Jaime Lewis (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Jaime Lewis, and today I'm sitting down with Diabetes and Metabolism Endocrinologist, Dr. Adam Spitz, to talk about diabetes management. Before we get started, Dr. Spitz, I'd love to know how this became a passion of yours. What made you want to become an Endocrinologist?

Dr. Adam Spitz, MD: I was initially very, very interested in clinical nutrition and the impact that nutrition has on health. And as it so happened at St. Luke's Hospital in New York, they had a program that combined that with endocrinology. So it was a perfect match.

Host: Okay. Well, to start with this subject, give us an overview of the most common types of diabetes cases. What causes each of them?

Dr. Adam Spitz, MD: Most diabetes in the United States, 90%, is Type 2 diabetes. This is caused by a genetic predisposition where the cells in the pancreas that make insulin, cannot make enough insulin to overcome insulin resistance. There's genetic and environmental lifestyle factors that make the body more resistant to its own insulin. And then in someone who's genetically predisposed, they're not able to make enough insulin to overcome that resistance, and their blood sugar then goes up. There are about 36 million people in the United States with Type 2 diabetes, of whom about 1 million are right here in North Carolina.

 Type 1 diabetes represents 10 percent of diabetes in the United States, and this is an autoimmune disease, and this is where the body's immune system sees the cells of the pancreas that make insulin, the beta cells, it sees them as foreign and it attacks them. And then those cells can no longer make insulin, they're destroyed. And then as a result, you become completely dependent on taking insulin for survival. And that is Type 1 diabetes. And there are about 2 million Americans with that.

Host: Wow. Okay. Well, what are some of the common stigmas or myths that you hope to debunk in your work when it comes to diabetes management and care?

Dr. Adam Spitz, MD: The most common one is that it's the patient's fault. And while lifestyle and self care does play a very important role, we don't like to blame the patient. It's not the patient's fault. There's, you can have two people with identical lifestyles, and one may have diabetes and the other one may not. So it's not the person's fault and throwing blame at someone doesn't help things.

Host: That's important. What improvements have you seen in diabetes management over the last, say, decade?

Dr. Adam Spitz, MD: For Type 2 diabetes, it is still how a person takes care of themselves with healthy eating and exercise is still vitally important. I think that we've seen a shift with nutrition where there's a much greater emphasis on healthy fats and instead of just all carbs are okay, that's not the case.

So that's very, very important. So absolutely, break out the guacamole and the all natural almond butter. And I think we're seeing a greater emphasis on a variety of exercise. It used to be all about cardio. Now it's mixing cardio with strength training. That's also very important. So those are some of the lifestyle improvements that we're seeing.

And from the pharmaceutical end, the big story, of course, is GLP 1 medication, so that's going to be Ozempic and drugs like that. And unless you've been living under a rock for the past few years, you've must have heard of this, it's in the news constantly, and, this drug class has actually been around for 15 years, more than 15 years.

It's just that with Ozempic and tirzepatide, we've now got drugs that are just far more potent. And so that's why we're seeing so much of it in the media, because now it's also being used for weight management. But these drugs have really helped to revolutionize diabetes care, because they lower blood sugar, lower body weight, in persons who are high risk of heart disease, they help to lower the risk of death from heart disease.

Now we're seeing some data on improvements in people with kidney disease. The other big story is a class of drugs called the SGLT2 inhibitors. I call them the POA glucose drugs. These are pills, and you literally POA glucose, you have to drink more water. And these drugs, are a big story because they also really help to lower the risk of death from heart disease in people who are at high risk.

And they also lower the risk of progression from kidney damage to worse kidney damage. And they especially improve the risks of hospitalization and death from congestive heart failure. And a really great thing about both of these drug classes is that neither of them cause hypoglycemia. So if you're not using them with traditional drugs like insulin or sulfonylureas that can cause low blood sugars, it takes a big worry off your head that out of nowhere the patient can be driving and suddenly develop a severe low blood sugar and pass out.

The other big story for Type 1's but also for Type 2's are the glucose sensors. These are small devices that you can wear on the back of your arm, and they measure glucose under the skin, which is similar to what blood is. And then you have an app on your phone, and it transmits that information to the app.

