Pam discusses the care and treatment of kids with diabetes with Dr. Asma Deeb, a leading pediatric endocrinologist in the Middle East and North Africa region who specializes in diabetes in children. Dr. Asma, who is the founder of the Arab Society for Pediatric Endocrinology and Diabetes (ASPED – @asped_news), shares her expertise and views on how far Type 1 Diabetes has come, and what the future of diabetes looks like.
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Episode 13: Diabetes in Children – A Conversation with a Leading Paediatric Endocrinologist
Pam 0:02
Hello and welcome to Dia-Logue, the Diapoint podcast. I’m your host, Pam Durant. I am so excited about today’s episode because I get to interview Dr. Asma Deeb. When I decided I was going to start a podcast, she was probably the first person I wrote down that I wanted to interview because she was really the first person I met in the UAE who specializes in paediatric endocrinology, and is an expert in Type 1 Diabetes. She happened to have been my son’s doctor for a few years, but she’s such a special person who has dedicated her entire life to supporting children and family with diabetes and other conditions. I always tell other moms of children with diabetes that she’s a true rock star. If I can use that term to describe a doctor. She’s a trailblazer, and she has really elevated the quality of care in the region. There’s not enough time and one podcast to describe this. So I am so incredibly honored to have her on the show.
Pam 1:24
A little bit more about Dr. Asma Deeb. She’s a consultant and Chief of Paediatric Endocrinology at Sheikh Shakhbout Medical City Abu Dhabi also known as SSMC. Her training as a physician began in the UK in 1991. She obtained an MD degree in growth hormone gene expression in 2002, from the University of Newcastle, she was appointed as a clinical Lecturer in Paediatric Endocrinology at the University of Cambridge between 2001 and 2005. And she went on to obtain a CCST in paediatric endocrinology. She has a special interest in disorders of sexual differentiation, use of technology in the management of children with diabetes and genetics of diabetes in which she has published in peer reviewed journals. She has many, many publications to her name, her work and dedication to children with diabetes is endless. She is one of the founders and the President of the Arab Society of Paediatric Endocrinology and Diabetes, also known as ASPED. In this role, she established the main strategies for ASPED in the UAE and throughout the region. And she continues to educate and mentor so many others interested in this profession. Her work has enabled ASPED to become part of the International Society for Paediatric and Adolescent Diabetes, ISPAD. And they will be getting ready to host that international meeting for ISPAD, in Abu Dhabi in 2022. So I could continue and go on forever about how excited I am to have Dr. Asma with us. But let’s go to the show.
Pam 3:01
Dr. Asma, thank you so much for joining us today. Ever since I’ve started a podcast actually, you are at the top of the list for me to interview because I think you have a lot to do with the reason why I’m here. As I mentioned in the intro, you were Erin’s first doctor, and you were the person that invited me to speak in front of several doctors on a few occasions about our life with Type 1 Diabetes. So thank you very much for that. For those of you that haven’t had the pleasure to meet Dr. Asma, she really is, I believe, and many others believe, the driving force of the reason why paediatric endocrinology is so good in the UAE today. Not many people know that. She’s been working in this field a very long time and pushing it forward really to grow and become what it is today. So I want to start with just asking you, how did you get into paediatric endocrinology?
Dr Asma Deeb 3:56
Okay, well, thank you very much indeed, Pamela, for the invite and the very generous introduction. I really appreciate what you said. And you’re a person with passion. So that’s what’s in common between you and I. You think about me when you think about a doctor for a child with diabetes. And I think about you when I think about patients, advocates and supporters, so we have a mutual interest. So paediatric endocrinology. While I never planned to be a doctor, and medicine was not the top priority of my career when I was 18 years old, but I ended up being a doctor. I’ll tell you later how that happened. But it happened. And while I wasn’t very excited about the idea of being a doctor, I was super excited to be a paediatrician. And I was even more excited to be a paediatric endocrinologist because I felt that children with chronic diseases are those children that are highly in need. And it’s not only about treating acute illness, giving children with pneumonia, a course of antibiotics and things are done. But children with chronic diseases can be companions to us, we can make friends with them, and we can relate because many of us are either mothers or fathers or have friends with children. So I thought paediatric endocrinology is a good fit for my passion. And I have always been a person who likes the non-intensive side of medicine. So I never like to be in an emergency room, resuscitating collapsed people, but I’d rather have a person sitting in front of me telling me what he or she feels and we can relate and talk. So that’s where paediatric endocrinology came into the equation of my future plans.
