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Think big (and don't be an idiot) - Dr. Partha Kar on the future of diabetes care

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Вміст надано Stacey Simms. Весь вміст подкастів, включаючи епізоди, графіку та описи подкастів, завантажується та надається безпосередньо компанією Stacey Simms або його партнером по платформі подкастів. Якщо ви вважаєте, що хтось використовує ваш захищений авторським правом твір без вашого дозволу, ви можете виконати процедуру, описану тут https://uk.player.fm/legal.

When you have a national lead on diabetes who really seems to listen to patients and delivers on some big ideas, you get our attention. Dr. Partha Kar is the diabetes co-lead of NHS England. We talk about access, getting more out of your doctor’s visits and what he sees in the future of diabetes tech.

Dr. Kar's announcement (after our interview was taped) that CGM or Flash Glucose Monitoring will be available to all people in England with type 1 diabetes

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Check out Stacey's book: The World's Worst Diabetes Mom!

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Episode Transcription Below:

Stacey Simms 0:00

Diabetes Connections is brought to you by. Dario Health – Manage your blood glucose levels. Increase your possibilities. By Gvoke HypoPen, the first pre-mixed autoinjector for very low blood sugar. And By Dexcom. Take control of your diabetes and live life to the fullest with Dexcom

This is Diabetes Connections with Stacey Simms.\

This week when you're a national leader on diabetes, and you really seem to listen to patients and you deliver on some big ideas, you get our attention. Dr. Partha Kar says it shouldn't be that unusual.

Partha Kar 0:39

And I also feel that clinicians sometimes believe that people living with type 1 diabetes won't be able to handle the truth, so to speak, oh, you can't tell them when you can. They're all adults are surrounded by adults, and they deal with tough calls in their lives all the time. You know,

Stacey Simms 0:57

Dr. Kar is the diabetes co-lead of NHS England. Yes, this is a US centric show. But I've followed him on social media for a long time. And I've loved what he has to say. We'll talk about access, getting more out of your doctor's visits, and what he sees in the future of diabetes tech.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome to another week of the show, I am your host, Stacey Sims, and we aim to educate and inspire about diabetes with a focus on people who use insulin. If you're part of our mostly American audience, I hope you had a really good Thanksgiving, I hope the travel was safe. If you had to go anywhere, I hope the food was great. And I hope the family was okay to really hope you had a great holiday. If you're part of our international audience, which is still pretty big, I would expect it to be bigger this week, just because of who we're talking to. And that is Dr. Partha Kar, national specialty advisor for diabetes with NHS England. And this is one of those times where I just was interested to see what somebody had to say, as I mentioned in that the opening teaser, I followed him online for quite a while. And I thought you might be interested as well. And boy, when I put it in the Facebook group, you all were thrilled. So I hope you enjoy the interview. He didn't have a ton of time to talk to me. But that is to be expected. But I'm really happy with the questions I was able to ask. And you know, just the fact that he was able to share some information with us, even though his his health system is is markedly different than ours here in the States.

Before we jump in, I do want to take a moment this is a little self promoting. But gosh, guys, I got such exciting news recently. And that is that I won this huge book price. Yes, I know the book came out a while ago, but I won best new non fiction in the American Book fest. This was of course for the world's worst diabetes mom real life stories of raising a child with type 1 diabetes. And it kind of took me didn't kind of it really took me by surprise. I had entered it earlier this year, I had forgotten about it. When we got the email, my publisher kind of emailed me quickly and said, you know, being a finalist is really nice. And then she said no, no, wait a minute, you. That was kind of my reaction to it was laughing. But I won. So I know you're asking, Okay, the world's worst diabetes mom came out in 2019. How did we win an award in 2021. The book fest the American Book, festival boards are kind of rolling. So you're eligible for almost three years. So this year's books were from certain dates in 2120 20 in 2019. This was our first time entering the book, and it was actually our last chance to enter. So boy, I'm so excited. I'm really proud of the book. And I have some news coming in December. I have some more book news that was already planned before this award. But thank you for letting me indulgent, do a little patting myself on the back. It was not easy to write and get it out and do everything we needed to do for it. And boy, you all have been so supportive, considering I haven't been able to do any kind of book tour at all right? I mean, it came out at the end of 2019. I think I went to two or three places. And that was it. And just like everybody else in 2020. It hasn't been the same since I'm hardly alone in that.

So more book news coming up, and Dr. Partha Kar in just a moment I should probably tell you just a little bit more about him if you're not familiar. He has been a consultant in Diabetes and Endocrinology on the national level there in the UK since 2008, clinical director of diabetes from 2009 to 2015. And here's the full title national specialty advisor diabetes with NHS England. And there are so many things that he's been involved with, most recently, very prominently getting the FreeStyle Libre being available across the country over there and I will talk about that specifically. Being very involved in language matters. Getting CGM available to all t one D pregnant patients. And he hinted this week that a big announcement was coming. So I will link that up in the show notes so you can find out we talked The week before Thanksgiving here in the States, so timing wise full bit tricky, but he was announcing something big and I will include that to the best of my ability.

Okay, Diabetes Connections is brought to you by Gvoke Hypopen. Almost everyone who takes insulin has experienced a low blood sugar – and that can be scary. A very low blood sugar is really scary. And that’s where Gvoke HypoPen comes in. Gvoke is the first autoinjector to treat very low blood sugar. Gvoke HypoPen is premixed and ready to go, with no visible needle. That means it’s easy to use. How easy is it? You pull off the red cap and push the yellow end onto bare skin – and hold it for 5 seconds. That’s it. Find out more – go to diabetes dash connections dot com and click on the Gvoke logo. Gvoke shouldn’t be used in patients with pheochromocytoma or insulinoma – visit gvoke glucagon dot com slash risk.

Partha Kar Welcome to Diabetes Connections. Thanks so much for making some time for me and my listeners. Absolute pleasure. Thank

Partha Kar 5:55

you for asking.

Stacey Simms 5:56

I gotta tell you, I'm a little nervous. I'm a huge fan. I'm just following you on social media. And then I put into my Facebook group like I always do. You know, do you have any questions for this guest? We've got a part of the car coming up. I have very few questions from the group. But I have lots of oh my gosh, I love him. Tell him we love him. Tell him. Thank you. Thank you. And I'll tell you specifically why they're thanking you in a moment. But you do have a quite a big fan club over here. So going in, I guess I'm trying to butter you up. But going in, you should know that.

Partha Kar 6:24

No, it's very quiet, very kind. I always see this, you know, at the end of the day, it's my job to do as well. But you know, the love and blessings you get is just makes it stronger. So yeah, no, absolutely. Thank you.

Stacey Simms 6:35

You're welcome. Let me just start off by asking you, you do not live with diabetes? How did you get into the position that you were in today? Why this field for you. So I think

Partha Kar 6:43

a lot of it was, you know, when we are when we are training, you pick your subjects as you go along. And then I sort of gravitated towards Diabetes and Endocrinology because I thought there was an opportunity here to talk to a lot of people, you know, be a part of their journey throughout life. So it was quite good. And I like talking, and then sort of more towards type one, because I think I get got to realize the more senior I got a lot of attention, quite understandably, was into type two diabetes. And that's, you know, the bigger volume number, etc. But I think what I found that there's not a lot of things being done for type one as a trade back of that. So it's been more of a, let's see what we can do in the space. Let's try and help people. And I think just being an advocate, so to speak. So yeah, that's probably how it's graduated over the course of time. One of

Stacey Simms 7:31

the things that we've observed, just following your social media here in the US, is the adoption and use of libre for many more people, can you talk a little bit about how that came about?

