Article

Type 2 diabetes (T2D) has become a noncommunicable pandemic. Approximately 14.7% of the US adult population has diabetes.¹ Additionally, nearly 25% of the geriatric population has diabetes and nearly 50% has prediabetes.² Needless to say, most practices, regardless of specialty, see many patients with diabetes. We have made major advances in diabetes treatments, yet diabetes mellitus is still the leading cause of legal blindness, nontraumatic amputation, and end-stage renal disease requiring dialysis.³ 

While the prevalence of diabetes in adults is concerning, what is even more startling is the significant increase of T2D within the pediatric population. It was not too long ago that we considered T2D an “adult-only” disease. Now, 24% of children with diabetes have T2D, and 18% of adolescents have prediabetes.^4,5 This is not the end of the story. Recent studies have identified that the earlier you are diagnosed with T2D, the less responsive you are to diabetes treatments—and the disease will progress more rapidly to complications. 
 

We know that pediatric patients are not little adults. There are important physiologic and metabolic differences in our younger patients. The RISE study found that adolescents have lower insulin sensitivity than adults.^4,6 The pancreatic beta cells are more responsive at first and there is less clearance by the liver, which may indeed make insulin resistance worse. Finally, pancreatic beta cell function declines more rapidly in adolescents than in adults.^4,6 These physiologic changes can be even worse during puberty. The hormonal changes seen in puberty accelerate and amplify insulin secretion and worsen insulin resistance, which can result in hyperglycemia in those at risk.^7,8

The other complicating factor is the rapid rise in obesity in Americans. While childhood obesity is not quite at adult levels, it is a major risk factor for adult obesity. The prevalence of obesity in childhood was recently estimated to be 19.7% and is still on the rise.⁹ Obesity can be diabetogenic as we see an increase in visceral obesity. This triggers an inflammatory response that leads to worsening systemic insulin resistance and lipotoxicity from elevated circulating free fatty acids.⁸ 

Lifestyle and behavioral factors are also important in adolescents with T2D. While they are more independent than younger children, they are still largely dependent on the foods that are available in their home. Family food choices have a major impact on our youth. Further, the foods that our adolescents eat outside the home are more likely to be fast food or ultra-processed foods, which have been shown to contribute to obesity and T2D. 

Family history is a strong predictor of risk for T2D. In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort, 89.4% of pediatric participants had a first-degree relative or grandparent with T2D.¹⁰ This highlights the importance of both genetic risk and living environment as risks for T2D. 

The American Diabetes Association recommends that all children with specific risk factors be screened for diabetes starting at the age 10 years or at puberty, whichever comes first.¹¹ The screening tests recommended for diabetes are currently the same as for adults, yet there are few data supporting this regimen. To diagnose diabetes, you can use any of the following screening tests: fasting glucose, glucose tolerance, or glycated hemoglobin (HbA1c).¹ 

Risk Factors That Should Prompt Diabetes Screening¹¹

Screening is recommended in children who are overweight (≥85%) or obese (≥95%) and who also have ≥1 of the following risk factors:

• Family history of T2D in a first- or second-degree relative
• Maternal history of gestational diabetes
• Low birth weight for gestational age
• Physical signs of insulin resistance or related conditions (eg, hypertension, dyslipidemia, polycystic ovary syndrome)
• High-risk race/ethnicity (Native American, African American, Pacific Islander, Latino)

Diagnostic Criteria for Diabetes Mellitus¹¹

A childhood or adolescent T2D diagnosis should be taken seriously and communicated to the patient and family in a timely manner. Treatment should start immediately. There are several factors that make managing T2D in adolescents more challenging. Children do not control key aspects of their life, including nutrition and, often, free time activity. There are a lot of social pressures to be “normal,” and having a chronic disease will definitely make the child feel “different” and potentially feel socially isolated. There are high rates of mood disorders in children with diabetes, which can make self-management even harder.¹²

As mentioned above, treatment should begin immediately upon diagnosis. This is because T2D in younger people tends to be more progressive and less responsive to treatment options, and patients are much more likely to develop.^1,13,14 These same complications can be seen in adult patients, but in younger patients they develop earlier in the disease; specifically, renal and neurologic complications occur at even higher rates.¹⁴ 

The initial treatment should include both family-based therapeutic lifestyle changes (ie, nutrition, physical activity intervention) and medication.¹¹ There are fewer US Food and Drug Administration–approved medication options for children and adolescents, and those treatments that have been approved are less durable in this population. 