Pam 6:26
And how your patients are really lucky. That’s amazing. How long have you been practicing?
Dr Asma Deeb 6:31
Well, I started practising medicine in 1990. So a long time ago, and I have been doing paediatric endocrinology officially for the last 24 years. So 1997 when I took my first training position in paediatric endocrinology.
Pam 6:56
Amazing! No, no, I’m not calculating, and you do not, absolutely do not look like you’ve been practising since 1990 at all. And actually the way that we met so for those of you listening, you have to know like, this is how amazing Dr. Asma is. After Erin was diagnosed, we had just been communicating with the doctor in the US, who was really great and generous and supportive. But the time zone difference and not being here. It was so challenging. And one morning, we opened the newspaper, and we saw that announcement for some endocrinology meeting. And my husband said, ‘There must be a paediatric endocrinologist in that meeting, I’m going to go there on my way to work’ and I’m like, ‘You’re crazy’. You’re just gonna walk in and like, what do they call it? You know, crash the meeting, and you’re just gonna walk in, he’s like, Yeah, I’m gonna walk in, and I’m gonna go ask. And he said, every single person that he asked, he said, you know, my son has Type 1 Diabetes, I need a doctor that understands this, who should I talk to? Every single person that he came to said, ‘Oh, Dr. Asma’. And they just kept pointing to you and all roads lead back to you. So that’s just really amazing that you found that because you’ve just changed lives for so many people. And because you’ve been doing this for a while, it’s very safe to say that you are absolutely an expert in this area. With all the new technology and everything that’s available to us. Where do you see diabetes management going from both the technology side; and of course, parents are always asking, is there a cure? There’s new research that came out, someone had really great experience with the stem cell implant. Where is all of this going to be in 5,10, 20, or 50 years?
Dr Asma Deeb 8:47
Yeah, I mean, thank you for your initial comments. This is a very important question that we get asked. Without any exaggeration in every single clinic. We share the frustration with patients and families about finding a cure for diabetes. I mean, everybody agrees that Type 1 Diabetes is quite a challenging disease to manage. And I know some people adapt better than others. So the other day or before I start that, I mean, the research front and the technology front is expanding very rapidly. However, I can fully understand that some parents and families wanted to move faster towards cure. So I had the other day a parent of a newly diagnosed child and he was really frustrated and never forgot his comment. So he said to me, Okay, Dr. Deeb, you’re telling me about these devices and pumps and everything else, but you are still using insulin to replace the deficiency in insulin. It has been a century now, when insulin was first synthesized and used 1921 – 1922, that’s when insulin is known. And now, in the 21st century, you’re telling me that you are still doing the same thing, giving these patients insulin. I fully understand, he said that you are now going to use these fancy pens, and these fancy pumps. But again, come on, there’s no cure for this disease. Scientists and doctors had a century to think about it. And you’re telling me that the current technology has advanced. So that really was a flag for me. And I went home thinking about that father, who correctly said what he said. But again, the main issue with Type 1 Diabetes in particular, is people still do not know what causes it. Yes, we know it’s an autoimmune disease. Yes, we have these multiple hypotheses about the trigger, with different antigens. But nobody knows till today, October 2021, what causes diabetes. And until we know what the cause is, it’s not enough to know the trigger. We need to know what really causes it. And until then, I personally, in my humble opinion, and I don’t want to sound pessimistic here. But we don’t know the cause. It will be tough to find a cure. Yes, people have advanced insulin delivery. And now we hear about amazing new technologies and hybrid pumps and the move towards the artificial pancreas. But when we talk about a cure, I’m not really sure. I haven’t, to my best of my knowledge, seen a single paper that tells us diabetes is now cured. We hear about stem cell use, it’s a great idea. But until today, we haven’t seen it in clinical practice making people recover their pancreatic function, and living off insulin using stem cells. I’m not saying we should disregard stem cell treatment. But to all what I’m saying is, it’s not yet ready to be used for clinical practice. So if it is my son or daughter, I will never send them to have it done. Now, I might do it in the future. But I need to see some strong scientific evidence telling me that it works. And more important than the idea of it works, it doesn’t harm. We need to make sure that we are finding the solution, but not harming those children with diabetes. So to sum up, this part of your question, Pamela, technology is advancing immunology research is advancing to transplant science is advancing. But we’re not there yet. And an interesting start to your question, you said, how do you see diabetes going in the area of technology? I think it’s a bonus that children and adolescents are very smart when it comes to technology. And it’s something that they like, and they are good at it. So it’s very promising that technology methods of treating diabetes will flourish further and improve further.