Partha Kar 7:41

So I think Libre, I'm in freestyle Libre first came into the market on 2014 2015. And I think it started to sort of gradually make its way into the UK setting and the sort of people would buy it funded. And I think it sort of started taking off in 2016 2017. And that's when I sort of got into the job. And for me, people are always asking why this particular device, I think it's not the device, I think it's more of a mass device. And I think there'll be more competition coming along. But to me, it's be a very good example of what self management can do. I mean, simply put, if you see more of your numbers and more of your trends, you tend to intervene more and do better. So that's been the device and it's been a battle to try and get it into people's lives as you go along. As you're the system here is slightly different. You have to justify every single thing you do, because you're saying, Well, this is why we're trying to do it. And it's a funny place to be in because you know, you're you're sort of fighting, so to speak against other conditions, that doesn't feel right, either trying to justify why you needed more compared to X or Y. And I think that's the challenge. And then people start looking at well, actually, there isn't a randomized control trial, which showed y or Zed and I can't fund it. And I try and explain to people it's not just about the RCTs, or the randomized control trials all the time. It's not just about doing one see, it's about the quality of life and what it does do so yeah, I think I think that's how it came about. And then driving it through, pick up or take up around the country sort of battling with regions. So yeah, it's it's been a journey in the half, so to speak. Can you

Stacey Simms 9:14

get a little bit more specific in terms of how many people now in your system do have access and do use the freestyle?

Partha Kar 9:20

Yeah, I mean, I think we got I mean, given round, figure wise, we've got about 200, we got a quarter of a million people with type 1 diabetes, and I think about 53% of them are on it right now across the country, and of all our cards land. Well, I think it should be available, either, you know, Libre or its equivalent should be available to everybody, everybody, very soon.

Stacey Simms 9:42

So yeah, I mean, the reason I wanted to ask that is because first of all, it's already such a big number comparatively speaking too much for the rest of the world. Certainly, I've got to imagine you're starting to see better outcomes too. Yeah,

Partha Kar 9:53

absolutely. I mean, it's coming through your h1 HB ones is a better I mean, I can tell you from my own clinical practice, people are huge changes. We're seeing it across the country and the data we're collecting and guess what admission levels are down. People feel happier your HP once he's down, it's doing what it says on the tin.

Stacey Simms 10:08

What would be the ultimate goal? Is it with that device? Is it then moving on to other CGM? Or do you want to kind of get as many people as possible in this one?

Partha Kar 10:15

Oh, no, absolutely. I've always maintained I'm a Libre or freestyle Libre is has been the tip of the spear. I think there was a lot of things there, which was about showing people the what is possible, because before that, in the world of the NHS technology has always been seen as a Okay, well, let's see what we can do. I mean, for example, insulin pumps have been around for so long. We even had nice guidance on it available since 2008. But the pickup rate really low 15% 16%. Really many reasons behind it. And CGM for isn't traditional CGM like Dexcom. Really low again, 4% 5%, or there abouts. But I think this was about showing what could be done if you really pushed on it hard. And I think it's opened up many, many doors. You know, subsequently, because of that, we're looking at competition coming along, we're looking at every single pregnancy with type 1 diabetes not having access to a Dexcom, or Medtronic device, we're doing trials and closed loop, suddenly, it has become a flagship, and due to luck, serendipity or default, it's worked out as one of the projects, which has really, really played out well in the NHS. And so a lot of people are looking at it. And for me, that was always the purpose. It's the tip of the spear. If you can show you could do it with one, there's no reason you can't. And it's definitely not the end goal never has been. I think the end goal would be that every every person with type 1 diabetes, irrespective of the age has the ability to choose whatever technology they so can, whether it's flash, whether it's traditional CGM, whether it's a pump, or whether it's a closed loop, partnership salutely.

Stacey Simms 11:44

And I'm just a little bit more about the Libre, I'm curious to obviously the biggest objection many people would have had would have been cost. But inside your organization or external critics, what were their objections thinking going into something like this,

Partha Kar 11:57

I think the NHS always is a very traditional setup. And I think they're very good when it comes to drugs to pharmaceutical products. For example, pharmaceutical companies will do massive randomized control trials to show Okay, here is the drop in HBO and see, and thereby you can calculate it. The problem is with technology company, they necessarily haven't done that. If you look at Frisco Librem, the initial studies that came out, they never showed any change in HB one C, primarily because they chose a lot of people's age 20 with the excellent to begin with. And you're sitting there going, Well, that was a mistake, I think, for companies not to take up the trials, because straightaway to a lot of policymakers, you don't have any room to maneuver, because you're banking yourself completely on the ability that will show improvement of hypos and quality of life. Now, the other problem, I suspect has been there nice, which is our governing body, so to speak, who you know, looks at evidence, they're quite slow at coming off the blocks. Sometimes it can be too late in the technology world by the time you assess, you know, right now they're assessing Libre one you are Libre 123 out. So what are you assessing? There's got to be nimble and quick. That's been that was the obstacle people saying that. So I think there were that level of obstacle Well, nice having said so so why should be, there's also a lot of people who fundamentally believed that this was just a gizmo and this was just shiny toy, and we shouldn't give it to people with diabetes, they should or for example, they had to earn it, you know, they have to either have complications to have it, or they should be testing 10 times a day to get it, which I think is pretty silly. Because you know, the whole point of doing this exercise is to target people are finding it difficult to test and find giving it to people to stop them from having complications. But there you go, it's a very traditional set of thinking, which is what has been the challenge trying to break through?

Stacey Simms 13:39

Yeah, do we have similar issues in the states where they're doing trials? And you always see like, well, they're a one see went from 7.3 to 6.9. And that's wonderful. But you know, we need to reach the people who's a one sees our 10.5 100%, right, because of either education or access, or whatever it is. I know, I know, you're struggling with that as well. Yeah,

Partha Kar 13:58

  1. So, for example, you know, we have learned from that, you know, we, when we collected the real world data with Libre, we showed exactly what he said, the higher the higher your starting age, we want to see the better your outcomes. And you're like, Well, that's obvious. So what we're doing with those with Kevin, so what you're doing with closed loops right now, so we're running a real world trial evaluation throughout the country, it's about 34, five centers around the country, adults and pediatrics doing it. And guess what we see, again, the higher your agency, the better you're a flattening of your agency. So it's not rocket science. And I always am flabbergasted when people doing trials go like, no, let's just pick the people's controller really good. And as you said, but that goes against the whole deprivation thing that we discuss about because we know people who come from very deprived backgrounds will have worse control. So if you really want to tackle deprivation, you need to control that and you need to tackle that. So the thinking needs to be far more refined than what it is at the present moment. And hopefully we're trying to show some ways of doing so.

Stacey Simms 14:54

So one of my listeners said, I want you to please let parked the car know how much I appreciate In his posts, she goes on to say, there's not much I appreciate more than medical professionals who treat us like real people and don't talk down to us. Where did you learn your bedside manner your style or what you know what we as as not your patients see on social media because that's one of the things I think that very much resonates with people is that you're you're very plain spoken and you don't talk down to people with diabetes

right back to our conversation, but first Diabetes Connections is brought to you by Dario health. And you know, over the years, I find we manage diabetes better when we're thinking less about all the stuff of diabetes tasks. That's why I love partnering with people who take the load off things like ordering supplies, so I can really focus on Benny, the Dario diabetes success plan is all about you, all the strips and lancets you need delivered to your door, one on one coaching. So you can meet your milestones, weekly insights into your trends with suggestions for how to succeed, get the diabetes management plan that works with you. And for you. Dario is published studies demonstrate high impact clinical results, find out more go to my dario.com forward slash diabetes dash connections. Now back to Dr. Kar, talking about how he has developed a good bedside manner and respect for his patients.

