Emory Global Diabetes Research Center Faculty Authors New Diabetes Textbook

By Myra C. Patrick 

There are over half a billion cases of diabetes worldwide, and recent studies have revealed that the diabetes crisis shows no signs of slowing down.

To better addresses diabetes from a comprehensive, multidisciplinary perspective, Springer released its 2nd Edition of The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues. The textbook integrates information on diabetes from specialists in various disciplines, such as epidemiology and public health, many of which include researchers and health professionals engaged with the Emory Global Diabetes Research Center (EGDRC) and its global partners.

Multiple EGDRC-affiliated researchers are listed as chapter authors. Notably, their chapters cover diabetes management in three different regions of the world with fast-growing rates of diabetes, including Latin America and the Caribbean (LAC), Asia, and the United States.

Chapters:

• Diabetes Management in the United States: Megha Shah, MD, MSc, Associate Professor, Department of Family and Preventive Medicine 

• Diabetes Management in Latin America: Rodrigo M. Carrillo-Larco, MD, PhD, Associate Academic Research Scientist, Rollins School of Public Health

• Diabetes Management in Asia: Kavita Singh, PhD, Public Health Foundation of India, Gurgaon, India and Department of Global Health, Emory University; Roopa Shivashankar, MBBS, MD, Division of NCD, Indian Council of Medical Research, New Delhi, India; Nikhil Tandon, MBBS, MD, PhD, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India

• Healthy Lifestyles for the Self-Management of Type 2 Diabetes:Karla I. Galaviz, MSc, PhD, Adjunct Assistant Professor, Rollins School of Public Health; Mohammed K. Ali, MD, MSc, MBA, Co-Director of EGDRC and Foege Professor of Global Health 
• The Dynamics of Diabetes Prevalence, Morbidity, and Mortality:Edward W. Gregg, PhD, Faculty of Medicine, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

“We are delighted that chapters of The Diabetes Textbook have been led by our members," says Ali. “This is a testament to the reputation of our center’s depth and breadth of expertise, and as a hub for global diabetes research.”

Throughout the chapters, the researchers commonly address trends and barriers in diabetes management, which regardless of the region, they found similar roadblocks, such as treatment, which is a cornerstone of effective diabetes management.

Diabetes is one of the leading contributors of rising health care costs in the United States and disproportionately affects Americans from minority race/ethnicities and lower socioeconomic backgrounds. Shah says such disparities further complicate inequities in how highly effective medications are prescribed in the US.

“The newer classes of medications, like GLP-1 receptor agonists, are less likely to be prescribed to Asian, Black, and Hispanic patients and those with low incomes,” says Shah. “While there is no simple quick solution for this, our chapter calls on transparency in pricing to help prescribers find the lowest cost option for their patients and payers to cover the full cost of diabetes related care, including medications.”

The cost of treatment is also a barrier of management in LAC. Carrillo-Larco says that similar to the US, access to hypoglycemic medication in LAC is limited.

“On one hand, insulin is sometimes hard to get, either because of financial constraints, poor availability or limited infrastructure,” says Carrillo-Larco. “On the other hand, new oral hypoglycemic drugs are still expensive or not covered by many public systems.”

Not only do the researchers provide strategies to improve diabetes care and related disparities, they also highlight its complications that are often overlooked and are not generally associated with diabetes, such as mental health and oral health.

According to Shah, “Diabetes can cause distress related to the diagnosis or sometimes complex management that can lead to feelings of depression or anxiety.”

As for oral health, high levels of blood sugar affect the saliva and can lead to higher risk of tooth decay and gum disease.

“We often forget that diabetes affects every part of the body, which is why prevention, early detection, and treatment are so important," says Shah.

Many of the trends in diabetes research identified in these chapters are centered around using tools and technology for prevention and early detection in an effort avoid diabetes.

According to Carrillo-Larco, in LAC, “future research trends include risk stratification and precision care,” meaning that physicians will be able to better identify people at risk of having diabetes to prevent or delay the onset of diabetes.

“Similarly for diabetes complications, we will also have tools to assign specific treatment for patients depending on their unique profile and needs,” says Carrillo-Larco.

Many countries, including India, which has an estimated 101 million people living with diabetes, are also using tools to both prevent and manage diabetes. Singh and her co-authors summarize the impact of the COVID-19 pandemic on people with diabetes and how the role of telemedicine and digital health strategies help build resilient health systems to overcome some of the challenges of regular monitoring.

“Digital health technologies including mHealth, SMS, and remote monitoring devices could foster patient engagement in diabetes self-care,” says Singh. “These technologies can also bridge the 'know-do' gaps and potentially improve the interactions between patients and providers resulting in improved glucose control and reduced diabetes complications, particularly in resource-constrained areas of Asia.”