Clinician's Perspective: 100,000 Deaths from Diabetes, with Diana Isaacs, PharmD

Diana Isaacs, PharmD

In the wake of recent data from the Centers for Disease Control and Prevention (CDC) revealing deaths from diabetes had reached 100,000 in 2021, which marks the second consecutive year deaths have reached this figure, diabetes has been thrust into both the public health and mainstream news spotlight yet again. Combined with the added attention as a result of the COVID-19 pandemic, the spotlight on diabetes and diabetes care and education is brighter than ever before.

Although the initial headline of these stories and coverage may convey a disease state in dire straits, but, with advances in care and pharmacologic therapies, clinicians have never been more well-equipped to treat diabetes. The situation confronting patients and providers is one where the success of prevention efforts has yet to reach the level of success seen in diabetes technology and therapies. Still, many in the field remain confident improved prevention efforts for prediabetes and obesity could help turn the tide in the fight against diabetes.

For more perspective on the recent report, Endocrinology Network’s editorial staff reached out to Diana Isaacs, PharmD, Clinical Pharmacy Specialist and the Remote Monitoring Program Coordinator at the Cleveland Clinic, for her insight into the report and her reaction as a diabetes care and education specialist.

Q&A with Diana Isaacs, PharmD

Practical Cardiology: Were you surprised about the data in the CDC report or was this expected?

Diana Isaacs, PharmD: I am sad about it, but it still startles me. Even though, on a certain level, it's not surprising given the direction that we're going and the increased cases of diabetes overall. We know that more and more people have diabetes and, then, on top of that we have seen increases in obesity and other chronic conditions. So, unfortunately, I guess it's not shocking. It feels like even though we're in the trenches and we're trying to do all that we can, because more and more people are dying, somehow we're not able to stop this from happening.

PC: For clinicians, does it feel like a losing battle or do you feel like you guys are still making great progress in the fight against diabetes?

DI: I feel like we're making great progress. The medications, the technology, it's all advancing so quickly. I mean, just even the last few weeks, we've had FDA approvals for Omnipod 5 and Tandem's t:connect mobile app for remote bolusing. So, I do feel like we're making a difference.

I think what we're not doing is spending enough time on prevention efforts. I really think the problem is, by the time I see people, they already have their diagnosis—speaking of type two diabetes specifically. They already have their diagnosis, which means they may have really been having it go on for years undiagnosed. Oftentimes, other risk factors were present even years before that and were doing damage in their body.

So, I just think it's great. We have improved treatment and technology, but we also need to really focus on the prevention efforts. That way, we can stop this escalating number of people developing diabetes, because if more and more people develop it, then yes, there's probably going to be more complications and more deaths, because it's a numbers game. Prevention is key.

PC: Is it frustrating to see the parity in success for improving standards of care but pitfalls in prevention efforts?

DI: I've just been so interested about obesity and what we can do, because I think that is a big driving factor leading to more type 2 diabetes diagnoses and we just don't have a great handle on it. It's so, so clear that there is not a one size fits all approach.

It's very nuanced, we haven't been able to follow a figure out like one meal plan that works for people. We do have some pharmacotherapy options for obesity and I think it's just not widely used. It's often not covered and I think payers are not recognizing how much of a risk factor this is. So, I think we need to focus more on that. Otherwise, we're kind of always just playing catch up and it kind of feels that way right now.

Maybe we need to take some of our technologies and use those more for prediabetes as well. We have this amazing tool in CGM, right? Maybe it needs to be the standard of care that people with prediabetes or even people with obesity. Additionally, there is the Diabetes Prevention Program, but that's a very specific program that requires specific criteria. It'd be nice if there were just more programs and more coverage to help people before they advanced to that point.

PC: Do you foresee a future where we turn the tide and the number of diabetes deaths will plateau or even decline?

DI: Well, our population continues to grow. So, it's hard to say. I think if we could stop the growth of it, that would be success. I think there's a lot of efforts being made.

One is the advances in medications to treat obesity. I think having that is incredible, with semaglutide and tirzepatide, which will hopefully come out in the near future. Now, we want to start seeing increased access. We want to see more insurance plans starting to cover these drugs and more of a push in guidelines to start looking at bariatric surgery, but also, I think, to look at some of the population-level things like stress.

Stress is not good for like chronic disease management and it contributes to obesity and type two diabetes. I think COVID has just really exacerbated everybody's stress level. I know there's a lot of efforts about burnout, resilience, and that kind of stuff, but we really need to look at our whole society and culture and find ways to decrease the stress and make physical activity more a part of regular day-to-day.

Right now, physical activity is sometimes portrayed as a nuisance thing that people are just asked to fit into their life. It's like, you're supposed to exercise 30 minutes per day most days of the week and people are asked to just throw it in there, but then it becomes the first thing to throw out. Most people do not meet the physical activity guidelines and that's such a shame because, in addition to glucose, blood pressure, and weight management benefits, there are also all the psychological benefits.

So, we have tools available. Although there's definitely hope, a system-wide change needs to happen. So, yes, there's hope but we need to do a lot of work.

This transcript has been edited for clarity.