Partha Kar 16:20

I think it's come with time, if I'm very honest, and most likely, it's not like a suddenly over a bed. And one day I decided to become like this. And I think what I've realized over the course of time is their Medical School doesn't teach us consultations, kills diseases, a lot of stuff, right? It's just teaches us what the book said, which is my Insulet physiology, how it works, doesn't really teach us a lot about interaction with human beings, which is what we did with some things like the language matters and stuff and people found language matters. Interesting. I found that just human sense, you know, common sense, human, it's not that difficult to be nice to people. And we somehow are not we somehow, and I think social media teaches me a lot of stuff. I think my patients teach me a lot. And I don't say that in a glib way, because things like, you know, I will do transitional or young adults clinic. And I remember these words from this young girl who sat there looked at me and said, If he took an exam sometimes, you know, and I want to watch that. And she said that, I don't know. It just feels like I'm going to be asked what I'm doing with judgment, what I'm doing, you know, when I sat down, but like, that's not right, that's wrong. Why are we making people feel like that way? And then we are wondering why they're not coming back to our clinics. So a lot of my consultations were very honest, not about diabetes, with my patients they're very much about could be a football or movies. I mean, yesterday, when just watch the internals and today in clinic, we were talking about one of my patients, and that was the conversation, what did you think about that paid the post credits, what was it, and I think you build a rapport with people, they trust you more, you get along more. So I like to keep it very plain. And I also feel that clinicians sometimes believe that people living with type 1 diabetes won't be able to handle the truth, so to speak. Oh, you can't tell them when you can. They're all adults and or, or in or surrounded by adults, and they deal with tough calls in their lives all the time, you know, how to get a mortgage, you know, how to get your car or dealing with ups and downs, or the Why wouldn't they be able to they live with it. So I've always benefited that by turning around and saying I can't do this for you. It's outside my expertise. And I think finally, I'm also trying with my other role trying to deconstruct the myth, and the and the whole thing that doctors are built around them so that there's some sort of, you know, material human beings here for to burn themselves to the altar, normally not, you know, we trained professionals, like a fireman or a policeman and trying to do my best. And sometimes I'll get it wrong, sometimes I'll get it right. But at least I want to portray across that I'm trying and trying my best. And we'll see where we go from there.

Stacey Simms 18:50

You know, it brings up an interesting point, because I consider myself a very strong advocate with my doctors, for myself and for my children. But I still hear you get intimidated, you do very much respect my doctors, any advice for patients who who want to have a difficult conversation with their physician who want to start broaching that, hey, treat me like a partner and may not know how to start?

Partha Kar 19:12

Yeah, I mean, I think it's really difficult. It's really difficult to do that. Because I think this is why it's a bit like I always give the example of let's say, sexism. Now. It's not the it's not just the job of women to go and solve sexism, is it. I mean, it's men have got an equal part, you will not understand nuance as a man or a woman goes through, but you know, when it's wrong, and you can turn around and say, Nah, guys don't do that. Right. So I think what I would encourage rather my clinical colleagues to say that, look, it's not tricky to sort of have that feedback and saying your approach may not be the right thing. And I think this younger generation coming through which does that. So my advice to patients who would like to do that would be to, I think doctors feel very challenged as soon as you challenge them. It's an ego thing. Don't forget that we have been taught in medical school that we are the top of the top there is no Nobody better than us, right? When you're told that for five years, seven years, eight years, 10 years of your life that there was nobody better than you, it's very difficult to then sit in a space. And if somebody challenges you to actually take that on board, so there is a bit of that complex that has happened over the course of time. So the way to approach that would be to probably do it from a slightly different angle. And rather than pointing out the mistake and say, What would you say? What do you think if we did this? Do you feel like so I think you try and do that there'll be some people who are open to the idea of saying, I don't agree with that, and you go with it. But I think the biggest advice I can give is find an ally, was also a clinician who will do that for you. So in meetings, when I go to, I always see myself as that sort of advocacy role return rentable. And now I don't agree with that. Because I know I've spoken to a lot of people who want to agree with that. So that is the sort of fine balance to strike, it will change, doctors are changing. And you know, if you've been long enough in the system, the 90s, were different to 1000s were different, and now is different, but doctors are evolving slowly takes a long time to get you got good get rid of you got complex.

Stacey Simms 21:02

Another question from one of my listeners who wanted to know, Brexit to will, or already has had an impact on diabetes care or supplies,

Partha Kar 21:11

hasn't affected supplies, because we actually knew there was going to be a problem. So we planned and we worked with the industry to make sure we had good suppliers. And there will always be teething trouble as we go along with this. But no, we don't expect, he says Fingers crossed. We have some plans in place in case of anything, but Brexit is one of those political things in life, isn't it? So we just have to ride the storm with it as we go along. So

Stacey Simms 21:34

this is an American based podcast, mostly because I'm American, we do have listeners all over the world, which I'm very, very grateful for. But our healthcare systems are so different. I'm curious if you have any advice, or any lessons that you think we could learn from how how you all do it?

Partha Kar 21:53

Yeah, I mean, so I think the debate about healthcare becomes incredibly emotive on both sides of the Atlantic. I think that's the problem. So when you turn around, people start saying, so for example, if you challenge the NHS, people go like, well, you don't like the NHS, because you want to make it privatized to you. And you will? Um, no, not really, I'm just saying that there are gaps in the prison system as we fund it, for example, we say it's equal to all well, not really, if you come from a deprived community. Right, now we've got issues with race. So as I've said, if you're a black child, your chance of getting a continuous glucose monitor is half of that of a wide shot. This isn't the NHS which professes to be equal to everybody. It's not right. So the challenge is there, even however, the funding is, I think my advice to in the US setting would be it's so vast and so big. Taking aside the politics, which is so difficult to do, obviously, I think too much attention is focused when it comes to chronic disease on the to the three parts, which I think of type 1 diabetes, I think I see it as self management, peer support, and access to train professionals. That's the three things on which good type 1 diabetes care sets. And the US system is incredibly good about doing number three, too, it makes it more and more expensive, because we don't have any trained professionals. And so you end up having to really top load that bit. If you switched a lot of the attention to one and two, self management with technology of peer support, you probably will have better outcomes, I don't think it's about the make of the system. And it's insurance based or public funded. And that's where the politics comes in. It's about the switching of that mentality where you get peer support and self management as being a main key focus and investment into but the US system, partly the UK as well. But the US system hinges heavily on number three. And that's why you the costs are so out of control. That's my view, at least

Stacey Simms 23:38

we've seen it in our own experiences. And people who listen to this podcast know that that peer community matters immensely with camps and communities and meetups. And it's incredible. It makes such a difference. Absolutely. You mentioned language matters. Can you speak a little bit about that for people who aren't familiar? Yeah, I

Partha Kar 23:55

mean, I think there's a fair few versions of that. I'm the principal of that was built in Australia in 2012. And again, it's nothing dramatic. It's not I mean, became it basically saying just be nice to people. You know, I think you've got embroiled in this whole debate for a bit of time. Because it was done in the States. There was papers out of him that we picked up in the UK, different countries have done it and people get stuck up in the Oh, is it is it about calling somebody a diabetic or a person with diabetes, it's not lots of people don't mind being called diabetic, some people do mind being called diabetic, that's not about that what the document is about. The document is very, very simply about trying to be less judgmental about people whose lives you don't leave. Right? If you're saying to somebody, or you know, I'm not sure you're you should be doing that in the morning, when you don't know what like the lead. You don't know that they're having to, you know, rush to drop off their kid to school and do this and do that. It's not easy to then go you should have a very structured breakfast and take your insulin on time. Well, that's fine for you to say, but that for that individual. They might have two kids to drop off and then go to work while trying to make sure you know their husbands had their work. It's It's not easy. So I think that's what it's about don't don't try and judge others whose lives you don't leave lid. So that that was pretty much it.

