{"id":50804,"date":"2019-08-13T13:18:45","date_gmt":"2019-08-13T17:18:45","guid":{"rendered":"https:\/\/asweetlife.org\/?p=50804"},"modified":"2019-09-15T05:28:54","modified_gmt":"2019-09-15T09:28:54","slug":"chipping-away-at-diabetes-research-an-interview-with-dr-elizabeth-mayer-davis","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=50804","title":{"rendered":"Chipping Away at Diabetes Research: An Interview with Dr. Elizabeth Mayer-Davis"},"content":{"rendered":"

The 2019 recipient of the American Diabetes Association Kelly West Award for Outstanding Achievement in Epidemiology talks about the most pressing questions in the field of diabetes research, nutrition, and the future of diabetes treatment.<\/em><\/p>\n

Dr. Elizabeth Mayer-Davis, chair of the Department of Nutrition at the University of North Carolina at Chapel Hill and co-chair of the SEARCH for Diabetes in Youth study has focused her entire career, an impressive one at that, on better understanding diabetes to improve outcomes for patients. This mission has led to hundreds of papers and appointments to public health and nutrition advisory committees. Despite her long list of accomplishments, Dr. Mayer-Davis is incredibly down to earth. When I confess I am a bit starstruck, she laughs. \u201cI\u2019ve just been chipping away,\u201d she says.<\/p>\n

\"Dr.
Dr. Elizabeth Mayer-Davis<\/figcaption><\/figure>\n

Dr. Mayer-Davis\u2019s interest in diabetes began early. \u201cSomething close to high school,\u201d she says. \u201cEarly on, I was interested in terms of the science and\u2026all of the human cost, the clinical, behavioral, social, cultural issues, and what it means to an individual who has to manage this disease every single day. I did have a friend in high school who was diagnosed with type 1 diabetes. As I look back, that is the point in time that I remember very clearly following his experience.\u201d For her, part of the draw was the science, which she calls \u201cmagical\u201d. The other seems to be a deep caring for the impact the disease has on both an individual\u2019s long-term health and daily experience. Dr. Mayer-Davis is also concerned with the experience of \u201cvery vulnerable populations of people\u2026particularly people of underrepresented populations, minority populations\u2026that experience, in the case of type 2 increased risk, in the case of type 1 much worse outcomes in terms of glycemic control and other outcomes.\u201d<\/p>\n

Diabetes is such a complex, multifactorial disease in terms of risk, etiology, patient experiences, and health outcomes. With so many unknowns, how does a researcher approach such a vast challenge? To Dr. Mayer-Davis, the key is \u201cto be very clear on what the most important research question is. What are the gaps in the literature? What are the gaps that are the most likely to actually improve outcomes for people if they are filled?\u201d Defining the question to help populations is an art and a science, according to Mayer-Davis. After that, the challenge is to design the right study to answer your question. There\u2019s a deep thoughtfulness to her approach. Beyond selecting the right population, data<\/span>collection, measurement, and biomarkers, Mayer-Davis stresses the importance of collaboration. \u201cWe\u2019ve learned a lot,\u201d she says, \u201cbut we have so much yet to know, and nobody can know even a fraction of everything. It\u2019s about having the right team.\u201d<\/p>\n

I\u2019m eager to know what Dr. Mayer-Davis thinks are the most important questions in diabetes research right now. \u201cTwo things,\u201d she says. \u201cOne, there is a discrepancy in terms of having poor markers of glycemic control\u2026for patient groups other than non-hispanic whites. So that\u2019s a really important area of concern.\u201d She calls the second question, the emerging issue \u201cof overweight and obesity in type 1 for youth and young adults\u2026a very tricky area. It\u2019s not the same as in any other populations, because you have energy that\u2019s regulated in a particular way in type 1 diabetes, and you have insulin dosing, and related behaviors through the day\u2026There are a lot of clinical behavioral and metabolic differences that make overweight and obesity a tough problem in type 1 diabetes. It\u2019s complicated and it\u2019s difficult to manage.\u201d These are certainly significant issues and major research undertakings. Fortunately, Mayer-Davis is on it. Her \u201cteam has a grant now\u2026looking for some strategies for weight management specifically in type 1 diabetes. That\u2019s an area of work we will be engaged in for quite some time. We\u2019re looking at dietary and behavioral strategies that we hope may be helpful for people who want to address weight at the same time as managing their glucose. You can\u2019t do one without the other. You have to have approaches that take care of both.\u201d<\/p>\n