Metformin and insulin are the most-used medications, but their initiation is often delayed, as therapeutic lifestyle change is tried first. This has not been shown to be an effective strategy and may even undermine the value of therapeutic lifestyle change if the family is told later that medication may still need to be added. 

Recent studies have shown the benefit of select glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as important therapeutic tools to treat T2D in adolescence. Dulaglutide, exenatide, and liraglutide have been shown to be safe and effective in trials for adolescents with T2D.^15-17 These agents reduce glucose and body weight and may be important tools to help reduce extra glycemic risks (eg, cardiovascular disease, kidney disease), but they have not been studied for this purpose yet. 

Further, there is good support for the use of bariatric surgery for adolescents. While this is a relatively new treatment option, early and mid-term results are favorable compared with medication-based strategies.¹⁸ Further studies are needed to determine the long-term benefits.

Take home points:

1. T2D is becoming increasingly common in our youth.
2. T2D, when diagnosed earlier in life, is more progressive, less responsive to treatment options, and associated with earlier complications.
3. New studies support the use of novel therapies such as GLP-1 RAs and metabolic surgery in this age group.

Dr. Shubrook and Dr. Antonia M. Molinari have written a comprehensive review on treatment options and current guidelines for the management of T2D in the pediatric population, which can supply further information.¹⁹ 

Type 2 diabetes (T2D) has become a noncommunicable pandemic. Approximately 14.7% of the US adult population has diabetes.¹ Additionally, nearly 25% of the geriatric population has diabetes and nearly 50% has prediabetes.² Needless to say, most practices, regardless of specialty, see many patients with diabetes. We have made major advances in diabetes treatments, yet diabetes mellitus is still the leading cause of legal blindness, nontraumatic amputation, and end-stage renal disease requiring dialysis.³ 

While the prevalence of diabetes in adults is concerning, what is even more startling is the significant increase of T2D within the pediatric population. It was not too long ago that we considered T2D an “adult-only” disease. Now, 24% of children with diabetes have T2D, and 18% of adolescents have prediabetes.^4,5 This is not the end of the story. Recent studies have identified that the earlier you are diagnosed with T2D, the less responsive you are to diabetes treatments—and the disease will progress more rapidly to complications. 
 

We know that pediatric patients are not little adults. There are important physiologic and metabolic differences in our younger patients. The RISE study found that adolescents have lower insulin sensitivity than adults.^4,6 The pancreatic beta cells are more responsive at first and there is less clearance by the liver, which may indeed make insulin resistance worse. Finally, pancreatic beta cell function declines more rapidly in adolescents than in adults.^4,6 These physiologic changes can be even worse during puberty. The hormonal changes seen in puberty accelerate and amplify insulin secretion and worsen insulin resistance, which can result in hyperglycemia in those at risk.^7,8

The other complicating factor is the rapid rise in obesity in Americans. While childhood obesity is not quite at adult levels, it is a major risk factor for adult obesity. The prevalence of obesity in childhood was recently estimated to be 19.7% and is still on the rise.⁹ Obesity can be diabetogenic as we see an increase in visceral obesity. This triggers an inflammatory response that leads to worsening systemic insulin resistance and lipotoxicity from elevated circulating free fatty acids.⁸ 

Lifestyle and behavioral factors are also important in adolescents with T2D. While they are more independent than younger children, they are still largely dependent on the foods that are available in their home. Family food choices have a major impact on our youth. Further, the foods that our adolescents eat outside the home are more likely to be fast food or ultra-processed foods, which have been shown to contribute to obesity and T2D. 

Family history is a strong predictor of risk for T2D. In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort, 89.4% of pediatric participants had a first-degree relative or grandparent with T2D.¹⁰ This highlights the importance of both genetic risk and living environment as risks for T2D. 

The American Diabetes Association recommends that all children with specific risk factors be screened for diabetes starting at the age 10 years or at puberty, whichever comes first.¹¹ The screening tests recommended for diabetes are currently the same as for adults, yet there are few data supporting this regimen. To diagnose diabetes, you can use any of the following screening tests: fasting glucose, glucose tolerance, or glycated hemoglobin (HbA1c).¹ 

Risk Factors That Should Prompt Diabetes Screening¹¹

Screening is recommended in children who are overweight (≥85%) or obese (≥95%) and who also have ≥1 of the following risk factors:

• Family history of T2D in a first- or second-degree relative
• Maternal history of gestational diabetes
• Low birth weight for gestational age
• Physical signs of insulin resistance or related conditions (eg, hypertension, dyslipidemia, polycystic ovary syndrome)
• High-risk race/ethnicity (Native American, African American, Pacific Islander, Latino)

