Episode 42: DICE 2026 - The Highlights

John Pemberton was at Croke Park on 21 May for DICE — Diabetes Ireland Conference and Exhibition — Ireland's premier annual event for healthcare professionals working in diabetes. The day also saw the launch of the landmark National Policy and Services Review for diabetes in Ireland. John grabbed a microphone and seven conversations. This episode is all of them.

Anjanee Kohli is Co-Director and Creative Director of The Glucose Never Lies® and the host for this episode. John Pemberton is founder of The Glucose Never Lies® and a paediatric diabetes dietitian at Birmingham Women's and Children's NHS Foundation Trust; he is also a person living with T1D. This episode reflects the independent views of both.

This episode covers:

• Sinead Powell (Education and Support Coordinator, Diabetes Ireland): the COPE programme, emotional wellbeing in type 2 diabetes, language, stigma, and why information alone is never enough
• Kathy Breen (Clinical Specialist Dietitian and Dietetic Lead, National Diabetes Programme): what Language Matters looks like in practice, person-first language, and its inclusion in the new national strategy
• Kate Gaievska (Clinical Manager for Advocacy and Research, Diabetes Ireland): why adult diabetes psychology services in Ireland are effectively non-existent, what the strategy commits to, and the long road of implementation
• Professor Fidelma Dunne (University of Galway / National Clinical Trials Network in Diabetes): how clinical trials get funded, why real-world data matters, and why research is not the icing on the cake
• Christine Newman (Diabetes Consultant, Galway): hybrid closed-loop in pregnancy, CGM for type 2, and the case for free glucose strips for gestational diabetes
• Professor Derek O'Keefe (Consultant Physician and Professor of Medical Device Technology, UHG): Mochara, a bounded AI education tool that matched nurse and doctor performance in trials, ambient clinical documentation, intelligent dynamic triage, and what multimodal AI means for diabetes care
• Dr Tomas Griffin (Consultant Diabetologist, Galway / DTN Ireland): what the strategy means for pump access, the DTN Ireland roadshow, and why every tier of hospital in Ireland is now starting pump therapy

Show notes: https://theglucoseneverlies.com/

Have more questions? Ask GNL Grace, a diabetes educational adviser built by a team with skin in the game. Grace gets you 80% of the way there with 20% of the effort; the final 20% takes self-discovery, guided by human expertise and trial-and-error learning. https://theglucoseneverlies.com/gnl-grace/

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Collaboration: John Pemberton — john@theglucoseneverlies.com

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Transcript

SPEAKER_00 0:11

Hello and welcome back to the Blue Curse Never Lies. I am Angie Coley, not John Pemberton, as you've probably guessed. I'm the co-director and creative lead here at GNL, and today we're gonna talk about episode 42. So this episode is all about what's happening in diabetes care in Ireland right now. And when I say right now, I mean right now, because John was at the DICE conference in Dublin earlier on in the month. So DICE is the Diabetes Island Conference and exhibition. So it's Ireland's annual gathering for healthcare professionals working in diabetes where they all come together to take stock of where things are, where they're going, and what needs to change in diabetes care in Ireland. So this year's conference was quite significant because it coincided with the launch of a landmark national policy and services review for people with diabetes in Ireland. So we're talking about a framework that's meant to shape the future of diabetes services across the entire country. So the timing of John being there couldn't have been better, really. So John being John, he didn't just attend, he grabbed a microphone and a corner of the conference and he sat down with seven of the key speakers for some quick fire, 10-minute conversations, no frills, no lengthy setups, just John getting straight to it with some of the most interesting people in Irish diabetes care. And what came out of those conversations is what you're about to hear. As it's a jam-packed episode, I just wanted to give you a bit of an overview as to what's coming. So, first of all, we start with Sinead Powell, who is an education and support coordinator at Diabetes Island. She's been working in diabetes for about 30 years, and she talks about the emotional weight that comes with a type 2 diagnosis, including the stigma, the self-blame, and the programme COPE, which gives people a proper, supported place to process all of that. Next, we hear from Kathy Breen, who is a clinical specialist dietitian working across diabetes and obesity, and she's also the dietetic lead for the National Diabetes Programme. So she picks up the baton on language and specifically about the way that healthcare professionals talk to people with diabetes and obesity. So she goes into some real practical territory on what person-centered language actually looks like in a consultation room. So given that myself and John are both dietitians, so this one is particularly relevant for us as well. So from there we move into psychology with Kate Gayevska, who is a psychologist by background, but she also works as a clinical manager for advocacy and research at Diabetes Island. So she talks about something that I think will resonate with a lot of people that are listening, and that's the fact that access to psychological support within adult diabetes services in Ireland has essentially been non-existent, and what the new strategy might mean for changing that. Our fourth conversation is with Professor Fidel Badun from the University of Galway, who directs the National Clinical Trials Network in Diabetes. So this is the one for anybody who's ever wondered how research actually translates into the treatments and technology that end up changing people's lives. She shares why clinical trials matter, not just to academics, but also to every clinician and every person with diabetes. And she makes a really compelling case for why real-world data service audits and even small service evaluations are more accessible and more powerful than most people realise. And there's a really great line about clinical trials being like a village raising a child. Lots of different people, lots of different skills, so that was really great to hear. Then we hear from Christine Newman, who is a diabetes consultant based in Galway, who also works across a couple of other hospitals in Ireland. So her focus is diabetes in pregnancy, and she talks through what the strategy means for women coming into pregnancy with type 1 or type 2 diabetes, and also for those who develop gestational diabetes. So there's some really concrete stuff here about hybrid closed loop technology in pregnancy and also access to CGM and what needs to change from that regard. Segment six is the one that I feel hit close to home for those of us at GL because it overlaps quite significantly with what we've been exploring with GL Grace. So here John spoke with Professor Derek O'Keefe, who is a consultant physician at the University Hospital of Galway and professor of medical device technology. The conversation covers AI, digital health, and what's genuinely coming down the line for diabetes care. Derek talked a lot about a system that his team built in Galway called Mukhara, which is Irish for my friend. So it uses a bounded AI model to educate patients about their medications, and it performed just as well as the nurse or the doctor in trials as well. He's also fascinating on intelligent dynamic triage. So the idea that AI can help to flag people who actually need an urgent appointment versus who's doing well and could be seen later. So that's really grounded, it's practical, and it's happening right now. So that was a really important bit of the conversation. Finally, we round out with Dr. Thomas Griffin, who is a consultant diabetologist who splits his time between the hospital and community care in Galway. So he co-founded the diabetes technology network Ireland, which is modelled on the DTN in the UK. And he talks about the work they've been doing to reach hospitals across Ireland that have never started before, and also how to empower both clinicians and people with diabetes to understand what technology is available to them and also what technology they're entitled to as well. So there's a great momentum to the conversation and it's a good one to end to end on. So that's the seven conversations, seven different perspectives, and I think together they give a really vivid picture of where diabetes care in Ireland is right now and also where it's heading. So there's a lot of hope in this episode, and it's the kind that comes from the people who've been pushing hard for a really long time and can finally see things that are beginning to move. So a couple of things I'd like to say before you dive in. So first of all, if you're in Ireland and you're living with diabetes, whether that's type 1, type 2, gestational or any type, then this episode is definitely worth your time. The strategy that was launched at this conference is a tool that you could definitely use. It sets out what services and technologies you should have access to, and knowing that puts you in a much stronger position to advocate for yourself or for your loved ones that are living with diabetes. And secondly, if you're a healthcare professional working in diabetes in Ireland or anywhere, a lot of what's discussed here translates. So that's enough from me, and I'll hand you over to John, who, as you'll hear, is very much in his element wandering around a conference with a microphone.

SPEAKER_04 6:48

So welcome to the Gluccoast Neverlides Podcast. We're on a special here at the DICE conference over in Dublin. And I have now the fortune of a quick 10-minute blast with some of the key people who have spoken today and some of the key information they've got. And most importantly for me is to pass out what's been happening in Ireland, what's going on with certain topics, and also what does the future look like for care at Diabetes Irish Centre. So I'm not going to remember everyone's name, so I'm going to get you to introduce yourself. Do you want to introduce yourself and where you work?