Pam 14:04
I never thought of it from that perspective. If Erin hears this podcast he’s gonna be like, Mom, Dr. Asma said, I can do more gaming because of technology, I’m good at it. So that’s one aspect. But you’re absolutely right. They are so tech savvy. And they can be so creative with these things. And what you said about stem cells, I will never forget, one of the scientific meetings of yours that I came to, where you presented a case of one of your patients, and their family went to a clinic that was promising a cure with stem cells. The family used all of their life savings, and it didn’t work because like you say it is too soon. And when we were newly diagnosed, we also asked the doctor that we saw, you know, ‘Is there a cure?’ And his answer was, you know, ‘Don’t wait for the silver bullet’. And then at Diapoint really, I do believe that maybe someday there will be a cure, but maybe though there won’t be, but I always always try to encourage people, live your best life today. Because that’s what we have. If there’s a cure out there for sure, we will all be so happy. And you know, do just so many other different things and live very differently. But for now, this is where we are. And people are living amazing, full lives with diabetes. And I think as soon as, sometimes once you get past that acceptance phase, then I find that even the outcome starts improving, when you kind of embrace it, you can manage it better, you’re more open minded to all the different solutions that we have today. So thank you for sharing that. And if then, in this case, because I know you’ve also done a lot of studies in this as well, if I have a child with diabetes, or even as an adult with diabetes, how should I decide which technology to use? Because there’s a few different insulin pumps, or some people prefer pens. What is the best way to decide because that’s also a big question that a lot of people have, should I pump? Should I not pump? How do I know?
Dr Asma Deeb 16:08
I think the best decision for patients and family is the informed decision. So people need to be educated about what’s available, and what suits one, might not suit the other. So the best thing to do is to tell people, what’s available, and having a support from diabetes educators, or the specialist nurses in diabetes, in showing people with hands on sessions, what insulin pen means, and what insulin pump can help. So discussion, education, and referral to citation of studies. We all hear that okay, well, insulin pump is the best treatment for diabetes mellitus. I’m not challenging that. But I would add to that sentence for suitable candidates. Or because yes, it’s the best technology, but it might not suit some people. We also hear that this particular insulin is better than that insulin, but again, we live in different areas of the world. And this particular insulin might not be available wherever that patient is. So when we talk diabetes, we need to have this global thinking about accessibility, and about affordability in addition to suitability. Because I, about 10 years ago, there was this interesting study that appeared in The Lancet, Lancet is a very prestigious medical journal. So this article was asking, what’s the main cause of death in children with diabetes? And if this question is asked to a group of healthcare professionals, or even medical students, people will straight be thinking about hypoglycemia, a severe one, or severe diabetes ketoacidosis. Now, the answer wasn’t that. And I’m not underestimating the danger of acute severe hypoglycemia, or severe ketoacidosis. These are severe complications. They might lead to death but this is a rarity. What’s common in mortality for children with diabetes is a single thing. And that single thing is lack of access to insulin. That’s why children around the world with diabetes die. They die because they cannot access insulin. So if we think about it from the perspective of global diabetes, then accessibility to insulin is the foremost important reason. Now, if we have the luxury of the choice, and back to your question, what would you advise the patient to have, then again, it’s a matter of discussion. There are two important areas here, the patient or the family need to know and need to want. So if they know fully about the insulin pump, but the child doesn’t want it, it’s ridiculous that I push or force for it. Because at the end of the day, the child is the end user of this and if he or she doesn’t want it, for whatever reason, partly because I failed to educate them properly, or they might not see it fitting to their lifestyle, then the pump is out of the window. And again, I am an advocate, and I am a fan of technology and use of insulin pumps. But again, the patient and the family choice should come first. And that choice should come after full discussion and full education with the patients on what are the other varieties. And the same comes with continuous glucose monitoring. I mean, I don’t think it’s debatable that continuous glucose monitoring is the way forward to manage diabetes. And of course, it’s not only because it’s real time reading, and it allows us to uncover all the hidden readings, it helps us diagnosing and managing nocturnal hypoglycemia, but also, because it improves quality of life. I think that’s a fact. So these young children, they will not prick their fingers anymore, they will have the satisfaction and the reassurance for parents that they are safe, and they are. Okay. So it’s an amazing discovery. But can we really force this on everybody? We cannot. Because first of all, it might not be available. I mean, we cannot just stand in international meetings and we say it’s either CGM or not. Because in some areas in the world, you don’t even have stripes. And I hear about very sad stories of parents trying to cut the strip into two, so that they can afford to make it last longer.
