Debates in Type 1 Diabetes – what is the future of diabetes technology and what is a “cure?” Our interview with David Panzirer and Dana Ball
by Adam Brown, Hannah Deming, Nancy Liu, and Kelly Close
twitter summary: The biggest debates in diabetes – technology, debates and the “cure”. Find out more from the influential duo in our HCT interview.
short summary: We had a wide-ranging interview with two of the pioneers of the Helmsley Charitable Trust’s (HCT) Type 1 Diabetes (T1D) program (which gives $50 million a year to type 1 research, treatment, and services): HCT trustee David Panzirer, and patient advocate (and now T1D CEO) Dana Ball. In part three of our interview, David and Dana share insights on one of the biggest debates in type 1 diabetes – what is the future of diabetes technology, what is a “cure”, and more. Read on and please stay tuned for the last two installments in our five-part series:
Part 3. Debates in Diabetes: Technology, Debates, and the “Cure”
Part 4. The T1D Exchange: A story of David and Dana’s drive to accelerate innovative type 1 diabetes research.
Part 5. What can diabetes advocates learn from successes of the HIV/AIDs movement?
KELLY: The Helmsley Charitable Trust’s (HCT) T1D Program has a major focus on technology. How did that start?
DAVID: It became clear to us early on that the cure wasn’t around the corner and we needed to provide better care for people today. It was also obvious to us that technology was the way to do so.
DANA: David drove the technology interest and he helped me understand the importance of devices. Whenever I came to New York for work, I’d stay at his house, which provided a real understanding of what it means to have a child with type 1 diabetes.
The devices should be smarter, and if they were, they could actually relieve some of burden for families and people with type 1 diabetes. This is the future.
The most surprising thing to me was the family impact of having a child with type 1 diabetes; not the impact on his daughter. The devices should be smarter, and if they were, they could actually relieve some of burden for families and people with type 1 diabetes. This is the future.
ADAM: How can HCT help get more patients on diabetes technology? What are the biggest barriers?
DAVID: We need the help of the entire community and organizations like yours. We need a huge campaign that shows these new devices can actually ease the burden and make type 1 diabetes more manageable. The more people that use the devices, the more of an incentive there is for companies to innovate.
DANA: Glycemic control is challenging and this is a 24/7 problem. I think we also need to work on awareness for clinicians, especially primary care providers who see adult type 1s. If physicians aren’t educated and supporting we won’t make progress.
DEBATES IN DIABETES
KELLY: Will an artificial pancreas be approved in the US?
DAVID: I do not believe a fully automated artificial pancreas is attainable. That being said, I do believe we can improve dramatically what is being done today. I don’t think you can ever completely remove the person with type 1 diabetes out of the equation. I believe the issues are more the companies than the FDA. We need the companies to step forward and commit resources towards insulin automation.
DANA: When it’s ready to go, I think it will be approved. My new worry is what is the cost, will payers cover the device, and how high will the financial burden be on patients? I think our healthcare system is under financial pressure and payers have shared they are looking for superior solutions at no additional cost – they say, “no new money.” This is going to be tough as we prepare to bring new solutions forward and the community needs to work together to prepare accordingly. Patients have to become aware that they will have a big role in the near future when challenges arise.
ADAM: What do you think about a glucagon/insulin vs. an insulin-only artificial pancreas?
DAVID: I believe in the dual hormone approach because I have seen a lot of Dr. Ed Damiano’s work and results, and it more closely mimics the body’s natural functions. As I have heard some say, insulin alone is like driving a car without the brake pedal. [Editor’s note: To learn more about Dr. Damiano’s work on a dual hormone approach in the bionic pancreas, please read our test drive on the Beacon Hill study and our learning curve on the Summer Camp study.]
DANA: I love the combination, but it’s early and we don’t have an approved stable glucagon. This will continue to be an interesting debate over the next five years.
KELLY: Will glucose responsive insulin ever happen?
DAVID: I think if you told people with type 1 diabetes you could have a once-a-day injection that would normalize blood glucose and eliminate hypos, they would be all over it. That is the promise of glucose responsive insulin.
I think if you told people with type 1 diabetes you could have a once-a-day injection that would normalize blood glucose and eliminate hypos, they would be all over it. That is the promise of glucose responsive insulin.
It is in very early stages and has very long time before it is a therapy in people, if at all. I am not sure if it will ever happen; give me a crystal ball and I will let you know. If we knew the steps to take to make this a reality, it would have happened a while ago; it is not that easy.
DANA: God I hope so! I agree with David, this would be an amazing breakthrough for patients with diabetes.
ADAM: Type 1 diabetes prevention vs. cure?
DAVID: I am not a “cure” guy. Although we do and will continue to do cure-based research, we have started to put a focus on prevention. As a parent of a child with type 1 diabetes, I hope that I am wrong. If a cure happens, it isn’t even on the horizon now. Our major focus is giving people with type 1 diabetes better tools to manage their disease, so when there are cure therapies that come, they will be healthy enough to receive them.
DANA: With the right work over the next decade, we could see potential cures in decades to come, depending on your cure definition. It will be more than likely easier to ultimately prevent type 1 diabetes, but prevention is a tough conversation because people live with the disease today. Type 1 diabetes is time consuming and a burden – patients need solutions now! I think we have new tools and resources to better characterize patients at risk and learn how the disease develops, why some people develop disease, and what protects those that don’t get type 1 diabetes. My guess is there is a lot of work that has to happen first before we will be able to move forward more effectively.
LOOKING TO THE FUTURE
KELLY: Dana, as you think about the type 1 diabetes field over the next decade, what do you expect to see?
DANA: I think it’s going to be a very good decade for us. I wake up every day excited about the willingness of our community to work together – from the government, industry and the funding community, to families and individuals. Automating insulin delivery requires technology. How fortunate are we that we’re in the best era of technology development?
Automating insulin delivery requires technology. How fortunate are we that we’re in the best era of technology development?
There’s no doubt in my mind – we will be successful in type 1 diabetes. All the pieces are coming together. I think it’s going to be a decade where we see less burden and less worry for people with type 1 diabetes. I think we’re sitting on the cusp – we’re armed with all the tools and it’s like we’ve broken ground. We have the foundation of the house, and now we have to figure out what type of house we want and what’s on the first floor. I’m hooked. All of the seeds I’ve planted for over a decade are finally moving. I think it’s going to be an awesome decade.
KELLY: David, is there a finish line in your mind? What does it look like for you?
DAVID: The finish line for me would be to try and reverse or prevent type 1 diabetes and make it so that future generations don’t have to worry about the disease at all. Recognizing that is a long way off, I would settle for getting tools to people with type 1 diabetes that significantly ease the burden of managing this disease. My immediate aspiration is to try to automate basal rates overnight, so that people can sleep through the night without fear and without running high to avoid severe hypos. I would like to take nighttime from a period of extreme worry to a period of perfect blood glucose control. I wholeheartedly believe that this is an attainable goal that would have an absolutely dramatic effect people’s outcomes.
KELLY: What do you want the legacy of HCT to be?
DAVID: I want the legacy to be that we have put our hearts and souls into easing the burden of managing this disease. I want to be part of the solution that makes this disease easily treatable and keeps people healthy while we wait for that elusive cure.
DANA: I hope the HCT legacy becomes a place where passion meets strategic execution. In the very near future, I hope patients with diabetes will have a product in their hands that has been touched by HCT and co-created with the community.
[Disclosure: diaTribe is supported in part by a generous grant from the Helmsley Charitable Trust.]
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