A provider toolkit with clinically relevant resources related to diagnosis and management of central precocious puberty.

CPP Provider Toolkit

A pair of experts in the management of diabetes review the role of insulin therapy and review the approval process for biosimilars, including the FDA's approval of the first interchangeable insulin biosimilar.

Interchangeable Insulin Biosimilars: A Game Changer in Diabetes Management

Podcast hosted by Diana Isaacs, PharmD, and Natalie Bellini, DNP aimed at providing real-world perspective on the latest advances in diabetes management.

When the words bias and stigma are brought up in medicine, they often refer to disparities related to the racial- or gender-based differences in care for patients. At the 

Association of Diabetes Care and Education Specialists (ADCES) 2022 annual meeting

, a presentation by Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness, took aim at addressing 

 and the impact it can have on patients as well as their ability to meet treatment goals.

According to the National Eating Disorders Association, weight stigma, also known as weight bias or weight-based discrimination, is defined as discrimination or stereotyping based on a person’s weight. With an interest in learning more about the history of weight stigma versus the current landscape and how a new emphasis on patient-first language in diabetes management may influence the fight to eliminate weight stigma in clinical care settings, 

reached out to Kahan, and that conversation is the subject of the following Q&A.

Understanding Weight Stigma, with Scott Kahan, MD, MPH

Endocrinology Network: Can you describe the origins of weight stigma and how it impacts patients today?

So, at the most basic level, weight stigma is driven by assumptions, and often judgments, about people based on their appearance. That goes back forever, because in Western societies and, in particular, in the US, there is just so much judgment about people based on appearance and weight is one of those areas that tends to be judged. Studies on weight stigma started in the mid-20th century, but really increased over the last 20-30 years.

We have been making real progress. Unfortunately, not nearly enough. The progress has largely been made in terms of minimizing explicit weight stigma, like just yelling out at somebody: "You're such a fat slob!". Or something like that. We don't see that nearly as much as we used to, but implicit weight stigma, which is much more subtle. Things where we make assumptions and have various beliefs about people that are, again, driven by their weight. Whether it is about their intelligence or whether about their likelihood to be compliant with medical recommendations. Those are quite common and even ubiquitous. That's something that we haven't made all that much progress on.

Endocrinology Network: How difficult is addressing weight stigma in clinical practice?

It doesn't have to be as difficult as it seems. Ultimately, what we want to communicate to patients is that we care about them and we want to help them to live healthy lives as well as to be able to participate in their lives and not be limited. Whether by their weight and weight problems, like diabetes, and, certainly, not to be limited by experiencing weight stigma, the important thing to get across to patients is to communicate that gaining a lot of weight is not a healthy thing, to communicate those healthful behaviors will improve their lives, their enjoyment of their lives, and their quality of life. Typically, this is done without words—it's done in the tone of our voice and it's done in the way we interact with them. But let them know that carrying excess weight doesn't make them a bad person, nor does losing weight make them a good person. We want to separate the condition and the behaviors from the value of the person itself.

Endocrinology Network: How does use of patient-first language in diabetes and obesity management help reduce weight stigma?

So, I certainly think there's a lot of overlap. In some ways, the use of patient-first language in obesity is following on the heels of the use of patient-first language in diabetes. The focus on that started earlier in the field of diabetes. It didn't start with diabetes, there's plenty of other areas that we were it's now second nature to us people first language.

For example, we don't call people with depression, depressives. It's just it's not natural and, largely, I think in diabetes we've made a lot of progress. It's not common anymore to call people with diabetes, diabetics. We're quite at the early stages of imparting the importance of using people-first language in obesity. So, we'll see where that goes.

I think it's a very important thing, in part, because it's a really easy thing. There are a lot of things that take time and money and effort. This is not one of them. It takes just a little bit of attention and a little bit of practice. It's nothing off our shoulders to utilize people first language and it makes a difference. No one likes to be called obese, let alone morbidly. So, there are plenty of studies showing that the terminologies we use can be more or less motivating for patients. It's a subtle thing, but it's an important thing and a valuable thing for all clinicians to consider when they interact with their patients.

Editor's note: This transcript has been edited for length and clarity.

