Health care researcher sets sights on improving care for people with early-onset diabetes
By Sue Rochman
In the field of delivery science, investigators with a medical degree often bring a unique perspective to their research. This is especially true for Anjali Gopalan, MD, MS, whose past experience as a physician treating patients grappling with a diabetes diagnosis informs her current work as a research scientist at the Kaiser Permanente Division of Research.
Gopalan joined the Division of Research in 2015. In 2018, she received a 5-year grant from the National Institute of Diabetes and Digestive and Kidney Diseases to study the initial care of younger adults (under age 45) with newly diagnosed type 2 diabetes. She has other research studies under way that are investigating barriers to medication adherence and race/ethnic disparities in early treatment and outcomes for all adults diagnosed with type 2 diabetes.
We spoke with Gopalan about her research portfolio and the issues driving diabetes research today.
How did you become interested in early-onset type 2 diabetes?
My interest in early-onset type 2 diabetes started in medical school. In my endocrinology rotation I got to spend time in a diabetes practice and attend the nutrition coursework and the education classes provided to patients. It made me realize how all-encompassing type 2 diabetes management is for patients. Every decision they make throughout their day is colored by their diabetes. I’m also interested in the role asymmetric information plays between doctors and patients, and studying this in patients with type 2 diabetes. There are things we know providers don’t communicate well to patients and that patients don’t know are important to share with us. Without open communication or without knowing how to ask the right questions, we can miss opportunities to best support people.
How does being at the Division of Research help you to explore these research questions?
Within Kaiser Permanente, we do an amazing job with diabetes management on the whole. Even so, younger individuals still really struggle, which mirrors national trends. This has to do with differences in physiology, but I believe a lot of it also has to do with the fact this population has a different way of navigating health care. Because of Kaiser Permanente’s electronic medical records, we have access to longitudinal information about people and their diabetes trajectories. This gives us the unique ability to look at how differences in care, medication initiation, and medication adherence affect patient outcomes. Also, the amazing diversity of the Kaiser Permanente Northern California population makes it possible to study and improve the care of subpopulations, like Latinx individuals and certain Asian populations, who are disproportionately affected by early-onset diabetes.
How does being a physician impact your work as a researcher, and vice versa?
The clinical work that I did as a primary care provider made me wonder as a researcher how I could bring scientific rigor to the health problems that I was seeing to change outcomes. It is very humbling when you talk to patients in qualitative interviews or in a focus group as a researcher. It’s a unique experience that you do not get in a pure clinical relationship with a patient. It is definitely very symbiotic to be both a researcher and a primary care physician, though my clinical practice has changed now that I see patients only once a week as an internist with The Permanente Medical Group at the Kaiser Permanente Oakland Medical Center.
What are you working on now?
One of the things I’m doing is diving in to investigate what type of patient and health care provider characteristics are associated with people starting metformin after a diagnosis. Metformin is the first line treatment for type 2 diabetes, and the American Diabetes Association recommends the medication for everyone who is newly diagnosed, in the absence of contraindications. There are reasons to think it is really beneficial for patients to start metformin early. We know that getting blood sugar under control earlier is protective in the long term. There also is data that shows that if you start earlier you might not need — or may delay the need to start — insulin and other medications. But we know that patients don’t always start on metformin as often as they should, and that adherence is really suboptimal. So, I’m really interested in how we can explore that, with the eventual goal of designing an intervention that would better support patients in initiating and adhering to the medication.
What do you like to do in your free time?
What my wife and I love most is spending time with our son, who is 2. There is no boredom in this house because he doesn’t allow for it. We like to take him on walks, and he loves just exploring in nature. Our free time is filled with trying to make him tired so he takes good naps. We also love to cook.