Pam 21:55
This is the time I’m hearing of this thought, oh my goodness.
Dr Asma Deeb 21:59
This is actually mentioned to me in one of the meetings of our society by a Sudanese doctor who has a patient and use very sharp knife to try and cut the strip into exactly two most of the times it will not work because it will not fit, but they try and other families that are still relying on urine glucose. So when we talk about the availability, let’s say that’s a given, then again, we need to think I have many children in clinic who are fully covered with insurance. And they are very happy about the idea of using continuous glucose monitoring. But they have severe allergies, severe skin allergies. So this is back to the golden concept in medicine, do no harm. I don’t want to treat a child with diabetes, but create major issues with her or his skin conditions. So you might think this is philosophical. But that’s what we see in real life. We need to tick all the boxes about the treatment. The patient wants that, the patient can afford it. We have the resources to educate the patient. And then we can sit, relax, drink coffee, and think about the modalities of treatment. But it’s really nice for you and I, you as a patient, a person who has always been an advocate for diabetes. And with this extensive knowledge that you have, and with me with the experience that we need to think out of the box, and not only to restrict our discussion about children who are privileged of having the money and the care and the different variety, because diabetes is a global issue. And no child is exempt from having diabetes, being in Dubai or in Africa or in the south east. This is a global issue. It has to be an international task when it comes to its treatment. And it’s incredibly important that all stakeholders come together to unify. It’s not about getting a good doctor or a good nurse. It takes more than that, to treat diabetes and improve the quality of life of these children.
Pam 24:36
You’re so right and I’m so glad you highlighted it because November being Diabetes Awareness month which is when this recording will come out and IDF is focusing on this. Access. Access to insulin number one, access to education, access to devices like you said, even checking your blood sugar, which you might be in a country where you can’t even find a glucose meter and strips. Or you might be in a country where your insurance – I overheard someone as I was waiting in a hospital pharmacy for my son’s insulin and having private insurance. They were very clearly buying something for diabetes management. It was, I believe it was strips or something to do with a glucose meter. And this was for an adult, I don’t think it was for a child. And he was, you know, trying to get samples from the pharmacist because it’s expensive, people can’t afford it. So like you said, we are so privileged even without the insurance covering our devices and everything so privileged that we can live where we are, and have access to the things we do. And I think also one, a woman from Costa Rica, highlighted in a meeting to me in the League of DiAthletes, the first meeting I went to, and they were talking about the camp they did. Because also in a lot of countries in Central South America also have access issues as well. And now with the internet, and all the I hate this word for people in diabetes, but ‘influencers’ that they use, sometimes that people that are on Instagram, or Tik Tok or whatever it might be and showing their devices, this kind of makes the gap even bigger. Because it’s one thing to be naive and not really know of all the technology that’s out there. But if you’re a young person with diabetes, and you see someone your age with that, and it looks all great, and it’s all looking like a lot of fun, but you don’t have access to that, that makes you feel even worse about having diabetes than you did before. It’s a huge issue. And I interviewed in an earlier episode in the podcast, a person, a young woman with Type 1. And she’s also an amazing advocate in Lebanon. Because they’re having so many challenges getting everything right now that you just talked about, and it was just barely scratching the surface of this access issue. So I’m so glad you highlighted that because there is so much to do. And I think you know, both of us whether you’re clinical or not clinical want to be part of the solution. And you’re right, everyone has to come together to bridge this gap. Because, you know, it takes a village, nobody should be left behind because they have diabetes. And sometimes I feel, I hate to say this, because I don’t want to get into this comparative suffering thing. Because no chronic condition is good to have, nobody wants to have anything. But because diabetes is not seen as a sexy chronic condition to have as a lot of other things are, people don’t pay attention to it. There’s still a lot of shame and blame around diabetes, therefore, then access and research and all these other things are not considered in the same way they are for some other conditions. So 1,000% Yes. That has to be addressed. And I also love what you said about letting the child have a choice in the matter, that can sometimes be really hard as a parent. I’ve done it when Erin was small, I let him make the choice. And I never said anything. I never expressed my opinion that at the time, you know, I didn’t know was right or wrong. And he’s okay.