Articles

Scott Kahan, MD, MPH, discusses the concept of weight stigma, its historical impact, and avenues for confronting weight stigma that currently exists in clinical care settings. 

Confronting Weight Stigma in Obesity Care, with Scott Kahan, MD, MPH

 highlights the reaction of certified diabetes care and education specialists to the POGO automatic blood glucose monitoring system.

With the uptake of the technology, which was billed as the first automatic blood glucose meter when approved by the FDA in 2016, increasing, results of the current study demonstrate a favorable response among diabetes care and education specialists with the POGO automatic blood glucose monitoring system.

“The relationship between the inherent complexity of the tools used to manage diabetes and their successful use in both the population of people with diabetes and the providers who deliver care to them is of increasing scientific interest. The POGO Automatic blood glucose monitoring system was designed to simplify testing anywhere by integrating test strips, lancets, and lancing devices into one disposable cartridge,” wrote investigators.

With an interest in learning more about the reactions and opinions of certified diabetes care and education specialist toward POGO automatic blood glucose monitoring system, Dave Yamauchi and Michael Tomasco designed the current study to aggregate data related to these reactions for the purpose of analysis. To do so, the present study was designed by dQ&A Research on behalf of Intuity Medical Inc, to collect feedback based on a series of 4 questions:

Is POGO automatic easy to teach, learn, and use?

Could POGO Automatic and Patterns improve the frequency of blood glucose checking and reduce instances of forgetting to check?

What are the reasons a patient who takes multiple daily doses of insulin might not check as frequently as recommended?

What are the top reasons for recommending a different blood glucose monitor?

The survey was sent to 300 individuals betweenJuly 27-August 4, 2021. Of these 300k, 289 completed survey responses. Investigators pointed out an honorarium was offered for completing the survey. Based on the aforementioned questions, participants were asked to rate their level of agreement to questions, with 1 indicating they strongly disagree and 5 indicating they agree strongly.

Initial analysis of survey results indicated 97% of respondents found POGO automatic blood glucose monitoring system was easy to use. Additionally, 94% agreed it was easy to learn, 93% felt it was easy to teach and 88% agreed use of the technology is easier to use than their patients’ current blood glucose monitor. Among the 242 respondents who provided information on what features make the system more convenient, 96% remarked it removed the need to handle separate lancets and test strips. Other notable responses included 86% of respondents noting use was much easier because use eliminates most of the steps required to check blood glucose with a traditional blood glucose monitor and 79% noted use was much easier because it resulted in fewer supplies to carry around.

Further analysis found respondents indicated the removal of need to handle separate lancets and test strips as well as the elimination of most of the steps required to check blood glucose with a traditional blood glucose monitor were identified as the factors most likely to encourage more frequent blood glucose check. Additionally, investigators found the leading reasons patients with MDI did not check the blood glucose as often as recommended was because they forgot to check (86%) or they were too busy (79%).

“POGO Automatic and Patterns could improve the frequency of patient blood glucose checking and reduce instances of forgetting to check,” wrote investigators

This study, “Certified Diabetes Care and Education Specialist (CDCES) Reactions to the POGO Automatic Blood Glucose Monitoring System,” was published at ADCES 2022.

A study presented at ADCES 22 details opinions of certified diabetes care and education specialists toward the POGO Automatic blood glucose monitoring system. 

Study Details Reaction to POGO Automatic Blood Glucose Monitors Among Diabetes Care and Education Specialists

Few fields in medicine have the amount of intersectionality as heart failure and 

. Decades in the future, many may wonder why it took both fields so long to recognize the sizable overlap between the conditions and impact they have on the quality of life among patients. With the revelations of the cardiorenal protective benefits of newer antidiabetes agents, namely SGLT2 inhibitors, driving this emphasis on a multidisciplinary approach, clinicians have been tasked with absorbing mountains of new data and applying it to clinical practice.

Association of Diabetes Care and Education Specialists (ADCES) 2022 Annual meeting

, this intersectionality between diabetes and heart failure management took centerstage during a presentation led by Christine Schumacher, PharmD, a professor of pharmacy practice at Midwestern University College of Pharmacy. With an interest in learning more about heart failure management in patients with diabetes, 

 reached out to Schumacher and fellow presenter Elizabeth Van Dril, PharmD, a clinical assistant professor of Pharmacy Practice at the University of Illinois at Chicago. That conversation is the subject of the video found below.

