Manuscript outlines increased risk of diabetic eye disease in Black Alabamians, encourages community collaboration

A recent manuscript published in The American Journal of Accountable Care works to investigate and overview the disproportionate risk that African American Alabamians have in developing diabetes, as well as identify the 4 main pillars of barriers that keeps this population from accessing eye care. Bryan Wilson, PhD, MBA, executive director medical affairs at Genentech, speaks on the article as a collaboration between Genentech and the American Diabetes Association's (ADA) Health Equality Now initiative.

The article can be read here. Those interested in Health Equity Now can learn more here.

Video transcript

Editor's note - This transcript has been edited for clarity.

Emily Kaiser Maharjan:

Hi everyone. I'm here with Bryan Wilson, executive director of medical affairs at Genentech, who is here on behalf of the ADA Genentech Health Equity Now partnership to talk about the findings regarding the burden of diabetic eye disease in Alabama, as well as strategies that target racial health disparities within that population. These findings are recently published in the Journal of Accountable Care. So welcome. It's really great to have you here.

Bryan Wilson, PhD, MBA:

Thank you. It's great to see you again.

Kaiser Maharjan:

Of course. So first, can you tell us a little bit about the findings that were just published?

Wilson:

So it's great to be back and see you again. And yes, the Breaking Barriers manuscript is our research review article that highlights an important public health problem across Alabama. We know that diabetes continues to be a really big issue across Alabama. And it's not specifically an Alabama problem, it's a US problem. But the comorbidities associated, 1 of the premier comorbidities associated with diabetes, is diabetic eye failure or diabetic eye health. And so this manuscript truly highlights the barriers that patients face, that health systems face, in tackling diabetic eye health and improving those outcomes. And like I said, it's not just an Alabama problem, but we hope that the barriers that we highlight can shed light on areas that everyone can highlight and tackle in the various parts of the US.

Kaiser Maharjan:

So this investigation was undertaken in Alabama. Can you tell me more about why the team chose to focus on that population?

Wilson:

Absolutely, so Alabama is a unique opportunity and a thriving community. But what we see in Alabama is the diabetes rates are higher compared to the rest of the nation. So the prevalence of diabetes in Alabama is around 13%. And that's fairly high, so when we think about that from a numbers standpoint, about 500,000 people are battling diabetes across Alabama. And that state's population is not nearly as high as some of your metro cities in the US. So when we think about this, that creates a huge burden on health systems.

Now, as I mentioned before, 1 of the comorbidities associated with uncontrolled diabetes and poor diabetes outcomes is negative diabetic eye health. And so we specifically chose Alabama because of that reason. Now, we also realized that certain populations, specifically African American populations, Hispanic populations, are impacted disproportionately with diabetes. We know that the population of African Americans across Alabama, it's about 27%, compared to the national average, which is around 12%. So we not only have a state where the African American community is high compared to the nation, but we also have a disparity of diabetes outcomes that disproportionately impacts this population. So we specifically chose Alabama for that reason to tailor interventions that take the community health in mind, while also tackling a really important health problem that many patients are facing.

Kaiser Maharjan:

Yeah, absolutely. That makes it a very interesting case study. Do you think you can explain a little bit about how you think that these findings will extrapolate to other populations across the US?

Wilson:

Diabetes is not an Alabama-centric problem, it's a national problem. It's actually a global problem. And we know that the comorbidities that are associated with uncontrolled diabetes are things like diabetic eye health, cardiac dysfunction, metabolic dysfunction, and also folks ability to live a vibrant, agile life. So when we look at these barriers, some of the ones that we highlight specifically in the review manuscripts are socioeconomic barriers, patients' awareness and access to eye screenings, whether a patient truly understands the importance of that initial, that first eyes screening is incredibly important. Also, a third barrier is tailoring educational materials to the patient's education level and to their cultural level as well. Those are some of the barriers that we know patients are facing.

Then also we highlight some of the barriers that are present within health systems. So if patients present really advanced stage diabetic retinopathy or really advanced stages of diabetic eye disease, can they get referred in the right way? Can they get referred in the proper and efficient manner to get connected to advanced care? And so we know that these barriers are not just syndrich to Alabama, but these barriers are national and global issues.

I also would like to mention, the review manuscript also highlights the work and that's incredibly important when companies like Genentech come into these communities. It's really important for us to highlight the work and not necessarily reinvent the wheel, but we align to the work that's already occurring and we co-create together. And so we hope that by co-creating with the Alabama community that we can create a case study and a case that this should be modeled across the nation and in other communities as well.

Kaiser Maharjan:

Yeah, that's beautiful. That's so cool. So I also understand that the paper outlines 4 barriers to equitable eye care, which you just laid out beautifully. Can you tell me a little bit more about how these pillars will shape future recommendations and actions by the ADA Genentech Health Equity Now partnership?

