Diabetes can be a lifelong journey. For Mandeep Bajaj, MBBS, American Diabetes Association® (ADA) President, Medicine & Science, the journey began with his father, Prof. Jasbir Bajaj, a leading endocrinologist and one of the few diabetologists in India at the time.

The elder Bajaj moved to Belfast, Northern Ireland, to pursue research in the 1970s. Dr. Bajaj described walking to the first day of primary school past heavily armed troops and armored vehicles.

“I knew nothing of the Troubles in Northern Ireland or of the politics, but I knew getting to school was the most important thing in my life,” recalled Dr. Bajaj, Professor of Medicine and Molecular and Cellular Biology, Baylor College of Medicine, and Chief of Endocrinology, St. Luke’s Medical Center, Houston. “That was an important lesson, that despite the challenges we face, we do what is most important no matter what. We saw it again during COVID.”

Dr. Bajaj recounted his experiences with diabetes in his presentation “Fighting Diabetes–A Journey That Began in Childhood” on Sunday, June 23, during the special session President, Medicine & Science Address and National Scientific & Health Care Achievement Awards Presentation. A key step for Dr. Bajaj was the 1976 International Diabetes Federation Congress in New Delhi. For the first time, diabetes was front-page news in virtually every newspaper in India.

He saw his first diabetes patients as a medical student at the All India Institute of Medical Sciences (AIIMS). Urine monitoring and fixed-dose insulin injections were the norm. Urine dipsticks were just being introduced, and treatment was advanced if more than one injection was given daily.

“Those were simple times, even though we thought we were practicing state-of-the-art diabetes management,” Dr. Bajaj said.

In the 1980s, the United States was an alluring beacon of opportunity and prosperity. AIIMS graduates wrote glowingly of rapidly advancing careers in radiology and other specialties. Dr. Bajaj decided to join the exodus.

“They sent tales of big careers, big houses and big cars,” he said. “My dreams were simple: make the lives of people with diabetes simpler.”

Residency at Montefiore in New York and a fellowship at Joselyn Diabetes Center put Dr. Bajaj on the road to translational research in type 2 diabetes. His first faculty position at the University of Texas Health in San Antonio in 2000 was a career accelerator.

He joined a research group that published more than 25 papers over the next four years exploring the role of free fatty acids in insulin resistance and peroxisome proliferator-activated receptor (PPAR) agonist activity in glucose and lipid metabolism in type 2 diabetes. Those early papers led to a focus on hepatic fat, liver fibrosis, and nonalcoholic steatohepatitis (NASH).

Liver disease is among the least recognized and most underdiagnosed complications of type 2, Dr. Bajaj explained. It is now the second most common cause of liver transplantation in the United States and a growing problem globally.

Diabetes-related liver disease is finally being recognized as one of many metabolic complications of in diabetes, he continued. That recognition has led to a name change from NASH to MASH, metabolic dysfunction-associated steatohepatitis.

About two-thirds of adults with type 2 diabetes have MASH, 41 percent have significant liver fibrosis, and 15 percent have advanced fibrosis.

“Liver disease is a missed opportunity for early diagnosis and early intervention in primary care,” Dr. Bajaj said. “Any patient with type 2 diabetes, two or more metabolic risk factors, and steatosis on any imaging modality are at risk for MASH.”

Current ADA standards of care focus on liver disease and recommend treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist with demonstrated benefits in NASH. Pioglitazone or GLP-1 receptor agonists are preferred agents for adults with type 2 diabetes biopsy-proven disease or at high risk based on non-invasive testing.

“The real world is otherwise,” Dr. Bajaj said.

A recent article in BMJ Open Diabetes Research & Care found just 28 percent of MASH patient are prescribed a GLP-1 receptor agonist alone, 33 percent pioglitazone alone, and 2.7 percent both.

“Diabetes has been a long journey,” Dr. Bajaj said. “My father gave me interest in diabetes, but neither he nor I could have expected that I would be standing here today as your President, Medicine & Science.”

Also during the session, the following award recipients were recognized.

The session can be viewed on-demand by registered meeting participants on the virtual meeting platform. If you haven’t registered for the 84^th Scientific Sessions, register today to access the valuable meeting content through Aug. 26.