A presentation by Christine Schumacher, PharmD, and Elizabeth Van Dril, PharmD, at ADCES examines the current state of heart failure management in patients with diabetes. 

Spotlighting Heart Failure Management in Diabetes at ADCES 2022

Results of a new study provide evidence that suggests leveraging a combination of artificial intelligence and noninvasive imaging could provide a reliable, inexpensive screening method to improve detection rates of 

A study assessing the utility of electrocardiogram (ECG) recordings and a machine-learning algorithm, called the DiaBeats algorithm, results demonstrate use of the AI-integrated approach and, if externally validated, could be used to stratify individuals based on risk, which could prove useful in low-resource settings.

“In theory, our study provides a relatively inexpensive, non-invasive, and accurate alternative [to current diagnostic methods] which can be used as a gatekeeper to effectively detect diabetes and pre-diabetes early in its course,” wrote investigators. “Nevertheless, adoption of this algorithm into routine practice will need robust validation on external, independent datasets.”

As the notion of prediabetes as a benign condition has faded and the intrinsic risk associated with the disease has become recognized by the medical community, identification of low-cost, noninvasive methods for diagnosis or risk stratification for prediabetes and future diabetes has become paramount. With this in mind, a team from the Late Medical Research Foundation in Nagpur, India and M&H Research LLC sought to assess whether leveraging machine learning could identify prediabetes or diabetes from noninvasive cardiovascular imaging as the cardiovascular system bears some of the earliest signs of damage from the diabetic process.

To do so, investigators designed their study as an analysis using data from the Diabetes in Sindhi Families in Nagpur (DISFIN) study. A cross-sectional observational study aimed at estimating prevalence of type 2 diabetes in Sindhi families of Nagpur, 1262 of the 1462 individuals enrolled in the DISFIN study were included in the current analysis. From these 1262 individuals, investigators obtained data related to 10,461 time-aligned heartbeats recorded digitally.

This cohort had a mean age of 48 years and 61% were female. The overall prevalence of type 2 diabetes, prediabetes, and insulin resistance was 30%, 14%, and 35%, respectively. Investigators also pointed out hypertension, obesity, and dyslipidemia were present among 51%, 40%, and 36% of participants.

For the purpose of analysis, the 10,461 time-aligned heartbeats were split into a training set, a validation set, and an independent test set, which included 8892, 523, and 1046 beats, respectively. These recordings were processed with median filtering, band-pass filtering, and standard scaling. Investigators pointed out minority oversampling was performed to balance the training dataset prior to initiation of training and extreme gradient boosting was used to train the classifier that used the signal-processed ECG as input and predicted the membership to no diabetes, prediabetes, or type 2 diabetes classes.

Upon analysis, investigators found the DiaBeats algorithm predicted the classes with 97.1% precision, 96.2% recall, 96.8% accuracy, and 96.6% F1 score in the independent test set. Investigators noted a low calibration error (0.06) was observed with the calibrated model and the feature importance maps suggested that leads III, aVL, V4, V5, and V6 contributed most to the classification performance. Additionally, the predictions made by the algorithm matched the clinical expectations based on biological mechanisms of cardiac involvement in diabetes, according to investigators.

“Machine-learning-based DiaBeats algorithm using ECG signal data accurately predicted diabetes-related classes. This algorithm can help in early detection of diabetes and prediabetes after robust validation in external datasets,” investigators added.

Machine-learning algorithm to noninvasively detect diabetes and prediabetes from electrocardiogram

Called the DiaBeats algorithm, new research suggests leveraging the machine learning-based algorithm, combined with ECG recordings, could help predict increased risk of developing prediabetes and type 2 diabetes.

