S2 Episode 6: What's Next? Emerging Trends in Type 2 Diabetes Management

Join Drs Carol Wysham and Silvio Inzucchi as they discuss how type 2 diabetes management has evolved over the years, and the most promising developments on the horizon. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982419). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Continuous Glucose Monitoring in Persons With Type 2 Diabetes Not Using Insulin https://pubmed.ncbi.nlm.nih.gov/34633261/ Macrovascular Complications of Type 2 Diabetes Mellitus https://pubmed.ncbi.nlm.nih.gov/30961498/ Rate of Decline in Kidney Function and Known Age-of-Onset or Duration of Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/34282181/ Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/26378978/ Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/27299675/ Tirzepatide Prescribing Information https://uspl.lilly.com/mounjaro/mounjaro.html#pi Glycemic Targets: Standards of Care in Diabetes-2023 https://pubmed.ncbi.nlm.nih.gov/36507646/ 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines https://pubmed.ncbi.nlm.nih.gov/30879355/ American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update https://pubmed.ncbi.nlm.nih.gov/35963508/ 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension https://pubmed.ncbi.nlm.nih.gov/30165516/ The Role of BNP Testing in Heart Failure https://pubmed.ncbi.nlm.nih.gov/17168346/ Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT) Rationale and Design https://pubmed.ncbi.nlm.nih.gov/32916609/ A Heart Disease Study of Semaglutide in Patients With Type 2 Diabetes (SOUL) https://clinicaltrials.gov/ct2/show/NCT03914326 GLP-1 Receptor Agonists and Kidney Protection https://pubmed.ncbi.nlm.nih.gov/31159279/ Glucagon-like Peptide 1 Receptor Agonists, Diabetic Retinopathy and Angiogenesis: The AngioSafe Type 2 Diabetes Study https://pubmed.ncbi.nlm.nih.gov/31589290/ A Study of Tirzepatide (LY3298176) Versus Insulin Lispro (U100) in Participants With Type 2 Diabetes Inadequately Controlled on Insulin Glargine (U100) With or Without Metformin (SURPASS-6) https://clinicaltrials.gov/ct2/show/NCT04537923 The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD https://pubmed.ncbi.nlm.nih.gov/34406410/ Comparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease https://pubmed.ncbi.nlm.nih.gov/19523535/ Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus https://pubmed.ncbi.nlm.nih.gov/30090738/

Join Drs Carol Wysham and Carel le Roux for practical, actionable strategies when targeting weight management as a key goal in type 2 diabetes prevention and treatment. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982418). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources UK Prospective Diabetes Study https://www.dtu.ox.ac.uk/ukpds/ National Diabetes Prevention Program https://www.cdc.gov/diabetes/prevention/index.html The Finnish Diabetes Prevention Study (DPS): Lifestyle Intervention and 3-Year Results on Diet and Physical Activity https://pubmed.ncbi.nlm.nih.gov/14633807/ The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It https://pubmed.ncbi.nlm.nih.gov/16855180/ Antidiabetics, Glucagon-like Peptide-1 Agonists https://reference.medscape.com/drugs/antidiabetics-glucagon-like-peptide-1-agonists Semaglutide (Rx) https://reference.medscape.com/drug/ozempic-rybelsus-wegovy-semaglutide-1000174 Weight Management: Obesity to Diabetes https://pubmed.ncbi.nlm.nih.gov/28848305/ Efficacy and Safety of Tirzepatide in Type 2 Diabetes and Obesity Management https://pubmed.ncbi.nlm.nih.gov/36750526/ Tirzepatide Once Weekly for the Treatment of Obesity https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

Opportunities abound to upgrade your technology in type 2 diabetes patient care. Join Dr Carol Wysham and nurse practitioner Davida F. Kruger in a discussion on the latest wearables and devices. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982417). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources SGLT2 Inhibitors and GLP-1 Receptor Agonists: Established and Emerging Indications https://pubmed.ncbi.nlm.nih.gov/34216571/ How May GIP Enhance the Therapeutic Efficacy of GLP-1? https://pubmed.ncbi.nlm.nih.gov/32396843/ Continuous Glucose Monitoring in Primary Care – Are We There? https://pubmed.ncbi.nlm.nih.gov/34845158/ Finger-Stick Glucose Monitoring: Issues of Accuracy and Specificity https://pubmed.ncbi.nlm.nih.gov/20351231/ FreeStyle Libre 3: "Almost Like Wearing Nothing" https://www.medscape.com/viewarticle/979580 FDA Okays Dexcom G7 Continuous Glucose Monitoring System https://www.medscape.com/viewarticle/985274 InPen https://www.medtronicdiabetes.com/products/inpen-smart-insulin-pen-system Patch Pumps for Insulin https://pubmed.ncbi.nlm.nih.gov/30070604/

