Video transcript
And the fact that the haves and the have nots, that gap is getting wider and wider and wider. That really does weigh on my mind, especially as all these advances happen. They're wonderful. But then that gap is getting wider and wider and wider, and I don't know if it's a matter of sharing resources or finding some way to help each other, but that is a question that I hope gets answered one day. Hello everyone. I'm Dr. Alice Cheng, endocrinologist from the University of Toronto in Canada. And these are the five things we don't know that I wish we knew. So, first of all, a question that I often have in my mind is about women and hormones and impact on diabetes. We have information certainly about puberty, we have information around pregnancy, but when we're talking about other stages of life or changes in life, such as menopause, there's actually very little data available looking at the impact of menopause and hormonal changes on glycaemic control, on sensation of hypoglycaemia, perception of hypoglycaemia, et cetera. So that's one area that I would definitely like to see expanded. Another one that I would like to see expanded is looking at ethnicities and having much more detailed ethno-specific data from clinical trials to better understand how non-pharmacologic and pharmacologic therapies impact different ethnicities in different ways. We have some of those data, but as you'll notice, they tend to be very broad strokes. So they'll talk about an Asian population. Well, Asia is an extremely large continent with many different peoples within them, and therefore it does not have the specificity that I think would be helpful. And with that then leads to the third question that I have, which is around personalised medicine. And I guess that the two topics ahead almost feed into that to some extent. What I would love to see in the future at some point would be an easy-to-use, point-of-care kind of tool or risk assessment, or something that would allow us to see a given individual and know exactly what non-pharmacologic or pharmacologic therapies are going to suit that person the best. And whether that's through different biomarkers, and proteomics, or metabolomics, or other kind of omics, I feel like that would be a very important question to answer. And then the fourth thing that I would like to see answered is looking at the chronicity of treatments, particularly in the obesity space. We're now living a time where pharmacotherapies in particular for the management of obesity are really exploding. And a question that often comes up is how long should we be using these therapies for? And the current answer is, because it is a chronic disease, it makes sense to use it chronically, but how do we do that responsibly? Does it mean intermittent use? Does it mean changing the dosage? Does it mean oscillating? What does that actually mean? And then, ultimately, of course, how will we pay for it? But I think having a better understanding of how to individualise that chronicity would be very interesting to find out. And then the final question that I would like to see answered has to do with health equity and the fact that the haves and the have nots, that gap is getting wider and wider and wider. And this is true within a country, and this is true between countries. And I certainly don't have the answer how to solve that. But that really does weigh on my mind, especially as all these advances happen. They're wonderful. But then that gap is getting wider and wider and wider, and I don't know if it's a matter of sharing resources or finding some way to help each other, but that is a question that I hope gets answered one day.