In this episode of The Heart of Innovation, Global PAD Association CEO
and Interventional Cardiologist Dr. John Phillips interview renowned diabetes expert Dr. Robert Gabbay, MD, PhD. Dr. Bob shares critical insights into both alarming trends and groundbreaking solutions in diabetes care. For clinicians and patients alike, this conversation reveals crucial developments that are reshaping our understanding of diabetes management.The Youth Diabetes Crisis: A Growing Emergency
Early in the broadcast, co-host
highlights a disturbing trend that’s receiving insufficient attention in mainstream healthcare discussions: the rising incidence of severe diabetes complications in young adults. Recent research shows a significant increase in 18-27 year-olds presenting in emergency departments with Critical Limb Ischemia (CLI), a severe stage of peripheral artery disease (PAD) that can lead to amputation.“This is not the diabetes pattern we’ve historically observed,” explains Dr. Gabbay. “We’re seeing young adults with vascular complications that once were primarily limited to patients in their 60s and 70s.”
The statistics are sobering:
Studies show younger patients (<65) with CLI have a 24% increased risk of amputation compared to older cohorts
Despite their younger age, these patients face worse limb-related outcomes
The combination of diabetes and peripheral artery disease creates particularly high-risk scenarios
This trend reflects broader concerns about earlier onset type 2 diabetes and accelerated vascular complications, creating what Dr. Gabbay describes as a “perfect storm” for severe outcomes at younger ages.
STRIDE Trial: GLP-1 Agonists Revolutionizing PAD Treatment
One of the most exciting developments discussed in the interview is the recent STRIDE trial results, examining semaglutide (a GLP-1 receptor agonist) for patients with both diabetes and peripheral artery disease (PAD).
The findings are remarkable:
Patients receiving semaglutide showed a median 26-meter improvement in maximum walking distance
This represents a statistically significant 13% improvement at one year
Quality of life measures showed significant improvement
There was a 54% reduction in risk of death or needing revascularization procedures
“To put that into context,” notes Dr. Gabbay, “we usually consider an increase in walking distance of 10-20 meters clinically important in PAD, so this exceeded expectations.”
Walking is a lifeline for many diabetics as they are at high risk of developing circulation issues in their legs, known as Peripheral Artery Disease, as mentioned above. Walking allows these patients to develop their collateral network of vessels, known as ‘natural bypasses’ around severely narrowed or blocked arteries, which improves their prognosis with less chance of amputation.
These results are also particularly significant because, as Dr. Gabbay points out, “The only drug we’ve had available for PAD symptoms is contraindicated in heart failure patients and causes numerous side effects, limiting its use to less than 10% of eligible patients.”
Innovation in Insulin Delivery: Beyond Conventional Pumps
The interview also explores how technology is transforming insulin delivery systems. Dr. Gabbay discusses the latest advances in insulin pump technology that are dramatically improving patient experiences:
“The newest generation of pumps represents a quantum leap from what was available even five years ago,” Dr. Gabbay explains. “We’re seeing systems that require minimal user intervention, learn from individual patterns, and automatically adjust delivery.”
Key innovations highlighted include:
Closed-loop systems that function as artificial pancreases
Smart algorithms that predict glucose fluctuations and adjust insulin delivery preemptively
Integration with smartphones and wearables for seamless monitoring
Streamlined designs that reduce the psychological burden of diabetes management
These advances are particularly important for addressing therapy adherence issues, which Dr. Gabbay identifies as one of the most significant challenges in diabetes care.
Regenerative Medicine: The Promise of Stem Cell Therapy
Perhaps the most revolutionary possibility on the horizon is the potential of stem cell therapy to fundamentally alter the course of diabetes. Dr. Gabbay provides insight into ongoing research that offers hope for what many would consider a functional cure.
“What makes these approaches so exciting is their potential to restore the pancreas’s natural ability to produce insulin,” says Dr. Gabbay. “Rather than managing diabetes, we’re talking about potentially reversing it.”
The research focuses on:
Stimulating regeneration of insulin-producing beta cells
Implanting lab-grown pancreatic islet cells
Using gene therapy to reprogram existing pancreatic tissue
Developing immunotherapies to prevent autoimmune destruction of new beta cells
While cautioning that this research remains in development stages, Dr. Gabbay expresses optimism about the accelerating pace of breakthroughs in this field.
AI Digital Twins: Personalizing Motivation and Treatment
A fascinating innovation discussed in the interview is the emerging use of AI “Digital Twins” - virtual models that simulate an individual’s metabolism and potential responses to different interventions.
“One of our biggest challenges is helping patients visualize the benefits of difficult lifestyle changes,” Dr. Gabbay explains. “With Digital Twin technology, we can show someone exactly what improvements they might experience with specific diet or exercise modifications.”
These personalized visualizations serve multiple purposes:
Increasing motivation by making abstract benefits concrete and visible
Identifying the most effective interventions for each individual
Allowing virtual testing of medication combinations and dosages
Predicting long-term outcomes based on current behaviors
Dr. Gabbay sees particular promise in using this technology to address the psychological aspects of diabetes management, which are often underaddressed in traditional care models.
Looking Forward: A Multifaceted Approach
Throughout the interview, Dr. Gabbay emphasizes that the future of diabetes care requires integrating these various approaches rather than seeking a single solution.
He alludes to the diabetes epidemic as complex and multifactorial, stating that there’s no one single holy grail solution at this point. He explains that our responses need to be equally sophisticated – combining pharmacological innovations, technology, regenerative medicine, and psychological approaches tailored to individual needs.
But what’s 100% certain going forward is the role and responsibility patients play in developing Type 2 diabetes and reversing it. Dr. Gabbay says, “Patients must look in the mirror and make a conscious decision to exercise, eat better, and get enough sleep.”
If you have diabetes and need support for diabetic neuropathy, leg cramps, leg pain, wounds that won’t heal, call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS or go to PADhelp.org, to talk with a PAD Navigator who can help you find timely, effective, limb-saving care.
This blog post highlights key points from our exclusive interview with Dr. Robert Gabbay. To experience the full depth of his insights and learn more about these groundbreaking developments in diabetes care, watch the complete interview above,
Share this post