
I'm an endocrinologist atSutter Health and UCSF.

(00:26):
We have a special guest today,Osagie Ebiskozian, and my
co-host, David Kerr, willintroduce him.

David Kerr (00:35):
Thank you, david.
I'm David Kerr.
I'm speaking to you from SantaBarbara, california.
I'm also a senior investigatorwith Sutter Health.
I am so pleased to welcomeOsagie today.
I've known him for a number ofyears.
He and I have actuallyco-authored a recent manuscript
looking at the digital divide.
But, osagie, for our listeners,how did you get into diabetes

(00:59):
and how did you end up with theType 1 Diabetes Exchange being
its supreme leader?

Osagie Ebekozien (01:07):
you end up with the Type 1 Diabetes
Exchange being its supremeleader.
Well, thank you.
I appreciate the pleasure andreal honor to be joining both of
you today, and I'm a fan of thepodcast, I should say.
I got a chance to listen toAnpita's episode and Bob Gabay's
episode and I hope that I'll beable to share some of my own
reflections as well today.
So you know, I'm based here inBoston and I've been in Boston

(01:28):
now for the past 15 years or so.
I trained as a primary carephysician and been practicing as
a family care physician caringfor people with diabetes, and
then in 2012, I got anopportunity to get involved in
community-based diabetes care ata federal qualified health
center in Boston.

(01:48):
You know, one of the earlyprojects then were funded by
Kresge Foundation to reallythink about how do we create a
wellness program for peopleliving with type 2 diabetes, and
particularly it was forAfrican-American women in type 2
diabetes living in publichousing units in Boston.
So that's really where myinterest in population health

(02:11):
diabetes care really startedfrom.
So I started to transition fromseeing patients in clinic to
really start thinking about thebroader population and how can
we make an impact there.
So did that work 2012,.
A lot of insights into healthequity, population health,
really thinking more holisticabout what happens outside of

(02:33):
the clinic.
And then went on to work forthe city of Boston really
playing a role, serving as headof population health, thinking
about type 2 diabetes, obesityand all of those insights.
And then in 2017, 2018 was whereI got the opportunity to get

(02:53):
involved with 2-1-D Exchange.
2-1-d Exchange back then in2017 was thinking a lot more
around the population healthspace for type 1 diabetes and
I've had all that experiencewith type 2 diabetes, working in
the primary care center,working at Boston Medical Center
, working for the city's publichealth department, and I had the
chance to be able to getinvolved and really start to

(03:15):
help the organization thinkabout how do you bring that same
lens of population health in atype 1 space.
So I find myself really, reallylucky to be where I am now and
my role as the Chief Med CorpsOfficer of 2-1-D Exchange.
I am overseeing our work with62 type 1 diabetes centers in 22
states and 10 type 2 diabetescenters across five states as

(03:39):
well.
So we're doing a lot of workand I'm more than happy to speak
about it.
But I think one key thing isthe power of collaboration,
which is some of the things thathave been the thread in the
last 15 years of my career indiabetes.

David Kerr (03:55):
So, just in a simple couple of sentences what's the
state of play for type 1diabetes in the United States
now?
What's working well and what'smissing?
What do we still need to do?

Osagie Ebekozien (04:08):
I love that question.
You know there's a very popular2-1-D exchange paper in 2019
that my colleagues Nicole Foster, kelly Miller from the JIP
Center put out.
In the show that outcomes A1Coutcomes were getting worse from
2010, 2012 to 2019.
And that paper was sort of likea landmark paper and a shock

(04:31):
for the diabetes system andfolks were like wow, like I
can't believe in the last eightyears with all of this great
insight, all of the newtechnology we already had CGMs
then, we already had pumps thenthat those outcomes were getting
worse.
Now we had a paper, a follow-uppaper, similar methodology,

(04:51):
similar pattern, where we lookedat new kinds of data and this
is data from the clinics nowthat are engaged in
collaboration, in data sharingand a whole population, not just
people that were involved withclinical research prior to the
exchange model.
And the new paper shows thatoutcomes are getting better.
We also published that in thesame journal, like we did in the

(05:14):
last time DTT, so that paperwas in 2023.
Last year we showed thatoutcomes were getting better for
more than 40,000 patients withtype 1 diabetes.
So similar kind of trend curvebut more importantly, mini-1c
outcomes going down, decay ratesgoing down, severe hypoglycemia
going down.
So that's what we're excitedabout.

