David Kerr, MBChB, DM, FRCP, FRCPE is Director of Research and Innovation at Sansum Diabetes Research Institute (SDRI) in Santa Barbara, California. He is a UK-trained physician and endocrinologist and has spent many years trying to help people “tame the beast” that is diabetes. This is his third time living in the US, having been a researcher at Yale in the 1990s, and then an Editor of the Journal of Diabetes Science and Technology in 2010 while he lived in the San Francisco Bay area.
David went to school and University in Scotland and subsequently spent most of his professional life being a full-time clinician. David is a Fellow of the Royal Colleges of Physicians of Edinburgh and London, Visiting Professor at Bournemouth University and for many years has held a Gold Clinical Excellence Award from the National Health Service in the UK.
David joined SDRI here in Santa Barbara in April 2014 to help develop the idea of “breaking the code” – taking what is already available and what is being developed and modifying and creating technology and other innovations to benefit the maximum number of people with diabetes for the longest period of time and with the minimum disruption to their lives. He is the creator of multiple free web-based resources for people with diabetes and more recently the lead researcher for www.MilFamilias.com and https://www.sansum.org/farming-for-life/.
You can follow him on Twitter: @godiabetesmd
Q & A with David:
Q: There’s a decided focus on the Latino community at Sansum Diabetes Research Institute (SDRI); was this focus original to the mission?
A: Sansum SDRI was founded 75 years ago by Dr William Sansum, the first physician in the United States to manufacture and prescribe insulin to a person with diabetes. Since then the Institute has continued to have a long-standing focus on Type 1 diabetes, including diabetes in pregnancy and the development of the artificial pancreas. I came to the Santa Barbara, CA area from the UK over five years ago looking at the potential role of tech to relieve the burden of people living with diabetes and perhaps prevent Type 2 diabetes. Within the last two-three years, as I started noticing our population demographics, I began asking the question “why is there a disproportionate impact of diabetes on underserved populations…Latinos, Native Americans, etc. For example, within the Latino population, 1 in 2 are at risk of diabetes and those with it have higher A1Cs. And, there are more complications, such as end-stage kidney disease and higher mortality for stroke. They also have less access to innovations, technology, and proper resources which creates a vicious cycle leading to poor outcomes.
So, the next question was “what are we going to do about it?” As we started looking at the first question, we determined that there are several non- biological factors that play a huge role within the Latino population. To better understand the disproportionate impact of diabetes, we recruited 1,000 families where at least one member had diabetes. We are collecting data on the 5 main determinants of human health — behaviors, biology, psychology, genetics, the environment, and more. We determined that in order to achieve our aim, the one thing that needed to happen was to create a new type of healthcare specialist. Within the Latino community, these specialists have traditionally been used as “promotoras” who have some level of training to assist with basic healthcare education without being a professional. Their efforts have not been as meaningful to the cause, so we wanted to create a more official highly-trained role for what we are calling “citizen scientists” who are learning how to do point-of-contact access, analyze data, look at measurables, and conduct health literacy. These citizen scientists are now involved in recruitment, data collection, the use of technologies, clinical diabetes, and care navigation.
For the future of improving healthcare in underserved populations, we have also found that we need to be looking at the environment, specifically…the air we breathe. Air pollution is increasingly recognized as a factor in driving the diabetes pandemic, worsening diabetes
conditions. For this, we are working with the Santa Barbara University of California’s School of Environmental Studies to determine levels that impact.
So, the list of factors we’ve learned that are drivers for diabetes in this population includes zip code, air quality, employment, education, and health literacy as well as the common biological factors, such as family history, age, and obesity. Once we break the code for Latinos,
we can help more underserved populations.
Q: Would you share information on how the Farming For Life program works?
A: So, after understanding why diabetes is so much more common in certain populations in the U.S., we have introduced our “intervention.” We have a mantra that is “Eat your Medicine.” For this intervention, we are providing the Farming for Life program for participants with medical prescriptions for fresh vegetables to access those fresh vegetables. We are working with local doctors and are sourcing from local farms. To prove the effectiveness, we are tracking health measurements of 150 people with or at risk of diabetes and are finding that everyone is seeing improvements in food security and there’s an overall improvement in A1C levels, weight control, waist circumference, and improvement in sleep. But, what’s really eye-opening is the astonishing reduction in high blood pressure. Next, we’ll layer on education and rewarding Latinos for providing their health information. The way we will do this is by introducing a new currency – “agricultural units of care.” How this works is that by joining the Farming for Life program, you would earn agriculture units of care (AUCs) by meeting certain goals. For example, if your high blood pressure lowers, you might receive 10 AUCs and maybe you’d spend 5 of those units with the Institute at SDRI on an eye screening. The idea is that individuals can use their own health information to get better care. Subsequently, we plan to ask health insurers to help us support this program and make it easier for these patients to get into prevention as their costs will be much less. We need to think radically about what’s in it for the individual.
Q: You’ve been working in the diabetes space a while and have created several programs that help patients. Where are these ideas coming from?
A: I was a clinician in a hospital with 20,000 diabetes patients with all kinds of complications. I found that most people with diabetes hate having diabetes and are quite hungry for new innovations and information that will improve their lives. Challenges for people without diabetes are 100x more difficult for those with the disease. Everything is harder with diabetes, for example, long-distance travel is especially hard if you are on injectable insulin, so to help, I created Diabetestravel.org to help make travel easier and safer for people with diabetes. We want to minimize personal risk. Similarly, exercise can be challenging for people using insulin. For this, I worked with international experts to create www.excarbs.com. Both of these resources are completely free to use. I’ve also been working with colleagues on “dos and don’ts” regarding exercise (60% of people with Type 1 are carrying excess weight).
We’ve recently created LatinoDiabetes.net to share any new knowledge from the research community that’s happening in that space that is relevant to Latinos with diabetes and their health providers. We have it translated in layman’s terms in English and Spanish. We’re starting to work with a major publisher of medical research to see about getting this approach replicated for multiple populations and diseases.
Q: What do you see now as the way ahead for innovators working on the problems associated with diabetes?
A: Doing something small, then doing another small something…and another, as opposed to trying to do something huge…in a short term, this is more likely to be effective and sustained…so-called “nudge medicine.” To achieve this, it is fundamental to understand your target audience, to know who is going to pay for your project, and then, importantly, to know what success is going to look like. It takes two things; money and time.
Our mission is simply to reduce the disproportion of the burden of diabetes across the U.S. There is no reason why different groups of people should be affected differently.
David’s Networking Interests:
- People who see the value of food as medicine (food industry leaders who want to collaborate or are looking for a trial partner to determine the health value of their food product)
- Collaborators/supporters of the environment as a driver for disease control
- Social impact investors who see the ROI in terms of relieving the burden of disease and cost to the system