SPEAKER_07 7:17

Sure. My name is Sinead Powell, and I am an education and support coordinator with Diabetes Ireland.

SPEAKER_04 7:24

Perfect. And we've had a little chat before, and you said for you, the language matters is very important and emotional well-being, particularly with type 2 diabetes, or just uh in general, people with type one and type two, the language matters and then emotional well-being. So what is it that you're kind of looking forward to moving forward? So from our perspective in the UK, we've had the language matters piece out for a little while. What's the situation in Ireland?

SPEAKER_07 7:47

So I work in the charity Diabetes Ireland. Uh, having worked in diabetes for 30 years, I think I'm in a privileged enough position that I've seen an awful lot of change in person-centered care. So when I started out, it was very much a medical model and it was not a nice place to be. You heard complications inside out. So I've seen an awful lot of change, but I suppose the most the biggest thing for me as a dietitian, how how much influence that we have in supporting people to figure out what they need from us. And I think it's so important to communicate with people with diabetes how we're here to support them, as opposed to, as in the past, if you don't do what I say, this will happen. So, yes, I've seen major advances in technology, but for me personally, motivational interviewing, how can I help you, is one of the most rewarding aspects of my job.

SPEAKER_04 8:51

So obviously, that makes total sense. I'm a dietitian as well, and I it's interesting to see other healthcare professionals work. It's always very interesting to see from doctors and nurses and dietitians. Everyone's got a kind of their own style. And you can always see people, in my opinion, who are very much numbers focused. So they come in, they're sort of like they're looking at the screen, looking at the screen, and the occasional glance at the person with diabetes and then back at the screen, it's kind of numbers, I'll sort your numbers out, and that's what we're here to talk about. And other people will just kind of walk in and they'll be like, Okay, you you've made it here today. First of all, thank you for coming. And so maybe there's something that you want to get out. Do you want to tell me what it is that you want to get out of today? And that's a great place to start. Are those the kind of things that you do within your practice? Do you have any kind of lines or an approach that you typically take to allow that to happen?

SPEAKER_07 9:37

So, in my role in charity, I'm not so much one. I have been um more group-based online learning. And we I was employed initially to come to get to produce what's called the COVID program, which was based on nice criteria and the likes of experts. So that's way, way back. So that what I've been doing for the last few years is developing an emotional and well an emotional and mental health well-being program to support people living with type 2 diabetes. Um it's been it sits alongside structured education where I felt there was nothing there before. We have no psychological support in diabetes Ireland. And I suppose even after the direct trial, when we heard about remission, I could observe people, you know, coming in thinking, I shouldn't have got this, I should have been able to prevent this. Um, I gave this to myself. And and I don't think as healthcare professionals, we recognize the impact of that in type 2 diabetes. And and personally, I don't like the word prevention because I think for so many people there's so many things out of their control. So to work in the language matters group, but also to be uh able to develop a supportive space where we have now got this program called COPE, which stands for Connect, Overcome, Prioritize, and Power. It's using a lot of CBT light tools, but it's actually giving the space for people who have type 2 diabetes who are struggling with the condition when they know what they should do, uh, but they don't have the tools and that inner monologue of oh my god, why do you do this? So so uh we have so much information at our fingertips about whether it's true or not, but we're not giving enough space for that social connection. And it's been so rewarding for me to be part of that development where you can see 12, 14 people on screen able to talk about the the emotional impact, the burden where they now can hear other people feel the same. And that space has not been created before, so I'm very passionate about it. Oh, I work in a charity and there is no money for anything. So we have designed, we've got some research behind it, but we have no funding to scale up and roll out. So for for for my uh the rest of my working career, I'm going to try and engage more around grant applications funders because I really believe in this, and I believe language matters feeds into this so that we will make it an easier space for somebody with diabetes, type 2 diabetes, to not be embarrassed, to not feel judged, to be able to say openly, I have type 2 diabetes, and they can't, I don't believe now.

SPEAKER_04 12:25

Yeah, I mean it goes all around. I've got a good mate of mine who works um in Stigma for obesity, and it's a very similar sort of situation where if information was the issue, it would be solved by now. But the reality is we've got the same genetics, the same human bodies that we had 400 years ago, except 400 years ago there weren't as many cars, there weren't as many um fast food places on the corner, there wasn't the whole environmental shift which has pushed our bodies towards this more likelihood to get diabetes, not through anyone's fault, but because the environment has shifted so much, and obviously your genetics cannot change at that rate. So then we're having to intervene with cognitive behavioural approaches, you know, different ways. But like you say, there's there's a big stigma attached to oh, if you had type 2 diabetes, it's your fault, you could have prevented that. But the reality is if that was true, then you wouldn't have it across the world, increasing it the cadence it is. It's an environmentally driven thing, and it's our job to maybe step in and hold that space for some of them to say, let's acknowledge that and let's be okay with it, and then let's see if we can help you. And that sounds like that's the word that you're really keen on doing and have started to do.

SPEAKER_07 13:37

Really keen on doing, but also to recognize that my role is limitations and so much of this is around public policy and driving better language around the prevention messages. So we have a program called, you know, preventing type 2 diabetes, and there's there is something in that. You know, if we are going to change and have less judgment and less bra blame, we have to be careful about our language because not everybody, as you just said, realizes the extent of how much is outside a person's control when it comes to obesity making change. So this is a small step uh as part of that journey, so that, as I said, people will feel more supported to say they have diabetes and then look for help.

SPEAKER_04 14:21

Well, for someone listening who's got some money, it sounds like a pretty decent thing so you can invest some money in. Uh, you can drop me an email and I will get I'll get pass you on an email and you can give your hard-earned cash and philanthropic efforts to potentially help people feel less stigmatized, able to say they've got attached to your diabetes and then do something about it, because keeping it locked away is not going to help. But thank you for his time. I really appreciate it.

SPEAKER_00 14:43

Thank you.

SPEAKER_04 14:56

So this is the second of our little snippets, quick fire rounds of what's been going on at DIES. Would you like to introduce yourself?

SPEAKER_05 15:02

I will, thank you. Uh my name is Kathy Breen. So I am a clinical specialist dietitian working in diabetes and obesity, and I also work with the National Diabetes Programme as a dietetic lead.

SPEAKER_04 15:12

Okay, perfect. So as you notice, the first two people want to dietitians, as we're the best. So we get the fair the get the best best on first. And we just um chat with one of your colleagues who's talking in general around emotional well-being, around language matters, and how sometimes the stigmatization of type two diabetes and obesity is a real thing. I know that's a passion of yours. So, what have you kind of are you taking to this conference or what are you taking away from this conference? What are you hoping in Ireland with all the changes with the funding? What's how do you foresee the future and what what would you like to see?

SPEAKER_05 15:42

Yeah, so I think what one of the things I'm really passionate about is language and the way we talk about diabetes and obesity and health in general. Um we were really, really happy that one of the recommendations on the policy that we launched today included reference to language matters and the importance that all healthcare professionals in Ireland become familiar with the principles and concepts of speaking to people in a helpful, collaborative, person-centred way.

SPEAKER_04 16:08

These sound like basics that should be part of So let's dig into some of the basics because people who listen to they go, okay, language matters. Yeah. I kind of get it, but give me some examples. So I'm going to give you some like two opposite ends of the spectrums. I'm going to pretend you're coming into my office, and obviously you're someone who's living with obesity or diabetes, and can you come in? You'd be like, okay, we'll see you BMI, and it's kind of like it's on the um it's on the heavy scale kind of, you're in the obesity category. Um that time you lose some weight, do you think? That's obviously not that's not a great example.

SPEAKER_05 16:38

Yeah, that would be one end of the spectrum.

SPEAKER_04 16:40

So you you give the you give me the compliment of how that could be improved.

