Viral Shah, MD, is a Professor of Medicine in the Division of Endocrinology and Metabolism and is the Director of Diabetes Clinical Research at the Center for Diabetes and Metabolic Diseases at Indiana University School of Medicine. Dr. Shah serves as Chair of the Diabetes Technology Interest Group at the American Diabetes Association, Editor-in-Chief for Clinical Diabetology, and an Editorial Board Member for Diabetes Care and the Journal of Diabetes Science and Technology.  

Dr. Shah has over 200 research publications in the field of diabetes technology and therapeutics, as well as investigations of bone fragility and fracture prevention in adults with T1D. Most recently, Dr. Shah was the recipient of the 2024 Mary Tyler Moore and S. Robert Levine MD Excellence in Clinical Research Award from Breakthrough T1D.  

 

Interview with Viral Shah, MD 

In this interview, Dr. Shah discusses his involvement with the T1D Exchange Quality Improvement Collaborative (T1DX-QI) as an endocrinologist, clinical researcher, and trialist.  

The T1DX-QI was established in 2016— with the support of The Leona M. and Harry B. Helmsley Charitable Trust — to refine best practices and improve the quality of care and outcomes for individuals living with T1D. Growth has been tremendous, with over 60 endocrine clinics across the U.S. participating in the Collaborative. 

Fueled by top leaders in diabetes care, the T1DX-QI has become an engine of innovation and inspiration. By engaging with the shared, data-driven, and systematic methods of the T1DX-QI, clinics have seen unprecedented success in their approach to diabetes management.   

With members working closely to identify gaps in care, discover and refine best practices, and share research — the process has become knowledge-sharing at its very best. While collated data gives clinics a clear sense of “where they are,” it also demonstrates “where they can be” by applying shared, evidence-based methods for improving care. 

  

Take us back to the beginning — what led you to endocrinology? 

“It’s been a long, interesting journey for me,” said Shah, who was born and raised in India, where he also attended medical school. “Physicians were a rarity in the rural part of Gujarat, India, where I grew up. As part of a government program, they visited once a month.” 

“While no one in my family is from a medical background, I saw that the medical fraternity had so much to offer, and they became my role models. At a very early age, I decided it was something that I would like to do.”  

“In India, Gujarat is one of the states with a higher prevalence of diabetes and prediabetes at almost 20%,” explained Shah. About half of my medical residency program entailed diabetes management — so endocrinology was a natural fit for me. But it’s also personal, as my grandmother lived with type 2 diabetes and my uncle lives with type 1.” 

“When I started medical school in 1997, there weren’t antibody tests available in most parts of India. So, everyone was essentially diagnosed with ‘non-insulin dependent’ diabetes — unless proven otherwise. If they developed complications or needed insulin, then they had ‘insulin-dependent diabetes.’ Since then, the terminology has evolved into type 1 and type 2.” 

“We also used porcine and bovine insulin in India because developing countries are generally 30 years behind developed nations,” said Shah. “I still remember using Benedict’s test — holding up a test tube to see color changes associated with glucose in a patient’s urine and entirely manage their diabetes based on the result. Things have changed drastically in the last 10 years. It’s unbelievable.” 

 

What do you like best about what you do? 

“After medical school, I just felt like endocrinology was a ‘perfect fit’ for me.  Since I’ve only cared for people with diabetes for the last 12 years, I’ve been asked many times, ‘Why do you only practice diabetes — don’t you get bored by that?’” 

“My answer is no. Everyone who lives with diabetes is different. Not just as a person but their diabetes management, its complexities, and so forth. I feel like even though I mostly care for type 1 diabetes, there is so much to keep me engaged, especially in terms of changing technologies and ongoing research.” 

“As a student of science, I’m still learning,” said Shah. “It’s a constant process. And I will tell you, a lot of the teachings and learnings come from my patients who are living with diabetes 24/7.”  

 

How is Indiana University involved in the T1DX-QI?  

“I’ve had a long-standing relationship with T1D Exchange before the QI Collaborative,” said Shah. “Both Dr. Linda DiMeglio, Chief of Pediatric Endocrinology at Indiana University, and I were Steering Committee members for the T1D Exchange Registry, along with Dr. David Maahs, who I previously worked with at Barbara Davis Center and is now at Stanford.” 

