From Barcelona to Montreal: Going beyond borders to champion the prevention and remission of diabetes

Interview with Dr. Josep Iglesies-Grau, a cardiologist doing a fellowship at the EPIC Center

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This article is adapted from the third edition of the Foundation’s magazine

“When it comes to health, an ounce of prevention is worth a pound of cure. It’s time to change the paradigm, rethink our system, which focuses on treatment, and invest more heavily in preventive medicine. I chose the Montreal Heart Institute because it’s simply the best place to make that shift happen.”

Originally from Catalonia, Dr. Josep Iglesies-Grau has been doing a fellowship in preventive cardiology at the EPIC Center since 2020. The young specialist is passionate about this promising new approach, in which the Montreal Heart Institute has played a key role on the world stage.

The EPIC Center: A hub for the future of preventive cardiovascular medicine

Having trained as a cardiologist in Barcelona, Dr. Iglesies-Grau instinctively turned to preventive medicine early on in his studies. “I immediately gravitated towards all aspects of cardiovascular prevention and the many facets of patient management. Together, nutrition, exercise, smoking cessation, the proper use of medications, and treatment adherence play a significant role in preventing heart disease and other conditions. The reasons why I’m interested in this field are obvious—I feel that this proven preventive approach isn’t being given enough attention,” he said.

In 2017, while doing his residency in Europe, Dr. Iglesies-Grau realized how much ground had to be gained. “In Europe, there’s extensive expertise when it comes to care and great advancements in cutting-edge technology, but when patients ask what they can do to prevent disease, what changes they should make to their diet, or what they should do to improve their health, the responses from healthcare professionals are quick and sometimes evasive, often because they don’t have the time. Diet isn’t discussed enough in European universities, and physicians aren’t taught how to write a personalized prescription for exercise,” he explained.

So, when he went in search of a health institution for a specialization in preventive medicine, he looked overseas. “Like the rest of Europe, Catalonia has no formal program in heart disease prevention. Two of my mentors told me about the EPIC Center and the possibility of receiving unparalleled training as part of a fellowship in preventive medicine here. I first came for a visit in 2018 to express my interest in the program, and I started my training at the Institute in 2020. I have absolutely no regrets,” he noted.

The Diabetes Clinic: Hope of reversing the disease

Since arriving at the EPIC Center, Dr. Iglesies-Grau has spent a lot of time working at the Diabetes Prevention Clinic. “A major part of my fellowship is devoted to the prevention and remission of prediabetes and type 2 diabetes—two risk factors for cardiovascular disease—and I’m investigating the possibility of reversing this disease through lifestyle changes. I’m also interested in early insulin resistance, a factor in the development of the disease that’s not given enough consideration,” he said.

“For the last 50 years, every person newly diagnosed with diabetes has simply been told, ‘Sorry, but you’re diabetic. Take this medication for the rest of your life… Get more exercise and eat healthy.’ That works only to a certain extent—the disease continues to progress and the patient is eventually readmitted to hospital. I’m trying to better understand the conditions associated with these situations and how they tie in with cardiac disorders to find a way to achieve remission. I hope to go from ‘There’s not much we can do’ to ‘We might be able to reverse the disease.’ It’s a huge change in paradigm,” he added.

A greater need to support a growing number of patients

The Diabetes Clinic at the EPIC Center is growing rapidly and now has more than 350 participants, including former patients of the Montreal Heart Institute who are prediabetic, diabetic or insulin-resistant, but also people with diabetes who aren’t associated with the Institute. Dr. Iglesies-Grau feels this rapid growth demands additional resources. “I firmly believe in the clinic and EPIC Center’s potential—we’re really pushing the prevention approach, and the results are promising. But there’s a long waiting list because we can’t meet the demand,” he said.

“To offer better patient management and improve our services, we need to hire more staff. We need qualified health professionals like nutritionists, kinesiologists and nurses to provide the appropriate advice and support. Prevention is another way of understanding disease—it takes a lot of coaching to inspire patients to change their habits and guide them through the process. What we offer at the EPIC Center and the Institute is rare in the world, and support from donors would allow us to help more people,” he added.

The dream of a health system focused on prevention

As he gets ready to embark on a promising career, Dr. Iglesies-Grau is hoping to be part of a major change in mindset in the healthcare field. “I hope to see more cardiac prevention centres across Canada, in Europe and around the planet. I’d love for us to be able to offer many different resources to the population at large and to the family physicians who closely monitor their patients’ health,” he said.

“It’s crazy to think that the same four risk factors are at the root of the diseases with the highest mortality rates—diet, smoking, alcohol use, and inactivity. It’s high time we invested more in preventive medicine, not only because managing these patients costs the State a lot of money, but also because it’s a valuable opportunity to markedly improve people’s quality of life. We need to put prevention at the heart of our health system, and in the process, the EPIC Center could become an international benchmark,” he noted.

After spending three years at the Montreal Heart Institute, Dr. Iglesies-Grau said he’s delighted to continue his path at such an outstanding facility. “I love the EPIC Center and I believe that what’s happening here today can make a real difference. As a clinical researcher, I’d like to help champion the cause by showing that prevention is the approach we need to invest in, and the Institute is a fantastic place to carry out research projects that are close to my heart,” he added.

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