Latest / StartUp Health NOW Podcast / From the Archives: Aaron Kowalski, PhD, CEO of JDRF, Brings His Professional & Personal Experience to StartUp Health’s T1D Moonshot Impact Board

Transcript

From the Archives: Aaron Kowalski, PhD, CEO of JDRF, Brings His Professional & Personal Experience to StartUp Health’s T1D Moonshot Impact Board · StartUp Health NOW Podcast

• 0:00
  The thing that occurred to me over the last few years is life-changing breakthroughs depend on where you live and your circumstances.
• 0:07
  And the model that we've really been working off of more recently is the care in diabetes is actually a continuum. I'm fortunate to be on the front line of that continuum.
• 0:19
  [upbeat music] Welcome to StartUp Health NOW, the podcast where we celebrate the entrepreneurs and innovators who are transforming health. I'm your host, Logan Plaster.
• 0:30
  For the next few weeks, as we gear up for the launch of the next season of this podcast, which will drop after Labor Day, we'll be bringing you replays of our favorite episodes from the past.
• 0:40
  This week, we're taking it back to a conversation I had with Aaron Kowalski, the CEO of JDRF International.
• 0:47
  Anyone orbiting the universe of Type 1 diabetes will know that JDRF is the world's largest non-profit funder of T1D research.
• 0:56
  In his role atop that organization, Aaron has combined his professional experience as a molecular biologist and executive with his personal passion to cure Type 1 diabetes in order to impact patients like his own brother.
• 1:10
  Notably for this conversation, Aaron Kowalski is also a member of StartUp Health's Type 1 Diabetes Moonshot Impact Board.
• 1:18
  This board is a cross-disciplinary team of T1D experts spanning the gamut from research to funding to commercialization, and we're thrilled that Aaron is bringing this vast experience to the cohort in order to speed up innovation and support a generation of health entrepreneurs.
• 1:35
  A quick note about our Type 1 Diabetes Moonshot Fellowship.
• 1:39
  This three-year entrepreneurial program has been supported by a PRI from Helmsley Charitable Trust, and it's designed to help T1D startups overcome obstacles and commercialize more quickly.
• 1:50
  It's an incredible opportunity for any T1D startup, and we've got a few slots left in the cohort.
• 1:56
  So if you're a founder whose passion is Type 1 diabetes, I encourage you to apply at startuphealth.com/t1d, or you can email t1d@startuphealth.com. Now, on to my conversation with Aaron Kowalski from JDRF International.
• 2:15
  [upbeat music] Aaron Kowalski, thanks for taking a few minutes with me today.
• 2:20
  Uh, you're the CEO of JDRF International, the global leader in promoting research and community development around Type 1 diabetes, in addition to a lot of other things I'm sure you can explain.
• 2:31
  But for our, uh, sake today, you're the most recent addition to the StartUp Health, uh, Type 1 Diabetes Moonshot Impact Board.
• 2:39
  So I wanted to g- uh, have a few minutes to introduce you to our audience and learn about some of the work that you're doing. So thanks for coming on today. Great. It's, uh, great to be here.
• 2:48
  I'm happy to be representing JDRF. And yep, we, we fund research, and we work really hard to make sure that research h- uh, reaches the hands of people. Yeah.
• 3:00
  Uh, a- and I think that's the, the ultimate mission of JDRF is accelerating life-changing breakthroughs to cure, prevent, and better treat Type 1 diabetes and its complications.
• 3:09
  And for your life to be changed, you need to, uh, have that research be translated into therapies, uh, or treatment options that, that make your diabetes better. So that's something I'm proud of.
• 3:23
  Uh, the JDRF funds basic research. We have our venture fund. We have an incredible policy team that works on regulatory and health policy.
• 3:32
  All of those pieces need to line up so that somebody does better, and, um, and, and, and we do a [chuckles] lot of that. Give us a quick fly over of your career. I understand you've, you've been a scientist in the past.
• 3:44
  Uh, I'm not sure how long you've been at JDRF, but if you could paint that picture for us. Sure. So I'm a molecular biologist by training.
• 3:51
  I spent a lot of years in the lab, uh, working on molecular biology and protein biochemistry. Came to JDRF as a scientist.
• 3:57
  We have a team of scientists that oversee our research funding, which is over $100 million a year, and, uh, and kind of grew up here.
• 4:05
  I, uh, focused a lot initially in my early career on, uh, what we call artificial pancreas or automated insulin delivery systems, and then broadened to oversee our entire research portfolio and our policy work down in DC, and about three and a half years ago took on the role of CEO.