SPEAKER_05 16:46

Yeah, so I think it's a really interesting point because I think people, when we talk about language matters, they focus immediately on the words. And words can be tricky and people interpret words differently and they change over time. So I'll I'll come back to answer the question, but I do think a key thing when we talk about this is to recognize it's as much about how we are with person um and those kind of, I suppose, underlying ways of being. So am I judging this person or am I approaching the conversation in a neutral, non-judgmental manner? Um am I trying to be collaborative? Am I trying to be genuine with the person? So in some ways, I think if those things are in the conversation or in the consultation or whatever way we're interacting, you get away with a lot. If you use a word that maybe isn't quite right.

SPEAKER_04 17:33

If you're looking at someone, you're genuinely making eye contact and you kind of be like open gestures, etc.

SPEAKER_05 17:38

Totally, yeah. And somebody will correct you. So if you use a word that was uncomfortable for the person, but you have built a good relationship, they will say I don't like that word. Um, but more broadly, I guess to come back to the question, like what's a more helpful way, maybe of talking about weight. So again, neutralizing the language, try to use person first language where we can. So person with obesity, person with diabetes, not everyone has that preference. So again, you're probably best to start by asking how what the person wants to use, what term they want to use. Um, in diabetes, I guess we've a long history of very much focusing on numbers. And again, I think it's it's trying to defocus numbers, thinking more about health, quality of life. What it is that is important to the person as part of that conversation.

SPEAKER_04 18:32

So this is the third uh part of the quickfire round. So now we're moving on from dietetics and language matters straight into a nice little dovetail into psychology. So, do you want to introduce yourself and sort of say hello to the audience?

SPEAKER_01 18:45

Yes, hello everyone. My name is Kate Gayevska, and I'm a psychologist by background, but I work as a clinical manager for advocacy and research here in Diabetes Island. Perfect.

SPEAKER_04 18:55

So I've listened today and kind of seen the agenda, seen the strategy talk. Obviously, psychology seems to have a fairly big role in. So tell us a little bit about what's been discussed and learned today, and tell us a little bit about what the strategy has meant, I guess, for psychology and what it's going to mean for people with diabetes.

SPEAKER_01 19:13

Yeah, I think it's one of the biggest achievements and the great change and hope that I see that psychology is finally recognized and it's recognized by the Department of Health is part of the strategy. Um what happens in Ireland is that people with diabetes they don't have access to psychological care. There are some a few psychologists working in pediatric hospitals. However, in adult diabetes services, access to psychologists as part of a multidisciplinary team is actually non-existent. So one of the one of the priorities of the strategy uh was to highlight the need to develop the psychology teams. The strategy also highlights supports for organizations such as Diabetes Island to work on supporting people with diabetes and weing diabetes island have the programs to support them, mental health and well-being programs. We have uh dreams, type 1 dreams for people with adults with newly diagnosed type 1 diabetes. We have COPE for people with type 2 diabetes, we have care for parents of children with diabetes. So it's all has been recognized. And even from the point of view of the conference itself, an agenda was full of psychology-related topics. We had fantastic speakers today. So yeah, as a psychologist myself, I have to say I was pretty delighted today.

SPEAKER_04 20:33

So obviously, there's been now with recognized, and obviously you've got the programs there. What's the implementation challenge going to be like? Because if it's anything like in the UK, you've got the programs, you've potentially got the money, but are you gonna have the psychologists? Are you gonna have the people to do it? What what's how what's the sort of plan and what's the outlook for that?

SPEAKER_01 20:51

Yes, so that's a big question mark, I'd say. So the implementation plan for the strategy is still being discussed, and um there's no money promised to implement all those changes. So what we have is the vision. What we have is the goal that we want to go, uh, which is great. And it will be a great advocacy tool. So whenever we have again our pre-budget submissions as part of diabetes island role, advocacy role, and whenever you're asking parliamentary questions, we will be, of course, using the strategy. Listen, you promised us this, this, this, and that. And one of these tasks was to develop psychological services to support diabetes island in developing mental health and well-being programs. So if you ask what's the plan, I won't say what the specific plan is. To keep advocating, keep going, keep asking. And um, yeah, what needs to happen definitely is to also have more psychologists interested in diabetes, because even if we all of a sudden create 15 posts for people, we don't have people who have experienced experience. Experience and expertise. So this is a challenge. So it will take a few years until we get to where we want. But at least it's now recognized.

SPEAKER_04 22:08

It reminds me of Waynesville. If you book them, they will come. So you've got to have the money first. And then once you kind of develop the opportunities, people come into those opportunities. So it sounds like a lot of hard work has gone in. Big talks today, big strategy. And now it's about sort of making that count and pushing it forward. So it sounds like a job well done.

SPEAKER_01 22:27

Yep, thank you very much. And as a person living with diabetes, because I've been I've had diabetes since 1987, so nearly uh 40 years now, uh I'm absolutely thrilled and delighted to see it happen. So thanks a lot for the opportunity to share this. Thank you.

SPEAKER_04 22:57

So this is our fourth uh quick fire round, and now we're going to be talking all things clinical trials, which is important because ultimately things that get paid for are things that have evidence-based, whether that's a randomized control trial, whether that's a cohort study, whether it's real-world data. It's all important to build a portfolio of what actually works. Not what works once, but works multiple times. And we now have a perfect speaker to come and talk us about clinical trials, what they mean, what it might mean for Ireland moving forward. Do you like to introduce yourself?

SPEAKER_09 23:26

Oh, hello. Thank you. My name is Fidan Madonna, and I'm a professor of translational clinical trials at the University of Galway. And I'm indeed the director of the Institute for Clinical Trials and also the Director for the National Clinical Trials Network of Diabetes.

SPEAKER_04 23:42

So you're the absolute perfect person to have this discussion because you're obviously overseeing number one, a large number of trials undergoing, lots of students who are delivering these trials, and also directing, presumably, the government in terms of what needs to be looked at, how much money would be required to do it, and then in the negotiations of how much you would like and how much you get. So tell us, I think the audience would be interested to kind of get an idea of if you believe something's important to research, how do you go about it? How do you go about accessing that funding? How do you go about deciding which trial it is that you think would be best to answer that question?

SPEAKER_09 24:21

Okay, so as you framed it already, there's lots of ways in doing uh clinical research uh and they all give you valuable information. So you can have your randomized controlled trial. That's probably the highest level of evidence you're going to look for. They're costly to do and they're uh very rigorous because you have to fulfill lots of regulatory pathways. But you can do observation studies, cohort studies, and what's gaining momentum now is real-world data, which we can gather from databases, from electronic patient records and so forth. So there's lots of ways we can improve diabetes care by using research um methods. So um the the the whole focus of uh doing clinical trials really is to try and do them swiftly, to try and get your regulatory approvals done quickly, uh, to try and get your contracting done swiftly, to get all that in place in a timely and reproducible manner so that it's attractive for industry partners to come and work with you in an academic um setting. So Minister Carl McNeil here in our country, uh, who's our Minister for Health, is very keen on us becoming the go-to place in Europe to attracting clinical trials. And she has a working group looking at, you know, what are the current barriers in the country and how can we uh change those barriers. So I've been working on that group with her, and we've come up with a number of recommendations, and she's now going to try and implement those. But coming back to real-world diabetes care, if you look at any of the big interventions that have really changed the course of care for people with diabetes. So you look at the GLP1 treatments for type 2, you look at the SGLT2 inhibitor treatments for kidney disease and for cardiac disease and diabetes and the impact there. You've looked at uh CGMs and pumps in the standard treatment of uh type 1 diabetes. They have revolutionized uh the care of people with diabetes. They were only possible by industry partners, academic partners, and clinical partners coming together, working with patients to try and design those trials as best we can to give good, robust information and then to deliver it. So I'm a big advocate of industry, academia, and clinicians working together.