“I can speak highly of the QI Collaborative because prior to these initiatives, we had no idea what the status of type 1 diabetes care looked like across the U.S. Now, it serves as an example of how this can be accomplished to transform care,” said Shah, who is the PI for adult endocrinology at Indiana University, along with Dr. Tamara Hannon, who is PI for pediatric endocrinology.” 

“It’s a unique approach that hasn’t been taken for other diseases — even those that are more prevalent — with patients, providers, and clinics participating to discover best practices to solve current problems.”

“Having a clinic-to-clinic QI approach to improve type 1 diabetes care is a Helmsley-funded vision which has transformed the care of type 1 diabetes, not just in the U.S.,” said Shah. “It’s become a massive program with transatlantic collaboration initiated by Dr. Maahs. I have never seen such a powerful scientific movement before.” 
 

Can you explain more about your T1D research areas? 

“I’m a clinical researcher and trialist, and so what I tell people is: ‘Anything that’s being tested on a bench and is ready to move into a clinic — that’s my role,’” said Shah. “’ I can help you to do that part.’” 

Shah explained that his clinical research expands into three different areas. “First, I do clinical trials of technologies, such as CGMs and AID systems, and adjunctive therapies, such as GLP-1RA, to improve diabetes outcomes — but that’s only one aspect.”

Shah’s second area of interest is understanding the meaning of numbers, for example, investigating CGM metrics such as Time in Range data and understanding what it truly means in terms of predicting diabetes and its complications.  

“A lot of my research is discovering what’s meaningful,” explained Shah. “Such as connections between metrics and outcomes — if they reveal anything about predictions, whether it’s a complication or a change from one stage of glycemia to another.” 

“A distinct example of this is the development of a CGM Dynamic Index by my postdoctoral student, Dr. Eslam Montaser. In our initial studies, it can predict the development of stage 1 to stage 2, or stage 2 to stage 3, type 1 diabetes earlier than oral glucose tolerance testing.” 

“CGMs are powerful tools providing 288 to 1440 readings per day,” said Shah. “Data tells a lot about an individual. But if you can’t connect this data to other variables, then it’s a failure of science. Precision medicine is an area that fascinates me — understanding numbers and how we can predict what will happen by looking into that window and seeing how we can manipulate it.” 

Shah’s final interest area is in diabetes-related complications. “As an adult endo, I tell my pediatric colleagues they don’t see everything I do — bone fragility being one of them. It’s something I’ve observed a lot in people with type 1 diabetes, and it’s really sparked my interest.”  

“I’ve led a lot of studies investigating why people with type 1 diabetes break bones easier than people without diabetes,” said Shah. “Take hip fractures, for example, the risk is 6-fold higher in people with type 1 — particularly in post-menopausal females.”  

“We’ve found the problem lies in bone quality, not density. This means the collagen in the bone and ligaments can become thicker and thicker because of glycation. This can present as a trigger finger, limited joint mobility, or frozen shoulder, and the glycation process is increased with out-of-range glucose values.” 

“While we don’t know how to reverse it right now, there is a lot of research underway,” said Shah. 

 

What is one of the most valuable things you’ve learned as an endocrinologist? 

“I’ve learned the importance of listening to my patients. As a teacher, it’s one thing I encourage my students,” said Shah. “Patients are the ones who teach us the most. Type 1 diabetes doesn’t follow a textbook, so it’s important to listen and learn.” 

 

What is your hope for the future? 

“I’m super optimistic about the future of type 1 diabetes,” said Shah.  

“Are we there in terms of a cure? My answer right now is no, but there is incredible research underway. Our understanding and care of managing diabetes has become so good that over the long run, outcomes will be closer aligned to those without diabetes.”   

 

What do you enjoy outside of work? 

“I’m a boring guy,” Shah said with a chuckle. “Most of the time, I’m thinking about science — ‘What’s the next project? Or, oh, this is a great idea, how can I execute it?’”  

“Outside of work, it’s all about my family and kids, who are 8 and 4 — playing soccer, field trips, and watching them grow. When I was in Colorado, I really enjoyed hiking.”