• 4:25
  Uh, my, my background, uh, beyond that is my brother and I, two of six kids in our family, have Type 1 diabetes, so that was a big motivator.
• 4:33
  He, uh, my brother Steve, uh, has hypoglycemia unawareness, which is a big challenge, and hence kind of my passion for the device side of the equation, having continuous glucose monitors that could alarm for impending lows, starting to automate insulin delivery, which we're both benefiting from now, uh, w-was a passion of mine.
• 4:53
  Now as CEO, I try to shepherd more resources to solve those problems, still try to keep my finger on the, the, the pulse of the science, but also trying to engage more people and partners to help, uh, move the field along.
• 5:07
  I was reading a bit about a recent project that you did, the T1D Index Data Project, and it taught me a bit about the increasing- Great... numbers of folks with T1D globally.
• 5:19
  Um, and I wonder if you could speak to that, the growing challenge.
• 5:23
  Well, this is, uh, the index to me is one of the more important things we've done in the last decade, and it-- what, what this is for folks listening is a categorization of the impact of Type 1 diabetes around the world and looking at it from a country by country lens.
• 5:38
  And many people would say, just even, even up till today, Type 1 diabetes is a, a Caucasian, uh, North American, a Western European disease. And so it's not, that's not true.
• 5:51
  Type 1 diabetes affects people wherever they live. And a lot of that misconception comes from the fact that even a hundred years after the advent of insulin, uh, people still die for lack of treatment.
• 6:05
  So what this paper shows is in...Places like America, if you have great care, you're gonna live a long, healthy life with Type 1 diabetes.
• 6:13
  It's much different than when my brother and I were diagnosed back in the olden days which is-- w-was a much more grim diagnosis. But if you don't have access to that care, you will have challenges.
• 6:26
  Even, uh, uh, many kids still die, which is totally unacceptable to us.
• 6:31
  So what that's done for us has provided the foundation for a platform for change, and to drive better treatments to more people to ensure that they can live and thrive. Um,
• 6:44
  now you, you bring up the, the increasing incidents, and this is something that we're concerned about because
• 6:50
  part of the story is just we're seeing that with delivery of insulin and care, you, you can help people survive. But part of this is truly we're seeing more Type 1 diabetes and actually more autoimmunity emerging.
• 7:05
  I mean, that's a big area of focus of JDRF and NIH and other research organizations because, you know, why is that? And, you know, I think the answer is likely it's an environmental, um, issue, but what is it?
• 7:18
  Is it viral? Is it chemical? Uh, huge amount of research there. The bottom line is a lot of people have diabetes, um, Type 1, of course, many more Type 2 as well, so we need new therapies to help them do better.
• 7:36
  Yeah.
• 7:36
  Talk to me about this, this spectrum, where on one end we have, um, opening up access to millions more people in the world with the therapies we already know work, on the other hand, investing millions into experimental treatments, cures that we, we haven't even discovered yet.
• 7:56
  At JDRF, you've got to apportion funds and decide, okay, where on this spectrum do we live? What are your thoughts? Yeah.
• 8:03
  It's, uh, it's really something that we've been wrestling with a lot, and hence my smiling, because for many years I, I took the JDRF mission, and I was chief mission officer before CE- I was CEO.
• 8:16
  Life-changing breakthroughs to me, my definition was, uh, moving from where we are today to somewhere better. And when my brother was diagnosed, we did urine testing.
• 8:27
  It was a huge life-changing breakthrough, that blood glucose testing. I fought a lot, uh, here at JDRF for CGM access, life-changing breakthrough. Automated insulin, life-changing.
• 8:38
  Ultimately, I would love to take off my pump and have cells make insulin for me. I'd love to have, uh, we have drugs that look like they're gonna delay the onset of, uh, Type 1 diabetes, like teplizumab.
• 8:48
  So that is where JDRF really spent a lot of our energy. The thing that occurred to me over the last few years is life-changing breakthroughs depend on where you live and your circumstances.
• 9:02
  And what the model that we've really been working off of more recently is that care in diabetes is actually a continuum. I'm fortunate to be on the front line of that continuum. Very, very lucky. I have...
• 9:18
  My insurance pays for my diabetes supplies. I have an amazing doctor. I have the best technology. Um, I'm in an incredible place of privilege, really.
• 9:27
  Uh, but I look across the river here, I'm in Manhattan, uh, and there are kids, uh, who don't have such easy access to these advancements.
