Renowned endocrinologist, researcher and entrepreneur David Kerr is moving from the UK to Santa Barbara, CA, in April to become the first-ever Director of Diabetes Research and Innovation at the Sansum Diabetes Research Institute. Since 1993, he's been the lead clinician at Royal Bournemouth Hospital, the top site for insulin pumps in the UK (although only 7% of diabetics there are pumpers).
This guy has an incredible resumÃ© in the diabetes & technology world, from doing a stint as managing editor of the Journal of Diabetes Science and Technology to creating and launching his own free online resources and mobile apps for patients. Not to mention that he's a Fellow of the Royal College of Physicians of Edinburgh and for a number of years has held a Gold Clinical Excellence Award from the UK National Health Service (NHS).
He's quite an amazing individual to have on our team -- of those devoted to improving life with diabetes! -- and together with Sansum's new executive director Rem Laan, he's got some hugely exciting things planned at Sansum that could help galvanize diabetes innovation across the country. We talked with David to get the scoop (in his fetching Scottish accent, I should add):
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DM) Congratulations on the move, David. Isn't the "director of innovation" a brand new role at Sansum?
DK) That's right. When Rem contacted me, he talked about having me develop new areas of interest for Sansum. They're of course world-famous for their work in AP (artificial pancreas) research, and in expertise on diabetes and pregnancy. But they're also looking to explore new approaches to type 2 treatment, in-hospital diabetes care, and other aspects of diabetes.
We want to create a Center of Excellence and Innovation at Sansum. We're now talking to potential collaborators, including the 'usual suspects' in terms of pharma and device companies, but also to others who you wouldn't necessarily think of as having an interest in diabetes -- the Googles and Apples. I'm also in discussions with Ford Motor Company about the concept that surfaced a few years ago of in-car medical monitoring. So many areas are ripe for exploring!
Is there any concern that industry partners will push to fund research projects that are self-serving for them?
We can easily create a list of diabetes problems that need to be solved, but what we don't want is to produce research findings just for researchers. If we do something that could be of value for people with diabetes (PWDs), then we want to create the product sooner rather than later, rather than having it just be of academic interest. So that's why we need to have industry involved at an early stage.
It's not officially announced yet, but that will be Dr. Jordan Pinsker, an accomplished pediatric endocrinologist who's worked with the Army for many years. He'll be relocating from Hawaii.
And who will be taking over Lois Jovanovic's famous focus on diabetes and pregnancy at Sansum?
Kristin Castorino will be taking over the mantel there. Lois is still consulting to Sansum, but she's stepping down from many things. We plan to look at the prevention of gestational diabetes, and target mothers who've had gestational diabetes and their offspring as an early-stage prevention channel -- as well as exploring the roles of various therapies and devices in diabetic pregnancies. That expertise will continue and develop.
Isn't Sansum creating a new collaboration with UC Santa Barbara where you'll engage with different academic departments on various diabetes innovation projects?
Yes, we have a number of faculty members who've expressed a real interest in getting involved in diabetes and so a consortium concept has been formed between Sansum and UCSB. There are a number of problem areas we need to solve for PWDs around technology, and we're approaching these industry players to see if they'll become partners with us to help with the problem-solving -- using the expertise UCSB has from an engineering/ computing / social science point of view and Sansum from a clinical point of view.
Can you give some examples of projects coming out of that?
We want for example to look at developing a personalized cloud so these devices and the information from them can be stored and read and assimilated within a person's individual cloud, so they and their healthcare providers (HCPs) can access the data on much a more frequent basis and make it possible that devices can communicate through the cloud irrespective of who the manufacturer is. It's moving away from the idea that each single device must have its own downloadable software, which is different from the next device, and trying to unify that.
Another UCSB department we're talking with is digital games research, led by Deborah Lieberman. There was a report out recently about the uptake of diabetes apps, that found there are around 1,100 diabetes apps in the Apple store, but of people with diabetes who own smartphones, only about 1.2% use them. This is due to a number of factors including quality of the app, what it's there for, and lack of evidence of effectiveness.