Diagnostic Criteria for Diabetes Mellitus¹¹

A childhood or adolescent T2D diagnosis should be taken seriously and communicated to the patient and family in a timely manner. Treatment should start immediately. There are several factors that make managing T2D in adolescents more challenging. Children do not control key aspects of their life, including nutrition and, often, free time activity. There are a lot of social pressures to be “normal,” and having a chronic disease will definitely make the child feel “different” and potentially feel socially isolated. There are high rates of mood disorders in children with diabetes, which can make self-management even harder.¹²

As mentioned above, treatment should begin immediately upon diagnosis. This is because T2D in younger people tends to be more progressive and less responsive to treatment options, and patients are much more likely to develop.^1,13,14 These same complications can be seen in adult patients, but in younger patients they develop earlier in the disease; specifically, renal and neurologic complications occur at even higher rates.¹⁴ 

The initial treatment should include both family-based therapeutic lifestyle changes (ie, nutrition, physical activity intervention) and medication.¹¹ There are fewer US Food and Drug Administration–approved medication options for children and adolescents, and those treatments that have been approved are less durable in this population. 

Metformin and insulin are the most-used medications, but their initiation is often delayed, as therapeutic lifestyle change is tried first. This has not been shown to be an effective strategy and may even undermine the value of therapeutic lifestyle change if the family is told later that medication may still need to be added. 

Recent studies have shown the benefit of select glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as important therapeutic tools to treat T2D in adolescence. Dulaglutide, exenatide, and liraglutide have been shown to be safe and effective in trials for adolescents with T2D.^15-17 These agents reduce glucose and body weight and may be important tools to help reduce extra glycemic risks (eg, cardiovascular disease, kidney disease), but they have not been studied for this purpose yet. 

Further, there is good support for the use of bariatric surgery for adolescents. While this is a relatively new treatment option, early and mid-term results are favorable compared with medication-based strategies.¹⁸ Further studies are needed to determine the long-term benefits.

Take home points:

1. T2D is becoming increasingly common in our youth.
2. T2D, when diagnosed earlier in life, is more progressive, less responsive to treatment options, and associated with earlier complications.
3. New studies support the use of novel therapies such as GLP-1 RAs and metabolic surgery in this age group.

Dr. Shubrook and Dr. Antonia M. Molinari have written a comprehensive review on treatment options and current guidelines for the management of T2D in the pediatric population, which can supply further information.¹⁹ 

Type 2 diabetes (T2D) has become a noncommunicable pandemic. Approximately 14.7% of the US adult population has diabetes.¹ Additionally, nearly 25% of the geriatric population has diabetes and nearly 50% has prediabetes.² Needless to say, most practices, regardless of specialty, see many patients with diabetes. We have made major advances in diabetes treatments, yet diabetes mellitus is still the leading cause of legal blindness, nontraumatic amputation, and end-stage renal disease requiring dialysis.³ 

While the prevalence of diabetes in adults is concerning, what is even more startling is the significant increase of T2D within the pediatric population. It was not too long ago that we considered T2D an “adult-only” disease. Now, 24% of children with diabetes have T2D, and 18% of adolescents have prediabetes.^4,5 This is not the end of the story. Recent studies have identified that the earlier you are diagnosed with T2D, the less responsive you are to diabetes treatments—and the disease will progress more rapidly to complications. 
 

We know that pediatric patients are not little adults. There are important physiologic and metabolic differences in our younger patients. The RISE study found that adolescents have lower insulin sensitivity than adults.^4,6 The pancreatic beta cells are more responsive at first and there is less clearance by the liver, which may indeed make insulin resistance worse. Finally, pancreatic beta cell function declines more rapidly in adolescents than in adults.^4,6 These physiologic changes can be even worse during puberty. The hormonal changes seen in puberty accelerate and amplify insulin secretion and worsen insulin resistance, which can result in hyperglycemia in those at risk.^7,8

The other complicating factor is the rapid rise in obesity in Americans. While childhood obesity is not quite at adult levels, it is a major risk factor for adult obesity. The prevalence of obesity in childhood was recently estimated to be 19.7% and is still on the rise.⁹ Obesity can be diabetogenic as we see an increase in visceral obesity. This triggers an inflammatory response that leads to worsening systemic insulin resistance and lipotoxicity from elevated circulating free fatty acids.⁸ 

Lifestyle and behavioral factors are also important in adolescents with T2D. While they are more independent than younger children, they are still largely dependent on the foods that are available in their home. Family food choices have a major impact on our youth. Further, the foods that our adolescents eat outside the home are more likely to be fast food or ultra-processed foods, which have been shown to contribute to obesity and T2D. 