• 9:37
  So for us, we see if your life is going to be changed, access becomes a big part of that.
• 9:44
  And so, so we, we actually have a, a model that we call the right and the left side of the pipeline, the pipeline being moving from discovery research all the way to the hands of a person.
• 9:56
  To me, um, the, the left side of the pipeline is the bleeding edge, research and commercial development and ultimately regulatory approval. That takes where we are today and moves to somewhere better.
• 10:09
  But ultimately, the right side defines who gets access to those new advancements, and that's something that we've really ratcheted up, um, our focus on at JDRF because there's the social equity part of this, we want everybody to do better, but there's actually a business model part of this.
• 10:29
  You know, I've been on a CGM for sixteen years, and CGMs have become much better, continuous glucose monitors, uh, over that, that time period.
• 10:37
  But imagine if every kid and person with Type 1 in India, China, and Brazil had access to CGM, right? There would actually be a much better business model, and things would move faster.
• 10:48
  So we believe that access actually drives a more virtuous cycle of
• 10:55
  better health outcomes, which was our ultimate goal, but then continued investment into the next generation treatment options that's on the bleeding edge. Yeah.
• 11:04
  So i-it's really a model for us of, you know, how do you balance that? Of course, it's, it's, uh, something we wrestle with all the time is where do our dollars go the furthest?
• 11:14
  But we do recognize that access plays an important role in future funding of more advanced treatments.
• 11:22
  I-in terms of thinking of this concretely in terms of a case study, can you think of a success story of a, of a place where you've worked to open up access to the treatments that we know work for T1D?
• 11:34
  Well, here right in the United States, one of my most proud achievements here at JDRF was we fought really, really hard for access to CGM for Medicare population.
• 11:46
  So the Medicare population has a lot of people with Type 1 diabetes in it, and as you age with diabetes, you become more susceptible to hypoglycemia.
• 11:57
  So the people who have the most risk to-- due to severe hypoglycemia are people who are older and lived a long time with Type 1 diabetes. When the...
• 12:07
  So JDRF published a, a, a, funded a very important paper back in two thousand and eight, I was co-author of, um, showing the benefit of CGM, and in the Ne- published in The New England Journal, and it actually opened up private insurance quite a bit for coverage, but not Medicare.And that to me is a perfect example.
• 12:26
  So all of those people who are sitting there at high risk for hypoglycemia didn't have access to CGM. And we spent a lot of money and lobbied and, and worked with CMS, and, uh, actually got over the hump there.
• 12:41
  And that opened up coverage for I think it was like a hundred and fifty thousand type one people, and now we're seeing, um, coverage open up for type two people.
• 12:50
  That is a bunch of people whose lives were changed for the better. And we're now-- We just, uh, had another example, I... In, you know, say JDRF International, we have, um, represent folks all over the world.
• 13:02
  We just got the Australian government to commit two hundred and fifty million dollars to, uh, open up access for adults to have CGM in Australia. Great. It is life-changing for those folks. It's exciting.
• 13:16
  So, uh, advocacy and access to me are hugely important because without them, people don't see, see these advancements. Yeah.
• 13:27
  So big reason why we're having this conversation is your, uh, involvement in StartUp Health's Type One Diabetes Impact Board and this new Moonshot initiative that we're, uh, that we've launched.
• 13:37
  And so I'm curious, um, again, thinking about the spectrum, where on one end you have, uh, huge organizations, pharmaceutical companies, you know, pushing the bleeding edge.
• 13:48
  On the other, you have, um, really hundreds, even thousands of entrepreneurs around the world pushing on different aspects of the challenge and, and coming up with, with solutions.
• 13:59
  What do you see as the role and value of supporting, uh, entrepreneurs at scale in the Type One diabetes market? Yeah, entrepreneurship, I think, is the bedrock of innovation and, and driving us to a better place.
• 14:13
  And I, I love that, um, we have folks like StartUp Health coming into Type One diabetes. And, and the team is amazing because it takes a village.
• 14:25
  And JDRF, uh, funds a lot of research, but by no means do we think we can take on this problem ourselves. We work with the Helmsley Trust, now StartUp Health, governments.
• 14:35
  In finding those niches where you can drive more people, more smart people to get involved, think outside the box, combine, uh, different skill sets, is only gonna move us to better solutions faster. Yeah.
• 14:50
  So, uh, when David and the team reached out to me, um, I was thrilled to, uh, you know, lean in and, and provide support because, um, it, it, it just...
