Q&A: Samuel Dagogo-Jack, MD, DSc, discusses the past, present and future of endocrinology
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“I’ve always wanted to be a doctor,” Samuel Dagogo-Jack, MD, DSc, this year’s recipient of the American Diabetes Association’s Outstanding Achievement in Clinical Diabetes Research Award, told Healio.
The award recognizes exceptional contributions in patient-oriented clinical outcomes research that have significantly impacted diabetes prevention and treatment.
Dagogo-Jack is the A. C. Mullins endowed professor and chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center (UTHSC) and director of the Clinical Research Center at UTHSC. He has had a clearly recognizable influence on patient-oriented clinical outcomes research during the past 30 years. He is also a Healio | Endocrine Today Editorial Board Member and a past president of ADA. Dagogo-Jack has helped to shed light on the prevention and treatment of diabetes, prediabetes and related complications, with a particular focus on pathobiology.
Healio spoke with Dagogo-Jack about his history in the field, his current research and future developments in endocrinology.
Healio: What was the defining moment that led you to your field? Why do you do what you do?
Dagogo-Jack: After obtaining postgraduate clinical certification in internal medicine from the Royal College of Physicians (U.K.) in record time, I was encouraged by Pat Kendall-Taylor, MD, FRCP, then-chief of the endocrinology unit at the University of Newcastle, U.K., to pursue research training. That early pivot from the clinic to the lab bench was a defining moment that shaped my future career in academic endocrinology.
My early introduction to bench research was in the field of cytokines and growth factors. Stanley Cohen, PhD, and Rita Levi-Montalcini, MD, were awarded the 1986 Nobel Prize in physiology or medicine for their discovery of nerve growth factor (NGF) and epidermal growth factor in mice. Their pioneering work on growth factors opened new vistas and insights into the regulation of cell growth that has propelled novel therapies in hematology, oncology, rheumatology, dermatology, surgery, wound care and other fields. As a rookie researcher in Newcastle, I learned to develop immunoassays and bioassays for measuring EGF in mouse tissues and human body fluids. Using those assays, we studied the regulation of EGF in various physiological and pathological states in humans, and the hormonal regulation of EGF in man and mouse. Our studies led to seminal observations on the interactions among androgens, thyroid hormone, iodine status and the expression of EGF in tissues and body fluids.
Once bitten by the research “bug,” there was no turning back, and I set my sights on continuing my work in the best possible environment for biomedical investigation — the United States of America. My first home upon immigrating to the U.S. was the endocrinology division at Washington University in St. Louis. With additional training in patient-oriented clinical and translational research under the mentorship of Philip E. Cryer, MD, I developed an independent career in human metabolic research.
Healio: What area of research in endocrinology most interests you right now and why?
Dagogo-Jack: My research focuses on the interaction of genetic and environmental factors in the pathobiology, prediction and prevention of prediabetes, diabetes and their complications. In 2006, with funding from the NIH, we established the Memphis Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) comprising healthy, normoglycemic African American and European American adults with parental history of type 2 diabetes. For nearly 2 decades, we have followed this initially normoglycemic cohort for occurrence of dysglycemia and identification of those factors that induce early glucose dysregulation. Insights from the POP-ABC study reveal important roles of biobehavioral, biochemical, pro- and anti-inflammatory cytokines, metabolomic and molecular factors associated with progression from normal glucose regulation to prediabetes.
In 2013, we added a lifestyle intervention component to the POP-ABC study design and rebranded it the Pathobiology and Reversibility of Prediabetes in a Biracial Cohort. Our subsequent observations revealed that early lifestyle intervention after discovery of incident prediabetes was remarkably effective in preventing progression to diabetes, reversing prediabetes and restoring normal glucose regulation.
Healio: Have you ever been fortunate enough to witness or to have been part of health care history in the making? If so, please explain.