(05:37):
So we're excited that outcomesare getting better.
The state of type 1 diabetes isimproving and the recent 2-1D
exchange data is showing thattype 1 diabetes is improving and
the recent 2-1D exchange datais showing that type 1 diabetes
is improving.
However, there's still moreroom for us to go, and when we
compare our outcomes with thatof some of our friends across
the pond and I'm looking atDavid on the screen, I'm looking

(06:00):
at our friends in England, mpdaI'm looking at our friends in
Germany, I'm looking at ourfriends in Australia Even though
outcomes in the US, with 2-1-Dexchange and other networks, are
showing that things are gettingbetter, we still see that
there's room for us to evendrive that improvement further.
So the state of type 1 diabetesis improving, but we still have

(06:23):
some routes to go and we'reexcited to go along that journey
as well.

David Klonoff (06:28):
Osagie, what do you think are some areas where
we could improve care for thepopulation of folks with type 1?

Osagie Ebekozien (06:35):
One big piece is equity, and I think about
equity very broadly.
You know, one of the thingsthat we can do better in the US,
as compared to some of ourother counterparts across the
pond, is who has access to someof these exciting and innovative
technologies and therapies.

(06:55):
Let's pick CGMs, for example,or sensor-augmented pumps, or
hybrid closed-loop systems.
We've shown and we've publishedextensively that in all of
those systems we're seeing hugegaps, not just by race or
ethnicity, but also by insurance, and we're seeing how insurance

(07:15):
is really driving some of theseequity gaps.
And that's where we need tothink about how do we have a
more holistic approach to accessto these technologies.
How do we work with Medicare,medicaid to ensure that people
with diabetes on publicinsurance have very similar
access, and we're not dealingwith under insurance or dealing

(07:38):
with the challenges of co-paysor the education or some of that
that comes to the technologyaccess.
So that's one key piece I thinkwe can do better as a society,
as a system, is think about howdo we close gaps in who has
access to some of the greattools we have now.

(08:01):
The second protein is we need tothink about how do we move away
from competition across ourhealth systems to collaboration,
across our health systems tocollaboration.
And when you think about thework that is happening in a very
innovative space, it needs togo beyond just individual unique

(08:22):
institutions or even individualunique roles.
You know we're blessed with alot of great talent, but when
you bring all that talenttogether, when you bring all of
those resources together, whenyou bring the great insights
that is happening at SutterHealth to what's happening at
UCSF, to Mount Sinai, to Ready,you combine all of that, there's

(08:45):
a broader power, there's abigger input which we can
harness from all of thatcollaboration.
So I think we can do thatbetter.
I think we can be better insharing insights across health
systems.
I think we can be better inpromoting collaboration as
opposed to competition forcommercial market share.

(09:08):
So those two things are top ofmind.
First is close equity gaps.
Make things more available.
That makes technology moreaccessible.
Promote collaboration andcooperation and communication,
because so that best practiceshappening across the country get
spread and people can adaptthose really quickly and not

(09:28):
have to reinvent the wheelacross.

David Klonoff (09:30):
All of our different systems can adapt
those really quickly and nothave to reinvent the wheel
across all of our differentsystems.
Those are two good points.
What's been your success whenyou talk to payers about closing
these gaps?