Artificial Intelligence Tools Could Use ECGs to Predict Type 2, Prediabetes 

Data from a new study underlines the need for heightened awareness and control of cardiovascular risk factors among men with 

gonadotropin-releasing hormone (GnRH) agonists

An analysis of Swedish national databases, results of the study, which included more than 5700 men with prostate cancer and 28,000 without prostate cancer, suggest there was a 53% greater 5-year risk of cardiovascular disease in men with type 2 diabetes who received a GnRH agonist for prostate cancer compared with their counterparts who did not receive GnRH agonists.

“In this population-based cohort study, there was an increased risk of cardiovascular disease in men with type 2 diabetes receiving GnRH agonists for prostate cancer. Our findings highlight the need to monitor and control cardiovascular disease risk factors in men with type 2 diabetes and prostate cancer who are receiving GnRH agonists. In addition, we found a decreased risk of hypertension in men receiving GnRH agonists, which warrants further study,” wrote investigators.

With new data leading to concerns surrounding use of GnRH agonists, a team of investigators from European institutions in the UK and Sweden sought to evaluate how use may influence cardiovascular disease risk among men with type 2 diabetes. With this in mind, investigators designed a nationwide population-based cohort study using data from 2006-2016 recorded within the Prostate Cancer Data Base Sweden version 4.1 and the Swedish National Diabetes Register. With this data, investigates created 2 cohorts, 1 included men with and without prostate cancer and another including men with prostate cancer who did and did not receive GnRH agonists.

From the databases, investigators identified 28,445 men without prostate cancer and 5174 men with prostate cancer for inclusion in their analyses. Both of these cohorts had a median age of 72.0 (SD, 11.0) years. Among the 5714 patients with prostate cancer, 692 received GnRH agonists and 3460 had no exposure to GnRH agonists, with investigators noting similar baseline characteristics between these groups.

The primary outcome of interest for the study was a 10% increase in predicted 5-year cardiovascular disease risk score. The secondary outcome of interest for the study was worsening hypertension, which was defined sing the European Society of Hypertension Guidelines. Associations between GnRH agonist use and the primary and secondary outcomes were assessed using Cox proportional hazards regression models.

Upon analysis, results indicated men with prostate cancer who received GnRH agonists had a 25% greater estimated 5-year cardiovascular disease risk score compared to those without prostate cancer (HR, 1.25 [95% CI, 1.16-1.36]) and a 53% greater estimated 5-year cardiovascular disease risk score compared to those with prostate cancer but who did not receive GnRH agonists (HR, 1.53 [95% CI, 1.35-1.74]). Further analysis demonstrated those who received GnRH agonists had a 30% lower risk of hypertension compared to those without prostate cancer (HR, 0.70 [95% CI, 0.61-0.80]) and a 32% lower risk of hypertension compared to those with prostate cancer but who did not receive GnRH agonists (HR, 0.68 [95% CI, 0.56-0.82]).

“In this nationwide, population-based cohort study of CVD risk in more than 30 000 men with type 2 diabetes with 11 years follow-up, men receiving GnRH agonists had an increased predicted 5-year CVD risk score. We also found a decrease in blood pressure in men receiving GnRH agonists and in men with prostate cancer,” investigators added.

Association of Gonadotropin-Releasing Hormone Agonists for Prostate Cancer With Cardiovascular Disease Risk and Hypertension in Men With Diabetes

New research suggests there was a 53% greater 5-year risk of cardiovascular disease in men with type 2 diabetes who received a GnRH agonist for prostate cancer compared with their counterparts who did not receive GnRH agonists.

GnRH Agonists for Prostate Cancer Could Increase CVD Risk in Type 2 Diabetes 

Natalie Bellini, DNP, FNP-BC, is a nurse practitioner specializing in diabetes management with the R&B Medical Group based out of Niagara Falls, NY. 

Among the most coveted honors among those in the diabetes community is the Association of Diabetes Care and Education Specialists (ADCES) award for the diabetes care and education specialist of the year. An award granted to recipients as an honor for special contortions to the field of diabetes management through dedication, innovation, and sensitivity to patient care, the 2022 awardee is Anastasia Albanese-O’Neill, PhD, director of community screening and clinical trials education at the Juvenile Diabetes Research Foundation (JDRF).

