With the respected Dr. Robert Ratner stepping down at the end of last year, there's now a new mind in town leading the American Diabetes Association's national science and research efforts.
That new leader would be from Louisiana, who's been in diabetes research for over three decades. Leaving what he describes as his dream job at Pennington Biomedical Research Center in Baton Rouge, Dr. Cefalu takes on quite a challenge joining the ADA at a time when the organization is going through a realignment to become more "mission-based."
We're grateful for the opportunity for a phone interview with Dr. Cefalu in late February during his first week in this new ADA role, to learn about his professional background and what he hopes to bring to the country's largest diabetes organization.
An Interview with ADA's New Chief Scientific, Medical and Mission Officer
DM) Thanks for taking the time, Dr. Cefalu. To start, can you tell us how you first got involved in the diabetes field?
WC) I’ve been involved in diabetes since medical school and my first project on diabetes and heart disease, and so I guess my interest began in 1979 as a medical student and intern. I did my first research training at University of California Irvine and a research fellowship at UCLA, and that’s where I became interested in diabetes. Working in a research lab, some of the aspects of led me to be interested in glucose attaching to the protein and impacting A1C, affecting physiology.
Also at that time in the early '80s, UCLA had a great endocrine section in different diseases, but diabetes at that time didn’t have much to offer (people living) with diabetes. But I realized that diabetes affected just about every organ system, and it gave me an opportunity to do just about anything in research.
I became interested in the fact that there was just so much to do in this disease space. And that led to my first diabetes research project at Tulane, and it took off from there.
You’ve had a particular research interest in insulin resistance… can you expand on that and what the hot buttons are?
We know a lot about insulin resistance in prediabetes, but the real question at this point is trying to move forward and make sure the research can be translated into the population. If we have individuals who are obese and insulin resistant, the big question beyond delaying type 2 progression through interventions is: How do we create large-scale programs that work and make that available on a broad level for people, to really prevent or delay the disease moving forward?
Do you think we need more official recognition of prediabetes, or is the push for a 'pre-diagnosis' label perhaps less useful than we think?
There's a lot of controversy in this area. We know that risk is a continuum, and even the lower (glucose) point set by the ADA identifies a group at risk. Of course, the lower the glucose, the lower you are on the continuum, so the less likely you are to advance to the type 2 stage. But at this point, I look at prediabetes as a chief disease in and of itself. If you have abnormal glucose, blood pressure and lipids, all of those collectively are going to increase your risk. That’s the case we have made recently. As to the label of prediabetes, I think as far as identifying it and the company it keeps as to comorbidities, it needs to be understood and recognized.
When did you first get involved with the ADA?
My involvement with the American Diabetes Association has been ongoing through the years, including participating with diabetes camps. Since I returned to Louisiana in 2003, I’ve been heavily involved in ADA activities – including the medical journals, Diabetes and Diabetes Care.
Can you tell us more about your experience as an editor with those medical journals?
I’ve been involved with the journals for the past five years. What we’ve tried to do with Diabetes Care, in particular, is make it fresh and keep it relevant. We want to make sure the articles we’re publishing are not simply confirmatory, but offer some novel information.
One of the changes we’d made was to the Brief Report, which was not a full-fledged article but limited information. We changed that to something called Novel Communications in Diabetes that outlines proof-of-concept studies. For example, one might look at a higher-risk group but not necessarily a larger amount of patients, but maybe shows some promising results. This was a way for us to include research on the cutting-edge, but not proven definitely for clinical care.
We also added a section called Clinical Images in Diabetes, as a fascinating way to present a case or two of unusual diabetes. You’d present an image, such as a pancreas or MRI image, that may help in clinical care. The idea was to tie in the clinical presentation with a more (visual) look. That’s been a very popular format, as is the Point/Counterpoint section we’ve brought back to explore opposing viewpoints.
Has there been any discussion about adding specific topic focuses, or including more from the patient community?
We have created more special issues of the journal. The regular monthly issue would include tidbits from every discipline, but what I started doing is bundling manuscripts into special issues – whether it’s devoted to type 1, or mental health, the Artificial Pancreas, cardiovascular disease, or psychosocial most recently in December.