Stacey Simms 25:08

I think that the libre goal that you have I know you're not done with and you wouldn't call it a an ultimate success yet has been tremendous. What is next? Is it trying to get more pumps covered? Is it trying to get more equality as you've already mentioned, racial and economic lines,

Partha Kar 25:23

closed loops, I think I think is, is the is the next target, I think more more access to closed loops, more access to all the types of different loops that are available, and you touched upon it, irrespective of your deprivation, ethnicity, that's going to be huge for because going ahead, I want more people to have access to technology, because I think technology is an enabler sort of ticks, that box of self management, it also encourages more peer support. So if we did that, together well, and did more standardized training for healthcare professionals that I think that's the sort of ultimate goal. But I think closed loops are going to be the thing I suspect the focus and target on as we go ahead.

Stacey Simms 26:01

Fabulous. And I'll let you go. I know you got to run. But we are speaking during Diabetes Awareness Month, and you put out a video very plain spoken as you do, saying, basically, be nice. Don't judge, don't be an idiot. And you have a two minute long video explaining this. What was the reaction? I mean, it's a very plain statement, but at the same time, it's quite blunt. Yeah, I

Partha Kar 26:21

mean, I think I see the debates between and it's so silly, some of the stuff that goes on, on social media and wider and I can understand people do it because they have a book to sell, or a podcast or blog or whatever they want to do, or Twitter likes, but the simplistic narratives and never helped people, you know, we could we could turn around and say, Well, if you eat too many cakes, you will have type two diabetes, there is not a single evidence base that will support that statement. Yes, people say that right? You know, and I think that's the problem. And then that rolls into how did your child have diabetes? You give them too many cakes, and you sitting there going like what how uneducated Are you didn't come up with a statement like that. And it's so frustrating to see that. So I think the reaction has been good. I mean, I've always been known for my and I genuinely think when people don't know something, I'm very happy to explain it to them in today's day and age. If people say that, Oh, I didn't know that type 1 diabetes is an autoimmune disorder has got nothing to do with your diet or your lifestyle, then I'm sorry, you were just uneducated. And that's my bottom line to that. So you haven't even made the simple effort to open Google. So things like that. And I think that was the that was the idea of that is Diabetes Awareness Month. Just be aware of different types. Be nice to people don't judge others and you know, at least at least do some research and you've got Google on your smartphone. So simple.

Stacey Simms 27:41

Okay, last question. You mentioned the eternal is no spoilers. I haven't seen it. But I know you're a big Marvel fan. How was the movie?

Partha Kar 27:47

Oh, it's good. I really enjoyed it. It's as a standalone, it works really well. And my only big tip also is mistake for the after credits. Very good, especially the last one. Very, very good. All right.

Stacey Simms 27:58

Well, thank you so much for spending so much time with me. I really appreciate you being here. Thanks very much.

Partha Kar

Pleasure.

You're listening to Diabetes Connections with Stacey Simms.

More information at diabetes connections.com. Of course, there's always a transcript as well. I will link up how to follow Dr. Kar on social media, I highly recommend his Twitter feeds. And he is just very informative, very straightforward. And he's always willing to admit when he makes a mistake or something funny happens. I mean, he's just let's face it. He's just a human being online, which is why I think so many of us respond to him so well, that I liked a lot of the advice he gave there for us to take to our doctors, we really have to be straightforward with them. So many times they don't even realize what they're doing or how they're talking to us. Sometimes they do and they're they're just jerks. But most of the time, I think they want to have a good relationship with us. At least that has been my experience. There's only been one doctor, in my my experience. I'm not talking about Benny, because we've been very lucky with him. There's only been one doctor that I have fired. And I fired him from my hospital room because oh my gosh, was he talking down to me? So don't be afraid to do it. Alright,

Diabetes Connections is brought to you by Dexcom. And we were watching TV the other night. My husband and I are really into the expanse now, which is a sci fi show that's been out for a while. We are totally binging it, we're going through every season. So we're watching that. And the Dexcom went off the alert on my phone and Benny was upstairs in his room. And you know, for some reason, it took me back to the days when we basically had blood sugar checks on a timer. If you're of a certain age you remember this we would check doing a finger stick the same time every day at home and at school and whenever extra we needed to. It's really amazing to think about how much our diabetes management has changed with share and follow. I didn't stop the movie to check on him. I knew what was going on. I mean, I could decide whether to text him or go up and help out for this instance. I did absolutely nothing because I didn't need to using the share and follow apps have really helped us talk less about diabetes. which I never thought would happen with a teenager. Trust me Benny loves that part too. That's what's so great about the Dexcom system. I think for the caregiver or the spouse or the friend, you can help the person with diabetes manage in the way that works for your individual situation. Internet connectivity is required to access Dexcom follow separate follow app is required. learn more, go to diabetes connections.com, click on the Dexcom logo.

If you're listening as this episode goes live, Happy Hanukkah, we will be marking night three as you're listening again, if you're listening when the episode first airs, and Paul hits early this year, that my daughter's already packing school, but that's how it goes. I hope your life because they're yummy and your Hanukkah guilt is delicious. And you're not stressing out too much about diabetes, and you're able to enjoy what the holiday has to offer. Looking ahead. I mean, what am I going to say? Here? We are December. Oh my goodness. So we've got some great shows coming up. We've got a conversation next week with the folks at convatec. They make all of the insets except for Omni pod. But if you use a Tandem Medtronic, yep, so mid, those pumps, they make your insets. So we had a really good conversation about how to make those better, some good information for the community from them. And I'm hoping that'll be an ongoing conversation. And we have a lot of good stuff in the works for the rest of this year.

Going into January, does he I would ask is if you have listened to this far and you are not signed up for our newsletter, please make sure to do that I send out an email every week along with the show. And quite often there is more information in there than just a week's episode. We do surveys, we do research opportunities that I get from companies. There's a lot of info in that. And as we move forward next year, and I'm branching off into other projects, I'm gonna be using that newsletter to communicate more and more about things, not just the podcasts that I think are of your interest, but I don't spam you or anything dumb like that. So go ahead, you go to diabetes connections.com a little pop up will come up. If you don't see it, just scroll down. There's a little newsletter thingy that'll help you sign up there.

Thank you to my editor John Bukenas from audio editing solutions. Thank you so much for listening. We are back on track for our newscast this week. So I will see you back here Wednesday on Facebook or YouTube Live for in the news. And then on Friday, we turn that into an audio, podcast whatever works better for you. Feel free to join me in whatever way is the best. I'm Stacey Simms Until then be kind to yourself.

