Diabetes

Speaker 1: We've got to raise the sense of urgency. Speaker 2: Make the care more readily available. Speaker 3: Going to the experts for finding the gaps. Dr.: How do you end up connecting that data so it's useful? Speaker 1: We have to work together and align. Dr.: Welcome to Healthy Conversations the podcast, an open discussion amongst health care professionals about the latest innovations, what we're learning on the front lines of the health care industry, and how it's changing in real time. I'm Dr. Daniel Kraft. I'm here in conversation today with Tracey Brown, the CEO of the American Diabetes Association. Welcome, Tracey. Speaker 1: Hi Daniel. Dr. Kraft, thank you for having me. Very excited to spend some time with you. Dr.: Great to be with you as well. There's so much to talk about in terms of conversations around diabetes. I thought we'd start with a little bit of your own story, how you came to head up the American Diabetes Association. I think you've set an example of an empowered patient. Speaker 1: Yeah, so my journey to leading the American Diabetes Association, Daniel, is one in which I've had a interesting journey here. I am a trained chemical engineer. Along the way, I went back and got my MBA and then that thrust me into the business world. I'm a little bit of a right brain-left brain geek because while I was a engineer, data nerd, product development innovation person, I took a hard right turn and got into the creative advertising agency world for a while. I was diagnosed with diabetes. I actually was diagnosed with gestational diabetes. And so for, as you know, the majority of the women, almost 80%, once you have your child, the diabetes goes back dormant. Well I was in that minority 20%, Dr. Kraft. And so I have a beautiful daughter and with the beautiful daughter, my diabetes turned into type two diabetes. I am pretty hard charging type A, I can do things. And so I probably didn't take the diagnosis as seriously as I should have, in all honesty. My daughter would see me take my blood glucose readings every morning. She'd see me take my insulin. And at the young age of five years old, I'll never forget the moment, I'll never forget the day and I'll never forget how I felt. We were in the bathroom getting dressed, she was getting ready for kindergarten, I was getting ready for work. She just looks up at me and says, "Mommy, are you going to die from diabetes?" Stops you in your tracks. I was, I don't know, dumbfound for a minute actually. And made a commitment right then and there that absolutely not I would not die or succumb to diabetes and its complications. So I made a commitment to myself. I made a commitment to my family. I made a commitment that I would not only not succumb, but I would be the poster child of how you thrive while living with diabetes. That I would unapologetically tell my story as my form of driving awareness and I wouldn't stop fighting for a cure. And so from that day, literally, my life changed. And I really became an advocate, I really started trying to take true control of my situation. And through that, Dr. Kraft, I started working with the local chapter of the American Diabetes Association. There is an interesting event there that we have called Kiss A Pig. And you get all of the business leaders, 10 to 12 business leaders, and they're competing to raise money and awareness around diabetes. I had the instructions wrong, I thought the person who raised the most wouldn't have to kiss the pig. Long story short, I raised $300,000, my team and I, and then discovered I had to get on stage to kiss a pig. From that, that got the eyes of the national board at the American Diabetes Association. I ended up joining the national board. And from there, continuing to be very vocal, Dr. Kraft, about what I thought we could and should be doing more of. Yes, our mission is still relevant, but when you think about one out of two people in this country still living with pre-diabetes or diabetes, that's 122 million Americans. We have to do more faster to accelerate. And so that board opportunity led to them asking if I would actually come on as the CEO. So here I am. Dr.: Well thanks for sharing that journey. You come, as you mentioned, from the marketing and advertising world. It seems like so much about, given how prevalent it is, is about educating folks and the messaging around diabetes and how to approach it. What kind of lens have you taken from that world to the ADA? Speaker 1: All of it. If I think about my entire background, from the marketing and awareness to the data and analytics to the technology and innovation, all of those things have actually come full circle. Here's what I will tell you without a shadow of a doubt, the awareness in bringing this chronic disease, which by the way was an epidemic in this country before the current pandemic, we've got to raise the sense of urgency, the knowledge and the understanding and the awareness around diabetes. And I talk a lot about the fact that we can't talk about improving the wellbeing of Americans in this country without talking about diabetes. Because of its prevalence. You actually can't talk about improving the wellbeing of Americans in this country without actually talking about health equity. And so now more than ever, when you start to talk about raising awareness, we're talking about emotionally connecting with people, Daniel, in a very real way. So that is where kind of the marketing side, how are we actually emotionally connecting with people? Because behavior won't change unless there is actually a connection. People feel before they think. And at the basis of that emotional connection is trust. I mean, I'm trying to bring everything in my arsenal, everything from my prior experience to try and take down this epidemic. Dr.: We know we're supposed to exercise more and eat less. Or if you're a diabetic beyond the ADA diet, diabetes is so prevalent and underlies so many other chronic and even acute medical conditions. It seems so imperative to get a handle on that proactively rather than our sort of after the fact reactive mindset. Speaker 1: That is right. Absolutely. Dr.: And you're in the DC area, how do you end up, given the often misaligned incentives, you might have the cheese lobby of trying to get more cheese on the kids' diets in schools and other elements there that are often misaligned with health and particularly