• 15:01
  It, it-- There's more energy, more smarts, more money, more capital. Uh, moving into Type One diabetes means people will benefit faster. Yeah. You, you are so deep in this market.
• 15:12
  What would be some words of wisdom you might give to a founder who is beginning to tackle some of the challenges that they see?
• 15:18
  Oftentimes, entrepreneurs in these markets, uh, are people who have Type One, and they are coming up against their own personal challenge, and they're beginning to figure out, "Okay, I can be part of a solution."
• 15:29
  But they might n- They're not gonna have the depth of experience that you have. Yeah, my, my advice is always looking at impact.
• 15:38
  You know, I think there are a lot of good ideas out there, but ultimately, what is the impact? And the other thing that's, that's very inside baseball, but I'll, I'll say it because, um, it, it...
• 15:48
  it's the nature of this initiative, is Type One diabetes is more than just about A1C. You know, this is a really interesting-- I've seen so many things fail because they're so focused on changing somebody's A1C.
• 16:03
  They don't realize the diabetes, you know, people with diabetes live a whole life.
• 16:07
  And, uh, you've got to incorporate these advancements into not just, uh, does it lower somebody's A1C, but how does it affect their sleep? How does it affect their family life?
• 16:18
  What is, uh, what, what's their relationship with, with this advancement? And if you can focus on that more holistic lens of diabetes, like, I'll just give you a very specific example.
• 16:31
  You know, these closed loop systems that I, I, I worked on here a-at JDRF for a long time, everybody in the industry focused on the A1C side. In the diabetes world, the number one benefit people talk about is sleep.
• 16:47
  And to a fault, if you talk to somebody with diabetes, they'll say, "Oh my God, I sleep so much better." Yeah. It's a totally different lens of like what's important.
• 16:57
  And the what's important, uh, to me, that's the secret sauce of advancing, uh, a new, new treatment options. Uh, weight, that's another big one. Um, sleep, um, quality of life.
• 17:11
  Of course, we're trying to fix the glycemic problem, but life is more than glycemia. And, uh, that would be my one piece of advice is think, think bigger.
• 17:21
  We've talked a lot about a number of different types of technology. You worked on artificial pancreas technology.
• 17:26
  Is there something that you're particularly excited about that's really around the corner the next one, three, five years?
• 17:33
  I love that one, one, one, uh, area that we're really interested in is what we call SGL2, uh, inhibition. These new drugs that are being widely used in Type 2 diabetes have such a huge impact.
• 17:47
  You know, again, thinking about quality of life, they don't cause you to go hypoglycemic. Uh, these are drugs that cause you to pee out sugar, and they've been amazing.
• 17:57
  But they've been dangerous for people with Type 1 diabetes because of a,
• 18:03
  a, s- I don't know, a, a called surprise, surprise side effect of, um, what's called euglycemic DKA, which is where somebody gets ketosis but has a normal blood sugar level.
• 18:14
  And that's been tricky in the Type 1 community because, uh, most people associate ketosis with high blood sugar. Turns out that ketosis is driven by low insulin.
• 18:25
  It's a long in, again, inside baseball story, but these drugs are so good, and they have this incredible knock-on effect of reducing risk of kidney disease progression and heart disease progression.
• 18:39
  So we want to see them, uh, get into Type 1 diabetes. And one area that we've been focused on is, wow, what if you could, uh, combine continuous glucose monitoring with continuous ketone monitoring?
• 18:50
  Because then you would have a tool to minimize the risk of that and, and that side effect. So I think we saw Abbott just announce that they're going down that pathway.
• 18:58
  I think there are a number of innovative companies who are also trying to develop these sensors. That's a for example of a treatment. It has weight benefits, it has complication benefits, it has glycemic benefits.
• 19:08
  They're easy to use, uh, but they just need a little extra help in the Type 1 world, and that I thought was really cool. Awesome. Aaron, I love it. Uh, that's the time that we have.
• 19:19
  I'm inspired by the way that you've taken your experience as someone with Type 1 diabetes and in molecular biology, and now you're using that to open up access for folks in the US and around the world through JDRF.
• 19:31
  And I'm excited to have you on this impact board with us. It's, uh, uh, it's an honor, and thanks for, uh, having me, and thanks for all the team's doing to help, uh, drive our mission forward. All right.
• 19:42
  Keep up the great work. All right. Thanks, Logan. Be well. [upbeat music] Thanks for listening to StartUp Health NOW. We'll be back again with another episode next week. [upbeat music]