Our Chief Medical Officer has diabetes and a child with diabetes.
We talk with Todd Hobbs, vice president and chief medical officer for Novo Nordisk in North America. Todd brings a unique perspective to his job title – he was diagnosed with type 1 diabetes nearly 30 years ago and one of his sons has been a type 1 since the age of 5.
In this first of a series of posts with Dr. Hobbs, he digs into what he believes innovation in diabetes means.
Q1: As a diabetes patient, provider, Chief Medical Officer, and also a parent of a child with diabetes, you bring so many different perspectives to the table. What does innovation in diabetes care mean to you?
Because I live with diabetes each day, I can easily put myself in the shoes of the patient. When we’re talking about innovation, I don’t think about the science alone. I look at what this will practically mean to patients on a daily basis. In 2017 and beyond, I think of innovation in diabetes as coupling the advances obtained from new medications along with the explosion in digital technology, allowing individualized care for all patients with diabetes to become a reality.
Q2: In the next 10 years, where do you see diabetes innovation heading?
We have a lot of near-term opportunities to increase innovation in both type 1 and type 2 diabetes. These advances will look very different but the overall success for each will be dependent on how easily these new innovations can be adapted by patients.
Currently there is still a lot to learn about the underlying process in how patients develop type 1 diabetes. I think we have recently seen advancements in glucose sensors as well as pump technology that will allow for a fully automated closed-loop (artificial pancreas) system within the next few years. Clearly our research in this area as well as development of improved or faster insulin will help drive this innovation. In more of the 5-10 year range, advances such as islet cell encapsulation, immune modulation of the process that triggers type 1 diabetes, and glucose-responsive insulin can move closer to becoming a reality.
Innovation in type 2 diabetes may look a little different. Because type 2 diabetes is such a multifaceted disease process, highly influenced by the patient’s own lifestyle and other comorbidities, we have to be innovative in how we think of improvements to the treatment of this disease. Certainly advances such as a possible weekly incretin and oral GLP-1 agents will allow for significant numbers of type 2 diabetes patients to reach treatment targets, but these therapeutic advancements must be coupled with the necessary tools to educate and motivate both patients and providers so they can achieve the best outcomes possible. Innovation here can be around understanding a patient’s specific barriers to treatment, truly understanding their mindset and why some don’t actively participate in their care and others do. And what roles can we as a company play? Our efforts need to be centered on earlier diagnosis and treatment of type 2 diabetes, and also improving adherence to therapies once patients are diagnosed.
Q3: The diabetes scientific community has made so many clinical advances in diabetes treatments in the last 20 years – where do we still need to improve?
I’ll go back to adherence here. I think it’s safe to say that patients have a strong selection of diabetes medications they can choose from. Yet, adherence remains a profound problem. As an example, we know primary care physicians are not using GLP-1 agents as often as they should for type 2 patients, and that once initiated on either GLP-1 agents or insulin, many type 2 patients do not stay on these therapies for very long. We have to do more to understand the reasons behind this, and to work hard so that patients can benefit from these remarkable therapies and the ones to come in the near future.
Q4: What’s your take on technology when it comes to personalizing diabetes treatment?
I’d sum it up with that word ‘personalization.’ There is a very wide range of acceptance in use of technology for diabetes care. Acceptance varies by generation obviously, but also by type of diabetes, whether patients are taking insulin or not, and certainly by their overall engagement in the use of smart phones and aps on a regular basis. Some people welcome technology and others simply don’t embrace it. What we’ve got to continue to focus on is how to use multiple methods to reach patients either with high or low tech options, in order to meet their individual needs and preferences.
Q5: If you had unlimited funding to put toward diabetes research, what would you use the money for and why?
Certainly I would immediately invest more in those areas mentioned above for type 1 diabetes, as I do think we are on the cusp of finding a truly radical advancement for this disease in the way of prevention or accelerating the efforts around closed-loop systems or islet cell transplants, etc.
For type 2 diabetes, hands down, I’d direct the majority of the funding toward educational efforts. If we’re ever going to make a dent in type 2 diabetes, we have to prevent it. This starts with tackling issues such as childhood obesity, access to healthy foods, and encouraging a healthy lifestyle for those families at risk for developing diabetes. We can continue to invest in all facets of R & D for innovative diabetes medications, but it’s just as important to put this same level of effort and rigor toward prevention. This is the only way I think we will make a lasting impact.
I do think it is important for me to embrace this mentality personally as well. I am sure patients are frustrated to be told by their providers to make improvements in their lifestyle and yet see their own providers not follow this advice. Granted, nobody is perfect, but I believe I need to set a good example even now for those who may look to me for advice on living with diabetes, especially my very own son and other friends and family members.