Dr. Paul Rosman is an accomplished endocrinologist who has dedicated his career to simplifying the way diabetes is treated so that everyone with the condition can live healthier and happier lives. As a member of our Scientific Advisory Board, he wants to help those living with diabetes get actionable information out of their meter so that they can live their dreams with as little interference from diabetes as possible. We recently spoke with him about his passion for diabetes and his interest in Dario.
You spent 27 years as a practicing endocrinologist in Warren, Ohio. Why was this a “dream come true” for you?
Dr. Rosman: In my practice, I met many people with diabetes who struggled. Some fought and succeeded – that was always wonderful. There were many patients who could not conquer the burdensome legacy of their diabetes complications and some died. I was left with the memories of the strength and courage I witnessed and it left me believing in people.
However, too often the tragedies were preventable. I kept finding myself thinking, “If they only know how to manage their diabetes earlier.” I saw this as an unmet need. My research, and that of others confirmed for me that this was truly something that needed to be fixed. So, I figured out how to show people what they could do to manage their diabetes better than before, using information they already had and knew about.
I became interested in when treatment worked and why that was different than when it didn’t. Working with shift workers in steel mills on assembly lines or in hospitals taught me about sleep and time of day. I began understanding how recurring events, like interrupted sleep, impacted hormone levels and discovered that they were tightly connected. This led me to consider how individuals’ life events – not just food, but sleep patterns, physical activities, and stress levels – can impact blood sugars in a predictable way.
This challenge kept me alert, excited and growing in a busy and demanding solo practice. My dream had been to practice medicine with challenging medical problems where I could learn every day, grow my expertise and make a difference in prolonging and improving the quality of people’s lives. There it was.
What excites you about Dario?
Dr. Rosman: Dario can talk! Dario can talk to people with diabetes, and it can provoke an urgent phone call if the need arises.
The exciting challenge is to personalize our diabetes management tools. Dario can say different things to people engaging in different sugar changing activities as they go throughout the day. Dario can show people when their body works for them in managing their diabetes better.
Dario can warn them of impending problems and what actions to take to avoid them before they occur and when the danger is likely to be over. Dario can tell them when their medication starts to work, when to consider (with their doctor) when to alter their medication dose, and when their different medications are likely to stop working. It can also warn them that the medicine they just ingested may last for 5 days if that is the case, can make their sugar too low, considering the levels that were just recorded.
Dario can tell them when they need to check their sugar just because they begin an activity that is likely to cause a dangerously low or unwanted high sugar level. If integrated with a daily calendar it can tell if someone is going to be doing sports they never do or the things they usually do at the same time every day. Dario is a brilliant application of reliable technology to bring obtainable clinical information into actionable knowledge for predictable outcomes – and all with perhaps with only a handful of sugar checks at the appropriate time!
What are the key challenges that doctors have supporting their patients with diabetes?
Dr. Rosman:
1. Docs don’t know what it means for each individual patient to “win” with diabetes. You have to ask the patient to find that out. Target HbA1c’s are nice, but sustaining that success is the real goal if people are going to enjoy the legacy of health that is promised but not always delivered.
2. The script that docs work with is cluttered with data that means nothing usually because it is about what has already happened and does not usually allow patients to get predictable outcomes in the future.
3. Docs want to give medicine to people, but sometimes less is better. Docs don’t seem to know when that is. They don’t look to see what people are really able to do for themselves, and what they cannot do. They also don’t look at what glucose control systems still work in people even though they have diabetes.
4. You cannot address the needs of someone adequately when your major metric, blood sugars, can double in 10 minutes and fall by ½ in 20 minutes and you don’t expect to see that person or talk with them for the next 3 months. That makes no sense.
How do we make things better?
Dr. Rosman:
1. Look for positive things individual patients are doing, encourage them to build upon their successes, rather than focusing on the negatives that can make an office visit a depressing, functionally useless confrontational experience.
2. Stop overloading doctors, nurses and patients with cluttered data no one can use.
3. Talk with or have a trained nurse talk with people with diabetes more frequently – even twice per week – if they need it. Docs should be guides for people to get their bearings about their diabetes, and as caretakers, supporters and providers they need different tools and a different approach than is being used now. Diabetes is an intimate disorder, and doctors need to treat it with that in mind. It is not part of their training unfortunately.
4. Learn to look for and find the recurrent daily events that impact sugar trends consistently. That’s the way to get an early success and multiply it.
If you could help every person with diabetes understand one thing, what would it be?
Dr. Rosman: You can manage your diabetes well and live your life with a legacy of health, productivity and joyfulness! Let’s show people with diabetes and those who care for them how to do that.
Dr. Rosman is a recent addition to the Dario Scientific Advisory Board. Thirty years ago, as Dr. Rosman was beginning his career helping people with metabolic disorders, he saw how badly diabetes management approaches were failing patients. This has inspired him to spend most of his career researching and validating a new approach that could work for both doctors and patients. He has helped build an online diabetes university and tested out the management theories with thousands of people living with diabetes. The results were transformative and confirmed his hypothesis, inspiring a journey to build tools to help everyone with diabetes to realize their dreams for healthy and meaningful lives.