Dagogo-Jack: Yes, I am fortunate to be a principal investigator for two of the most celebrated landmark diabetes trials — the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) and the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study (DPP/DPPOS).
In 1993, the DCCT results gave the world the power of interpretive measurement. What is not measured cannot possibly be controlled. The DCCT showed definitively that glycemic control in people with diabetes, using an HbA1c goal of 7% or lower as the metric, significantly prevented the development of complications in the eye, kidney and nerves. That was the first time the world of diabetes clinicians ever had a roadmap regarding optimal targets for diabetes management. And it has remained a truly remarkable contribution, a gift that has kept on giving!
The second epoch-making experience was the discovery in the DPP that moderate lifestyle modification can prevent the development of type 2 diabetes in individuals at high risk. The significance of this simple yet profound discovery is underscored by the fact that nearly 97 million adults have prediabetes in the U.S.
The CDC has built upon the findings of the DPP by establishing the National Diabetes Prevention Program. In 2019, CMS approved reimbursement for diabetes prevention counseling for Medicare patients for the first time. The successful translation of the DPP findings in the community offers hope for stemming the tide of new cases of diabetes.
Healio: What do you think will have the greatest influence on your field in the next 10 years?
Dagogo-Jack: Weight control using GLP-1 receptor agonists has seized the popular imagination, at least in affluent Western countries. It seems that these drugs are fulfilling pent up societal demand for diet, exercise and weight loss in a pill or shot. If all goes well and no unexpected untoward events occur, one can predict a significant leftward shift in obesity, and that could result in numerous downstream outcomes for society.
If a large segment of the society with overweight/obesity gain access to these agents and lose weight, what we would witness is a nationwide attenuation of obesity-related ailments among those who can afford the drugs. Unfortunately, there would be an “incretin divide,” not unlike the digital divide that has elicited federal action to provide broadband to rural areas. There could be an outcry for a similar intervention to bridge the incretin divide.
Another area is the integration of genome sciences and AI in diagnosis, management and follow-up practices. Already, AI is being utilized to some extent in medicine, but the impact of generative AI in fostering advances in personalized medicine can only be imagined.
With massive phenotypic and genomic data inputs, large language models and integrative/predictive algorithms, it may be possible to foretell certain future clinical events with uncanny accuracy. If that occurs, the science of prediction will be elevated and “preventomics/preventology” would become a very attractive medical specialty.
Healio: If you could make an app for something in your life what would it be?
Dagogo-Jack: I would create an app that integrates my personal data (age, sex, height, weight, BMI), physiological data (heart rate, respiration, sleep hours, etc), physical activity and sedentary hours with my Outlook calendar of pending tasks to indicate a score for work-life balance level. This would be color-coded with red, yellow and green, with red meaning that balance is poor and green meaning that balance is being achieved. Once the code turns yellow or red, one can say an emphatic “no” to any additional work requests or assignments until the signal returns to green.
Healio: If you weren’t a physician and/or researcher, what would you be doing?
Dagogo-Jack: I’m not sure. I’ve always wanted to be a doctor and I like propounding and pontificating. I guess if I wasn’t a physician I would be a professor in some field or perhaps a preacher!
Healio: Who are you outside of your job? What interests you outside of endocrinology?
Dagogo-Jack: A student of ancient history, particularly precolonial Africa, a motivational speaker for inner-city youth, a gym rat (mostly racquetball) and a volunteer for good causes.
Healio: Whom do you admire and what would you ask that person if you had 5 minutes them?
Dagogo-Jack: Nelson Mandela, for reasons that need no enunciation. My 5-minute question would be: Why did you retire after just one term as president? The fledgling baby you fought to bring to life never was in greater need for a steady sublime hand.
Reference:
- University of Tennessee Health Science Center. Samuel Dagogo-Jack, MD, D.Sc. https://www.uthsc.edu/faculty/profile/?netid=sdagogoj#Biography. Published Feb. 21, 2024. Accessed June 17, 2024.
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