SPEAKER_04 26:47

Yeah, I mean, absolutely. So you've got the step, the step one, you've got the same trials, you've got obviously all the things the GLP ones, which have obviously been massive. You've got obviously big, well, originally AID or hybrid closed loop sort of pivotal trials, which is good. The bit that I was interested to hear you say, because I've been involved in a little bit of work of um from real-world data doing sort of causal paired matching, yeah, where essentially you've got a large wet set of data, yeah, and especially CGM data, and you've got, for example, we did some stuff where when you did activity, what happens to their glucose levels afterwards? So you take the original cross-sectional look, and then you think, right, we've got something here, and you take it to a conference, and someone goes, That's great, but they might have just come down anyway. Yeah you haven't got a comparison, you're like, goddamn you. Yeah, but I know we've worked with a few data scientists, and what they can do is go into the same person and find the matched period. Yes, and the only thing that's different is the activity. And it's not the same as a randomized control trial, but the ability to go in and mine that data and have as close to as possible a randomized control trial from observational data in the thousands.

SPEAKER_08 27:48

Yeah.

SPEAKER_04 27:49

That for me is really interesting because it also brings it into that's what people do in real life.

SPEAKER_09 27:53

Yeah. But coming back to your your you know, your randomized clinical trial uh to get over the cynics who say, well, that could have happened anyway, it has to be a placebo-controlled trial. So therefore, the only intervention is the intervention you're testing that could have had an impact. But you can do huge work if you have proper uh data sets uh of real-world evidence, because you know, let's say you take two million people with diabetes type two, you can categorize them into various groups, ethnicities, this, that, and the other, and then you can categorize their treatment interventions because not everybody will get a GLP one, not everybody will get another, and then you can do comparative analysis at a much cheaper cost than implementing uh a full-scale clinical trial, which costs millions. So, you know, we in in in the world where um money can be scarce, you have to look at what ways and means you might have that will give you good data that you can begin to look at. I think the real-world data is also of uh real important value following a clinical trial. So you remember the one that Helen Calhoun showed today, which was looking at pyoglettosome and uh and rosyglosome following the intervention, and that was very effective in improving diabetes care. But actually, uh, you know, it has a negative impact, which is an increased fracture risk. Now, you never pick that up on a clinical trial, and this is where the real-world data or the post the post-trial surveillance of the population was really important. So, as well as doing your clinical trial, you have to have ways and means of engaging that population long term once they once the trial is over, so that you can do this post-trial surveillance. So uh it's an exciting, very exciting world clinical trials. I believe that unless you engage in trials, examining uh new therapies, new devices, AI, or even designing a trial which looks at process A to deliver care versus process B. I mean, that's equally as important. So, unless you engage in that kind of work, you would still continue to deliver diabetes care like you did 20 years ago and you would make no progress. So I think it's a really, you know, diabetes research should not be the icing on the cake. Clinical trials is a fundamental part of healthcare delivery. Um, and we really need to embrace it in our diabetes strategy now and ensure that you know it becomes a fundamental part of what we do. So the data that we're collecting through a registry or however we're doing it should form the basis of how we can analyse our process of care, our quality of care, you know, our new interventions to justify that we continue to use them or not.

SPEAKER_04 30:43

And also to develop as well, because like there'll be people listening to this who are healthcare professionals within their like unit and they'll be thinking, all that clinical trial, you can do a small service audit which will reveal amazing savings. So it could be that you know you've got the date, the data's there for the picking because you've got your CGM data, you've got your insulin data, and then you've got whatever service evaluation or service change that you're looking to put in, especially with hybrid closed loops or something like that. In even if it's something like proactive contacts, we've now got all this data, we can see where their time in range is. It's just a text message out. Does that mean that by the time they come back into clinic in three months' time, they're got more time in range? And that is worth writing up, going to a poster, and someone will see it and go, that's amazing. We could do that.

SPEAKER_09 31:24

But I think people can be a little nervous of clinical research and clinical trials. They think, oh, that's going to be a lot of work. Oh, I don't know how to do that. Oh, I wouldn't have time to do that. You know, clinical research or clinical trial is like a village raising a child. There's lots of different people, lots of different skills coming together to deliver it. So you, the clinician or you, the nurse, would be doing a tiny part of the trial, and you'd be surrounded by a team of people who would all working towards the same endpoint to, you know, find a result from the piece of intervention that you're using. People shouldn't be scared about engaging in clinical research and clinical trial activity. I think it's fundamental. And of course, the the other really important aspect is, you know, services that engage in clinical trial work, better outcomes for patients, and you know, better health data. And and, you know, delivering clinical trials for the health system will give you at least a 10 euro, a 10 pound benefit for every one pound that is invested into it. So it's really a good investment of money from an economic perspective, but also from a health perspective.

SPEAKER_04 32:32

It sounds like it's going to be needed as well because now you've gone from a state in Ireland, as I understand it, we're getting this funding in to fund staff and also have a national registry where services will be benchmarked. And inevitably, when this happens, I work at Birmingham with the children's. You can't help but see where you are on that league table and you don't want to be down at the bottom, you want to be up towards the top. And we know that clinical trials and service evaluations are things that will push you up that scale because what gets measured gets managed.

SPEAKER_09 32:59

Yeah. And you know, if you're a patient with diabetes, you only want to be looked after in a service that's scoring high on the league table. So yeah. Either way, my training was all in Burning and Burning. So I have very fond memories of Birmingham and my interconnected diabetes training there.

SPEAKER_04 33:13

Oh, I think that's a great place to wrap it up. It sounds like what we need to think about is clinical trials and diabetes research is not just for people in universities, it's for people working on the ground. Small service evaluations do the job. And if you're gonna move your way up the league tables, which is important for the people who you look after, one pound, 10x reward. At least that sounds like a winner.

SPEAKER_09 33:33

Yeah, yeah, absolutely.

SPEAKER_04 33:34

Thank you very much for your saying that.

SPEAKER_09 33:35

Okay, thank you. Thank you.

SPEAKER_04 33:49

Okay, so here we are with uh quick snapshot number five. This time we're going to be talking about pregnancy and diabetes. And today today, certainly at the conference, there's been a big strategy release, and pregnancy is a huge part of that looking out for maternal outcomes and obviously um neonatal outcomes. So we have an expert in pregnancy and diabetes. Do you want to introduce yourself?

SPEAKER_06 34:07

Yeah, sure. My name is Christine Yumann, and I work as a diabetes consultant in Galway and then two other hospitals in the west of Ireland.

SPEAKER_04 34:13

Okay, perfect. So tell us a little bit about what you believe the strategy today is obviously going to free up some funds. What's that potentially going to mean for the services? What's it going to mean for the uh ladies who are thinking about getting pregnant around pregnancy across Ireland?

SPEAKER_06 34:28

So I suppose uh for me specifically, obviously most of my work is in diabetes in pregnancy, most of that is gestational diabetes. Um and then a smaller amount uh but growing is the women who enter pregnancy with pre-existing type 1 or type 2 diabetes. So my personal priorities for um pregnancy are getting as many women as possible who live with type 1 diabetes on hyperclosed loop delivery systems for pumps, ideally CGM for women who live with type 2 diabetes, kind of similar to what you guys have in the UK already. And then there's not specific to the strategy today, but there's an ongoing bit of work to get free glucose meters and strips for women who have gestational diabetes in pregnancy, because that's not something we have at the minute. There are different systems that are set up that kind of cap the cost of it, but it's it's not free. Uh it's only distressing for women if they went out of strips and they can afford them. And then there's a lot of healthcare professional time helping women access strips, filling out forms. This pharmacy is particularly you know, directing people here, there, and everywhere, which we'd ideally love to spend on delivering clinical care. So they are the three things I'm most hopeful for.

SPEAKER_04 35:26

So hopefully the strategy is going to provide some finance, some clarity to take the administration work away from the healthcare professionals so they can actually focus on the service delivery and also getting access to the emerging tools, whether it's CGM for type two, hyper closed loop for type one, um, is kind of like the the sort of big push. So your clinical practice where you were ladies who are coming through with type one, for example, what historically have they been using for the therapy and what are you what's what's the current situation now?

