Meet David Kendall, MD

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?”

What do you wish health care providers knew/thought more about when it comes to their patients?

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.”

Really?

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.

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5 Responses to Meet David Kendall, MD

  1. Marie Clouser says:

    My husband’s dr. tell’s my husband to lose weight, and he has, but he still eats the wrong foods, even
    if his blood sugar is w/in the limit. Rick went from Type 2, on pills only….to having it now w/ injections 2x
    daily.And he does not take insulin twcie a day. He slacks off…fingers hurt he says.

    You know you can’t help them,,,,they have to help[ themselves. Poor excuse I suffered a brain anudrysim
    yrs ago, and to stay aliv…I had to change my eating habits drastically. Whay can’t he? I suffer seizures if I
    come into contact w/ MSG in foods. So I either am sick everyday or like i do, avoid those foods completely.

    Missing out on fatening foods won’t kill you, seizures will!!! He will not eat a meal of low cal foods. What else
    do I do? Thanks, Marie Clouser

  2. My son is trying out for a kidney and pancreas tansplant noe at Vandy. He is 41 years old and had diabetes since he was 7.
    He was termed “Brittle”. and it has not been a easy 37 years. H got a pump at 18 years old, I believe it save dhis life. He began having heart attacks at 23. So I believe that the medical field should chech the hear tmuch earlier because that hit us from left field. Blood pressure should be clossly montiored very early, especially if the genetics is prone to have it in the immedate family. He was diagnoised at 23 WITH 55 year old hear after stenting. Stress testing should be started early.
    Disability( Social Security) should be easier to be approved it took1992 to 2003 to get him approved even though his heart Dr and then Kidney Dr said should never work again. They kept turning him down so he went to work, it cost him is legs, realy but 2 stents in heart, 2 stents, each leg, 9 heart attacks , 2 arrest, 7 by-passes on left leg, a big toe, then leg below the knee before he was finally approved. He is now in dialysis 3 times a week now, If the could just get his leg to fit…after 3 years of rubbing him raw, and if the had kept a better check on his kidneys when he broke out all over and went to the dr over y or 8 times, even dermatologist for the insane itching, until I blew the roof off ( but they have known me for years) as MOM after I called them all… they called and said it is the kidnrys… get him to A HOSPITAL; NOW. I have watched him suffer for so many years the most with the PDA in legs. His Father had a stroke 4 years ago after a anurism burst in head so document strokes in familys too. His mother had one the year before. There is no OTHER person in either family with diabetes however it s a autoimmune disease, my father ALS, I had thyroid at 21 or graves. I believe theyshould really investigate the “HoneyMoon” period in research, how can they not need a shot then? what is the differences between active diabetes and diabetes in the Honeymoon stage? What is the Body doing differently then ,is always been a question on my mind.
    Thanks fopr at least giving me a place to speak at

  3. mi esposo tiene 10 años de diabetes el es de complesion delgada pero ultimamente ha bajado de peso lleva control en su alimentacion y medicamento que acerpuedeo h

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