So another imperative for us is to try to set up an independent app reviewing process -- especially of the ones with gamification aspects -- to look at whether they follow the rules and strategy for effective gamification, and then whether they're built on evidence-based medicine with an educational component? The third step would be to ask PWDs to do a hands-on assessment. The idea is to then create an online database where people can get some guidance on these apps based on these three criteria.
Will you actually study the apps or games?
I think some of these companies need our help about how to put together a trial of their app. Also, gaming could be a very powerful tool for providing health benefits if it's used properly. I think we need to explore the use of games for behavioral change -- because that's the holy grail for a lot of tech companies, and for payers and heath services around the world.
You've stated publicly that you believe in the power of social media for improving patient outcomes. What does that mean for you in practical terms?
We've developed an interest in a different approach to diabetes care than the chronic disease model where people have an interaction with their clinician every six months or so. This is completely based on meeting a ton of people with diabetes over the years; I've had the privilege of having access to about 2,000 people with type 1, covering the whole spectrum of humanity, and it's quite clear we need a different approach to their care.
I've called this thing "Diabetes Moments," and it's the idea of looking at diabetes as whole, where life events can impact the ability for people to maintain good control and avoid hypoglycemia. The vision is to build a library of Diabetes Moments (or experiences), a site where people can go to find information and an approach to personalizing care, and eventually make it social so it can be shared with others, family members, and HCPs.
As a first stab we've put up two sites: VoyageMD.com, a travel site that's somewhat primitive but is an attempt to create something of value; and ExCarbs.com, which relates to exercise and insulin. We'll be adding a calculator there shortly so that people can enter the duration and intensity of their exercise and get some advice about carbs and when to test glucose and what to do with insulin.
Are these diabetes apps that you've created yourself?
Those first two are actually web-based, but we hope to move into other platforms soon. And I've actually created one app specifically for people with painful neuropathy, called 'Appy Feet. It helps capture daily or weekly changes in sleep, pain, and activity, mainly to look at the impact of when there's a change in therapy -- because that's such a difficult condition to live with.
So will the "Diabetes Moments" repository be video material, data, or written testimonials?
A mixture! At the moment, we've got some information and one calculator that helps you figure what to do with insulin when you fly long-haul, for example. We've been working in the UK to include some research, government and political resources. But what we really want is to have people contribute their experiences. For example, we want to capture what individuals do when they undertake certain forms of exercise -- particularly if they've got data profiles to share -- and create a library so that anyone, anywhere in the world can look up what other people have done.
There are lots of physicians, researchers and other healthcare providers who still don't embrace social media...
Yes, there are a lot of regulatory bodies, agencies, and charities that are fearful of social media. Part of it is historical, because they want to maintain the status quo of there being a hierarchical approach to healthcare, particularly in a medical problem such as diabetes. So people can be fearful of change and fearful of losing power and influence.
But I keep coming back to the fact that... if you look at outcomes in people with diabetes in terms of what's achieved, they're not very good and they've been stagnant for a number of years. Of course can find niches where things have improved but in general... things need to be done differently to give people a better opportunity to do well.
"Things are going to change big-time... because the status quo is really not an option.."
— Dr. David Kerr, on the future of diabetes care
All of what we're doing here in the UK and my sense of what we're going to do at Sansum is based on conversations and experiences from PWDs and their families. For example, it used to be the case for a young trainee endocrinologist who would attend a lot of conferences, take a lot of exams, and read a lot of literature, the one thing that improved their clinical care the most was attending a diabetes camp with children. This used to be a right of passage.
There's so much to learn because as you know, diabetes is not an exact science. There's an influence of biology but also psychology in terms of trying to achieve the goals.
What about risks of social media involvement for a clinic or institution?
On the negative side, we have to be cautious about confidentiality, and about making sure we're reaching the right people -- and it's not being hijacked by a small minority, which can occur in any large grouping.
Meanwhile, I'm just struck by the fact that PWDs spend one to two hours per day minimum having to deal with diabetes (on average, type 1 and type 2), and somehow sharing these experiences seems to make clinical sense to me. I mean, it's slightly old-fashioned for you, but sharing empathy and understanding... helps people achieve their goals.
Sounds like you're talking about the "ePatient Revolution"?