SPEAKER_06 35:55

Yeah, so I mean, I started working in the area in 2020, and then uh I'd say 80% of people were on MDI, and you'd have the odd person on a sensor augmented uh pump therapy. Now I would say a good 70% of our patients are on hybrid closed loop therapy. They either enter pregnancy on them or we start them in pregnancy, and then the remainder are on MDI, and I push really hard for the pumps. There are people who are just kind of very hesitant to start something new in pregnancy, anxious about pregnancy is something they've wanted for a long time and they don't want to make a big pivot. So I'm trying my best to be convincing, but it doesn't always work. But that's generally what we're seeing.

SPEAKER_04 36:29

And a mixture of different systems you're using does it depend on what they come in with. Presumably some women come in on a system or they have choice, what what can happen?

SPEAKER_06 36:38

For sure. So I'd say for women that come in on pumps, it's it's a broad mix. Um, but for anyone that we start on pumps in pregnancy, we give them all the options and we really we try and give them all the options, but ca CAMS APS and the Ipsos pump and DEXCOM is what we're mostly using.

SPEAKER_04 36:54

Everyone has got obviously the license and the strongest data to today. There's some decent data come out, haven't it, from the T-Slim with the surface trial.

SPEAKER_06 37:01

But yeah, where I suppose I'm personally just not we just haven't had as many people go through with that. But obviously we want to give our patients choice. So whatever they're not the other thing was not funded to offer people a pump change in pregnancy the way you guys are. Yeah, for sure. So we if somebody's near the we get a four-year, obviously same as yourself, it's a four-year-old.

SPEAKER_04 37:18

You do the best of what you got.

SPEAKER_06 37:19

Exactly. And if they're near the four-year mark, we'll try and bring forward that upgrade to to whatever will be best for pregnancy, which is obviously very often the IPSO pump and CAMS APS.

SPEAKER_04 37:29

So it sounds like quite an exciting time. So in terms of the strategy, is there a part within the strategy that's pregnancy specific and there's a real push on a certain few elements of it that you could highlight, or is it just an overall technology push, recognition push, it's more healthcare professionals push.

SPEAKER_06 37:45

Exactly. Yeah, and really as well, kind of delivering. I think the the thing for the strategy all in all is that it's really much bringing the care to the patient. So I kind of I thought I like to see that because that's how we run our practice. I'm based in Galway, but then I go do visiting clinics in other hospitals. So I think it's really in Ireland we're we're not good at you, you know, unifying healthcare in the different regions. Everyone's doing slightly different things, but it's satisfying to be able to deliver the same care to different people across the same region. And then I think that that's brilliant that that's being pushed as well. And we're doing the we've done the model of care, but we're updating the guidelines as well for pregnancy at the minute. So that's really what we're we're pushing as well.

SPEAKER_04 38:21

And those will be Irish specific guidelines to really help the teams kind of understand look, this is the picture, these are the best therapies. We've now got this strategy in place. This is the things you can access, these are the kind of buttons to press when you go into the fund holders, and then it's over to the people who are in those services to take those tools and put the pressure on them.

SPEAKER_06 38:40

Exactly. And then even kind of more than that, we're trying to be super practical. So when you talk about buttons to press, we're literally telling people changing the pump because people just aren't as familiar with the pumps, and you know, it just depends on what kind of hospital you work in. If you've got a really strong pediatric service that is doing a lot of pump starts, then just by sheer force you've got to get used to it. But if it's uh if it's a region where there's not as many pump starts, the adult staff and the pregnancy staff just by virtue won't be as familiar.

SPEAKER_04 39:05

Right. Well, thank you very much for your time. It sounds like an exciting time, certainly in the pregnancy space. Funding, guidelines, sounds like you've got a lot of work to do. It's so exciting. So moving on to slot six, we've now got for me what is the most uh exciting, the things that's close to my heart, which is how are we gonna embrace digital technologies, artificial intelligence to allow people to get the most up-to-date information as quickly as possible, but also to review some of their readings, the results, and actually beginning to really personalize care the 80% of the way there to leave the human beings to do the best 20% of what they're trained for. So um Do you want to introduce yourself? So, Derek from from Galway.

SPEAKER_03 39:54

So my name is Derek O'Keefe, and I am a consultant physician in the University Hospital of Galway, and I'm professor of medical device technology at the university across the road. And that's because my background is a physicianeer. So I'm a physician engineer. I would have trained originally in engineering. I would have done electronic engineering, then computer engineering, master's, PhD biomedical. And then I decided to go and do medicine to augment my knowledge in the healthcare space so that I'd have a 360-degree understanding of technology and medicine.

SPEAKER_04 40:22

I mean, you're the perfect person to speak to then. So obviously, when you look out at the current landscape of how care is delivered, whether that be education, whether it be insulin dosing changes, we're talking insulin, whether they're talking about personalizing even behavioral nudges, what do you see is available at the moment, or is it a bit of a tumbleweed and there's nothing?

SPEAKER_03 40:43

Uh yeah, so I mean there's a lot of hyperbody AI, obviously, um, and that doesn't always translate into tangible benefits. But maybe I can give you some examples from our own clinical experience in Galway and what we're trying to do, and then give you maybe the international landscape. So one thing, for example, uh about two years ago, there was a big global highlight on the GLP 1 medicines, for example. So I think it was around November, December 22, a lot of celebrities came out and said that they were on particular GLP1 for weight loss. Uh and in that case, it might only have been, you know, half a stone or a stone, but it was a difference enough that the media noticed it and picked up on it. And when they asked those celebrities, they were like, oh, it's not a diet, it's actually just this new medication that at the time was only approved really for um uh glucose control. Uh and so it actually caused a worldwide shortage of the medicine in 2023, as you as you listeners might know. Uh and one of the reasons was was it turns out the GLP ones not only improved blood sugar, as they've been doing since the early 2000s, people improved their weight. Uh they've also shown benefit now in uh cardiac function, liver function, kidney function. There's benefits for sleep apnea, uh, there's benefits now for addiction, which is very interesting, reduction in people's addiction to gambling and to illicit drugs and so on. There's benefits of the GLP ones for osteoarthritis pain. There's so many indications. It's one of these pleomorphic drugs. And one of the challenges with it is in 23 and 2024, it wasn't just endocrinologists prescribing this medicine anymore. And as you know, the physicians in endocrinology work so closely in an MDT team with their, you know, their nurse specialists and with their diabetes educators. Um so, for example, at a diabetes clinic in Ireland, I might have 50 patients at my clinic between 8 a.m. and 2 p.m. And I might be able to spend 10 minutes with patients because, you know, so many patients to see. And if I start them on a GLP1 medicine, I can explain, you know, the highlights uh side effects to them and what the medicine could benefit with them, could benefit them. But then I normally refer them to education to sit down with a diabetic diabetic educator for 20 minutes to go through all the other nuances of the medicine and to show them how to take it. And in January 23, I was just doing this routinely for one of the GLP ones for diabetes uh blood glucose control. And um I referred the patient in the January, and the patient came back to me four months later in the kind of April, May. And when I looked at their indices and spoke to them, I was like, oh, it hasn't really had much of an impact since I started you in January. You must be one of the non-responders, because that happens in these medicines. And they said to me, No, no, no, I actually only started it last week. And I was like, What? I said, I give you the prescription in January. And they were like, Yeah, but the nurse you referred me to, she told me she couldn't see me for three months for education. And I was like, What? And then, you know, I went away and we at our next MDT, we brought this up. And it turns out that everyone in the hospital, every specialty that was starting on a GLP one who didn't have, you know, diabetes trains nurses, was referring to over to our educational service, and her list just exploded. There is, BHO have already said there's going to be a 12 million person shortfall by 2030 in healthcare. So we we're we're all fighting against that kind of tie going out. And this is just a great example of that. That there just physically wasn't enough time in this nurse's day to educate, you know. She used to educate, well, say, 10, 20 people a week, and now she was asked to be doing 200 a week. And so we thought about that, but when you think about how you educate patients, and one way we do it, obviously, is we ask them. To read leaflets. We ask them to maybe look at a video and all that kind of information or look at a website. That's all one-way information. Like you can't stop a 20-minute video and ask a question about a GLP one. And so what we thought it was a great opportunity because ChatGPT had just been launched in November 22, take one of the open source LLMs, large language models, that basically just collect lots of data and synthesize it. And the challenge with the AI that's out there, you know, that we can all use on the internet is it's trained on data from the internet. 60% is Reddit, uh, 20% is social media like Facebook and Instagram, and a very small percentage of it is actually real textbooks with, you know, maybe um authoritative knowledge. So we created a system in Galway called Mocara, which is the Irish for my friend, whereby we actually just upload the PDFs that are approved by the medical manufacturers, the CE marked ones, the FDA marked ones, the uh approved information from reputable health sources like our National Health Service, and then put that into a digital moat. That's all that the AI is trained on. The LLM reads that, you know, chops it up into tiny bits so that it's able to pull answers back. And then we asked people to use that as an educational tool. So we what we did is we got a lot of patients together, we randomized them to either being trained by the nurse, being trained by the doctor, or being trained by this interactive avatar called Mokara. And the avatar, you can have any ethnicity in the face of the avatar, you can have any language, so it's instantly scalable. And so we did that study then in 2024, and the remarkable thing is the avatar was as good as the nurse and the doctor in educating patients because we gave them the survey beforehand about their knowledge of GLP ones and side effects and so on. We gave the survey afterwards, and yeah, the survey was even better for the GLP ones. And one of the feedback from the patients was I actually liked using the avatar because it was in my pocket. I could just say to it, for example, can I use a GLP 1 if I want to get pregnant? And it would just give me the answer. They didn't have to go reading through the PDF or search through 10 blue links on Google looking for the answer. So that's very interesting. And the also the other thing they said to us was, I wasn't embarrassed to ask the avatar a simple question. Sometimes I feel there's a barrier, you know, asking the nurse or the doctor. So we thought that was fascinating. So I think that's a great example of how properly governed and controlled generative AI can be instantly used to help patients have a better understanding of their medications. Or indeed, if we're talking to patients and we say, you know, you have type 1 diabetes, unfortunately, we have all these reasons why you have it, and this is the pathway, and here's the education material we're going to give you. This is another tool we can give patients because normally, when you're told a life-altering diagnosis, you have all these questions and it's flowing around in your head, and you may not hear anything beyond the initial conversation. So now patients can go home and just have a chat with this avatar. And we live in the TikTok generation where people want 30-second bites of information. So this is a great way of giving them that authoritative 30-second chunks in the direction of questions that they want to have, which is very interesting.