Benny 32:24

Diabetes Connections is a production of Stacey Simms media. All rights reserved. All wrongs avenged

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When you have a national lead on diabetes who really seems to listen to patients and delivers on some big ideas, you get our attention. Dr. Partha Kar is the diabetes co-lead of NHS England. We talk about access, getting more out of your doctor’s visits and what he sees in the future of diabetes tech.

Dr. Kar's announcement (after our interview was taped) that CGM or Flash Glucose Monitoring will be available to all people in England with type 1 diabetes

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Check out Stacey's book: The World's Worst Diabetes Mom!

Join the Diabetes Connections Facebook Group!

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Episode Transcription Below:

Stacey Simms 0:00

Diabetes Connections is brought to you by. Dario Health – Manage your blood glucose levels. Increase your possibilities. By Gvoke HypoPen, the first pre-mixed autoinjector for very low blood sugar. And By Dexcom. Take control of your diabetes and live life to the fullest with Dexcom

This is Diabetes Connections with Stacey Simms.\

This week when you're a national leader on diabetes, and you really seem to listen to patients and you deliver on some big ideas, you get our attention. Dr. Partha Kar says it shouldn't be that unusual.

Partha Kar 0:39

And I also feel that clinicians sometimes believe that people living with type 1 diabetes won't be able to handle the truth, so to speak, oh, you can't tell them when you can. They're all adults are surrounded by adults, and they deal with tough calls in their lives all the time. You know,

Stacey Simms 0:57

Dr. Kar is the diabetes co-lead of NHS England. Yes, this is a US centric show. But I've followed him on social media for a long time. And I've loved what he has to say. We'll talk about access, getting more out of your doctor's visits, and what he sees in the future of diabetes tech.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome to another week of the show, I am your host, Stacey Sims, and we aim to educate and inspire about diabetes with a focus on people who use insulin. If you're part of our mostly American audience, I hope you had a really good Thanksgiving, I hope the travel was safe. If you had to go anywhere, I hope the food was great. And I hope the family was okay to really hope you had a great holiday. If you're part of our international audience, which is still pretty big, I would expect it to be bigger this week, just because of who we're talking to. And that is Dr. Partha Kar, national specialty advisor for diabetes with NHS England. And this is one of those times where I just was interested to see what somebody had to say, as I mentioned in that the opening teaser, I followed him online for quite a while. And I thought you might be interested as well. And boy, when I put it in the Facebook group, you all were thrilled. So I hope you enjoy the interview. He didn't have a ton of time to talk to me. But that is to be expected. But I'm really happy with the questions I was able to ask. And you know, just the fact that he was able to share some information with us, even though his his health system is is markedly different than ours here in the States.

Before we jump in, I do want to take a moment this is a little self promoting. But gosh, guys, I got such exciting news recently. And that is that I won this huge book price. Yes, I know the book came out a while ago, but I won best new non fiction in the American Book fest. This was of course for the world's worst diabetes mom real life stories of raising a child with type 1 diabetes. And it kind of took me didn't kind of it really took me by surprise. I had entered it earlier this year, I had forgotten about it. When we got the email, my publisher kind of emailed me quickly and said, you know, being a finalist is really nice. And then she said no, no, wait a minute, you. That was kind of my reaction to it was laughing. But I won. So I know you're asking, Okay, the world's worst diabetes mom came out in 2019. How did we win an award in 2021. The book fest the American Book, festival boards are kind of rolling. So you're eligible for almost three years. So this year's books were from certain dates in 2120 20 in 2019. This was our first time entering the book, and it was actually our last chance to enter. So boy, I'm so excited. I'm really proud of the book. And I have some news coming in December. I have some more book news that was already planned before this award. But thank you for letting me indulgent, do a little patting myself on the back. It was not easy to write and get it out and do everything we needed to do for it. And boy, you all have been so supportive, considering I haven't been able to do any kind of book tour at all right? I mean, it came out at the end of 2019. I think I went to two or three places. And that was it. And just like everybody else in 2020. It hasn't been the same since I'm hardly alone in that.

So more book news coming up, and Dr. Partha Kar in just a moment I should probably tell you just a little bit more about him if you're not familiar. He has been a consultant in Diabetes and Endocrinology on the national level there in the UK since 2008, clinical director of diabetes from 2009 to 2015. And here's the full title national specialty advisor diabetes with NHS England. And there are so many things that he's been involved with, most recently, very prominently getting the FreeStyle Libre being available across the country over there and I will talk about that specifically. Being very involved in language matters. Getting CGM available to all t one D pregnant patients. And he hinted this week that a big announcement was coming. So I will link that up in the show notes so you can find out we talked The week before Thanksgiving here in the States, so timing wise full bit tricky, but he was announcing something big and I will include that to the best of my ability.

Okay, Diabetes Connections is brought to you by Gvoke Hypopen. Almost everyone who takes insulin has experienced a low blood sugar – and that can be scary. A very low blood sugar is really scary. And that’s where Gvoke HypoPen comes in. Gvoke is the first autoinjector to treat very low blood sugar. Gvoke HypoPen is premixed and ready to go, with no visible needle. That means it’s easy to use. How easy is it? You pull off the red cap and push the yellow end onto bare skin – and hold it for 5 seconds. That’s it. Find out more – go to diabetes dash connections dot com and click on the Gvoke logo. Gvoke shouldn’t be used in patients with pheochromocytoma or insulinoma – visit gvoke glucagon dot com slash risk.

Partha Kar Welcome to Diabetes Connections. Thanks so much for making some time for me and my listeners. Absolute pleasure. Thank

Partha Kar 5:55

you for asking.

Stacey Simms 5:56

I gotta tell you, I'm a little nervous. I'm a huge fan. I'm just following you on social media. And then I put into my Facebook group like I always do. You know, do you have any questions for this guest? We've got a part of the car coming up. I have very few questions from the group. But I have lots of oh my gosh, I love him. Tell him we love him. Tell him. Thank you. Thank you. And I'll tell you specifically why they're thanking you in a moment. But you do have a quite a big fan club over here. So going in, I guess I'm trying to butter you up. But going in, you should know that.

Partha Kar 6:24

No, it's very quiet, very kind. I always see this, you know, at the end of the day, it's my job to do as well. But you know, the love and blessings you get is just makes it stronger. So yeah, no, absolutely. Thank you.

Stacey Simms 6:35

You're welcome. Let me just start off by asking you, you do not live with diabetes? How did you get into the position that you were in today? Why this field for you. So I think

Partha Kar 6:43

a lot of it was, you know, when we are when we are training, you pick your subjects as you go along. And then I sort of gravitated towards Diabetes and Endocrinology because I thought there was an opportunity here to talk to a lot of people, you know, be a part of their journey throughout life. So it was quite good. And I like talking, and then sort of more towards type one, because I think I get got to realize the more senior I got a lot of attention, quite understandably, was into type two diabetes. And that's, you know, the bigger volume number, etc. But I think what I found that there's not a lot of things being done for type one as a trade back of that. So it's been more of a, let's see what we can do in the space. Let's try and help people. And I think just being an advocate, so to speak. So yeah, that's probably how it's graduated over the course of time. One of

Stacey Simms 7:31

the things that we've observed, just following your social media here in the US, is the adoption and use of libre for many more people, can you talk a little bit about how that came about?