Dr Asma Deeb 28:20
Sure, sure. I see. But let me just maybe finish up with a positive note here. You mentioned that as a chronic disease, maybe diabetes is not as attractive compared to other diseases. And I cannot agree more with that. Except that diabetes did it for itself. What I mean by that is with a new era of the use of AI, Artificial Intelligence, people can see clearly that diabetes has a place in this and diabetes have made medicine, one of the top areas where AI can be applied. Why am I saying this? I mean, yesterday we were in ADNEC in an international meeting about events and business and I was called to speak among other colleagues who are doing business logistics and other non-health-related things and what my role in the discussion yesterday was to highlight the importance of introducing Big Data and artificial intelligence in healthcare and medicine. And 90% of my talk was about the use of technology in diabetes. So yes, there are areas which are a little bit sad and depressing like access to insulin. But again, there are areas which are very encouraging, people like and utilize technology. And if you look at statistics in UAE in particular, the number of mobile devices used per capita in UAE is one of the highest in the world. And it will be unwise of us if we do not utilize that in improving healthcare. So I was speaking at a high degree of ease yesterday because it’s very easy to sell the idea of diabetes when it comes to technology. So I managed to easily tell people how we can connect these devices, how we can cloud store them, and how we can do telemedicine with people with diabetes. We can utilize the big data that we receive in continuous glucose monitors. And we can structure that data in very nice ambulatory glucose monitoring profiles, that enables us. I talked at ease with the data upload, data storage, data connectivity, data sharing between patient and the device and the caretaker and the healthcare professional. So we are no longer disconnected when we talk about diabetes. Patients and parents are feeling much happier now. Because they have this sense of security. So these toddlers and young children playing in the school field, having the ability to connect with their parents and health carers through these high tech connectivity. So there are very good sites, strong sites for diabetes. And the reason why I’m saying diabetes did it for itself is it’s not hard to sell the idea of use of technology and diabetes, because when we talk, advanced technology, big data and artificial intelligence, the very first prerequisite is data. And we are overwhelmed with data that we can input and the output we need helps us diagnose where the problem is, helps us how to prevent it. Not only that, but it has been heavily utilized. Nowadays those predictive algorithms were the basics for utilization of the hybrid advanced loop system, and the 870 sorry, the 780G pumps where nowadays, these clever algorithms enable pumps to predict what will happen. They will predict if the blood sugar will go low or high. Not only that, but they will prompt the pump to produce many bonuses to correct hyperglycemia. In addition to switching the automatic switch to hypoglycemia, which we knew for a while. So that is a great perspective when it comes to utilization of technology. And I might be biased here, but I challenge any other healthcare specialties or subspecialties in providing a better model than diabetes. When it comes to utilization of technology, maybe I don’t know enough about other areas of medicine. But I know enough about how we can utilize technology best to improve technology in diabetes, and better manage diabetes and improve patients’ quality of life. I hope that makes sense.