Family history is a strong predictor of risk for T2D. In the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort, 89.4% of pediatric participants had a first-degree relative or grandparent with T2D.¹⁰ This highlights the importance of both genetic risk and living environment as risks for T2D. 

The American Diabetes Association recommends that all children with specific risk factors be screened for diabetes starting at the age 10 years or at puberty, whichever comes first.¹¹ The screening tests recommended for diabetes are currently the same as for adults, yet there are few data supporting this regimen. To diagnose diabetes, you can use any of the following screening tests: fasting glucose, glucose tolerance, or glycated hemoglobin (HbA1c).¹ 

Risk Factors That Should Prompt Diabetes Screening¹¹

Screening is recommended in children who are overweight (≥85%) or obese (≥95%) and who also have ≥1 of the following risk factors:

• Family history of T2D in a first- or second-degree relative
• Maternal history of gestational diabetes
• Low birth weight for gestational age
• Physical signs of insulin resistance or related conditions (eg, hypertension, dyslipidemia, polycystic ovary syndrome)
• High-risk race/ethnicity (Native American, African American, Pacific Islander, Latino)

Diagnostic Criteria for Diabetes Mellitus¹¹

A childhood or adolescent T2D diagnosis should be taken seriously and communicated to the patient and family in a timely manner. Treatment should start immediately. There are several factors that make managing T2D in adolescents more challenging. Children do not control key aspects of their life, including nutrition and, often, free time activity. There are a lot of social pressures to be “normal,” and having a chronic disease will definitely make the child feel “different” and potentially feel socially isolated. There are high rates of mood disorders in children with diabetes, which can make self-management even harder.¹²

As mentioned above, treatment should begin immediately upon diagnosis. This is because T2D in younger people tends to be more progressive and less responsive to treatment options, and patients are much more likely to develop.^1,13,14 These same complications can be seen in adult patients, but in younger patients they develop earlier in the disease; specifically, renal and neurologic complications occur at even higher rates.¹⁴ 

The initial treatment should include both family-based therapeutic lifestyle changes (ie, nutrition, physical activity intervention) and medication.¹¹ There are fewer US Food and Drug Administration–approved medication options for children and adolescents, and those treatments that have been approved are less durable in this population. 

Metformin and insulin are the most-used medications, but their initiation is often delayed, as therapeutic lifestyle change is tried first. This has not been shown to be an effective strategy and may even undermine the value of therapeutic lifestyle change if the family is told later that medication may still need to be added. 

Recent studies have shown the benefit of select glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as important therapeutic tools to treat T2D in adolescence. Dulaglutide, exenatide, and liraglutide have been shown to be safe and effective in trials for adolescents with T2D.^15-17 These agents reduce glucose and body weight and may be important tools to help reduce extra glycemic risks (eg, cardiovascular disease, kidney disease), but they have not been studied for this purpose yet. 

Further, there is good support for the use of bariatric surgery for adolescents. While this is a relatively new treatment option, early and mid-term results are favorable compared with medication-based strategies.¹⁸ Further studies are needed to determine the long-term benefits.

Take home points:

1. T2D is becoming increasingly common in our youth.
2. T2D, when diagnosed earlier in life, is more progressive, less responsive to treatment options, and associated with earlier complications.
3. New studies support the use of novel therapies such as GLP-1 RAs and metabolic surgery in this age group.

Dr. Shubrook and Dr. Antonia M. Molinari have written a comprehensive review on treatment options and current guidelines for the management of T2D in the pediatric population, which can supply further information.¹⁹ 

Nick Burwick, MD, discusses important takeaways that he gathered from the AVAHO 2022 meeting in San Diego. In keeping with this year's theme of self-care in cancer care, the keynote speaker, 'Patient Lee' Tomlinson, made a big impact on Dr Burwick with a motivational message about practicing compassion for not only your patients, but also for yourself. This theme continued with Dr Fay Hlubocky's presentation on resources available for self-care.

Dr Burwick also appreciated the multidisciplinary aspects of this year's AVAHO meeting that showcased the range of VA Whole Health options, the implementation of the Schwartz Rounds, and a diverse group of cancer care providers.

