Diabetes Core Update- A Focus on Obesity Part 3 April 2024

In this special series on obesity, our host, Dr. Neil Skolnik, discusses the obesity epidemic with some of the foremost experts in the world. In Part 3 of the series, Dr. Skolnik is joined by Drs. Susan Fidler, Charles Vega, and Margot Savoy. Together, they talking about discussing obesity with patients – how to open the conversation on this sensitive topic, how to handle resistance to addressing the topic, and how to avoid stigma and bias. The Focus on Obesity series is a collaborative project of the American Diabetes Association and the American Academy of Family Physicians. The entire program will comprise a total of seven episodes: four episodes of Diabetes Core Update, which will cover topics of interest for family physicians, primary care clinicians, and other health care professionals; as well as three episodes of its sister podcast, Diabetes Day by Day, which will be tailored for people with overweight or obesity and their caregivers. The combined seven-episode program will be released between February and June 2024 and can be freely accessed at https://diabetesjournals.org/journals/pages/podcasts_obesity. Funding support for the “Focus on Obesity” series is jointly provided by Lilly and Novo Nordisk. Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Dr. Susan Fidler is Associate Director of the Family Medicine Residency Program at Abington Jefferson Health. Charles Vega, M.D., Clinical Professor of Family Medicine, Director, UC Irvine Program in Medical Education for the Latino Community, and Associate Dean in the School of Medicine at the University of California, Irvine. Margot L. Savoy, MD, MPH, FAAFP serves as senior vice president for education, inclusiveness, and physician well-being at the American Academy of Family Physicians

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis 2.     Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes 3.     Improved Glycemic Outcomes With Diabetes Technology Use Independent of Socioeconomic Status in Youth With Type 1 Diabetes 4.     Cardiovascular and Kidney Risks in Individuals With Type 2 Diabetes: Contemporary Understanding With Greater Emphasis on Excess Adiposity 5.     Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes   For more information about each of ADA’s science and medical journals, please visit www.diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

In this special series on obesity, our host, Dr. Neil Skolnik, discusses the obesity epidemic with some of the foremost experts in the world. In Part 2 of the series, Dr. Skolnik is joined by Drs. Deborah Horn, Thomas Wadden, and Donna Ryan. Together, they discuss, in detail, approaches to obesity including lifestyle, medications and bariatric surgery. The Focus on Obesity series is a collaborative project of the American Diabetes Association and the American Academy of Family Physicians. The entire program will comprise a total of seven episodes: four episodes of Diabetes Core Update, which will cover topics of interest for family physicians, primary care clinicians, and other health care professionals; as well as three episodes of its sister podcast, Diabetes Day by Day, which will be tailored for people with overweight or obesity and their caregivers. The combined seven-episode program will be released between February and June 2024 and can be freely accessed at https://diabetesjournals.org/journals/pages/podcasts_obesity. Funding support for the “Focus on Obesity” series is jointly provided by Lilly and Novo Nordisk. Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Thomas Wadden PhD,  is a Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania. He is the former director of the Center for Weight and Eating Disorders at Penn.   Donna Ryan, MD Professor emeritus at the Pennington Biomedical Research Center in Baton Rouge, Louisiana. Deborah B. Horn, DO, MPH, Medical Director for the UT Center of Obesity Medicine and Metabolic Performance; Fellowship Program Director, Allison Family Foundation Fellowship in Clinical Obesity Medicine and Metabolism, McGovern Medical School Selected references:  STEP-1 Trial (Semaglutide) – Wilding J,  Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine. 2021; 384(11), 989-1002. DOI: 10.1056/NEJMoa2032183 SURMOUNT-1 Trial (Tirzepatide) - Jastreboff, A.M., Aronne, L.J., Ahmad, N.N., et. al. Tirzepatide Once Weekly for the Treatment of Obesity. The New England Journal of Medicine. 2022; 387(3), 205-216. DOI: 10.1056/NEJMoa2206038 STEP – 4 Trial - Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021; 325(14), 1414-1425. DOI: 10.1001/jama.2021.3224 SURMOUNT-4 Trial - Aronne LJ, Sattar N, Horn DB, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38–48. doi:10.1001/jama.2023.24945 Diabetes Prevention Program Trial:  Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393– 403  Look Ahead Trial: Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54.