Partha Kar 7:41

So I think Libre, I'm in freestyle Libre first came into the market on 2014 2015. And I think it started to sort of gradually make its way into the UK setting and the sort of people would buy it funded. And I think it sort of started taking off in 2016 2017. And that's when I sort of got into the job. And for me, people are always asking why this particular device, I think it's not the device, I think it's more of a mass device. And I think there'll be more competition coming along. But to me, it's be a very good example of what self management can do. I mean, simply put, if you see more of your numbers and more of your trends, you tend to intervene more and do better. So that's been the device and it's been a battle to try and get it into people's lives as you go along. As you're the system here is slightly different. You have to justify every single thing you do, because you're saying, Well, this is why we're trying to do it. And it's a funny place to be in because you know, you're you're sort of fighting, so to speak against other conditions, that doesn't feel right, either trying to justify why you needed more compared to X or Y. And I think that's the challenge. And then people start looking at well, actually, there isn't a randomized control trial, which showed y or Zed and I can't fund it. And I try and explain to people it's not just about the RCTs, or the randomized control trials all the time. It's not just about doing one see, it's about the quality of life and what it does do so yeah, I think I think that's how it came about. And then driving it through, pick up or take up around the country sort of battling with regions. So yeah, it's it's been a journey in the half, so to speak. Can you

Stacey Simms 9:14

get a little bit more specific in terms of how many people now in your system do have access and do use the freestyle?

Partha Kar 9:20

Yeah, I mean, I think we got I mean, given round, figure wise, we've got about 200, we got a quarter of a million people with type 1 diabetes, and I think about 53% of them are on it right now across the country, and of all our cards land. Well, I think it should be available, either, you know, Libre or its equivalent should be available to everybody, everybody, very soon.

Stacey Simms 9:42

So yeah, I mean, the reason I wanted to ask that is because first of all, it's already such a big number comparatively speaking too much for the rest of the world. Certainly, I've got to imagine you're starting to see better outcomes too. Yeah,

Partha Kar 9:53

absolutely. I mean, it's coming through your h1 HB ones is a better I mean, I can tell you from my own clinical practice, people are huge changes. We're seeing it across the country and the data we're collecting and guess what admission levels are down. People feel happier your HP once he's down, it's doing what it says on the tin.

Stacey Simms 10:08

What would be the ultimate goal? Is it with that device? Is it then moving on to other CGM? Or do you want to kind of get as many people as possible in this one?

Partha Kar 10:15

Oh, no, absolutely. I've always maintained I'm a Libre or freestyle Libre is has been the tip of the spear. I think there was a lot of things there, which was about showing people the what is possible, because before that, in the world of the NHS technology has always been seen as a Okay, well, let's see what we can do. I mean, for example, insulin pumps have been around for so long. We even had nice guidance on it available since 2008. But the pickup rate really low 15% 16%. Really many reasons behind it. And CGM for isn't traditional CGM like Dexcom. Really low again, 4% 5%, or there abouts. But I think this was about showing what could be done if you really pushed on it hard. And I think it's opened up many, many doors. You know, subsequently, because of that, we're looking at competition coming along, we're looking at every single pregnancy with type 1 diabetes not having access to a Dexcom, or Medtronic device, we're doing trials and closed loop, suddenly, it has become a flagship, and due to luck, serendipity or default, it's worked out as one of the projects, which has really, really played out well in the NHS. And so a lot of people are looking at it. And for me, that was always the purpose. It's the tip of the spear. If you can show you could do it with one, there's no reason you can't. And it's definitely not the end goal never has been. I think the end goal would be that every every person with type 1 diabetes, irrespective of the age has the ability to choose whatever technology they so can, whether it's flash, whether it's traditional CGM, whether it's a pump, or whether it's a closed loop, partnership salutely.

Stacey Simms 11:44

And I'm just a little bit more about the Libre, I'm curious to obviously the biggest objection many people would have had would have been cost. But inside your organization or external critics, what were their objections thinking going into something like this,

Partha Kar 11:57

I think the NHS always is a very traditional setup. And I think they're very good when it comes to drugs to pharmaceutical products. For example, pharmaceutical companies will do massive randomized control trials to show Okay, here is the drop in HBO and see, and thereby you can calculate it. The problem is with technology company, they necessarily haven't done that. If you look at Frisco Librem, the initial studies that came out, they never showed any change in HB one C, primarily because they chose a lot of people's age 20 with the excellent to begin with. And you're sitting there going, Well, that was a mistake, I think, for companies not to take up the trials, because straightaway to a lot of policymakers, you don't have any room to maneuver, because you're banking yourself completely on the ability that will show improvement of hypos and quality of life. Now, the other problem, I suspect has been there nice, which is our governing body, so to speak, who you know, looks at evidence, they're quite slow at coming off the blocks. Sometimes it can be too late in the technology world by the time you assess, you know, right now they're assessing Libre one you are Libre 123 out. So what are you assessing? There's got to be nimble and quick. That's been that was the obstacle people saying that. So I think there were that level of obstacle Well, nice having said so so why should be, there's also a lot of people who fundamentally believed that this was just a gizmo and this was just shiny toy, and we shouldn't give it to people with diabetes, they should or for example, they had to earn it, you know, they have to either have complications to have it, or they should be testing 10 times a day to get it, which I think is pretty silly. Because you know, the whole point of doing this exercise is to target people are finding it difficult to test and find giving it to people to stop them from having complications. But there you go, it's a very traditional set of thinking, which is what has been the challenge trying to break through?

Stacey Simms 13:39

Yeah, do we have similar issues in the states where they're doing trials? And you always see like, well, they're a one see went from 7.3 to 6.9. And that's wonderful. But you know, we need to reach the people who's a one sees our 10.5 100%, right, because of either education or access, or whatever it is. I know, I know, you're struggling with that as well. Yeah,

Partha Kar 13:58

  1. So, for example, you know, we have learned from that, you know, we, when we collected the real world data with Libre, we showed exactly what he said, the higher the higher your starting age, we want to see the better your outcomes. And you're like, Well, that's obvious. So what we're doing with those with Kevin, so what you're doing with closed loops right now, so we're running a real world trial evaluation throughout the country, it's about 34, five centers around the country, adults and pediatrics doing it. And guess what we see, again, the higher your agency, the better you're a flattening of your agency. So it's not rocket science. And I always am flabbergasted when people doing trials go like, no, let's just pick the people's controller really good. And as you said, but that goes against the whole deprivation thing that we discuss about because we know people who come from very deprived backgrounds will have worse control. So if you really want to tackle deprivation, you need to control that and you need to tackle that. So the thinking needs to be far more refined than what it is at the present moment. And hopefully we're trying to show some ways of doing so.

Stacey Simms 14:54

So one of my listeners said, I want you to please let parked the car know how much I appreciate In his posts, she goes on to say, there's not much I appreciate more than medical professionals who treat us like real people and don't talk down to us. Where did you learn your bedside manner your style or what you know what we as as not your patients see on social media because that's one of the things I think that very much resonates with people is that you're you're very plain spoken and you don't talk down to people with diabetes

right back to our conversation, but first Diabetes Connections is brought to you by Dario health. And you know, over the years, I find we manage diabetes better when we're thinking less about all the stuff of diabetes tasks. That's why I love partnering with people who take the load off things like ordering supplies, so I can really focus on Benny, the Dario diabetes success plan is all about you, all the strips and lancets you need delivered to your door, one on one coaching. So you can meet your milestones, weekly insights into your trends with suggestions for how to succeed, get the diabetes management plan that works with you. And for you. Dario is published studies demonstrate high impact clinical results, find out more go to my dario.com forward slash diabetes dash connections. Now back to Dr. Kar, talking about how he has developed a good bedside manner and respect for his patients.

