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Career focuses on diabetes, its cardiovascular effects
Treatment of diabetes will resemble hypertension management, which is multi-drug therapy, says Alan J. Garber, MD, PhD.
Alan J. Garber, MD, PhD, has long been a leading authority on diabetes and metabolic syndrome and its effects on the cardiovascular system. Like many cardiologists and endocrinologists, Garber is worried about the future health of the country and the rising prevalence of type 2 diabetes.
“We cannot keep increasing what has now become the major risk factor for heart disease in America,” Garber said in an interview. “We need to see some reversal in that trend towards improving heart disease endpoints.”
Professor of medicine, biochemistry and molecular biology, at Baylor College of Medicine, Garber is a member of the Coronary Heart Disease section of the Cardiology Today Editorial Board. He is also chief medical editor of Endocrine Today, a sister publication also published by SLACK Incorporated.
He graduated from Temple University in 1968, completed a PhD in biochemistry in 1971, and a residency in internal medicine. He was a fellow in metabolism and a junior faculty member at Washington University Medical School and Barnes Hospital in St. Louis before transferring to Baylor in 1974.
Diabetes research
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Professor of Medicine, Biochemistry and Chief Medical Editor, |
Garber has devoted much of his professional career to diabetes research.
“Right now, we’re exploring new treatment options for diabetes,” he said. “It’s clear that the existing treatments all fail to maintain adequate diabetes control in the long run at varying rates. So it’s obvious that modern treatment of diabetes is going to have to increasingly resemble hypertension management, which is multi-drug therapy.”
Diabetes is becoming increasingly prevalent with the highest recorded rates than at any prior time; a 2005 CDC estimate said the total number of patients with diabetes in the United States is 20.5 million.
“We evolved to conserve every single calorie possible because of the scarcity of food years ago,” he said. “Now what we have is a situation of calorie excess. Our bodies are not designed to shed unnecessary calories or to protect us against their metabolic consequences.”
Garber is currently the editor of Diabetes, Obesity and Metabolism and also served as editor of the diabetes and metabolism volumes of Endocrine and Metabolism Clinics of North America. He co-chaired the 2006 American Association of Clinical Endocrinologists/American College of Endocrinology/American Diabetes Association Inpatient Diabetes and Control: A Call to Action Consensus Conference and chaired the writing panel that produced the resulting Consensus Statement that recommended strategies for improving patient care. He is immediate past chairman of the Council on Complications for the ADA.
Therapeutic regimens
Garber and his colleagues have made progress in the identification of early risk factors and have recommended adjustments to diabetes therapeutic regimens.
“We recognize increasingly that diabetes is not a clear-cut diagnosis. Instead, it is somewhat arbitrary. In other words, euglycemia, or normal glucose tolerance, does not suddenly become diabetes. Glucose is a continuous variable,” he said. “It tends to rise as we get older, and at some point we diagnose diabetes based upon an arbitrary conclusion by an expert committee. We know that there’s a transitional state, or the pre-diabetic state, which is a state of increased risk for atherosclerotic disease and for diabetic microvascular disease.
“The point at which this begins is much more ill-defined, but the risk also increases continuously as hyperglycemia increases,” Garber said. “In the end you develop unusual the concept that diabetes develops not as the result of an exponential increase in glucose, but rather as the result of concomitant increases in vascular risks in terms of both large and small blood vessels.”
Additional emphasis on diagnosis and treatment in the early stages of diabetes and pre-diabetes is essential to its management. Failure to do so means that drug therapy is often initiated too little and too late, he said.
“People are no longer normal and beginning to develop diabetic tendencies,” he said. “We have to diagnose this point early on and deal with it before they develop serious disease.”
When he is not working Garber and his wife, Susan, professor of rehabilitation medicine at Baylor, are patrons of the Houston Opera. He also likes collecting French porcelains, a hobby that grew from a friendship he has developed over the years with a director at the Sevres porcelain museum in Paris. It is not just the aesthetics of the works that capture his attention.
“I like the handmade, artisan nature of the artistic pieces,” he said. “In a machine age, you tend to value the product of a single individual.” –by Eric Raible