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     Leisure-time physical activity may attenuate the impact of diabetes on cognitive decline in middle-aged and older adults 2.     Outcomes of SGLT-2i and GLP-1RA Therapy Among Patients With Type 2 Diabetes and Varying NAFLD Status 3.     Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes 4.     Association of body weight time in target range with the risk of kidney outcomes in patients with overweight/obesity and type 2 diabetes mellitus 1 Diabetes 5.     Modifiable Lifestyle Factors, Genetic Risk, and Incident Peripheral Artery Disease among Individuals with Type 2 Diabetes   For more information about each of ADA’s science and medical journals, please visit www.diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

In this special series on Obesity, our host, Dr. Neil Skolnik will discuss the Obesity epidemic with some of the foremost experts in the world.  In Part I we will focus on the epidemiology of obesity, social disparities with regard to obesity, obesity as a chronic disease, the consequences of obesity and some of the reasons that the prevalence of obesity has increased over the last fifty years; in addition we will discuss how to evaluate patients for obesity. This special series is a collaborative project of the American Diabetes Association and the American Academy of Family Physicians and is sponsored by Novo Nordisk and Lilly. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Margot L. Savoy, MD, MPH, FAAFP serves as senior vice president for education, inclusiveness, and physician well-being at the American Academy of Family Physicians Walter C. Willett, M.D., Dr. P.H., Professor of Epidemiology and Nutrition at Harvard T.H. Chan School of Public Health, Professor of Medicine, Harvard Medical School Deborah B. Horn, DO, MPH, Medical Director for the UT Center of Obesity Medicine and Metabolic Performance; Fellowship Program Director, Allison Family Foundation Fellowship in Clinical Obesity Medicine and Metabolism, McGovern Medical School   Selected References: CDC - Adult Obesity Facts @ https://www.cdc.gov/obesity/data/adult.html Sumithran P, Prendergast LA, Delbridge E, eta al. Long-Term Persistence of Hormonal Adaptations to Weight Loss. N Engl J Med 2011; 365:1597-1604 Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995; 122:4816. Koh-Banerjee P, Wang Y, Hu FB, Spiegelman D, Willett WC, Rimm EB. Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men.Am J Epidemiol. 2004; 159:11509.

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial  2.     Occurrence of Gastrointestinal Adverse Events Upon GLP-1 Receptor Agonist Initiation With Concomitant Metformin Use   3.     Diagnostic yield of a proactive strategy for early detection of cardiovascular disease vs usual care in adults with type 2 diabetes or chronic obstructive pulmonary 4.     Low-Dose Anti-thymocyte Globulin: Treating Stage 2 Type 1 Diabetes 5.     Assessment of Glycemic Control by CGM, Hemoglobin A1c, Fructosamine and Glycated Albumin in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes   For more information about each of ADA’s science and medical journals, please visitwww.diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

In this special episode of Diabetes Core Update:  Focus on Geriatrics Part 3, our host, Dr. Neil Skolnik will discuss diabetes in a geriatric population with Dr. Medha Munshi, Director of the Joslin Geriatric Diabetes Program. In this episode we will discuss three cases, with each case presenting different challenges and ideas that are crucial in providing excellent diabetes care to older adults. This special episode is supported by an independent educational grant from Sanofi. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Medha Munshi, M.D.,   Director of the Joslin Geriatric Diabetes Program, Associate Professor of Medicine at Harvard Medical School

In this special episode on Residual Risk: A Focus on Triglycerides, our host, Dr. Neil Skolnik will discuss Residual Risk, Triglycerides and how to reduce residual risk with Dr. Charles Vega, Clinical Professor of Family Medicine and Associate Dean in the School of Medicine at the University of California, Irvine. This special episode is supported by an independent educational grant from Amarin. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Charles Vega, M.D., Clinical Professor of Family Medicine, Director, UC Irvine Program in Medical Education for the Latino Community, and Associate Dean in the School of Medicine at the University of California, Irvine.   Selected references referred to the in the Podcast: Icosapent Ethyl: REDUCE-IT - N Engl J Med 2019; 380:11-22 ADA Standards of Care: Diabetes Care 2023;46(Supplement_1):S158–S190 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: Circulation. 2023;148. doi: 10.1161/CIR.0000000000001168 See Episode 1 for further references.