Partha Kar 16:20

I think it's come with time, if I'm very honest, and most likely, it's not like a suddenly over a bed. And one day I decided to become like this. And I think what I've realized over the course of time is their Medical School doesn't teach us consultations, kills diseases, a lot of stuff, right? It's just teaches us what the book said, which is my Insulet physiology, how it works, doesn't really teach us a lot about interaction with human beings, which is what we did with some things like the language matters and stuff and people found language matters. Interesting. I found that just human sense, you know, common sense, human, it's not that difficult to be nice to people. And we somehow are not we somehow, and I think social media teaches me a lot of stuff. I think my patients teach me a lot. And I don't say that in a glib way, because things like, you know, I will do transitional or young adults clinic. And I remember these words from this young girl who sat there looked at me and said, If he took an exam sometimes, you know, and I want to watch that. And she said that, I don't know. It just feels like I'm going to be asked what I'm doing with judgment, what I'm doing, you know, when I sat down, but like, that's not right, that's wrong. Why are we making people feel like that way? And then we are wondering why they're not coming back to our clinics. So a lot of my consultations were very honest, not about diabetes, with my patients they're very much about could be a football or movies. I mean, yesterday, when just watch the internals and today in clinic, we were talking about one of my patients, and that was the conversation, what did you think about that paid the post credits, what was it, and I think you build a rapport with people, they trust you more, you get along more. So I like to keep it very plain. And I also feel that clinicians sometimes believe that people living with type 1 diabetes won't be able to handle the truth, so to speak. Oh, you can't tell them when you can. They're all adults and or, or in or surrounded by adults, and they deal with tough calls in their lives all the time, you know, how to get a mortgage, you know, how to get your car or dealing with ups and downs, or the Why wouldn't they be able to they live with it. So I've always benefited that by turning around and saying I can't do this for you. It's outside my expertise. And I think finally, I'm also trying with my other role trying to deconstruct the myth, and the and the whole thing that doctors are built around them so that there's some sort of, you know, material human beings here for to burn themselves to the altar, normally not, you know, we trained professionals, like a fireman or a policeman and trying to do my best. And sometimes I'll get it wrong, sometimes I'll get it right. But at least I want to portray across that I'm trying and trying my best. And we'll see where we go from there.

Stacey Simms 18:50

You know, it brings up an interesting point, because I consider myself a very strong advocate with my doctors, for myself and for my children. But I still hear you get intimidated, you do very much respect my doctors, any advice for patients who who want to have a difficult conversation with their physician who want to start broaching that, hey, treat me like a partner and may not know how to start?

Partha Kar 19:12

Yeah, I mean, I think it's really difficult. It's really difficult to do that. Because I think this is why it's a bit like I always give the example of let's say, sexism. Now. It's not the it's not just the job of women to go and solve sexism, is it. I mean, it's men have got an equal part, you will not understand nuance as a man or a woman goes through, but you know, when it's wrong, and you can turn around and say, Nah, guys don't do that. Right. So I think what I would encourage rather my clinical colleagues to say that, look, it's not tricky to sort of have that feedback and saying your approach may not be the right thing. And I think this younger generation coming through which does that. So my advice to patients who would like to do that would be to, I think doctors feel very challenged as soon as you challenge them. It's an ego thing. Don't forget that we have been taught in medical school that we are the top of the top there is no Nobody better than us, right? When you're told that for five years, seven years, eight years, 10 years of your life that there was nobody better than you, it's very difficult to then sit in a space. And if somebody challenges you to actually take that on board, so there is a bit of that complex that has happened over the course of time. So the way to approach that would be to probably do it from a slightly different angle. And rather than pointing out the mistake and say, What would you say? What do you think if we did this? Do you feel like so I think you try and do that there'll be some people who are open to the idea of saying, I don't agree with that, and you go with it. But I think the biggest advice I can give is find an ally, was also a clinician who will do that for you. So in meetings, when I go to, I always see myself as that sort of advocacy role return rentable. And now I don't agree with that. Because I know I've spoken to a lot of people who want to agree with that. So that is the sort of fine balance to strike, it will change, doctors are changing. And you know, if you've been long enough in the system, the 90s, were different to 1000s were different, and now is different, but doctors are evolving slowly takes a long time to get you got good get rid of you got complex.

Stacey Simms 21:02

Another question from one of my listeners who wanted to know, Brexit to will, or already has had an impact on diabetes care or supplies,

Partha Kar 21:11

hasn't affected supplies, because we actually knew there was going to be a problem. So we planned and we worked with the industry to make sure we had good suppliers. And there will always be teething trouble as we go along with this. But no, we don't expect, he says Fingers crossed. We have some plans in place in case of anything, but Brexit is one of those political things in life, isn't it? So we just have to ride the storm with it as we go along. So

Stacey Simms 21:34

this is an American based podcast, mostly because I'm American, we do have listeners all over the world, which I'm very, very grateful for. But our healthcare systems are so different. I'm curious if you have any advice, or any lessons that you think we could learn from how how you all do it?

Partha Kar 21:53

Yeah, I mean, so I think the debate about healthcare becomes incredibly emotive on both sides of the Atlantic. I think that's the problem. So when you turn around, people start saying, so for example, if you challenge the NHS, people go like, well, you don't like the NHS, because you want to make it privatized to you. And you will? Um, no, not really, I'm just saying that there are gaps in the prison system as we fund it, for example, we say it's equal to all well, not really, if you come from a deprived community. Right, now we've got issues with race. So as I've said, if you're a black child, your chance of getting a continuous glucose monitor is half of that of a wide shot. This isn't the NHS which professes to be equal to everybody. It's not right. So the challenge is there, even however, the funding is, I think my advice to in the US setting would be it's so vast and so big. Taking aside the politics, which is so difficult to do, obviously, I think too much attention is focused when it comes to chronic disease on the to the three parts, which I think of type 1 diabetes, I think I see it as self management, peer support, and access to train professionals. That's the three things on which good type 1 diabetes care sets. And the US system is incredibly good about doing number three, too, it makes it more and more expensive, because we don't have any trained professionals. And so you end up having to really top load that bit. If you switched a lot of the attention to one and two, self management with technology of peer support, you probably will have better outcomes, I don't think it's about the make of the system. And it's insurance based or public funded. And that's where the politics comes in. It's about the switching of that mentality where you get peer support and self management as being a main key focus and investment into but the US system, partly the UK as well. But the US system hinges heavily on number three. And that's why you the costs are so out of control. That's my view, at least

Stacey Simms 23:38

we've seen it in our own experiences. And people who listen to this podcast know that that peer community matters immensely with camps and communities and meetups. And it's incredible. It makes such a difference. Absolutely. You mentioned language matters. Can you speak a little bit about that for people who aren't familiar? Yeah, I

Partha Kar 23:55

mean, I think there's a fair few versions of that. I'm the principal of that was built in Australia in 2012. And again, it's nothing dramatic. It's not I mean, became it basically saying just be nice to people. You know, I think you've got embroiled in this whole debate for a bit of time. Because it was done in the States. There was papers out of him that we picked up in the UK, different countries have done it and people get stuck up in the Oh, is it is it about calling somebody a diabetic or a person with diabetes, it's not lots of people don't mind being called diabetic, some people do mind being called diabetic, that's not about that what the document is about. The document is very, very simply about trying to be less judgmental about people whose lives you don't leave. Right? If you're saying to somebody, or you know, I'm not sure you're you should be doing that in the morning, when you don't know what like the lead. You don't know that they're having to, you know, rush to drop off their kid to school and do this and do that. It's not easy to then go you should have a very structured breakfast and take your insulin on time. Well, that's fine for you to say, but that for that individual. They might have two kids to drop off and then go to work while trying to make sure you know their husbands had their work. It's It's not easy. So I think that's what it's about don't don't try and judge others whose lives you don't leave lid. So that that was pretty much it.