SPEAKER_04 46:58

So I've got some questions for you. I wouldn't say I'm an AI efficient, I don't know, but I know a little bit and we've sort of developed a model for Tat 1 Dabby's education. So I'm interested to know your model. So obviously you've got a bounded model, you've fed in the PDFs. It's RAG. Did you it's RAG? Yeah. Oh, you rag and um then also with that, have you got like a philosophy on top of that? So you obviously got the information, but what kind of philosophy you've given to your LM? So, for example, does it just go and feed the thing, or does it have like, I want you to focus on what's the most important information, what's the most um uh well researched on like grade A to D. So what's kind of like the the real good stuff versus the kind of consensus stuff, or is it just simply enough on this this example, just straight up? This is the information.

SPEAKER_03 47:40

Yeah, it's just the information. And we have to be careful with that because if you put too much kind of interpretive rules into it, you're not sure how it's gonna pull it. How it's gonna pull it, yeah. And so we had to make sure it was pulling straight straight. Yeah, yeah, sure. Uh and it seems to have worked out. We did two or three trials in it now so far to kind of establish its efficacy. And it's working really well, I would say. And I'd so this is the kind of thing you're gonna see on your medication package in five years. You'll have a QR code or you'll just take a picture of whatever box that you're using and it'll just pop up and say, Hey, I see you're using metformin. Do you want to talk about that? Yeah. Uh and I think that's going to be really now then the the question everyone asks me is, oh no, that means because the AI did better than you, the nurse and you are out of a job. And I was like, listen, I got a thousand jobs a week to do. If it can do one of them better than me, let at it.

SPEAKER_04 48:24

100%. I mean, the the the bottom line I feel like with AI is it's amazing at getting you 80% of the way there for the average person like you from what the research shows. What it doesn't do is allow the human being, the very good clinician, to kind of go, okay, that's the average, but you're not that average. Or let's have a little discussion about how this might apply to you because you've got this unique thing over here. And this you so it allows you as a clinician to actually bring out your brilliance rather than spend the 80% information jockeying it, which needs to be done by an AI.

SPEAKER_03 48:51

Exactly. And I think there's always going to be edge cases, right? So that's where your kind of, as you said, clinical specialty comes into it. Um, but people need to get the bread and butter, the basics of their understanding of the disease or their medications, and I think that's where AI is going to help a lot. So that's one example in you know, patient education. Another example of AI's use, and this is ubiquitous around the world, is AI being used in clinical workflows. And what I mean by that is uh, you know, in America in particular, we have uh the EHR electronic health record. When it came in, it was revolutionary 20 years ago in America. And what they realized very quickly was the clinicians, the nurses, the dietitians, the doctors were spending 50-60% of the encounter turned towards their PC typing in the note. And so it just broke that human empathy connection with the patient. And so the way they tried to fix it initially about 20 years ago is they had a scribe in the room with the doctor. And the problem was that there was a third person in the room which broke the connection, but also somebody had to pay that third person. And you know, there's rules around wages and so on. So pretty quickly that model disappeared and they offshored it. So now you'd be in a room with a microphone and a speaker, and there'd be someone in you know a developing part of the world listening to the conversation, typing it. And then about five years later, that disappeared, and then you had people recording it and doing uh real-time text, what's the word, uh, text typing from the from the audio. And now in the last three years, you have things like I think one of them's called Heidi, or you have ambient listening. So this is just like your Alexa at home or your Google home. And so that just listens to the entire 30-minute conversation. It ignores all the bit about talking about the sports or the family holidays or whatever you talk with your patients about beyond the kind of quantitative or stuff, and it literally pulls out the data, puts it straight into the EHR, and it's saving uh doctors in America about one to two hours of work a day in typing. And I mean, that's just such a bonus because then they can actually talk to the patient as opposed to spending in their head, oh, half the time I gotta be typing notes.

SPEAKER_04 50:48

Yeah, I mean, absolutely. And I think also, uh I think for anyone who listeners out there thinking that, oh, I don't know about AI and this is it, it's irrelevant because it's coming, it's coming fast, it's like a massive tidal wave. So you're better off investing the time to understand what it is and what it isn't, and most importantly, how you can adapt as a healthcare professional, could be in anything, to make sure that you understand how these things work and they understand that they need human engineers above them to ask the right questions to develop the models, and you're better off being those people than the people who either they're, you know, but you'll get the opportunity to be do the 20% of the things that you love doing, and the 80% of stuff you don't love doing, let that take care of it.

SPEAKER_03 51:26

Exactly. So I think it's probably equivalent physically of if there's a robot there that can lift a heavy box across the room, let the robot lift a heavy box, and then maybe you could do the wiring to plug it into the wall. That's where your finesse comes in. And I think because of it, a lot of blue-collar jobs will disappear because of the heavy lifting stuff. A lot of the white-collar jobs, the repetitive, you know, the Excel sheet wrangling that we all do, trying to move data between different digital islands, different software. That will disappear and it'll allow all the clinicians to be better clinicians because that quantitative burden with all the numbers will disappear, allowing us to be more qualitative with patients. And I think that's only to be welcomed. I suppose it's just a tool. It's just like the internet. Both the patients will be using it more, the clinicians will be using it more. And actually, in the last year in Galway, we've completely redesigned our medical undergraduate curriculum to include digital health training for future doctors in year one so that they understand the limitations, the biases, the data sets. They have to be able to ask those questions. And so patients and clinicians need to be involved with the development of these tools because, as you said, they're coming. So we need to be involved with their development so we make sure they're effective.

