Q&A: Physician and Researcher on Diabetes and Endocrinology Care Today

CQD sat down with endocrinologist Kevin Pantalone, DO, to get some perspective on the state of endocrinology care in the U.S.

Q. As Director of Research at Cleveland Clinic’s Endocrinology & Metabolism Institute (EMI), what are you most enthusiastic about in your field?

A Endocrinology is a field that is advancing in all aspects. I often hear about exciting clinical trials evaluating the efficacy and safety of many potential medications which may someday obtain FDA approval. Many of these medications are for the more rare conditions that we treat, many of which currently have a limited number of treatment options, such as acromegaly and Cushing’s disease. There are also numerous medications in development to help address the obesity and diabetes epidemics.

Q. What do you see as the greatest challenges in your field?

A There are number of societal issues that continue to complicate our line of work. Looking from a global perspective for example, most endocrinologists would probably agree that the diabetes epidemic is being driven by the obesity epidemic, a complex disorder that requires a multidisciplinary and multi-modality approach to treatment for long-term success. Currently, our ability to address obesity has many challenges, one of which is the lack of insurance coverage for anti-obesity medications approved for chronic weight management. We know that we need to address patients’ weight in the management of type 2 diabetes (T2D), and this may require medications in addition to dietary interventions, exercise counseling, and effective treatment for sleep disorders and other potential psychiatric issues (stress, depression, anxiety, etc.)

Q. How is Cleveland Clinic EMI addressing care for overweight patients with T2D?

A We have developed a comprehensive weight management program that addresses all of the above issues, centered on shared medical appointments (SMAs). It is led by Bartolome Burguera, MD. The group setting has been effective for many patients struggling with weight management and all of the adverse conditions associated with it, including diabetes. We are also collaborating with our endocrine colleagues in the community and in centers around the country – including our affiliation with the National Diabetes and Obesity Research Institute. We are offering CME courses and events, sharing care paths, offering “teach the teacher” sessions, and developing patient care tools in the electronic medical record.

Q. What could physicians be doing to stem the diabetes crisis?

A It appears that we often fail our patients by waiting for them to be diagnosed with T2D to begin treatment. We know that many patients with obesity and/or pre-diabetes will ultimately develop T2D, yet we are lax in initiating our interventions until the actual diagnosis of T2D is confirmed. Furthermore, when we do initiate treatment in our patients with T2D, we must be more aggressive early in the course of disease, when patients still have a fair amount of residual beta cell function. This approach has been coined a “treat to target” approach, which is different from the historical approach we have taken with T2D management, commonly referred to as “treat to failure” approach. Being aggressive with lifestyle modification and weight management programs in our patients with recently diagnosed T2D is paramount to our future success, as is taking a more aggressive approach to the pharmacologic intensification of therapy, which has been endorsed by both the American Association of Clinical Endocrinologists and the American Diabetes Association.

Q. Any final thoughts?

A It is clear that all physicians are in this fight together, and we can and must learn from each other if we are to push forward in improving the quality of care we render to our patients. If you are interested in learning about research, developing an obesity clinic and more, visit our EMI page. Let’s continue to work together to see that the health of our country progresses in the right direction.