might contribute to our obesity epidemic and the related diabetes that follows. Speaker 1: I talk about health and good health and access to health care. These are human rights, Daniel, which requires all of us to get aligned. All of us. And so when you think about what we are doing from an American Diabetes Association, is of course there is a large piece of what we do that is about reaching out to the actual people who are living with diabetes and those who care and love all of us living with diabetes. So there's a consumer piece of this. There is a very large advocacy piece to this. You talk about policies, legislations, laws, all of these things actually need to be working in concert to actually help bring down this epidemic. And then the third very large piece of what we do is with the health care professionals, the scientists. All of these things actually have to work together. And to your point, you brought up cheese, diet is one of the most hotly contested areas that there are. When we start to talk about things like the US dietary food guidelines, those guidelines are actually created and developed for healthy people. Daniel, 60% of Americans have a chronic disease. So we've got to make sure that we, the collective we, are leaning in to make sure that the guidelines actually reflect the majority of the population that is walking around here, which is with 60% having a chronic condition, not as healthy as we would all want to be. And when you think about how those dietary guidelines are used, think about all of the institutions that leverage those. Whether it be schools, nursing homes, prison system, hospitals. This is why from an advocacy perspective, you will see the ADA head on in there trying to align. Because at the end of the day, we want Americans to be able to thrive. Thrive, thrive, thrive. And that is the terminology I use for myself as a person living with diabetes, I'm thriving with diabetes. But there's a whole lot of pieces to this, Daniel, that have to get into alignment Dr.: Even with dietary guidelines that can't be one size fits all. What is the ADA doing to try and help not silo diabetes, but understand the complexities? I'm curious as to how you kind of parse diabetes across its continuum. Speaker 1: Diabetes is complex. There is no one size fits all. I mean, as we know, if it weren't complex Daniel, somebody would've found a cure by now. Look, we at the American Diabetes Association, we're the largest patient driven diabetes advocacy organization. But there's lots of people who have been swinging at this as well. Yes, it's complex. I want to start with the different variations of diabetes. You're right, there are a lot. I know there are differences and there are commonalities. And so, one of the things that I try not to do is silo people living with diabetes regardless of what kind of diabetes it is. We all make thousands of decisions a day, we are all faced with some of the same inequities. Being able to get access to the affordable drugs that we need. We all, whether you're type one, gestational, type two, we all deal with food. The mere fact that you have diabetes is about the fact that our food needs to be broken down, the glucose needs to provide us energy, needs to get in the cells. And whether you have type one down to gestational or whatever, your body's ability to do that isn't where it needs to be. So we say, share a lot of the same struggles. That's point one. Point two, as it relates to things like nutrition. There is no one size, there is not. We do know from science and data... And we are a science-based, fact-based organization, that is in our DNA, will always be. We do know there are some nutrition therapies that work to allow people living with diabetes to manage their diabetes. We recently released a nutrition consensus paper that identifies about eight or so nutrition therapies, from Mediterranean to paleo to low carb, very low carb, low fat, very low fat. We're never going to prescribe a diet. But there are some diets that work well to manage those blood sugars. We're going to continue to promote the things that we know help with your blood sugars: your diet, your exercise, your stress management. All of those things, whether you're a type one, type two, gestational, you need to manage those things. And so that's where we are. And our whole thing is how can we remove barriers that are in the way that make it more difficult for people living with diabetes, thrive? We think about as our lens, how can we help people who are living with diabetes live their best life right now, today, while we're still fighting for a cure? Dr.: [inaudible 00:14:16], Hippocrates said let food be thy medicine and medicine be thy food. And particularly that's relevant... I don't have diabetes, but I just recently was sent a continuous glucose monitor with an app and I can look at my realtime blood sugars and my metabolism and give me insights. Maybe I could discover I'm pre-diabetic, it's not just about when I spike, et cetera. So there's all these new innovations coming in, in our connected data-driven age. What are some of the innovations that you're most excited about and that the ADA's been driving that are going to help us both connect to our diets and our physiology and disease? Speaker 1: You just hit on one, Daniel, which is the continuous glucose monitor. My blood sugars are what people who don't have diabetes blood sugars are right now. That CGM for me was an unlock, Daniel. I was able to get off of insulin. I went to four oral medicines. I was able to get off four oral medicines. I'm only on one. And truth be told, I could get off of that. I could. And I was just about to do that before this COVID thing and then I just decided not to. But my point being, CGM technology gives the people the ability with realtime data to understand what's happening with their body. You might be saying, why was the CGM the unlock for you? And by the way, I do know, I do know how many [inaudible 00:15:40] I should be eating. I do know that stress increases blood sugar. I do know that lack of... I know all of these things, but until I actually saw the impact of the spike on my blood sugar, that connection led me to actually change my behavior. And it empowers people living with diabetes to make choices. And when you empower people to start to understand the foods, their exercise, their sleep, their stress, how to start