An individual who found unexpectedly found her way to the diabetes community as a result of personal connection, O’Neill joined the field later than many of her colleagues, but her time in the field has been characterized by her fervor to advance care of patients with type 1 diabetes. Ahead of the 

Diabetes Dialogue: Therapeutics, Technology, & Real-World Perspectives

 Diana Isaacs, PharmD, and Natalie Bellini, DNP, reached out to O’Neill to take part in an interview about what inspires her passion, her work within the field, and insight into the project she has decided to focus on during her year as ADCES Diabetes Care and Education Specialist of the Year.

That conversation is the subject of the special edition ADCES 22 episode of Diabetes Dialogue found below:

Diabetes Dialogue: Therapeutics, Technology, and Real-World Perspectives

 is available in an audio-only format on 

In this episode, the hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, sit down with ADCES 2022 Diabetes Care and Education Specialist of the Year Anastasia Albanese-O’Neill, PhD, to discuss her inspiration, her work within the field, and insight into the project she has decided to focus on during her year as ADCES Diabetes Care and Education Specialist of the Year.

Diabetes Dialogue: Sit Down with Diabetes Care and Education Specialist of the Year, Anastasia Albanese-O'Neill, PhD

The 2022 meeting of the Association of Diabetes Care and Education Specialists (ADCES) is the first in-person instance of the meeting since 2019. With more than 2500 attendees, the event not only showcased the latest advances in 

 for those in the field, but also provided an opportunity to connect with colleagues that did not exist during the height of the COVID-19 pandemic.

At the 4-day meeting attendees could attend more than 100 individual sessions dedicated to topics ranging from management of CKD to eliminating weight stigma and even suicide prevention issues. Held in Baltimore, MD, the 

 epitomized the unique aspects of the organization, and the profession, that has allowed diabetes care and education specialists to advance the field of diabetes management. While on-site the ADCES’s first in-person meeting in 3 years, 

 caught up with former ADCES diabetes educator of the year Gary Scheiner, MS, CDE, owner and director of Integrated Diabetes Services, to learn more about his reaction to the meeting, its programming, and having an opportunity to collaborate with colleagues.

Endocrinology Network: With this being the first in-person ADCES meeting since 2019, what has your impression been of this year’s meeting?

The in-person aspect is what makes this special for me. I can do a virtual conference, get the information, and I can follow up with questions virtually if I have to, but there is no replacement for the face-to-face interactions, meeting with colleagues, and meeting new people that I get to have here. Also, in the exhibit hall meeting there are opportunities with the various company representatives to learn more about what's new and what's in the pipeline.

Endocrinology Network: What do the themes and topics of discussion at the meeting say about the goals of the ADCES?

Those are valuable areas. I think they are areas that set the diabetes care and education profession apart from others in terms of getting into the trenches and really being able to communicate effectively with patients. I hear so many horror stories about people with all kinds of health conditions who just suffer and don't have good outcomes because of poor communication with their health care providers. If there's one thing a diabetes care and education specialist is good at its communicating. So, it's important because that's sort of our forte.

It's one thing to know something, it's another to communicate effectively, and being able to inspire and motivate others to take good care of themselves. So, I'm proud to be part of that.

Endocrinology Network: How does the diversity of attendees, both in traditional terms and in terms of titles and educational background, improve the ability of the ADCES?

Diversity is so important. It's another kind of trademark of this profession. People from so many different walks of life, whether somebody is from the mental health field, nursing, nutrition, dentistry, exercise, we have certain things in common, but we all have to learn from each other.

A good diabetes care provider has some skills in a lot of different areas. You have to know a little bit about the emotional side of it and be able to address it. You have to understand nutrition, at least to a certain extent. You have to be able to counsel patients on exercise and sports and so on and you also have to understand the medication side. So, having a diverse membership and diverse attendees at a meeting like this, it speaks volumes because we have a chance to learn from each other, collaborate, and expand our skill sets.

Endocrinology Network: As diabetes care and education specialists are tasked with learning more and more, is there any concern they may become overburdened in a similar manner to endocrinologists and primary care providers?

It's an interesting question. I mean, you have a breadth of knowledge and expertise that is forever expanding. I still think it pales in comparison to what an endocrinologist and a primary care physician have to do. It's a fraction, but I think it highlights the need for specialization in diabetes.

