As a girl growing up in the suburbs of Chicago, Neda Laiteerapong, MD, MS, would listen as her father told stories about his work. He was a general practitioner but also acted as an addiction medicine physician. His stories were often positive anecdotes about how he had managed to help a patient at a time before clear treatment protocols existed. However, as is so often the case in the moments that shape us, it was a less uplifting story that Laiteerapong remembers most. One evening her father came home distressed. He said that a patient with a substance abuse problem had become very angry. This patient had tried to light people on fire. “I thought, ‘I want to help that person,’” Laiteerapong says. “What made them get to that point, where they were so angry, their minds so out of control? I wanted to help that person.”
This has been her goal ever since: to help as many people as possible. The fourth generation in her family to go to medical school, Laiteerapong earned her MD from Boston University and then completed her residency at The University of Chicago Medicine, where she is currently a general internist and associate director for the Center for Chronic Disease Research and Policy.
It was during her residency, when she was looking for the best way to help as many people as possible, that she began to consider diabetes. “It affects so many people, including those who are historically marginalized or have lower access to care, and affects so many parts of people’s lives,” she says. “And there are things we can do for diabetes that actually work. We have good drugs that are accessible for a lot of people, and we have good evidence for how to prevent and treat diabetes.”
As a researcher, Laiteerapong works in translational epidemiology to ensure that these treatments get into the right hands. Using economic modeling, she determines whether a new drug or technology is cost-effective and how to overcome systemic problems that prevent patients from receiving care. “A big factor is the cost of medications and the difficulty patients can have in gaining access to drugs through insurance,” she says. Generic drugs are also an issue. “Some diabetes drugs are generic and effective, but it’s hard to enter the U.S. market as a generic drug. It usually takes several years before a generic can enter the market, even after the drug patent has expired.”
Laiteerapong’s research has also centered around the legacy effect of hyperglycemia. “The goal, after being diagnosed with type 2 diabetes, is to get your blood glucose back within a healthy range. The clinical guidelines say to do it very aggressively, but in clinical practice you see many people taking their time,” she says. “My research shows that the first year of blood glucose control in real-world populations has effects on people’s clinical outcomes 10 years later. If you don’t get your blood glucose under control now, when you’re newly diagnosed, then the window of opportunity to change the trajectory of your health closes.” She adds, “It’s like compound interest. You want to invest early, otherwise you won’t get the same payout at retirement.”
Laiteerapong’s mission to help as many people as possible is more than mere numbers. She’s recently moved into behavioral health and is working to integrate a holistic systems approach into how we discuss diabetes management. “Diabetes affects every part of your life, more so than some other diseases or acute illnesses,” Laiteerapong says. “Your doctors might ask you to adopt a very different lifestyle than you had before. That can obviously cause psychological distress, and this can lead to even bigger problems, like depression and anxiety.”
She is currently in the final stages of developing a U.S. diabetes simulation model that will help with forecasting the risk of diabetes complications and integrate newly recognized complications of diabetes, like depression and dementia. “Studies show that depression increases the risk for diabetes and diabetes increases the risk for depression,” she says. “It’s all interwoven.”
Like her father before her, Laiterapong recognizes a crucial need. “I think of people, their whole self,” she says, “and I don’t separate their physical and mental health.”
