Meet David Kendall, MD, Chief Scientific and Medical Officer at the American Diabetes Association. David dreams big – from cures for diabetes to the Champions Tour in golf.
David leads the Association’s scientific and medical group, including medical affairs, professional education, publications and research. This group provides scientific and medical input and expertise support for every other function of the Association, such as advocacy, development and marketing and communications.
Sounds like a pretty big responsibility, but David has the background and the skills to step up to the task. So I sat down to chat with him about what brought him to diabetes.
Why did you become an endocrinologist?
The short answer is $10 an hour – but let me explain:
I took a year off between college and medical school and needed to find work. Through a connection at the University of Minnesota, I found a research job with a group that worked in diabetes and transplantation. At that point, the job appealed to me because it paid $10 an hour. Honestly, I thought it was great pay for a recent college graduate, and it involved the science I enjoyed, so I started working there.
I kept that job all through medical school and ended up joining the group as a resident, fellow and ultimately as faculty doing similar research work.
What kind of research was it?
Originally I was in the clinical research center (diabetes and metabolism), then I focused more on the pancreas and kidney transplant program work. I was always interested in what makes biochemistry clinical (how hormones and chemical signals work in the body – or in some cases, DON’T work in the body).
When I combined that with having been in diabetes research since the year prior to medical school, it was an easy choice for me to continue into endocrinology.
I’ve heard you also have some personal connections to diabetes – care to share those?
Despite the “good money” in diabetes research (yes, that’s sarcasm!), having a personal connection to disease was also key for me. An aunt of mine was diagnosed with type 1 diabetes in the 1950s, so I knew about type 1 from my mother who lived with my aunt until she passed away at an early age.
My grandfather on my mother’s side also had diabetes (he was also a physician) and his diabetes was complicated by heart disease. So in a sense both type 1 and type 2 diabetes were familiar to me.
Having a personal connection to the disease is not what got me into diabetes, but it is what kept me there.
What do you wish people knew/thought more about when it comes to thinking about their health care provider?
My favorite perspective on health care is that it’s an elective procedure. You can do as much or as little as you wish. You may have to do the bare minimum to function, but the more you do, the more you’ll benefit. You can get advice from your health care team, but whatever you choose to do with it is personal choice. It is important to have a continuous dialogue with your health care provider and work to overcome some of the challenges. I don’t think people choose to do the wrong thing, I think it’s really more that the advice must be better suited to that individual. If it’s not working well, both patient and provider team should ask “what else could we try?”
Same thing! What they are giving is advice – not commands or specific instructions. So it’s important to aim for the best advice possible for that individual.
I also think that every health care provider should recognize that humility is the greatest attribute they can have. This is an essential part of medical care. We have to understand how little we actually DO know – both about the individuals we see and the individual diseases we treat. We also have to be willing to admit when we don’t have full understanding and do our best to get as much information as possible (even in the absence of perfect information).
I’ve been reading Atul Gawande’s book Better: A Surgeon’s Notes on Performance and really liked this piece of advice he gives; “Ask an unscripted question. Ours is a job of talking to strangers. Why not learn something about them?” I used to do that in clinic, and still do, and find it’s what I remember best.
You’ve been in the diabetes field since long before I was diagnosed. What changes you have seen?
When I first started in the diabetes field, people looked at me like I was from Mars. “Why would you do that?” they asked. “There’s nothing new, nothing changing in diabetes.”
Yeah, but all we really had at the time was animal insulin and first generation sulfonylureas. That’s it – so just about everything we use today to treat diabetes has been introduced since the 1990s (and, consequently, virtually everything I learned as a fellow is obsolete).
The last 15 years have seen a remarkable expansion in the available treatments for diabetes. Even blood glucose monitoring was controversial then. There were arguments for and against sharing information about blood glucose because they thought people with diabetes wouldn’t have the skills to self-manage the disease. At that point it was the physician’s job to manage diabetes. But now physicians and other health care providers don’t really manage diabetes. Patients manage diabetes with the guidance of their health care team.
People with diabetes now have a nearly normal lifespan. The management (although arguably complex) is infinitely better than when my aunt and grandfather sharpened their needles before injections and urinated in a cup to determine their glucose levels. Now we have remarkable tools – but how do we provide better care?
I think that’s what we have coming up in the next decade. Everything from drug development to care delivery has to be better integrated. You can’t just hand someone a tool and hope they know how to use it. Insulin pumps and CGMs are useless unless someone knows how to use them – it’s like giving someone a Ferrari in rush hour – it’s an incredible remarkable improvement that can’t be used to its full potential.
If you could tell the world one thing about diabetes, what would it be?
That it’s important to take a step back periodically and appreciate how remarkable the progress has been in the last two decades.
We’re approaching the 100th anniversary of the discovery of insulin, but most of that time, progress was imperceptible. In the last 10 to 20 years we have seen major advances. Although it can still be frustrating, people should marvel at the progress that’s been made, and those who live with diabetes should have every expectation that the pace of discovery should be as great or greater than that in the past 10 to 20 years.