The fact that we can focus on just diabetes-related issues, hopefully, we're going to be able to stay on top of that. If you told any physician that you're only going to treat one condition, they could do a great job and they could really hone in on it, but they're asked to treat so many different conditions.

In our case, we're sticking to diabetes. In my case, I work primarily with type 1 diabetes. Those are mainly the areas that I focus on. I know there are other providers who focus almost exclusively on a type 2 diabetes space. So, I think there is some specialization developing even with the certified diabetes care and education specialist community and I'm optimistic that because we're just working in the diabetes space that we'll be able to able to keep up.

Gary Scheiner, MS, CDE, discusses themes and topics of discussion at ADCES 22.

Themes and Hot Topics at ADCES 22, with Gary Scheiner, MS, CDE

In many conversations related to diabetes, the focus is solely on patients with type 2 diabetes. Although patients with type 1 diabetes also face an increased risk of adverse outcomes as a result of the condition, they can go overlooked in larger, public health efforts. To combat this and improve care for patients with type 1 diabetes, multiple organizations have been formed with the specific intent of advancing management for this patient population. One of these organizations is the 

With a mission of improving outcomes for the entire T1D population through driving real-world evidence and collaborative change, the organization is regarded as a leader in the space. A nonprofit organization founded in 2009, the Boston-based organization has grown by leaps and bounds in the last 13 years, including becoming a leader in data collection among patients with type 1 diabetes. With a registry including more than 3000 patients with type 1 diabetes, the group partners with major organizations and trialists to help further research as well as patient care.

Association of Diabetes Care and Education Specialists (ADCES) 2022 Annual Meeting

 Diana Isaacs, PharmD, and Natalie Bellini, DNP, dive deeper into the T1D Exchange and how they are helping patients in a sit-down interview with David Walton, the chief executive officer of the T1D Exchange. In their conversations, Walton details how he became involved in the organization, how patients can become involved or contribute data, and what plans the organization has for the future.

In this special edition ADCES 22 episode of Diabetes Dialogue, Diana Isaacs, PharmD, and Natalie Bellini, DNP, are joined by David Walton, CEO of the T1D Exchange, who takes our hosts on a deep dive into the history of the organization, what it is doing right now to improve patient care, and how it expects to grow and improve management of type 1 diabetes into the future.

Diabetes Dialogue: The T1D Exchange, with David Walton

The Association of Diabetes Care and Education Specialists (ADCES) annual meeting is a showcase, not only of the latest advances in management of diabetes, but also of the passion diabetes care and education specialists bring with them to the frontlines of care. The 

At this year’s meeting, thousands of attendees took to the Baltimore Convention Center and on-demand sessions for updates in diabetes management. Among the attendees to this year’s ADCES annual meeting was Korey Hood, PhD, a staff psychologist and professor at Stanford University. Although not an endocrinologist, Hood is also the founder of 

, an online resource for patients with diabetes. Designed to provide patients with diabetes a one-stop shop for information related to diabetes management, including sections dedicated to finding a CGM device that is best for you, information on new sensors, testimonials on varying topics from other patients with diabetes, and a slew of resources on other topics within diabetes management.

Hood’s goals with DiabetesWise goes beyond just providing information to patients, it has expanded and now includes a site specifically designed for providers of patients with diabetes. This site, 

, is geared towards offering providers with resources to better equip them to manage patients with diabetes, including a device library, a prescription tool, and best practices resources. During his time at ADCES, Hood sat down for an extended conversation with Diana Isaacs, PharmD, and Natalie Bellini, DNP, the hosts of 

Diabetes Dialogue: Therapeutics, Technology, & Real-World Perspectives.

 That conversation with Isaacs and Bellini is the focus of the first of multiple special edition on-site episodes of Diabetes Dialogue recorded at the ADCES 22 annual meeting.

In this special edition of Diabetes Dialogue recorded on-site at ADCES 22, our hosts are joined by Korey Hood, PhD, a staff psychologist and professor at Stanford University. Founder of DiabetesWise and DiabetesWisePro, Hood talks to Diana Isaacs, PharmD, and Natalie Bellini, DNP, about his efforts and how the online resources are pushing care forward.