Stacey Simms 25:08

I think that the libre goal that you have I know you're not done with and you wouldn't call it a an ultimate success yet has been tremendous. What is next? Is it trying to get more pumps covered? Is it trying to get more equality as you've already mentioned, racial and economic lines,

Partha Kar 25:23

closed loops, I think I think is, is the is the next target, I think more more access to closed loops, more access to all the types of different loops that are available, and you touched upon it, irrespective of your deprivation, ethnicity, that's going to be huge for because going ahead, I want more people to have access to technology, because I think technology is an enabler sort of ticks, that box of self management, it also encourages more peer support. So if we did that, together well, and did more standardized training for healthcare professionals that I think that's the sort of ultimate goal. But I think closed loops are going to be the thing I suspect the focus and target on as we go ahead.

Stacey Simms 26:01

Fabulous. And I'll let you go. I know you got to run. But we are speaking during Diabetes Awareness Month, and you put out a video very plain spoken as you do, saying, basically, be nice. Don't judge, don't be an idiot. And you have a two minute long video explaining this. What was the reaction? I mean, it's a very plain statement, but at the same time, it's quite blunt. Yeah, I

Partha Kar 26:21

mean, I think I see the debates between and it's so silly, some of the stuff that goes on, on social media and wider and I can understand people do it because they have a book to sell, or a podcast or blog or whatever they want to do, or Twitter likes, but the simplistic narratives and never helped people, you know, we could we could turn around and say, Well, if you eat too many cakes, you will have type two diabetes, there is not a single evidence base that will support that statement. Yes, people say that right? You know, and I think that's the problem. And then that rolls into how did your child have diabetes? You give them too many cakes, and you sitting there going like what how uneducated Are you didn't come up with a statement like that. And it's so frustrating to see that. So I think the reaction has been good. I mean, I've always been known for my and I genuinely think when people don't know something, I'm very happy to explain it to them in today's day and age. If people say that, Oh, I didn't know that type 1 diabetes is an autoimmune disorder has got nothing to do with your diet or your lifestyle, then I'm sorry, you were just uneducated. And that's my bottom line to that. So you haven't even made the simple effort to open Google. So things like that. And I think that was the that was the idea of that is Diabetes Awareness Month. Just be aware of different types. Be nice to people don't judge others and you know, at least at least do some research and you've got Google on your smartphone. So simple.

Stacey Simms 27:41

Okay, last question. You mentioned the eternal is no spoilers. I haven't seen it. But I know you're a big Marvel fan. How was the movie?

Partha Kar 27:47

Oh, it's good. I really enjoyed it. It's as a standalone, it works really well. And my only big tip also is mistake for the after credits. Very good, especially the last one. Very, very good. All right.

Stacey Simms 27:58

Well, thank you so much for spending so much time with me. I really appreciate you being here. Thanks very much.

Partha Kar

Pleasure.

You're listening to Diabetes Connections with Stacey Simms.

More information at diabetes connections.com. Of course, there's always a transcript as well. I will link up how to follow Dr. Kar on social media, I highly recommend his Twitter feeds. And he is just very informative, very straightforward. And he's always willing to admit when he makes a mistake or something funny happens. I mean, he's just let's face it. He's just a human being online, which is why I think so many of us respond to him so well, that I liked a lot of the advice he gave there for us to take to our doctors, we really have to be straightforward with them. So many times they don't even realize what they're doing or how they're talking to us. Sometimes they do and they're they're just jerks. But most of the time, I think they want to have a good relationship with us. At least that has been my experience. There's only been one doctor, in my my experience. I'm not talking about Benny, because we've been very lucky with him. There's only been one doctor that I have fired. And I fired him from my hospital room because oh my gosh, was he talking down to me? So don't be afraid to do it. Alright,

Diabetes Connections is brought to you by Dexcom. And we were watching TV the other night. My husband and I are really into the expanse now, which is a sci fi show that's been out for a while. We are totally binging it, we're going through every season. So we're watching that. And the Dexcom went off the alert on my phone and Benny was upstairs in his room. And you know, for some reason, it took me back to the days when we basically had blood sugar checks on a timer. If you're of a certain age you remember this we would check doing a finger stick the same time every day at home and at school and whenever extra we needed to. It's really amazing to think about how much our diabetes management has changed with share and follow. I didn't stop the movie to check on him. I knew what was going on. I mean, I could decide whether to text him or go up and help out for this instance. I did absolutely nothing because I didn't need to using the share and follow apps have really helped us talk less about diabetes. which I never thought would happen with a teenager. Trust me Benny loves that part too. That's what's so great about the Dexcom system. I think for the caregiver or the spouse or the friend, you can help the person with diabetes manage in the way that works for your individual situation. Internet connectivity is required to access Dexcom follow separate follow app is required. learn more, go to diabetes connections.com, click on the Dexcom logo.

If you're listening as this episode goes live, Happy Hanukkah, we will be marking night three as you're listening again, if you're listening when the episode first airs, and Paul hits early this year, that my daughter's already packing school, but that's how it goes. I hope your life because they're yummy and your Hanukkah guilt is delicious. And you're not stressing out too much about diabetes, and you're able to enjoy what the holiday has to offer. Looking ahead. I mean, what am I going to say? Here? We are December. Oh my goodness. So we've got some great shows coming up. We've got a conversation next week with the folks at convatec. They make all of the insets except for Omni pod. But if you use a Tandem Medtronic, yep, so mid, those pumps, they make your insets. So we had a really good conversation about how to make those better, some good information for the community from them. And I'm hoping that'll be an ongoing conversation. And we have a lot of good stuff in the works for the rest of this year.

Going into January, does he I would ask is if you have listened to this far and you are not signed up for our newsletter, please make sure to do that I send out an email every week along with the show. And quite often there is more information in there than just a week's episode. We do surveys, we do research opportunities that I get from companies. There's a lot of info in that. And as we move forward next year, and I'm branching off into other projects, I'm gonna be using that newsletter to communicate more and more about things, not just the podcasts that I think are of your interest, but I don't spam you or anything dumb like that. So go ahead, you go to diabetes connections.com a little pop up will come up. If you don't see it, just scroll down. There's a little newsletter thingy that'll help you sign up there.

Thank you to my editor John Bukenas from audio editing solutions. Thank you so much for listening. We are back on track for our newscast this week. So I will see you back here Wednesday on Facebook or YouTube Live for in the news. And then on Friday, we turn that into an audio, podcast whatever works better for you. Feel free to join me in whatever way is the best. I'm Stacey Simms Until then be kind to yourself.

Benny 32:24

Diabetes Connections is a production of Stacey Simms media. All rights reserved. All wrongs avenged

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