"It Takes a Village" to Tackle the Diabetes Epidemic

Dennis P. Scanlon, PhD: I’m sure we’ll be able to come back in another year or so, and there will be a lot more that we can discuss. I want to thank you all. This discussion was great, and we certainly reviewed a lot of information about treatment considerations for patients with type 2 diabetes.

I want to ensure that each of you had a chance to share what’s on your mind. I threw a lot of specific questions at you, but want to give each of you an opportunity to get some final thoughts in—just a minute or two on anything else that you’d like to either reiterate or highlight that we didn’t talk about.

Zachary T. Bloomgarden, MD, MACE: I think what I would say is [that there are] 2 ends of the diabetes spectrum. On the one hand, I think that diabetes—the epidemic—is growing. Whether it’s growing quite as rapidly now, or a little bit less, we know about all of the bad things that are going on and that the availability of sugar-sweetened beverages and lack of physical activity are generating huge numbers of persons with pre-diabetes and diabetes. We’re going to need re-engineering of society, not just of healthcare, to address much of these burdens.

Then, on the other end, is the individuals who have the most complications of diabetes. I see a lot of bright light coming ahead and enabling us to do a better job of taking care of those people with diabetes who have chronic kidney disease, who have neuropathy, who have retinopathy, and who have cardiovascular disease. There have been so many wonderful and encouraging developments in that space, and I see this as really important.

Michael Gardner, MD: It is an extremely exciting time to be in the diabetes care space—all of the new things that we’re finding, all of the new things that we can do with medications, in terms of maybe finally addressing cardiovascular disease and the comorbidities of diabetes.

But, I think we also need to keep in mind that there are these big disparities that we’ve touched on several times throughout this conversation. We need to look at some of the simple things, as well, in terms of reaching out to the people where they are, in terms of individualizing our care. “What do you do for a living? Is this a meaningful plan for you? Does it get at what you need? Does it get at what your hopes, dreams, aspirations, etc, are?”

We need to also work on disseminating the information. There’s only 5000 of us, right? (As was pointed in an earlier segment of this program.) Disseminating that out and supporting the primary care providers and the other medical professionals who touch these patients very regularly, as well as community health people.

John A. Johnson, MD, MBA: I would say, just making sure that we always keep the patient at the center of everything we do, and in a collaborative way, by pulling all of our resources together—the provider, the patient, the plan. How can we effectively improve care, enhance quality, and improve the member experience, such that we eradicate diabetes as the ultimate goal?

Again, we want to make sure that we do this in a collaborative way because no one of us can do it alone. Managed care cannot bear the responsibility, but we want, at the same time, to partner with the pharmaceutical industry, with the provider community, and with large hospital organizations to make sure that we close the care gaps and reduce complications of diabetes.

Robert Gabbay, MD, PhD, FACP: I would agree. It’s an incredibly dynamic time in the world of diabetes, and I think there’s this amazing opportunity with the new tools, new treatments, with partnerships, and really this idea of “it takes a village.”

There’s a role for us, as specialists, to be able to guide that process. And certainly, at Joslin, we’re committed to partnering with a lot of different organizations to improve diabetes care nationally and globally. I do believe that this is a moment in time that we’ve really not seen in recent history—where so much can be done to implement things that we already know work and reach more people.

Dennis P. Scanlon, PhD: Great. You guys have been a fabulous panel. It certainly made my job very easy as moderator. On behalf of the panel and the editors at the American Journal of Managed Care, we want to thank you for joining us.