Absolutely. I think the movement to democratize health and collaborate with healthcare providers and change healthcare is unstoppable.
That doesn't mean it's going to be smooth -- it's going to be very bumpy. But that's OK. Wherever we get to with this has got to be better than where we are at the moment. It's still a disaster when we see some of the outcomes that occur. And also some of the problems with access, with health literacy, and with (dare I say?) arrogance among some of my medical colleagues. I think we need to move away from this, because it's got to benefit the people living with the condition.
Did you have a personal connection to diabetes that got you started in this field?
Actually no. How I got into it was slightly bizarre. I wasn't quite sure what I wanted to do, and I ended up working in the UK in a gastroenterology department learning how to do endoscopies. In clinic I saw lot of people who had irritable bowel syndrome. A lot of my colleagues were quite scathing and rather put down about some of the people living with IBS. But it occurred to me that these people may have a hyperactive or easily triggered autonomic nervous system; so I had this this weird, outlandish idea, and I asked my boss, 'how do we go about looking at the autonomic nervous system'? And he said to me, 'you need to see a chap called Robert Tattersall,' who was a major player in diabetes in the 1980s-1990s... And we just got on, he invited me to join the department and we undertook some research into awareness of hypoglycemia -- and the rest is history, really.
It never fails to excite me and interest me that there are so many unanswered questions. The clinical aspects of (diabetes) are just mind-boggling in terms of the variation of what is possible, and not possible. And for many people, it can be a nightmare to live with. So from a doctoring sense, there's a lot to be done and lot we can do.
Bringing you on, Sansum is committing to blazing a trail in innovation. What exactly is the approach?
Diabetes Moments is going to be core to what we'll be doing.
We're also going to be, I hope, doing do a lot more about in-hospital diabetes care. I suspect the U.S. is similar to most of Europe in that the standards leave a lot to be desired. We've been doing some work locally in the UK to reduce errors in insulin administration and we've been quite successful, but there's still a whole host of other things to do there.
And then Sansum needs to develop an interest in type 2 diabetes as well. We've been working with a startup trying to create a behavioral modification program using novel a platform, the idea being that we need to do more in the lifestyle space for anyone with diabetes. Instead of ratcheting up the number of therapies -- which brings issues of side effects, they're expensive, the hassle factor -- to try to improve what's on offer from the lifestyle perspective.
From the type 1 point of view, we've just done a review of 1,500 of our type 1s, looking at problem of excess weight gain. In type 2 it's a given that this is a problem, but we're also seeing an increasing number of type 1s who say it's difficult to lose weight, they're gaining too much... I think a lot of people are over-insulinized. That's due to a lot of factors, including fear of hypos, the carbs might be too high... I think there's actually a need at a personal level to utilize people's own data -- review the carb ratio and how it changes, and so on. I think fine-tuning of an insulin regimen at an individual level in type 1 is the way forward. This is applicable to pumpers and people on MDI as well.
What's next in Artificial Pancreas trials at Sansum?
It's got to move from the investigation unit to the real world. We need to understand what needs to be developed to allow people to use the AP for longer (from 24 hours to weeks), and as part of their daily activities -- the whole aspect of living with a machine. The algorithms need to cope with biological and physical variation between individuals and within individuals.
That's a tall order, but my point of view is, we don't have to wait until it's perfect. Many aspects of the AP can be implemented now to reduce the burden of diabetes. I need to convince my academic colleagues that there's a lot we can offer before we reach Nirvana.
As a wrap-up, what's the most important thing you'd like people to know about the Sansum Diabetes Research Institute (@SansumDiabetes) and your approach to leading innovation?
Sansum is taking a view of diabetes research and innovation from the point of view of people living with the condition. We understand there's a need to develop technologies that will reduce the burden of living with diabetes for everyone, including the families. We already have a world-class reputation in artificial pancreas and in pregnancy and diabetes, and we want to develop world-class impact that matters across a spectrum of multiple aspects of diabetes.
The ethos at Sansum is going to be one of collaboration, and the more we can work with PWDs the better.
Huge thanks David! We can't be more pleased to welcome you to the U.S. as part of our growing army of diabetes innovators!