Pam 33:46
It does. And it makes me very hopeful for the future. And then also when it comes to access. Well, a lot of these things are not, you know, affordable for everyone. But if you have someone in a very remote area that maybe doesn’t have access to doctors or anything like that, you know, if you think of some remote places in Africa, and early on. I remember I used to work for a big tech company, and when they were looking for business development in Africa, and for example, the banking sector, nobody ever had brick and mortar banking. So they kind of just jumped right into this mobile era. And if everyone has a mobile phone, then you can also track, and manage your diabetes. So it’s kind of thinking of those systems a little bit differently. So that gives me a lot of hope for access as well as data. I know that you have to go to a meeting and I’m going to wrap this up. I hate that because I can talk to you like all day really. Maybe even two days we can split this up into a whole season of diabetes with Dr. Asma. I actually like it. So I’ll ask you one more question before you go. Because you are the founder President of the Arab society of Paediatric Endocrinology and Diabetes, which is a really huge thing. And like I mentioned in the beginning of the show, you are the driving force that made things so much better for people with diabetes here, particularly Type 1 and children and families. And everybody needs to know that and understand it, because you just, the last time I saw you I think we were talking, and you’re like, I’m here and working at my desk, and then, you know, all these other things are happening out there. And people don’t realize that you are the thing that keeps the wheels moving and pushing and driving everything forward. And then you know, it’s made such a difference for so many people because when Erin was first diagnosed, I knew no doctors, no paediatric endocrinologist, I couldn’t find anything. And then slowly over the years, I’ve seen your meetings and the attendees grow and not just for the UAE, but for the entire region. And it’s amazing. So any advice that you would have for someone wanting to study endocrinology or paediatric endocrinology? As a final question.
Dr Asma Deeb 36:12
Go for it. It’s amazing, very interesting. Very brainstorming, you need to have your brain on the go all the time, and that prevents Alzheimer disease. So I am biased, but I am biased for a good reason. It’s an area of medicine, where everything makes sense. Studying the hormones, and understanding these amazing feedback systems that God created in us is just fascinating. And whatever you study in medicine being physiology, histology, anatomy, pathology, pharmacology, it will be directly applied in clinical care. And that’s the beauty about it, nothing is wasted. So do not regret the long study in medicine because everything you learnt in the medical school, directly or indirectly will be used and applied in medicine. But that’s only if you do endocrinology, and only if you do paediatric endocrinology.
Pam 37:26
Wonderful. I truly believe it. I’m not an endocrinologist, but the things that I just find that affect blood sugar, it’s fascinating. It’s a fascinating field. So thank you for that. Thank you so much for your time, and your wisdom and your insight and everything that you do for all your patients. I can’t thank you enough.
Dr Asma Deeb 37:46
Thank you very much, mutually Pamela, you did help us a great deal. And please let us continue this very fruitful collaboration.
Pam 37:57
Definitely, thank you, have a wonderful day.
Dr Asma Deeb 38:00
Thank you very much indeed.
Pam 38:02
This was such a powerful interview. And I’m so grateful to Dr. Asma for her continued support, and making the time to speak with me today about some of these very important topics. And thank her for very eloquently highlighting so many of the issues and challenges that people with diabetes are facing right now, particularly access. I do hope that we can all work together to continue to improve access for everyone, particularly to insulin as she highlighted and please check the show notes for links of how to find Dr. Asma. And also for ISPAD and the upcoming meeting that they’re having in Abu Dhabi in 2022. Thank you all for listening. If you like what you hear, please like it, share it, comment on it, and tell your friends about it. That will help us continue to do what we’re doing and we love what we’re doing. We look forward to bringing you more interviews soon. Have a great day.
Show Notes and Links
Disclaimer: It should go without saying that the Diapoint podcast is not intended as or should not be used as personal medical advice. You will hear us interview medical experts and others, but please always always ask your qualified doctor, diabetes team or other expert about your health. What works for one person does not always work for another person. What you should always do when you discover any new health information is ask YOUR doctor about it. This information should empower you to have a discussion with your healthcare providers about it. Diapoint, our guests, sponsors and business partners are not here to replace that advice. Living a full, healthy life means taking the proper medical advice from your qualified physicians, diabetes team or other healthcare providers.
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The Founder & Managing Director of Diapoint, Pam Durant, shares her experience as the mother a teenage son who was diagnosed with Type 1 Diabetes at 20 months old.
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