Personalizing Diabetes Care: An Interview with Dr. Mariela Glandt

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Personalizing Diabetes Care: An Interview with Dr. Mariela Glandt

With the growing demand for individualized treatment, endocrinologist and diabetes specialist, Dr. Mariela Glandt, recently opened Center for Diabetes Care, a state of the art clinic in Tel Aviv. The center has a multi-disciplinary approach, where a team comes together to take care of the patient. The results are phenomenal. Most of Dr. Glandt’s patients with Type 2 diabetes have an A1c in range within three weeks of starting treatment. Her approach emphasizes not only drug therapy, but diet, exercise, and emotional support. “Once patients start to see results, they participate more in their own care. The positive feedback does wonders for their health.”

“I try to be always available to my patients,” Dr. Glandt says. “Not just when they’re sitting in front of me in the office.” And very soon her services will include an app where patients can send information directly to her, as well as a telemedicine feature that will enable patients to reach her directly. In the meantime, in addition to treating patients in her clinic, Dr. Glandt consults with patients around the world via Skype.

We are thrilled that Dr. Glandt took the time to talk to us and tell us all about her specialized treatments, and her hopes for the future of diabetes care.

Why did you decide to become an endocrinologist?

Endocrinology was a natural choice for me. My father has had Type 1 diabetes since he was 17, so I grew up thinking about (and worrying about) sugars, lows and highs. But all of endocrinology has been interesting to me since I took biology in high school. I’ve always loved to think about how hormones function, and how they’re a means for the body to communicate.  Moreover, endocrinology, and particularly diabetes, fits my personality. I like to take care of people over the long run and help them overcome challenges.  I was never meant to be a surgeon. I was very clumsy in the OR!

We’ve witnessed an explosion of Type 2 diabetes cases since you started practicing. Why do you think this has happened?

It really has been an explosion! I remember when I gave my first presentation on diabetes there were only 8 million people with diabetes in the US.  I believe the increase is probably a combination of many factors: our sedentary lifestyle, the fact that people were encouraged to eat low fat/high carb for so many years, and perhaps also due to other factors that are less clearly understood, such as the fact that some of the chemicals that are found, for example, in our plastics, may contribute to decreased insulin secretion and insulin resistance.

What’s the doctor’s role in prevention? 

Prevention needs to start as early as possible (with the pediatrician). The doctor’s role in prevention is to encourage patients to eat healthier, to exercise, to not smoke (which is a risk factor for diabetes!), and to try to decrease stress levels in their lives.  The key is to help the patient do this is in a realistic and concrete way, and not just make blanket recommendations. Let’s think how you, patient X, can fit exercise into your busy schedule and try to help the patient come up with a plan. Placing blame on the patient is a mistake many doctors make. Rather than telling patients they’re wrong, I try to give them the tools to make good decisions about their health. Guilt is not a motivator. And we tend to overlook baby steps. It’s not realistic to tell a patient to change their entire diet overnight. But asking a patient to cut out one thing, sodas, for example, can make a big impact on overall health.

Why is it better to be treated in a ‘diabetes center’ as opposed to seeing your endo a few times a year?

There is much evidence to show that long-term, multi-disciplinary intervention in patients with diabetes actually reduces mortality and morbidity. There is further evidence that when the patient commits to a treatment plan the success is also much greater.  I believe a team approach is necessary because diabetes is a very complex disease.  It’s something dynamic that requires the patient’s input throughout out the day.  This means that the patient needs a great deal of education and also needs emotional support to help him or her to be strong enough to handle this kind of demand. A diabetes center is much more able to provide this kind of help.  Visiting only the doctor may in many instances be enough, but in many others, it may fall short given the demands of diabetes care.

Most people who have lived with diabetes for many years/decades, have experienced periods of deep frustration and that feeling of… “I can’t do this anymore…” How do you help a patient overcome diabetes burnout? 

First of all, it’s important to acknowledge that burnout is completely normal.  It’s very difficult for anyone to be on their “best behavior” at all times. Burnout is expected.  But if the person is in my office it means they are still present, trying to take care of themselves to some extent.  It’s an opportunity to help the patient take a deep breath and to give them tools to help them get back on track.  Many times there are tips, or new medications or gadgets that might make things easier. Many times just giving them hope is enough.  There are so many new innovations cooking (and this time it’s for real) that the patients must take good care of themselves today in order to be healthy enough in the future to enjoy the changes that are coming. I also emphasize that patients shouldn’t beat themselves up over a few weeks of bad numbers. Don’t waste energy feeling guilty. Instead focus on doing better.

Has the availability of newer drugs changed the way you treat Type 2 diabetes?

Absolutely.  New drugs have added many more colors to the palate– making the artist’s job (as I call my job) much more fun.   They have made it possible to personalize the treatment of diabetes to a much greater extent than was possible in the past.  The SGLT-2 inhibitors and the GLP-1 receptor agonists have particularly changed my practice, and are especially effective when combined with older drugs such as pioglitazone.

Often I’m able to get patients with Type 2 off insulin. For those who need insulin, though, taking it is not a reason to feel like a failure.

Compare today’s care with the care your father had when you were growing up. What is the biggest change you’ve seen in Type 1 treatment?  

Well, for one thing, there were no glucometers when I was growing up, which meant that my dad knew what his blood sugar was only once every three months when he went to the doctor’s.  You can imagine what that meant for a Type 1 with regard to hypoglycemia.   I spent my early childhood in Argentina, and my dad was among the first Argentines to wear an insulin pump.  If I remember correctly, it had no cannula, but rather a needle poking him at all times. He didn’t wear it for long!

Today he wears a CGM and he’s on tregludec, doing great.

 Five things you tell every patient.

1) Don’t fight diabetes. Accept it and spend your energy fighting something else

2) Don’t judge yourself. Glucose numbers are not grades

3) Take care of yourself.

4) Invest in understanding diabetes so that you can control it and not let it control you.

5) You are not sick. You just lack insulin and it needs to be replaced.

What are you most excited about in the diabetes tech/pharma pipeline?

I believe the mechanical artificial pancreas is not too far away. I would say it’s almost inevitable, which is extremely exciting. Patients will still have to wear things on their bodies, of course, but it would be such a relief to not have to have to think about diabetes minute by minute throughout the day. The bio-artificial pancreas seems to be further away from becoming a reality. But I am hopeful.

I recently read about research where a microneedle-patch device which is applied to the skin. The needles contain nanoparticles such as an enzyme that senses when glucose is above a certain threshold and causes insulin to be released. The needles are so small, it would be completely painless.  That would be exciting!

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