FAQ: Why should the primary care community care what’s going on at the beta cell level if there’s no direct way to measure it right now?

Frequently asked questions for the primary care community, excerpted from a conversation between a leading primary care physician and a world-renowned beta cell researcher. (2:56)


Dr. Leahy: I’m just a true believer that our primary care community will be more knowledgeable and be more effective if they better understand at the genesis of such a common disease and start to think about contributing factors that may improve or worsen blood glucose values based on that understanding and also be prepared for effective use of all the drugs we have.  I mean the thing that’s so interesting in our world is that we went from having almost no drugs for treating Type II diabetes to an explosion of drugs over the last ten years.

In many ways I think the future will be starting to think about using drugs based on presumed pathophysiological benefit as opposed to simple habit.  And I am convinced that there will be a day and I don’t think it’s light years away were we will be using genetic information to define what drug therapy is potentially going to be most effective in that individual, what other kind of interventions.  So that’s sort of the big picture. 

I think also from our grooming of the next generation of primary care doctors, their approach to disease, not just diabetes, is very much going to be pathophysiological based and they will have tests available to them that we don’t use today.  So even though we don’t currently test an insulin level, because I don’t think it really tells us a lot, I have not doubt that there will be tests in the future that are legitimized at different stages in the disease that are based on either dynamics of insulin secretion or secretion of other kinds of factors or coordinated looking at different kinds of metabolic testing and putting it together into kind of nomagrams that would make us more effective in thinking about the disease. 

And then finally, I think as one just talks to a patient we in some respects have to get away from the concept, “Oh this is a disease of insulin resistance. Oh, you’ve struggled with your diet and exercise your whole life.” “Oh,” don’t say to the patient, but in your mind think, “You’re just fat and the problem is if you took better care of yourself, you know you wouldn’t be dealing with this disease.”  That’s not always correct.  I mean there is this genetic imprinting that people carry.  There are environmental factors that negatively impact different aspects of glucose control physiology -- one of them beta cells. 

The concept: why is there so much diabetes in developing populations?  Well, you know, there’s a real idea out there that maybe malnutrition early in life has negatively imprinted beta cells so they don’t develop properly.  And that could be a huge public health issue for the future.  So, I think the general issue right now is to prepare our doctor population for the future, but also to make them more effective about how they communicate the pathogenesis to the disease, how they start to think about interventions and how they try and balance all these different drugs that are out there as to which might be most effective for the patient who’s sitting in their office.