Diabetes Dialogue: Exploring DiabetesWise, with Korey Hood, PhD

Few fields in medicine have seem the extensive level of collaboration as cardiometabolic health in recent years. As a result of this growing acknowledgement of the intersectionality between metabolic, renal, and cardiovascular conditions, multiple specialties have been tasked with the responsibility of prescribing and optimizing care of 

Although much of this focus was, at least initially, focused on heart failure management in patients with type 2 diabetes. Further examination of SGLT2 inhibitors revealed renoprotective benefits and 

 joined endocrinologists and cardiologists as bearing responsibility for prescribing these agents to patients. More recently, finerenone has demonstrated its ability to reduce the progression of chronic kidney disease in patients with type 2 diabetes and the ongoing FIND-CKD trial will determine whether the nonsteroidal MRA could provide similar benefit in patients without diabetes.

Updates in CKD management in patients with diabetes was the focal point of a session led by Sara Reece, PharmD, director of interprofessional education and associate professor in the School of Pharmacy at the Philadelphia College of Medicine Georgia, at the 

Association of Diabetes Care and Education Specialist (ADCES) 2022 annual meeting

. To learn more about the expectations and updates related to CKD management for members of the diabetes care team, 

reached out to Reece for further insight into the topic. A transcript of that conversation can be found below.

Updates in CKD Management for Patients with Diabetes

Endocrinology Network: Can you describe the main points of emphasis from your presentation on CKD management in type 2 diabetes?

Just thinking in terms of CKD and knowing the role of SGLT2 inhibitors with the ADA Standards of Care for this year clearly stating, for folks with chronic kidney disease and diabetes, that it's appropriate as a first-line treatment to put them on an SGLT2 inhibitor. With folks with chronic kidney disease with and without type two diabetes, finerenone is important for delaying the progression of chronic kidney disease.

Unfortunately, oftentimes, screening is not being done with the GFR and the albuminuria, and it really needs to be done. So, those were the points of emphasis in our presentation. The other is the consideration of making sure folks are getting treatment when they need it and considering, again, right away starting with SGLT2 inhibitors, then also starting finerenone in those with chronic kidney disease to delay the progression.

I think if folks if really did look at some of that trial data, certainly there was enough evidence to justify it to use, especially given the statistics on the number of people that end up with end-stage renal disease that have chronic kidney disease. Although there are folks out there that really wait to look at more evidence. I think of myself, for example, when getting an Apple Watch. I waited a while to get an Apple Watch to let other people try it out. So, I think there's going to be the same type of thing with this particular medication.

Endocrinology Network: What are some areas in immediate need of addressing to improve patient care?

Well, I would say 2 things right off. First, I would say recognizing what I like to call the 3 musketeers: dyslipidemia, hypertension, and diabetes. All of those have to be addressed to really delay progression, or even development of CKD.

So, really addressing all three of those, and making sure that absolutely all three of those being treated appropriately. It's more than just glycemic control. Then the other piece is using time in range, beyond just a HbA1c, because it gives a lot more deeper data and looking at outcomes. That's important when it comes to CKD looking at that time in range.

Endocrinology Network: Is there any concern the growing intersectionality of diabetes and the expanding knowledge base could contribute to burnout among diabetes care and education specialists?

I can absolutely appreciate what you're saying. Working in a family medicine practice with family medicine physicians and between medicine residents, just seeing day in and day out the burden they carry. Burdens of course sounds negative, but just keeping pace of everything because of the umbrella conditions.

It's a little bit different for the Diabetes Care and Education Specialist, I think we're coming to realize as a specialty, diabetes is on a cardiometabolic spectrum. So, as we're keeping up with our knowledge, we've got to think about cardio, vascular, metabolic, and renal in addition to the glycemic aspects of it. So, I think coming to conferences like this are important because you have the opportunities for the sessions to really get that information. After this, when folks go back home to really watch sessions they could not attend and read journals. I know the ADA and the ADCES does a good job with their journals. So, really looking just beyond glycemia but putting in including articles on renal, cardiovascular, and metabolic topics.

Editor's Note: This transcript has been edited for length and clarity. 