What makes Dr. Robert Eckel unique among the many accomplished physicians serving in leadership roles for the American Diabetes Association (ADA)? Aside from 40 years’ practice in endocrinology and heart complications, he has lived with type 1 diabetes (T1D) himself for over six decades, and two of his five children also happen to have T1D.
That means Eckel, currently the ADA’s president of Medicine & Science, “gets it” in ways that other healthcare providers may not, which surely served him well in his practice at the University of Colorado School of Medicine over the past four decades.
Dr. Eckel, what stands out to you about the ADA’s first-ever virtual Scientific Sessions?
COVID-19 has had a tremendous impact on the ADA and across the globe. When it hit (the U.S.) in March, the ADA was already re-posturing in terms of science and medicine, and the necessity of having budget and staff reductions.
Looking back now, I think the virtual Scientific Sessions were highly successful and the best it could be. We’re amazed at having more than 12,500 registrants, which was unexpected — we were hopeful for 10,000 people. Early on we were lagging behind, but in its last month, it grew from about 4,000 people to more than 12,000. And those who registered can have access to the presentations for a full 90 days after the meeting concluded. There were times in the past when I wanted to be in three sessions at the same time, but couldn’t do that. Now, I have the opportunity to go back and listen to the full presentation on my own, at my own pace. This is a problem that could be solved virtually, but not in a live meeting setting.
Even with a virtual exhibit hall, it wasn’t the same…
No, it wasn’t. There was an option to go into a virtual exhibit hall and displays. But it wasn’t like walking around and finding out more about a medication or device and being able to talk to individuals in person. Those in-person interactions in the exhibit hall can’t be reproduced by a 3-D virtual hall. You can casually walk around and experience and learn, with people you meet along the path. I think we missed those experiences that are an important part of this.
How will this shape future ADA events?
The pandemic has really changed a lot of things about how we communicate and meet. Most of us now are used to Zoom, Skype, or another platform to connect virtually, and the idea of being in a room can be captured virtually. There’s still a downside of being separated by geography and not being present personally. Networking with other researchers, being present during a presentation where an excellent talk is given… it’s just not the same.
Still, the success of this 2020 virtual meeting, I think, has made the ADA think about its meetings going forward and possibly doing ‘hybrid’ events. For example, we’d have a live meeting where you could see presentations and interact with colleagues in person. But you’d also have a virtual component, which could meet the needs of a lot of people who don’t have the funds or desire to travel, or ultimately who need only access to certain sessions that they could gain access to from halfway around the world, rather than traveling somewhere in the U.S. to attend an event in person.
Can you share your personal diabetes story?
I don’t really remember life without diabetes. I was 5 years old, back in February 1953. We know now there’s a prelude to the diagnosis that may take up to 3 years, but I just don’t have any recollection of life before my diagnosis. My mom, at that time, took a very sick child to Cincinnati Children’s Hospital, which is now one of the more highly recognized centers in the country.
I was in diabetic ketoacidosis (DKA) at the time, and I’d never been to the hospital before, so I do remember a couple of things:
One: My mother couldn’t stay over with me, so she went home at night.
Two: The blood test lancets that struck your fingers seemed like swords, so huge and they hurt like hell compared to the existing fingerstick technology that’s out there now, the size of a little pinprick.
That pain became a tie-in with my first days with diabetes that is stuck in my brain.
What was it like in those ‘dark ages’ of diabetes management?
At the time, the ability to manage diabetes was very crude. Largely, it was based on the Clinitest tablets that you’d drop into urine with 10 drops of water, and a gradient series of colors from blue to dark brown would reflect how much glucose was in the urine. An estimation, looking back, is that if everything was blue and there was no glucose in the urine, your A1C level at that time could’ve been anywhere up to 9.0 percent. That’s with all blues!
Yet I remember as a child having many green or orange to dark-brown ranges, which might have reflected A1Cs up to 12 or 13 percent. I don’t know where my control really was back then, but I can assure you it wasn’t great by today’s standards. I remember that quite well.
I also remember a problem with the Clinitest itself, where it would get really hot once you dropped the tablets in, and if you held it too long it would burn. And if you spilled the liquid onto your skin, you could be severely burned. This could never ‘pass Go’ by the FDA [Food and Drug Administration] in modern times.
Wow, and you must have been taking animal insulin…?
Yes, I grew up with a single injection per day of
At times, I might have felt sorry for myself. But I don’t look back with a lot of negative feelings, because that was just life in the ‘50s and ‘60s and where we were in diabetes. I learned a lot of lessons that would help me later and in medical school.
How did your own diabetes influence your career choice?
I found myself more and more interested in the question: Why is someone sick? And what is the recommended therapy? I was driven by curiosity. My fundamental drive wasn’t based on my own T1D, but more related to the broad picture of curiosity related to how people get sick and why some treatments don’t work.
I majored in bacteriology as an undergraduate and was at a hospital system where the infectious disease faculty was outstanding. Maybe I should have focused on that, but I had this research bent. I also wanted to have a clinical position that would be consistent with my life with T1D. And so I decided on endocrinology because if I didn’t like research, I could practice as an endocrinologist and be helpful to young people or even adults who were managed intensely with insulin with type 1 or type 2 diabetes. The bottom line is: I love research but I made a career decision to not study diabetes research as my direct interest. Rather, I focused on lipids and metabolism, which of course relates to diabetes but is more directed at cardiovascular disease.
What was it like going through medical school with T1D?
I went to a school where sometimes I was on call every other night or maybe every third night. Knowing my glucose at the time, as there was no fingerstick technology, wasn’t possible. Sometimes I’d get a large snack in the cafeteria just to avoid going hypoglycemic on my shift. I remember feeling nauseated at times because my sugar levels were so high.
I do remember in my pathology class during my second year, the faculty overseeing my microscopic examination of patients also found out about my diabetes and questioned why I’d been admitted into medical school. They commented that I wouldn’t live long enough to become a very effective doctor since I’d likely die in my mid-40s. You remember things like that when you’re 72 years of age like I am now.
There was also a time at the University of Wisconsin as a resident where I was making rounds on the cardiovascular floor, in the last month of a 3-year training program. My students with me started to wonder about my judgment, and one of them knew that I had T1D. There were no insulin pumps or sensors then, and they ended up calling a nurse to do my glucose and my reading was frighteningly low at 19 mg/dL. Here I was making rounds and not making much sense.
What did all that teach you?
That all helped me take ownership and be involved in my own management even more. Ultimately, I graduated to an insulin pump in the early 1990s here at the University of Colorado, where I’ve been since 1979. And the greatest advance in my diabetes management has been using a continuous glucose monitor (CGM), allowing me to be on top of my diabetes so much more.
And you have two sons with T1D, as well?
Yes, I do. I should mention that my late wife, the mother of my children who died of breast cancer, also had a number of autoimmune thyroid diseases. So two of my five children having T1D should not be a surprise. They developed type 1 right after my wife Sharon died in 1994-95, within 3 months of one another.
My sons were 12 and 11 at the time. So they can blame their T1D on their parents entirely. It really reflects something interesting scientifically that I don’t have an answer for: Why do children of T1D fathers have twice the incidence of type 1 than children of type 1 mothers? That’s certainly very perplexing.
What words of wisdom might you have for others with diabetes?
It’s amazing that we don’t know what the future bears and my encouragement to people is that diabetes is a life, not a disease. It’s a life and it impacts you 24/7 on every level. It’s an ownership concept, and I consider myself a survivor for being around this long with what diabetes management was like in those earlier days.