Diet can be a hotly-debated piece of diabetes management<\/a> and Mayer-Davis is no stranger to this subject. A registered dietician, she\u2019s worked directly with patients with diabetes, co-authored numerous nutrition therapy recommendations, and was even appointed to the 2020 Dietary Guidelines Advisory Committee by the U.S. Departments of Agriculture and Health and Human Services. With all the different diets touted as beneficial for diabetes or weight loss, Mayer-Davis admits it can be very confusing for people to decipher all the information out there and much of it is not well-supported. \u201cPeople are always talking about glycemic control and weight,\u201d she says, \u201cbut even if you\u2019re just looking at glycemic control, there are very few data from good studies to really look at say the keto diet, or even just moderately reduced carbohydrate diets. It may be the case that a modest, reasonable reduction of carbohydrate may be beneficial in terms of glycemic control. But really what\u2019s needed are well-conducted studies that are done over a long enough period of time, with appropriate measures of adherence to the diet, acceptability of the diet, and a range of outcomes preferably from continuous glucose monitoring not just A1C. Right now, we don\u2019t have the data to make a grand statement.\u201d<\/p>\n

Dr. Mayer-Davis is trying to address this lack of data. In the SEARCH Nutrition Ancillary Study<\/span><\/a>,\u00a0 protein and leucine were associated with reductions in A1C and carbs were positively associated with higher A1C. According to Mayer-Davis, \u201cFor the type of study that it was, I\u2019m confident in those results and those results are consistent with a low carbohydrate diet being consistent with better glycemic control measured by A1C. Still, that wasn\u2019t a clinical trial where you have a defined intervention and continuous monitoring, where you can look at time in range, occurrences of low blood sugars or over target, and really using those more precise interventions and measurements to get better at the questions. It is suggestive, but that\u2019s where we are.\u201d<\/p>\n

Dr. Mayer-Davis acknowledges that nutrition is a key piece of a complex puzzle. About the current challenges for people with type 1 diabetes, she says, \u201cThe reality is that in this last decade or two especially, we\u2019ve had amazing advances in terms of insulin pumps, hybrid close loop, continuous glucose monitoring, kids staying on their parents\u2019 insurance\u2026in spite of all of that, we\u2019re not doing any better in this country with regard to glycemic control. So why is that? It\u2019s not just about available drugs and devices. This is about how people can actually manage their diabetes in their day to day experience. Taking advantage of the technology is a tremendous challenge.\u201d<\/p>\n

Looking ahead, I ask Dr. Mayer-Davis what the ideal future of diabetes treatment looks like five, ten years from now. \u201cWow,\u201d she says. Laughing when I admit it\u2019s a tall order. \u201cIt is\u00a0<\/i>a tall order. What I\u2019m thinking about first is if we could implement what we already know how to do. That has to do with health policy, insurance coverage, education, all of the really policy driven aspects, and not just education for patients and families, but support for them to be able to manage their diabetes. I think all of those social determinants for health and health policy, really need to come along, in these next few years, so that we can make sure that patients are able to take advantage of the technology that we have. On a longer time scale, of course, I, like everybody, truly want a cure\u2026that\u2019s obviously what we want. But there\u2019s a long time between now and then. So, it\u2019s figuring out [ways to better support people with diabetes]\u2026 alongside that, improving the advice that we can give on nutrition as a function of conducting the right studies. That kind of combination is what\u2019s needed while we are waiting for the day\u2014and I do think this day will come [but] we\u2019re too far away from it to get complacent.\u201d Until then, Dr. Mayer-Davis has no plans to stop \u201cchipping away\u201d; she gains inspiration and energy from her students, colleagues, and people with type 1 diabetes who participate in their studies. Ultimately, she says, \u201cwe are\u00a0<\/i>making progress. It is slow, and I\u2019ve been doing this a long time, but that\u2019s okay. The people in the studies, the families, the parents, the students, and sometimes students themselves who have type 1 diabetes bring the inspiration. And the progress that we are making to move all of this forward.\u201d<\/p>\n

\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

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