In our latest episode of The Hard Things About Healthcare, we spoke with Dr. Nestoras Mathioudakis, an endocrinologist at Johns Hopkins School of Medicine who is deeply committed to both patient care and cutting-edge clinical research. Dr. Mathioudakis focuses on addressing inequities in diabetes technology, alleviating clinician burnout, and harnessing the power of AI to shape the future of endocrine care.
Health Disparities in Diabetes Technology
One of Dr. Mathioudakis’s primary research areas involves understanding why certain populations face reduced access to critical diabetes tools like continuous glucose monitors (CGMs) and insulin pumps. In a large retrospective study of nearly 2,000 patients with type 1 diabetes, the findings were striking:
“We did this retrospective study in our clinics… unfortunately, at every step of the process, Black patients had substantially lower odds of all of those things occurring… it really couldn’t be fully explained by traditional social determinants of health…”
By shedding light on these inequities, Dr. Mathioudakis and his colleagues have driven important conversations on how to discuss, prescribe, and document technology use:
“…we realized after joining this collaborative that part of the problem in this area is that we're not capturing data about device use consistently in the electronic medical record…”
They have since applied for—and received—funding from JDRF (Breakthrough T1D) and the Helmsley Charitable Trust, which will help them expand their research and refine prescribing practices to ensure more equitable access.
AI to Alleviate Clinician Burnout
Beyond expanding technology access, Dr. Mathioudakis is a strong advocate for using AI to reduce clinician burden—especially in data-heavy fields such as endocrinology. He points out that endocrinologists can spend up to eight hours a day in electronic health records (EHRs):
“We spend upwards of eight hours per day in the EHR… if I have a clinic that starts at 8 a.m. and ends at 5 p.m. with 16 patients scheduled, I’m probably up at 6.30 pre-charting, and I’m probably wrapping up documentation at 10 or 11.”
Johns Hopkins is now testing solutions like AI-powered audio transcription that could streamline charting and free doctors to spend more time on face-to-face patient care.
Data Overload: Making Sense of CGMs and Pumps
Managing diabetes involves an avalanche of glucose readings and pump data. While this information is essential for treatment decisions, the process can eat into a patient’s entire appointment:
“…you’ll have a patient who doesn’t remember their password to their Dexcom app, doesn’t remember the password to the clarity, you’re spending 15 minutes as a physician dealing with password management.”
Dr. Mathioudakis sees seamless integration with EHRs as the holy grail—allowing clinicians to view CGM and pump data at a glance:
“I was thrilled that the diabetes technology meeting that Dexcom announced my integration. So you will share directly from your Dexcom device to my chart. The data will be in the EMR, it could not be easier to access that information and that we've got to make it easier for diabetes care because of the vast amount of information we actually have to collect before we can make any decisions.”
AI in Pre-Diabetes Prevention
Dr. Mathioudakis also envisions AI helping to prevent or delay the progression from pre-diabetes to full-blown diabetes. He’s currently wrapping up a 12-month randomized controlled trial of 368 adults with pre-diabetes who used an AI-based diabetes prevention program, comparing it directly to human-led interventions:
“This is going to be one of the first studies in all of medicine to compare head-to-head the standard human-based intervention to AI technology.”
Should AI-driven coaching prove as effective—and cost-effective—as traditional methods, it could open the door to greater accessibility and scalability in diabetes prevention.
Looking Ahead: Empowered Patients, Sustainable Solutions
By integrating AI into everyday workflows, streamlining data-sharing processes, and prioritizing equitable access to CGMs and pumps, Dr. Mathioudakis aims to lower the daily burden of diabetes management for both patients and clinicians. With continued research and the practical deployment of these technologies, endocrinology is poised for a future where:
Fewer patients slip through the cracks
Clinicians enjoy deeper, more meaningful interactions with patients
Critical diabetes tools become accessible to all
For more insights into the challenges shaping healthcare innovation—and how providers like Dr. Mathioudakis are meeting them—subscribe to Honey Health and stay tuned for future episodes of The Hard Things About Healthcare.
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