Join Dr Carol Wysham and Dr Katherine Tuttle as they discuss advances in kidney disease management in patients living with type 2 diabetes. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982416). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification https://pubmed.ncbi.nlm.nih.gov/12859163/ KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/32998798/ Prevalence of Non-diabetic Kidney Disease and Inability of Clinical Predictors to Differentiate It From Diabetic Kidney Disease: Results From a Prospectively Performed Renal Biopsy Study https://pubmed.ncbi.nlm.nih.gov/36517108/ Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) https://repository.niddk.nih.gov/studies/edic/ UK Prospective Diabetes Study https://www.dtu.ox.ac.uk/ukpds/ Kidney Disease and Obesity: Epidemiology, Mechanisms and Treatment https://pubmed.ncbi.nlm.nih.gov/28090083/ Diet and Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/31728497/ SGLT2 Inhibitors and the Diabetic Kidney https://pubmed.ncbi.nlm.nih.gov/27440829/ GLP-1 Receptor Agonists in Diabetic Kidney Disease: From Clinical Outcomes to Mechanisms https://pubmed.ncbi.nlm.nih.gov/32694999/ Cardiovascular Outcomes Trials: A Paradigm Shift in the Current Management of Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/35927730/ Effects of Long-term Antihypertensive Treatment on Kidney Function in Diabetic Nephropathy https://pubmed.ncbi.nlm.nih.gov/4077229/ A Randomized Trial of Intensive Versus Standard Blood-Pressure Control https://pubmed.ncbi.nlm.nih.gov/26551272/ Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus https://pubmed.ncbi.nlm.nih.gov/20228401/ Effects of a Fixed Combination of Perindopril and Indapamide on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes Mellitus (the ADVANCE Trial): A Randomised Controlled Trial https://pubmed.ncbi.nlm.nih.gov/17765963/ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) https://pubmed.ncbi.nlm.nih.gov/36202661/ Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/27299675/ Empagliflozin in Heart Failure With a Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/34449189/ Cardiovascular and Renal Outcomes With Empagliflozin in Heart Failure https://pubmed.ncbi.nlm.nih.gov/32865377/

Join Dr Carol Wysham and Dr Javed Butler as they discuss the stealth complication of heart failure in patients with type 2 diabetes, including subtle signs and symptoms of heart failure and the importance of early detection and treatment. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982415). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/nejmoa1504720 Framingham Heart Study https://www.framinghamheartstudy.org/ Heart Failure https://emedicine.medscape.com/article/163062-overview Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association https://diabetesjournals.org/care/article/45/7/1670/147048/Heart-Failure-An-Underappreciated-Complication-of Brain-Type Natriuretic Peptide (BNP) https://emedicine.medscape.com/article/2087425-overview The Effect of Spironolactone on Morbidity and Mortality in Patients With Severe Heart Failure https://www.nejm.org/doi/full/10.1056/NEJM199909023411001 Eplerenone in Patients With Systolic Heart Failure and Mild Symptoms https://www.nejm.org/doi/full/10.1056/nejmoa1009492 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063

Drs Carol Wysham and Medha N. Munshi discuss the unique challenges and strategies when treating older adults with type 2 diabetes. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982414). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Type 2 Diabetes Mellitus https://emedicine.medscape.com/article/117853-overview Diabetes in Older Adults: A Consensus Report https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.12035 Geriatrics https://www.medscape.com/resource/geriatric Hypoglycemia https://emedicine.medscape.com/article/122122-overview Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline https://academic.oup.com/jcem/article/104/5/1520/5413486 Sodium-Glucose Cotransporter 2 Inhibitors: An Overview https://www.medscape.com/viewarticle/892957_9 Euglycemic Diabetic Ketoacidosis https://www.ncbi.nlm.nih.gov/books/NBK554570/

Who are the likely beneficiaries of more nuanced diabetes treatments, and how might these agents advance diabetes care? Silvio Inzucchi, MD, and guest Joshua Neumiller, PharmD, dig deep into recent drug developments. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/963278). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022 https://diabetesjournals.org/care/article/45/Supplement_1/S125/138908/9-Pharmacologic-Approaches-to-Glycemic-Treatment Patient Education Interventions Improve A1C Values https://pubmed.ncbi.nlm.nih.gov/35426637/ Therapeutics for Type-2 Diabetes Mellitus: A Glance at the Recent Inclusions and Novel Agents Under Development for Use in Clinical Practice https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8474306/ Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Medical Care in Diabetes—2022 https://diabetesjournals.org/care/article/45/Supplement_1/S39/138909/3-Prevention-or-Delay-of-Type-2-Diabetes-and

Are health equity and better outcomes within reach for all patients with type 2 diabetes? Drs Enrique Caballero and Silvio Inzucchi discuss how we can change the status quo. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963277). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources National Health and Nutrition Examination Survey https://www.cdc.gov/nchs/about/factsheets/factsheet_nhanes.htm Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016 https://jamanetwork.com/journals/jama/fullarticle/2757817 Diabetes mellitus in the Pima Indians: Genetic and evolutionary considerations https://pubmed.ncbi.nlm.nih.gov/6624895/ HbA1c Performance in African Descent Populations in the United States With Normal Glucose Tolerance, Prediabetes, or Diabetes: A Scoping Review https://www.cdc.gov/pcd/issues/2021/20_0365.htm

Patients with type 2 diabetes and obesity have more options today than ever before. Join host Dr Silvio Inzucchi and obesity expert Dr Ania Jastreboff as they discuss how to successfully support weight loss in people with type 2 diabetes. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963276). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Long-term Drug Treatment for Obesity: A Systematic and Clinical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928674/ What's New in Medications for Weight Management for People With Diabetes https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/new-in-medications-for-weight-management FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014 https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 Diabetes and Obesity -- Inextricable Diseases https://www.heraldopenaccess.us/openaccess/diabetes-and-obesity-inextricable-diseases Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline https://academic.oup.com/jcem/article/100/2/342/2813109

Want to prevent kidney disease progression in patients with type 2 diabetes? Join host Dr Silvio Inzucchi and nephrologist Dr David Cherney as they unpack the how and why behind current recommendations. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963275). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease https://kdigo.org/wp-content/uploads/2020/10/KDIGO-2020-Diabetes-in-CKD-GL.pdf Introduction: ADA Standards of Medical Care https://diabetesjournals.org/care/issue/45/Supplement_1 Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Medical Care in Diabetes — 2022 https://diabetesjournals.org/care/article/45/Supplement_1/S39/138909/3-Prevention-or-Delay-of-Type-2-Diabetes-and