SPEAKER_04 52:32

Yeah, I mean, I couldn't agree more. I mean, so obviously we've you have, I have, given it the regardless of the big sell aren't it's coming, and it's coming thick and fast, and it's going to come in various different ways. So getting on board and understanding it is number one. Where do you see it going in the next? I think five years is impossible to predict because it's so fast. In one year's time, where do you see AI really coming in and making a big shift in the next year?

SPEAKER_03 52:58

Okay, so I said the f the f first thing is that at the moment the AI we have is called our artificial narrow intelligence. It takes a lot of text, for example, and it synthesizes it, and that's your LLMs, you know, when you say, tell me all about Tom Cruise's career. Normally you type that into Google, it gives you 10 blue links, and you've got to click through the links and pull it for you. Whereas the GPTs, they just pull it together in a single paragraph, right? So but they're only trained on text. When you're listening to something on YouTube or Spotify, you listen to Taylor Swift, and then it suggests Lana Del Rey, and you're like, wow, that's really cool, because it's listening to all the audio patterns and suggesting single kind of modes, if that makes sense. So what we're going to see from a research point of view in the next year or two is a lot more multimodal, which means if you're making a decision on someone's healthcare, it's not just looking at the text in their EHR, it's looking at the retinal scans they've had recently, it's looking at their laboratory data, and it's saying not only on the medications they have and the text, but based on their eye diet data, based on their urinary data in the labs, we think the next medication choice would be this. So it's a far more nuanced discussion. So I think that's important to say from a practical point of view, back to workflows. Um, so those 50 patients I might see on a you know a Tuesday morning clinic, for example, in one of my type two clinics, at least 20 of those 50 patients are what's called fixed follow-ups. So I book their clinics based on calendar appointments. I'll see you all in six months' time or 12 months' time because things are going okay. Those patients come back to me in 12 months' time, they come in for their 20-minute appointment. And again, that 20-minute appointment, they've probably driven an hour and a half, parked for an hour, waited in the waiting room for an hour to see me for 20 minutes. And then they come in and I look at their numbers and we chat with them, what's important to them, and everything's going great. And all we end up doing is talking about the premiership, and that's great and all that, but I've overmedicalized their life. So, what you're gonna see AI doing, especially now in diabetes, because by its nature it's a chronic disease, it's quantitative because it's about sugars, and you're seeing a lot of the big med tech companies um giving the clinicians tools with time and range, with you know, all the different metrics of hypoglycemia. And so we're gonna be able to rag rate patients, red, amber, green, and especially tie that into the booking system for appointments. So if I have somebody who is you know struggling with their A1CE, struggling with their time and range, struggling with hypoglycemias, they get an urgent appointment in the next month, even sooner. And if everything's going grand for another patient, that gets extended because everything's going grand. And that kind of intelligent, dynamic triage, as we call it in Galway, is coming. It's here already in the clinical kind of research, but it's coming to clinical practice very soon in some of the big med tech companies next year.

SPEAKER_04 55:31

Yeah, I mean, I've seen some things is population health by glucose kind of doing that and triaging based off ATTD, you know, kind of uh metrics, which is interesting. Um and we're we're putting together a project actually where we're at the moment humanizing, where we're triaging them, and then you can have a look at how many boluses. I mean, inevitably it's the timing ranges, though, they're not doing boluses, it's always the case. But then automating behavioral nudges, text messages through the NHS spine and ours, it's it's accurate to just kind of go, hey, how's it going? Notice to hear. Um great the other day you did kind of three boluses on that day. You had seven to ten timing range, and on that day you don't have zero. Kind of that might be something to consider. So it's like a positive framing, but it's just kind of a little nudge, and in pediatrics it might be to the caregiver who's there. But those little behavioural nudges, two to three times before you come back to clinic in three months, can make a huge difference in terms of as long as it's supportive and not punitive, and that's going to be the skill of the human beings developing the nudges and things from that.

SPEAKER_03 56:24

Relationships, yeah, for sure.

SPEAKER_04 56:25

Well, I certainly appreciate your time, and it's interesting that your practices, you're obviously way further on than a lot of people, and that's the whole point is having pioneers who can like set the bar, publish the research, offer ways to do it fairly simply, and then hopefully other people will get on board when they see the benefits. So thank you for your time. Thank you very much. Yeah. Okay, so here's the final segment from the first day of the Irish Strategy Day in terms of diabetes, and we have the main man to come and tell us about what it means for young people young people to adolescence into adulthood, and also with regards to technology. The diabetes technology island day is tomorrow. So do you want to introduce yourself?

SPEAKER_02 57:12

Great. Thanks very much for having me. Uh Thomas Griffin's my name. I'm a consultant diabetologist. I work in Galway University Hospital um in Ireland. I also work in the community. So I have a 50% job where I look after people who live with diabetes in the hospital, and 50% job where I look after people who live with type 2 diabetes in the community. A few years ago I used to work in Leicester with uh Professor Patrick Chowdry, and I was inspired by colleagues in the UK. So um if you know these colleagues yourself, so Pratique, Emma, um, Alistair, Safe, Mysarah, etc., etc., and Geraldine. Um and they set up the Diabetes Technology Network UK. And then myself and one of my uh friends who also worked UK Hannah Ford, who um who unfortunately can't be here today, uh, we came back to Ireland and we realized that there was a gap. So there was lots of people who wanted to do great work. We had access to funding for pumps, but maybe just needed to help educate both healthcare providers that these technologies were available and that they were able to do uh to put people on win some pumps if they, if they, if the person wanted it, and the healthcare provider was able to facilitate it. And then people living with diabetes that these technologies were available for them, and that the great things technology can do to help reduce the mental burden of living with type 1 diabetes. So we've done a couple of things for this. So, firstly, we've set up the Diabetes Technology Network Ireland, and this is the third year that it's taken place here in Croke Park, and we invite healthcare providers from around the country to come to and engage with different colleagues in industry, because as we all know, without industry and this isn't possible. The industry provides the different tech, there are ongoing developments and trying to bring new tech to market to help people live with diabetes and to reduce the mental burden and all of that. So this is our third year, and we've had excellent international speakers. On year one, we had uh Part the Car. Last year we had colleagues like Chantel Matthew, this year we have colleagues like Emma Wellmott, just to name a few. So, as part of that, then we decided that we needed to go around Ireland and to different hospitals in different areas um and engage with them. So we've been to Galway, where I'm from myself, Kenning, which is in the northwest of Ireland, Kerry, which is in the southwest of Ireland, uh, Dublin, and we have some plans to go to um Waterford, uh, Dundalk, Limerick, and other places around the country. So we've invited um the local healthcare providers to come, we've engaged with them and with local media to try and get people living with type 1 diabetes to come to these events. We've engaged an industry to come to the events with us, we've shown people what technology is available. We've given talks about the benefits of tech, we've addressed questions that people had. So some people were afraid of having a device attached to them, some people didn't actually know what a pump was, some people didn't think they were entitled to it. Some people were told in the past, and this is almost certainly true, that they couldn't have a pump. But things have changed, and engaging with people and empowering them to seek the technology that they deserve and they need to improve their lives. It's one of the things that we're we're really passionate about here.

SPEAKER_04 59:49

So it sounds like obviously your time at Leicester and seeing what obviously the DTN have done in the UK kind of give you an insight into okay, you know, this is working. It's a model that is effective. It's a dynamic model because you don't need that many people and you can make a lot happen with um a small number of people, which sounds like it. And it also sounds like today is quite important or very important in terms of a strategy perspective, because they're trying to put some whole-time equivalence, some numbers behind the services, some greater access to the technology. So the work that you've been doing in the background, hopefully getting people interested, getting people understanding what it is, they'll then maybe in a better position to take advantage of this strategy coming through. So, what what are you hoping that this strategy is going to do from a from your sort of DTN island and technology perspective? What are you hoping from this?