We talked about lifestyle, and this goes hand in hand with lifestyle, because aside from the obvious, just knowing what your blood sugar is, it's really empowering the patient. It's giving them the information that they need to do a better job of taking care of themselves. So imagine you're eating healthy and you're exercising and you pull out your phone, you open up the app and you look at your sensor, oh, look at that, my blood sugar is coming down, it's doing really good.

Well, that gives you that positive reinforcement. It really puts the patient in the driver's seat and helps them to do a better job of taking care of themselves. For Type 1s and sometimes Type 2s, the big story has been what we call AID, Automated Insulin Delivery, and that's where the sensor can communicate with an insulin pump.

That's a small device that delivers insulin under the skin, and the sensor can actually guide the pump to determine how much insulin to give, and it greatly improves control. It lowers the risk of low blood sugar, and perhaps most importantly, it gives the patient a mental break. If you speak to Type 1s and many insulin treated Type 2s, they don't get a break.

It just weighs on them constantly, and to be able to go to sleep at night knowing that this device is going to help keep you safe, to be able to go about your daily routine and enjoy life without having to think about your diabetes every moment of every day is just a tremendous breakthrough and I see these patients come back and they're just so happy to get that break.

Host: Well, you're touching on this right now, but I was going to ask, what innovations do you expect to see become a part of typical diabetes care in the near future?

Dr. Adam Spitz, MD: I think we're going to see what we have now just taken to the next level. There are other Ozempic and Mounjaro type drugs that are in the pipeline. Each successive drug seems to work that much better. So that we expect to see more of that. From the technology standpoint, we really hope to see smart insulins soon.

This is an insulin. You give it by injection and it binds up to proteins in the blood so it can't work, but then when the blood sugar goes up, that makes the insulin release from its binding site and then the insulin can then work. So we call that smart insulin. So that is something we really hope to see in the coming years.

We will see improvements. We continue to see improvements in these automated insulin delivery systems. Each new system gets that much easier to use and the sensors are getting smaller and easier to use, and we are seeing studies where the cells in the pancreas that can make insulin, that we can actually create those cells in the lab and infuse them into a patient.

That is something that it wouldn't be a shocker if we saw that five, seven, eight years from now on the market.

Host: So exciting. Well, can you give us a few quick tips to help someone who's maybe newly managing their own diabetes diagnosis?

Dr. Adam Spitz, MD: Sure. There are a lot of resources and remember you're not alone. This is a really, really tough disease to have. One of my Type 1 patients who I've known for 25 years, she has a niece, who's now an adult, but her niece plays the guitar and she played a song that's called Diabetes Sucks. So she clearly was feeling overwhelmed. And so the first thing is the management is a team approach and the patient's at the center of the team. It's actually very much like, the offense in football. So the physician or provider is the head coach. The patient is the quarterback who has to execute the plays.

But then there's other people. There are diabetes educators, and they are maybe the offensive coordinator. We also have a clinical pharmacist who we work with, who is also helping to coach the patient to do the best that they can do. So it is a team approach. For persons with Type 1 or Type 2, they can go online and get in contact with the American Diabetes Association and find out about all sorts of support services for Type 2s in particular.

 There are a lot of educational resources for patients, actually Type 1s and Type 2s, and that's just diabetes.org. They're very active here in North Carolina, and they really want to help people, so it's just a matter of getting in touch with them. And then for Type 1s, and in particular, families of Type 1s, there's the juvenile, what used to be called the Juvenile Diabetes Research Foundation, now called Breakthrough Type 1.

And so, if you just go to their website, jdrf.org, search Breakthrough Type 1, they have also a lot of support services. Both organizations do a lot of fundraising. Type 1 is striving to find the cure. Fun fact is that one of the very, very first mothers, that's who started JDRF, Mothers of Children with Type 1, one of the very first ones, Roz Greenspun, is right here in Charlotte.

Host: Well, Dr. Spitz, thank you so much for talking about this today.

Dr. Adam Spitz, MD: My pleasure.

Host: To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org.