diaTribe/Close Concerns and TCOYD Co-Host Sixth Annual Diabetes Forum at ADA

To mark the end of this month’s 72nd American Diabetes Association (ADA) Scientific Sessions in Philadelphia (see conference pearls in this issue), diaTribe editor in chief Kelly Close and Taking Control of Your Diabetes (TCOYD) founder and director Dr. Steven Edelman hosted the Sixth Annual Diabetes Forum. The lively panel discussion featured Drs. Julio Rosenstock (Dallas Diabetes & Endocrine Center, Dallas, TX); Lori Laffel (Joslin Diabetes Center, Boston, MA); James R. Gavin III (Emory University School of Medicine, Atlanta, GA); William Cefalu (Louisiana State University School of Medicine, New Orleans, LA); and Dr. John Buse (University of North Carolina School of Medicine, Chapel Hill, NC).

The panel reviewed the newly announced ADA/EASD position statement on the treatment of type 2 diabetes, which advocates for an individualized, patient-centered approach to therapy (see from the editor in diaTribe #43). Declaring this “a very rational approach,” Dr. Cefalu praised the statement for allowing the “physician to look at the patient and choose the medication that’s most appropriate at that time – I don’t think you can pencil a patient into a diagram.” Dr. Gavin called it “a more robust toolbox than the previous version.” But he also pointed out, “There’s little that you can do to hold the hands with PCPs to guide them through the decision process.” To this point, Kelly Close observed that primary care providers might find it hard to personalize and individualize therapy, given the wide array of choices.

Regarding the statement’s call for expanded patient involvement, Dr. Buse observed that in his practice, about 80% of patients do well, while 20% “have psychosocial problems” that present challenges. Dr. Laffel argued that “there’s no such thing as a bad patient – they’re fighting a bad disease.” While the panel was generally realistic about the challenges of actually implementing the recommendations of the position statement, they were in general agreement that this more patient-centered approach was the best way forward.

The results of the ORIGIN trial were also a major topic of the discussion (see conference pearls in this issue for more on its design and results ). Dr. Rosenstock was the most positive on the outcome, while most other panelists were far less enthusiastic. Overall, most felt ORIGIN was an interesting study but would not likely change the treatment of prediabetes or type 2 diabetes.

The evening closed with a discussion on the very real challenges of attracting the best and brightest to endocrinology, with Dr. Edelman declaring a “serious lack of young folks” in the field. The panel attributed this to the lack of time given to endocrinology in medical school – Dr. Rosenstock estimated only three hours are spent on the topic throughout all of medical school – as well as the lack of interest in clinical research, the rejection of grants, and the reduced earning potential for endocrinologists relative to other medical specialties. As the number of people with diabetes grows, we certainly hope this changes in the coming years. –AW