There are so many online journals, and there’s been an explosion of online materials where you can get just about anything published. I think the ADA has done a fantastic job of keeping the hurdles high, to make sure the quality of papers presented in their publications goes through rigorous peer review. In fact, our impact factor for Diabetes Care last year was the highest it’s been in the history of the journal (measured by readers surveys).
Why did you want to take on this high-profile post with ADA?
Well, I was in a very comfortable position at , which has been around since the early '80s and has a primary mission of being the biggest and best diabetes nutrition center in the country. Historically, it’s been involved in nutrition, obesity and diabetes research, and it’s been a center that has been involved in the Diabetes Prevention Program (DPP) and other landmark studies, including working with the Department of Defense on nutrition matters. I was executive director there, had a (endowed) chair and pretty good funding. I thought my job at Pennington was my dream job, but the ADA presented me with a once-in-a-lifetime opportunity here. It gives me a chance to work with individuals who are as passionate about the disease as I am. I do believe that over time we can make a difference. It’s a way to put into operation what I’ve been passionate about for 35 years now, at a much more global level.
What stands out out to you as working extremely well within ADA?
A lot is working well. Our signature meeting in June is incredibly important and is just around the corner. That will continue, and I’ll do whatever I can to help in that regard. Our research program has done extremely well, particularly with the .
What would you like to see the ADA do for mentoring young doctors and researchers?
We need to support individuals who are going to be the next generation of scientists, devoted to diabetes research. I think the ADA has done a very good job in creating the Pathway Program, which was created years ago to do this. We know that there are pressures for young doctors and faculty members to bring in grant dollars, so I think this program is fantastic and takes some of those pressures off. This program, if anything, needs to be expanded to make a difference in diabetes research for the future.
Clearly, quite a lot is happening in the diabetes advocacy space. How do you see ADA's involvement in that?
The advocacy program has done a remarkable job at federal and state level, and that will need to continue. This is an ever-changing environment and we need to be very nimble as far as diabetes advocacy and actions. Over the next couple of years, there will be at least some (healthcare system) changes we’ll need to go up against or be aware of. It’s a very challenging time, including for those with diabetes.
As to , it’s a very complicated issue. I think there are many moving parts, and the only way to really solve this is to bring those individuals and components together for discussion. Hopefully, there can be solutions brought to the table. I think the ADA’s role in moving forward is to convene these partners, to have a very transparent discussion on all of this moving forward.
What gets you most excited, as to ADA's just released in February?
Now, it’s primarily going to be mission-based. Whether it’s our drive for discovery and research, or programs supporting people with diabetes as far as resources, or raising our voice. With the way the strategic plan is now, we’ll be more mission-based and all of these aspects will be supported throughout the organization. It’s a time of change at ADA where we are going through a realignment to focus more on mission.
OK, but what exactly does “mission-based” mean?
What can you expect, I hope, is to see an approach that gets individuals in science and medicine to work more closely with those in advocacy or in other development programs. It’s about us all being on the same page, about what’s in the best interest of the patient; instead of just having an idea come from one side, we can all vet that idea and contribute more as a team. I hope what you’ll see is a more balanced, comprehensive approach to these issues. There's a lot of excitement and passion about what we’re doing.
In your opinion, what does the ADA need to do better?
It’s often a matter of resources. Research funding is increasing widely this year, and it’ll need to increase even more as we’ve outlined in our new Strategic Plan. The way to solve a big research issue -- let’s say understanding prevention of type 1 or complications of T2 -- these big science questions have to be addressed with major approaches. We need a more , where you have projects that can have basic science aspects that coordinate with clinical research approaches, and be put in place broadly. That might mean that larger research grants to help address the problem are really the wave of the future.
I don’t think the ADA can do it alone, and this is where combining resources with other sponsoring agencies and groups can help. I think to really solve these major disease issues, it’s not going to be solved in one laboratory, and ADA needs to be a part of that.
Thank you for taking the time, Dr. Cefalu! We're glad to hear about this collaborative approach, and look forward to seeing your contributions as we move forward.
This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.