Wilson:

So the American Diabetes Association, they actually have diabetic eye health guidelines that gives patients, providers, and any member of the healthcare community that is caring for these patients, it gives them a framework for how 1 can go about treating a patient that may present with diabetic eye disease. We highlight that in the article as well. Why that's important is because guideline-directed therapy is a mainstay. It's vetted by the academic community and the clinical community and so we wanted to align to that. It sustains the work because we're not just operating in a silo. So we're not just coming into the Alabama community and implementing measures, strategies that are not aligned to where the clinical community is already going, nor are these strategies outside and are not aligned to where the ADA feels that patient care should be going. So that creates a great pathway to sustainability. It allows us to maintain trust with the scientific and clinical community and it's also allowing us to co-create strategies that are vetted and scientifically proven, so that again helps to scale the work for if you're moving into another community, and if you're trying to apply to a different disease state.

Kaiser Maharjan:

Yeah, absolutely. So looking at those pillars that you guys have outlined, 2 in particular really stick out to me as calls to action for optometrists, which are lack of awareness and the importance of eye exams among people with diabetes and limited access to eye care. In your dream world, how would you like to see the optometric community respond to these limitations?

Wilson:

I love to the dream, so dreaming is incredibly important. And let's just highlight that the optometry community across Alabama, this is something that is a priority for them. There are great folks on the ground, Janene Sims at (University of Alabama at Birmingham, or) UAB, that are leading the charge, Edmund Arthur at UAB, great, brilliant optometrists that are leading the charge on these efforts, both from a scientific standpoint, and from a clinical standpoint. These optometrists are going out in the community, they're identifying adults, and older adults as well. We know that diabetic eye disease is starting to actually impact younger adults. And so that is something in my dream world that I would like to see more of as well, identifying those younger adults, maybe in the 35 to 45 age range, that are battling uncontrolled diabetes, and are honestly suffering from the complications of diabetic eye health.

And so with all of that in mind, my dream world is to see that work continue, to see not just not Genentech having a seat at the table, but multiple organizations, multiple companies that are taking and putting their equity stake in the game to tackle this problem. It's really important because it's not so much about trying to do something different or trying to reinvent the wheel. It's really about aligning to the work and finding ways to enhance that work and we already know that the optometry community in Alabama is doing that. So in my dream world, my goal will be to see that enhance, to see that optometry community have what the need: advanced resources, newer technologies to detect diabetic eye disease faster, and then create pathways to referrals in case those patients have advanced eye disease.

Kaiser Maharjan:

Yeah, absolutely. I mean, public health is a group project and we all got to put in the work to make it happen, so definitely aligned on your dream world I'd like live in it.

So many of these barriers to care are heavily influenced by racial inequity. How is the Health Equity Now partnership helping Black patients with diabetes gain better access to care, and what should the rest of the community be doing to help support these efforts?

Wilson:

Absolutely. It's an important question and we know historically in these communities, and Alabama specifically, it's a unique community because when we think about health care in Alabama, we cannot forget the Tuskegee trials. We know that ramifications of that and how that has infused mistrust amongst the community, specifically the Black community. So it's very important that we co-create with the community so if we are creating resources, whether they be educational in nature, if we're implementing some form of a quality improvement process within a health system, it's very important that we think about the cultural ramifications and the socioeconomic ramifications of these specific communities. And I'm specifically talking about the Black community, African American community, since that's the question that you asked. It's important that we tailor interventions with the community in mind and we have to make sure that we are aligning relevant and intentional strategies and resources. That's the only way that we're going to sustain the work. It's going to allow us to earn the trust of the community and when these things are over, the community is still in a great position to continue that work, and so awareness is key.

We actually hosted last year, a diabetic eye summit and it highlighted a number of different barriers and perceptions in how community members view their health. And so in that session, in that summit, we were able to debunk and shed light on and also expound upon how patients can be empowered, how they can have a broader understanding of their disease process, so that they can take ownership for the future. So those are some of the ways that we want to sustain the work, but also create impact in the African American community.

Kaiser Maharjan:

Yeah, that's really beautiful. Thanks for sharing that. Is there a way for members of the optometric community to get involved in the Health Equity Now program?

Wilson:

Yes, absolutely. So we actually have a landing page, it's the American Diabetes Association and Genentech Health Equity Now landing page. It's public. There are a number of different resources, there are a number of different strategies. We're highlighting what we're doing. Also within the manuscript that you're highlighting today, we shed light on some strategies that we're deploying as it relates to this partnership.

But this is something that we all can do and certainly science should not be conducted in a silo; science is for the community. These strategies are for the community and so this landing page is open to all, to lift and shift, see what we're doing and enhance the work, sustain the work, and also find ways to pivot in innovative ways. So that is open for all and hopefully folks will find it resourceful and useful.

Kaiser Maharjan:

Yeah, absolutely. So thank you so much for taking the time to talk about all these findings. It's been an absolutely illuminating conversation. I really look forward to hearing more as Health Equity Now continues to explore racial health disparities in eye care but especially just really emphasizing how to improve eye care for our diabetic patients.

Wilson:

Absolutely. This has been just an opportunity of a lifetime and we're so grateful that you would give us this opportunity to highlight and we have more to come. We will continue to share with not just the Optometry Times community but also the broader community. We have additional studies that are on the way that we're prepping for that we plan to share with the academic community. So we're looking forward to sharing our progress as we move along.