Osagie Ebekozien (09:42):
The first piece is they go from a state of
sometimes denial then move onto oh, maybe there are some of
those gaps.
Let's look at our data to aplace of this is exactly what we
can do to address that.
So I'll give an example weworked with some of our partners

(10:03):
in the Ohio Medicaid officesand also in Texas Medicaid
offices really looking at how dowe close gaps for access to CGM
for people in public insurance,and our role was really to be
able to share some of this datathat I referenced on.
Look at CGM outcomes, look atCGM access first for people in

(10:27):
public insurance in that state,compare that to people in
private insurance and you seethat huge gap.
And then start havingconversations with them on.
They have a role to play.
And the next question becomeswell, what can they do
differently?
And one of the things we'rebeing very critical in alighting
and amplifying is you can lookat your policies, your internal

(10:50):
policies, your internalprocedures, and think about how
some of the boarding, theadministrative boarding, how
some of the requirements of,well, you need to have glucose
checks or you need to haveevidence of DKA or you need to
have severe hypoglycemia or anyof some of the other
administrative criteria.

(11:13):
A lot of those things now get inthe way of that access.
So our work we're talking witha lot of the public, you know
Medicaid offices it's really toamplify the role of each of
those policies and the role ofsome of the administrative
burden.
It's beyond just this Medicaidcoverage for CGM or for insulin

(11:36):
pumps or for AID systems.
It's what else do you have todo to get that in the hands of
people that need it and whatpaperwork or hoops do they have
to run through?
How do you reduce a lot of that?
And that's where we start tosee the magic happen and we're

(11:57):
really excited that we've hadreceptive ears over the years to
work with partners on theground to push some of these
conversations forward.

David Kerr (12:02):
So, osange, we are presenting some data at the
American Diabetes, where welooked at the proportion of
people with type 1 using hybridclosed-loop systems.
Have you got a figure for whatit is at the T1D exchange at the
moment and where you think itshould be in, say, two years?

Osagie Ebekozien (12:24):
Yeah, so at the moment it's somewhere
ranging from 25 to 35% for whatwe're seeing in the data.
My prediction is in the nexttwo, three years we should get
closer to 60, 70%, and I thinkthat's going to happen very
naturally too, with even a lotof industry partners.

(12:45):
You know, onboarding newerpatients with type 1 diabetes on
the AID system at diagnosis.
I think that's one of thepremise of this system.
So in my personal opinion it'sthat we should start newly
diagnosed with AIDs and get thatto the hands of people.

(13:06):
Then I also feel that, as someof the patients with type 1 or
sensor-augmented pumps rollingover or renewing their plants,
all of that transition to movingthem from the prior legacy
systems to the newer systems, Ithink all of that naturally to
happen.
And then I think there's a lotof room for us to think about

(13:28):
some of the local systembarriers and local system
policies and practices as itrelates to who gets to be on AID
and who doesn't, so avoid biasin how that's being recommended
or prescribed.
So I feel very bullish.

David Klonoff (13:43):
I have one last question for you, Since you are
the chief medical officer at T1DExchange.
What are your plans and whatare the goals of this
organization at the current time?

Osagie Ebekozien (13:55):
We are very, very focused on improving
outcomes and less focused onimproving outcomes.
Now we're expanding the numberof centers we're working with
and we're expanding the impactof that.
So our first big piece isreally driving continue to drive
improvement in outcomes andexpand on that.
The second piece is we're inthe type 2 space with the intent

(14:21):
of learning from what's alsohappening for people with type 2
diabetes how that can beapplied to improve lives for
type 1 diabetes as well.
So we see a synergisticrelationship between type 1 and
type 2, and we want to make surewe're able to tap into both
worlds to really amplify that.
And then the third piece iswe're committed to reducing gaps

(14:44):
in care and we're workingextensively with many partners
to close equity gaps withinsurance, race and ethnicity
and language, and those are someof the key things that keeps us
going in the morning.

David Klonoff (14:57):
Osagie, thank you very much for joining us today
on Diabetes Technology Report.
On behalf of my co-host, drDavid Kerr, I would like to
thank you and invite thelisteners to attend our next
Diabetes Technology Report.
This podcast is available onSpotify, at the Apple Store and
at the Diabetes TechnologySociety website.

(15:20):
So until our next podcast.
Goodbye everybody.

David Kerr (15:24):
Thank you very much.