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ORLANDO — The United States is at a critical juncture in its efforts to treat chronic diseases, particularly type 2 diabetes, and now has a chance to change the dangerous trajectory it’s currently following, FDA Commissioner Robert Califf said Friday.

“The U.S. is leading the world in technology development, innovation, new gadgets of all kinds, new drugs, you name it,” he said. “These advantages unfortunately are not resulting in superior health and outcomes for the U.S., population, or for most individuals in the U.S.”


Health outcomes as a whole are deteriorating in the U.S., Califf said in his remarks at the American Diabetes Association conference, but he sees one outlier.

“There’s an exception for type 1 diabetes, which I believe is on the verge of a major breakthrough in terms of the biology and biological therapies that can make an enormous difference for this special population of people with diabetes,” he said. “But on the other hand, for the larger epidemic of type 2 diabetes, we’re failing right now.”

For type 2 diabetes and other conditions related to obesity, Califf said it’s important to not forget about bariatric surgery. “The more data we see about bariatric surgery, the better it looks, basically. And the question is, why is it underused in the U.S.?”


As for the runaway success of new obesity drugs, he called them “vastly underused” and “amazing” for their potential in other issues like alcohol addiction, smoking, gambling addiction, Parkinson’s, liver disease, and Alzheimer’s, while noting that studies are needed to confirm benefits versus harms.

“Get those trials done as quickly as you can,” he told his audience. “We need to know for which indications these drugs are beneficial and which are just a hope.”

Califf saw digital approaches to diabetes care being developed while he worked at Google and Alphabet. He also saw adoption of these devices follow a familiar pattern: They’re taken up by “people with Ph.D.s and living in urban areas, leaving most people out.”

Continuous glucose monitors are an example of technological success that may not be reaching what he called “the regular part” of the population.

“I think we’re at a point now between digitization and AI where we can either use digital technology to improve health for everyone or we can use it to cater to wealthy people who are highly educated.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

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