to dial it up or dial it down, to zone in, that is game changing. And so that is why we not only talk about that in our standards of care, but we do a lot of education, a lot of resources around... not only for the person living with diabetes, but for the health care professionals. To get as many of them as possible to cross that chasm as well. So that's one. Two what COVID-19, try to make lemonade out of the lemons that we have been served with COVID-19. Telemedicine. People have been talking about telemedicine, Dr. Kraft, for a long, long time. COVID forced the issue. And I believe through the data that I am seeing, that has started to break down some of those inequities that exist. Because people in rural settings, people maybe didn't have the time, couldn't get off of work, the transportation, whatever the scenario was, telemedicine has actually started to unlock there. And oh by the way, this is where the advocacy arm of the American Diabetes Association comes in and we actually start to use the power and the strength of who we are. When COVID hit, we were hearing from our health care professionals... Because we have several hundred thousands of health care professionals who are a part of the membership of the American Diabetes Association. We started hearing from the front lines that, "Look, with the lack of PPE, with the prevalence of what's happening with COVID-19, being able to use CGMs in the hospital setting sure would be helpful and useful. Not only for the person but also for the health care professionals." We went to work straight direct to CMS to start to work with them to get an emergency approval to use CGMs in the hospital. It happened. Telemedicine happened. We started getting calls flooded into our call center. "Look, we've got to make sure in order for me to get my supplies, my pumps, my CGM renewed is saying that I have to have an in-person visit, otherwise I'm not going to be reimbursed." Blah. You know all of that. Straight to CMS, working with them to say we have to lower these administrative burdens and hurdles right now. Got the emergency approvals for that. Oh by the way, senior citizens of Medicare required the use of CGMs. You had to be taking your blood sugar four times, four checks. We went to CMS and said, "Look, why four? People living with diabetes are in the strike zone. Disproportionate number of people with diabetes dying from COVID, hospitalized from COVID. Let's get ahead of this, get these folks CGMs. Why do we have to have four pricks?" So all of these things are kind of what's coming to the forefront and these are all innovations mixed with what we talked about earlier, Dr. Kraft, which is we have to work together and align all of these things. I haven't met any single person living with diabetes who wakes up and says, "I want to make the wrong decisions for my body and my life." And then I really don't know if people realize diabetes cost this country $327 billion. I really don't think people are running around saying, "how could we drive up more cost?" So it's this getting the awareness, the understanding, and then the alignment. And I think what we have been able to demonstrate through this COVID-19 pandemic, as awful as this is, some good things have come out of it. Dr.: Absolutely. I love how you used the word unlocked, both for your personal experience, understanding your own blood sugars, but now the ability to send that digitally to your clinician or to a clinical trial. Or the fact that now you can democratize some elements of diabetes care. There is also not just the social determinant self, but almost the digital determinants of health. Not everyone has a smartphone or good internet connectivity. And so how to even connect those dots moving forward. Speaker 1: We've got to figure out ways to personalize. One of the things that we have been doing at the American Diabetes Association is also studying cultural trends. Cultural trends in this country and the world. Because if you could understand where culture is moving, your ability to actually kind of go with the cultural momentum to get behavior change goes up. There is a real cultural movement and trend right now that talks about delivering for the average is no longer a thing. People are like, "I'm not average, and by the way, my diabetes is different than his or hers." And so this notion of how you personalized behavior, personalize care, personalize communication, that's where the world is going. And so we are trying to enable that as much as we possibly can through tools, resource and education. There's lots of technology out there, we've got to get it accessible for all. Dr.: Spot on. So we have a lot of health care providers listening. What lessons might you have in terms of how they communicate to their patients and also how that information coming back to them, what you want them to know about diabetes care and upping the game? Speaker 1: If you think about our goal and objective and our mission that was defined 80 years ago back in 1940, one of the things that sticks with me is our original founders way back then talked about this is about, let's not get confused, this is about the person living with diabetes. Their medical, economic, financial issues are our issues. So back in 1940, Daniel, we were talking about the modern word of being consumer-centric, patient-centric, all of those things. That is more relevant than ever today. And so for everyone, I say, start by making sure that you are a hundred percent lined in and focused on the person, and understanding and trying to put yourself from a walking in their shoes perspective. Flip the lens and see if you can actually emotionally connect, 'cause this is what we have to do. People are yearning to understand, "Do you see me? Do you hear me? And do you understand me?" And when we open our hearts to learn and seek to understand, good things will happen. Dr.: Great. Thank you so much for joining us in Healthy Conversations. So many conversations to have related to diabetes that can really help catalyze its present and its future and hopefully to put you all out of a job. Speaker 1: Exactly. Thank you so much, doctor. Appreciate you. Dr.: Thanks for listening to Healthy Conversations, the podcast. It's our mission to reveal the front lines of the health care profession and to educate everyone about the challenges and opportunities in this new landscape of health care.