ADA: Diabetes 'Battle' Is Waged in Primary Care

Christine Wiebe


October 16, 2015

Kevin L. Hagan, CEO, American Diabetes Association

Earlier this year, the American Diabetes Association (ADA) tapped Kevin L. Hagan to serve as its new chief executive officer "to reinvigorate the national fight to end the diabetes epidemic in America." Mr Hagan was previously CEO of Feed the Children. He recently spoke with Medscape about the organization's plans.

Medscape: This is a big anniversary year for the ADA. Where do you see it headed in the near future?

Mr Hagan: The roots of the ADA are as a professional medical association; we were founded by 28 physicians 75 years ago. Over the course of the past 75 years, our mission has evolved, and today we serve both healthcare professionals and consumers.

When the board chose me as the new CEO, one of the tasks they gave me was to elevate the conversation around diabetes in the United States, because it's not getting the attention that it needs. Ongoing service to clinicians is going to remain an important focus of our work going forward. I see it in some respects as the bedrock of how we can elevate that conversation.

Currently, the cost of diagnosed diabetes is more than $245 billion annually, and it is an escalating price. For me, the front lines of that war on diabetes is at the level of the primary care physician (PCP). As an association, we need to give greater attention to that group.

My own personal experience illustrates that as well. I was diagnosed with prediabetes several years ago. I was taking two blood pressure medications and was not in the best shape of my life, I have to admit. So, I worked aggressively to get my health under control, so that I could hopefully delay type 2 diabetes as long as possible. It was that PCP who was so important to me in that decision.

Medscape: What made the difference at that particular point? Were you extremely motivated? How much did your doctor influence you?

Mr Hagan: It was a very interesting interaction. I had had this PCP for years and years, so she knew my health well. She saw me putting on weight, and she prescribed the blood pressure medicine, which wasn't working—so we tried another one, and that wasn't working, and then we tried combinations.

At that point, quite candidly, she didn't sugarcoat the message. It was a very direct conversation that basically outlined for me a really dismal health state as I would age. Because of my trust in her, I felt like she could help me figure out a way to more effectively manage that.

Nobody wants to talk about lifestyle—but it's a critical conversation if we're going to reverse this trend.

I think PCPs want more information, more skill sets, and more training in these kinds of interventions, and they don't get a lot of this in medical school. I think we need to figure out a way to better serve that constituency of clinicians, because that's where the fight is occurring every day, as we try to manage diabetes and prevent future cases: in the PCP's office.

Every year, we publish our Standards of Care, which is the definitive guideline for clinicians who treat diabetes. We also have four scholarly journals, and they're all widely read. But at the same point, as an organization, we need to continually figure out ways that we can disseminate that information and provide easy access to it.

Medscape: At the ADA annual meeting, many people were saying that we've come a long way in treating diabetes, and we have a lot of really good interventions to help patients improve their lifestyles. It seems like the biggest gap right now is just doing what we know can and should be done.

Mr Hagan: Honestly, that's the question that we continue to struggle with every day. I mean, is there enough out there? Absolutely not; we always want more research, more science, better treatment. But we have made great strides in improving the lives of people who are living with diabetes.

We also have to acknowledge that clinicians have a really changing landscape. The rules are changing on them every day. And they're relying on people to come with expert knowledge to help them.

Medscape: What is the main message you want to communicate to healthcare professionals out there?

Mr Hagan: I think it's important for clinicians to know—and I'm sure they do—that diabetes is an escalating crisis in the country, and it's costing the healthcare system a fortune. There have been a lot of successes in care improvement, and the rate of diabetes complications has declined: There's been over a 50% reduction in stroke, and slightly more than a 50% reduction in amputation. These are all good things. But it doesn't mean we can rest on our laurels. The challenge is the increasing prevalence of type 2 diabetes in the country.

Clinicians need to address this issue head-on. This is not a "blame and shame" kind of issue; these are real health concerns, and we need to change the dynamic of conversations across the United States. In some populations in the United States, people will tell you, "This is in my background, so diabetes is inevitable, and I am just going to get this."

Clinicians need to take a very serious role in having that discussion—that nothing is a foregone conclusion, and if there are risks associated with the patient, they need to be addressed early on and not wait until the patient has diabetes.

So, let's start having this conversation. I think it's one that doctors particularly don't love having. Nobody wants to talk about lifestyle—"You should eat this, and you should do that"—but it's a critical conversation if we're going to reverse this trend. Our statistics show that if current trends continue, by 2050 one in every three US adults will have diabetes. That's a huge problem.

Medscape: There seems to be a big push to link PCPs to certified diabetes educators as well.

Mr Hagan: That is absolutely critical.

We want everyone involved in this fight. Because this is, in some respects, an all-out war. And despite the fact that we have access to a lot of resources and the best minds in this field, this fight is going to require the collaboration of all of us. In fact, clinicians play the most important role, because they are the ones with the access to the patient every single day.

That's where the battle is being waged. As the chief executive, I know that what we do is irrelevant if we can't put it into practice with the clinician.

Kevin L. Hagan has disclosed no relevant financial relationships.


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