Bob Amato and Mary O'Gara Look to the Future of Diabetes Care
In honor of Diabetes Forecast magazine’s 70th anniversary, we’re profiling people whose lives have been touched by diabetes—and who have touched the diabetes community.
The Heart of Perseverance
Some people can trace their life trajectory back to a single, ordinary moment. For Bob Amato, it was a casual question at a diabetes camp for boys when he was 12 years old. A counselor asked if he’d like to be on the track and field team that summer, and he accepted without much thought. After winning a few events, he got the running bug. Amato raced through high school, then college, and eventually accepted a coaching position at Providence College in Providence, Rhode Island, where he’s now a part of the school’s history: the Hall of Fame for men’s cross-country.
For many, this would be the mark of an impressive athletic career. But for Amato, the stakes were much higher. Diagnosed with type 1 diabetes at 7 years old in 1948 meant he was excluded from physical education and school sports. So when he joined Little League, he kept his diabetes quiet. “It was a different era,” says Amato, now 77. “I never said anything about my diabetes.”
He carried his secret with him into his high school track and field career, where he would participate in all-day events each Saturday. He took his insulin at home in the morning (he was using regular and NPH insulins at the time) and kept the dose consistent every day. On exercise-intensive days, such as Saturday track meets, he could up his carbohydrates to strike a balance. A large part of staying safe was remaining alert and being prepared. “I would have plenty of signals that a low was coming on, and I’d always carry food with me,” Amato says. He also kept urine glucose test strips in his pocket to use during breaks at the meet.
With college came more intense track meets. “I had to travel and carry needles and insulin, so I had to notify the coach,” he says. Amato remembers the exchange vividly: “My coach said, ‘Will it affect your running?’ And I said, ‘No.’ He said, ‘Alright, see you later.’ ”
Amato won a number of state championships with the team. After college, he took a job as a high school track and field coach. He never lost a meet, which spurred him to take on the cross-country coaching job at his college alma mater. From 1971 to 1985, Amato coached 26 Division I All-American athletes, two National Champions, and two World Champions, and he racked up four Big East titles and a 118-meet winning streak.
In retirement, Amato isn’t done winning, though he is done keeping his diabetes a secret. In 2015, he spoke in front of the U.S. Senate about the importance of Medicare coverage for continuous glucose monitors (CGMs), particularly for older adults who no longer get the warning signs associated with lows (a condition called hypoglycemia unawareness)—something he now experiences. “Hypoglycemia unawareness is the biggest problem I’ve ever had with diabetes,” he says. “But it’s been cleared up because of the CGM.”
Last year, Medicare began covering CGMs for people with diabetes who meet certain criteria—a decision that was personal to Amato. He had filed an appeal with Medicare to gain coverage for a CGM that would help him avoid dangerous lows. As soon as Medicare made the decision, Amato’s CGM was covered.
His hope for the future is simple: that researchers will put the finishing touches on a closed-loop artificial pancreas system (he participated in a trial last year) and then figure out a cure. “I think [researchers] are right on the edge,” he says. “It sounds wild, but they know what to do in order to cure diabetes. It’s just a way of figuring out how to do it.”
The Art of Education
Mary Margaret O’Gara, RN, CDE, knows a thing or two about diabetes. Not because she has it, but because she’s been educating people who do have it since 1981. “Even in the ’80s, I felt that self-management was the biggest piece to help control this chronic disease,” she says.
At the time, she was a nurse and diabetes educator and had just volunteered with the Colorado State Control Project, a precursor to the landmark Diabetes Control and Complications Trial (DCCT). She participated in a two-day educational program and left with a curriculum to teach her patients. “It was very basic, but it was a good knowledge base. And then the state followed these patients for two or three years to find out what happened after they had their education,” says O’Gara, now director of the Aspen Valley Hospital Diabetes Education Program in Aspen, Colorado.
The results? They had fewer complications, fewer emergency room visits, and cut costs both personally and for the community at large. “It was dramatic,” says O’Gara. Once the states with these control projects compared notes, it became clear that a larger trial was necessary. When the results of the DCCT came out, it changed the way health providers treated diabetes.
“In the 1980s, people with diabetes often had blood glucose in the 200 to 250 mg/dl range, and doctors didn’t blink an eye,” she says. The data that came from the DCCT confirmed a nagging feeling that O’Gara had for years. “I intuitively knew that we shouldn’t be leaving people’s blood sugars at 200 [mg/dl].”
In 2000, O’Gara developed an American Diabetes Association–recognized diabetes education program. Every year, more people are seeking out diabetes educators to help them manage their diabetes. “Medicare covering [diabetes education] was a huge factor for many people,” says O’Gara. (People with diabetes currently need a physician’s referral for Medicare to cover diabetes education.)
The future of diabetes education, says O’Gara, is telemedicine. “Self-management has to be tailored to where the patients are,” she says. “In the future, it’s all going to be electronic.”