SPEAKER_02 1:00:38

So the strategy is really important. And I think if you look around the world and try and find suggested numbers for staffing a diabetes service, and we did this when I was in the UK, it's actually very, very tricky to find. What this strategy does is puts numbers to the number of people that we think will be required to deliver a world-class diabetes service for people living with type 1 and all other types of diabetes in Ireland. And by getting these people, by getting a pipeline of people and a roadmap to excellence in place, we can start the process of recruiting people. The more people we get on board, the more technology we can on people living with diabetes get on board on that tech, and then we can support people living with a diabetes on tech to achieve uh phenomenal outcomes. I think that the the challenge I would say, I'm sure you've seen this in the UK as well, this is a peak of demand. So we're currently in the peak of demand of pumps. So in a few years' time, I think we'll have kind of anyone who's lived with diabetes for longer than say two years, will have been offered a pump and probably hopefully have gotten on boarded if they wanted to. And then we'll only have a kind of a maintenance uh requirement of maybe 40 or 50 people a year. But we're currently in the peak. So we we in ourselves we have a site waiting list. And by getting these extra people on board outlined in the strategy, hopefully we can make a real dent in this waiting list really, really quickly. The quicker we get on top of it, the quicker people get the benefits, quicker we can improve people's lives. And isn't that just a great thing if that can be delivered?

SPEAKER_04 1:01:58

I think also it's interesting because you obviously had the previous speaker, uh Derek, is from the same same place as you. Yeah, Derek, it's uh good friend of mine. He wants to see his ear below me in comments. I mean, I actually think you know you've got a capacity problem. And following these people up with the right bounded model from an AI perspective and the right information which you can feed in quite easily from the IFUs and the etc., you could probably develop a really good supportive tool that would cut down your follow-up requirements in terms of simple questions and and tech quick questions and also the pre-learning, because the pre-learning of the thing, sometimes if you've got that done before people rock up, then just putting on the text easy and then the follow-up. But if you're having to do all that teaching, that probably could be done by AI, and then you could speed up your cadence without having to necessarily have to kill yourself working 50 hours a day.

SPEAKER_02 1:02:49

We're actually perfectly positioned in Galway. Okay. And you were your previous um speaker, um, Derek is a professor of medical device technology. We have our diabetes clinical trials network, which is based in Galway. Uh Galway is the hotbed of medical innovation in the world, you might say. I believe it's kind of nine of the top ten uh medical device companies um have um offices or manufacturing facilities in Galway. And if we look at the diabetes technology companies and where they're based, so we have Dexham out the road, Avett up the road and down the road, and Medtronic out the road. All up the You got no excuses now. You've got no excuses. And again, in our own university, and we have the innovators um to work with these companies uh to develop packages, like you say. So again, wouldn't it be great if you had some type of augmented reality pump start set up where you didn't need some healthcare provider to help you with it, especially upgrades, right? We have loads of people who are far more proficient than I am with diabetes technology because they live with diabetes and they use these technologies every day, and yet you have healthcare providers going in to help them do these things, and they're actually far better at it than we are. And you're like, well, it's a good use of everyone's time. Probably not. You could have done this at home with the TV on, chilling out, and instead you're in here in a room, you could be instead of being at work or school or college or all these other lovely things you could be doing, and you could have done in the luxury of your own time, we could have got you a VR headset. You could be playing away with the the different bits, getting the bit getting it set up, getting it going. Wouldn't that be brilliant? And I guess we're perfectly positioned to try and kind of be the pioneers in this area.

SPEAKER_04 1:04:13

100% couldn't agree more. And I think the the hard bit, I think, for a lot of healthcare professionals and providers who've been around for quite a while is the pace of change that's coming with technology as it is both AI, both virtual reality, always to allow people to get the information to them in more of a personalized and effective way in their learning styles is there to be harvested now. But the challenge is adapting to that change at the pace of it when you're used to a face-to-face sit down in an education room for two hours model, and that's the way you've always done it, to be open to let's just let's experiment. Let's experiment and give these things a go because they're good. They are so good.

SPEAKER_02 1:04:56

In our own practice, we've changed. I'm sure you you've changed I I've talked to you about this before, and I know you've changed it a long time ago, but we've changed from things like saline starts to virtual follow-up, like within about a two-year window. So again, moving from maybe something that kind of with open loop pumps maybe offered an advantage. But now with hybrid closed loop, I'm not sure it offers a whole uh there's maybe a select cohort that kind of might benefit from a saline start, but it is quite small. But yeah. We look after a few uh I guess we do look at I I will caveat that for you. Maybe we look after some slightly people who are slightly older and maybe less technologically savvy, and they actually enjoy the being able to get to get used to it because they're worried that they won't be able to they they don't think that they'll be able to do it. But then actually, because hybrid closure works so well, once they get the saline version and they're off and they're running and like, well, I could have just gone straight on insulin, but they would have had fears, maybe. And it works really well, right?

SPEAKER_04 1:05:47

I mean, one thing that I've enjoyed about coming to the conference today is first of all to see the variety of different sort of disciplines who are interacting with each other, the fact that you've got a strategy behind it now, and like you say, numbers to go and press on the funders. And also, the good thing for if people listen, if you're in Ireland, you now know that sensors should be having monies available to treat or to support you at a certain number of cadence. Gives you the ammunition to get on board with putting the pressure on the people who've got the money. And that's how things happen. They don't just happen by clinicians pushing, they happen by people going, okay, if this is the plan and this is the technology that should be happening, and this is the way it should be going, then I'm entitled to that. Therefore, why am I waiting for this? So I need to help the clinicians put the pressure and so you can get the access to the things that you has been suggested by the strategy.

SPEAKER_02 1:06:35

Oh, for sure. And again, as part of our DTN Ireland project, we are going around to places encouraging healthcare providers, like the number of places who have never started a pump in Ireland that have started pumps in the last year. We've almost probably doubled. So the smaller hospitals, bigger hospitals, hospitals where like you would never have thought a pump start would occur, are now doing all of these things. So we have um three types of hospitals in Ireland, model two, model three, and model four. Model four, just for your listeners, is like the big hospital where you get the trauma, the neurosurgery, the cardiothoracics, etc. etc. And the model two is kind of you might have an acute medical assessment unit and some stable inpatients who need antibiotics, for example. And every every tier now there is an example in the country of every tier that is starting pump therapy. Whereas before it was just perceived that you could only do this in a model four. And if you are model three and model two, yeah, you have to send it to the big center. This is not the case anymore. People are really getting engaged, people are really getting empowered. And I think if you listen to people living with diabetes, those who have got their pumps, and as you know, it's life-changing.

SPEAKER_04 1:07:40

Well, I think that's a perfect way to finish it. So I want to say thank you for your time. Good luck tomorrow for the DTLN3. Perfect. Well, thank you very much for your time and good luck tomorrow. Great, thank you so much.

SPEAKER_00 1:07:53

Okay, so that's a wrap on our DICE special. That was seven conversations, one conference. And what strikes me from pulling this together is that the same themes keep on surfacing across every single one of these interviews, whether we're talking about dietetics, psychology, clinical trials, technology, or pregnancy care, it keeps coming to the same thing. So people feeling supported rather than feeling judged, getting access to the tools that already exist and work, and also closing the gap between what's possible and what's actually happening on the ground. That seems to definitely be led by the movers and the shakers, you know, the trailblazers, the people that we speak to in this episode. The national strategy that launched at DICE is a real moment for Ireland, but as almost everyone John spoke to acknowledged, a strategy is only as good as its implementation. So the vision is there, the evidence is there, so now comes the harder part. So if you're living with diabetes in Ireland, we'd really encourage you to look up the National Policy and Services Review, know what's been committed to, and if your service isn't reflecting it yet, use it. Share it with your healthcare team, bring it to appointments. A big thank you to everybody who gave John their time at DICE. It's very clear that Irish Diabetes Care has some genuinely brilliant, passionate people driving it forward, and we're grateful they were willing to share that so openly. If you enjoyed this episode, please do share it, especially with anyone in Ireland who this might help. And if you want to keep up with everything else that we're doing at the Glucost Never Lies, you can find us wherever you get your podcasts and also across our socials. We're very active across LinkedIn and also Instagram. And remember to sign up to our newsletter where you'll get the most up-to-date information about where you can access what's coming up next, including GL Grace, when she goes live. So until next time, take care and thank you for listening.