Nick Burwick, MD, discusses important takeaways that he gathered from the AVAHO 2022 meeting in San Diego. In keeping with this year's theme of self-care in cancer care, the keynote speaker, 'Patient Lee' Tomlinson, made a big impact on Dr Burwick with a motivational message about practicing compassion for not only your patients, but also for yourself. This theme continued with Dr Fay Hlubocky's presentation on resources available for self-care.

Dr Burwick also appreciated the multidisciplinary aspects of this year's AVAHO meeting that showcased the range of VA Whole Health options, the implementation of the Schwartz Rounds, and a diverse group of cancer care providers.

Nick Burwick, MD, discusses important takeaways that he gathered from the AVAHO 2022 meeting in San Diego. In keeping with this year's theme of self-care in cancer care, the keynote speaker, 'Patient Lee' Tomlinson, made a big impact on Dr Burwick with a motivational message about practicing compassion for not only your patients, but also for yourself. This theme continued with Dr Fay Hlubocky's presentation on resources available for self-care.

Dr Burwick also appreciated the multidisciplinary aspects of this year's AVAHO meeting that showcased the range of VA Whole Health options, the implementation of the Schwartz Rounds, and a diverse group of cancer care providers.

Bernadette Heron, PharmD, summarizes the offerings at the AVAHO 2022 meeting, from the standard sharing of updates across disciplines and specialties to the more specific focus on the role of self-care in cancer care.

Importantly, Dr Heron underscores the connection between the concept of self-care and the implements required for its realization in the clinical setting, resulting in an assortment of tools that practitioners can draw on as they continue the conversation that drives the evolution of cancer care. 

Bernadette Heron, PharmD, summarizes the offerings at the AVAHO 2022 meeting, from the standard sharing of updates across disciplines and specialties to the more specific focus on the role of self-care in cancer care.

Importantly, Dr Heron underscores the connection between the concept of self-care and the implements required for its realization in the clinical setting, resulting in an assortment of tools that practitioners can draw on as they continue the conversation that drives the evolution of cancer care. 

Bernadette Heron, PharmD, summarizes the offerings at the AVAHO 2022 meeting, from the standard sharing of updates across disciplines and specialties to the more specific focus on the role of self-care in cancer care.

Importantly, Dr Heron underscores the connection between the concept of self-care and the implements required for its realization in the clinical setting, resulting in an assortment of tools that practitioners can draw on as they continue the conversation that drives the evolution of cancer care. 

Lauren Cliffel, MSW, describes how the AVAHO 2022 meeting and the main theme of "Self-care in Cancer Care" reestablished the feelings of joy and compassion that led her to choose a career as a cancer care provider in the first place. 

The inclusive character of even the larger sessions this year is noted, in which all interdisciplinary contributors to cancer care were addressed as central to the delivery of an informed and effective care of patients and, importantly, how this care is enhanced by a restored sense of purpose among all those engaged in the specialty of oncology.

Lauren Cliffel, MSW, describes how the AVAHO 2022 meeting and the main theme of "Self-care in Cancer Care" reestablished the feelings of joy and compassion that led her to choose a career as a cancer care provider in the first place. 

The inclusive character of even the larger sessions this year is noted, in which all interdisciplinary contributors to cancer care were addressed as central to the delivery of an informed and effective care of patients and, importantly, how this care is enhanced by a restored sense of purpose among all those engaged in the specialty of oncology.

Lauren Cliffel, MSW, describes how the AVAHO 2022 meeting and the main theme of "Self-care in Cancer Care" reestablished the feelings of joy and compassion that led her to choose a career as a cancer care provider in the first place. 

The inclusive character of even the larger sessions this year is noted, in which all interdisciplinary contributors to cancer care were addressed as central to the delivery of an informed and effective care of patients and, importantly, how this care is enhanced by a restored sense of purpose among all those engaged in the specialty of oncology.

Key data on chronic conditions in type 2 diabetes, presented at the 2022 European Association for the Study of Diabetes (EASD), are discussed by Dr Carol Wysham, from the University of Washington School of Medicine. 

Focusing on nonalcoholic fatty liver disease (NAFLD), Dr Wysham reports on a large national registry out of Sweden that explored the rates of microvascular complications in patients with NAFLD. The study showed that NAFLD is independently associated with chronic kidney disease and retinopathy. Coupling the findings with the rise in diabetes risk per population, the presence of NAFLD may represent an additional risk factor for microvascular complications.  

Next, Dr Wysham comments on another large, real-world study using data from the UK National Health Service (NHS), investigating a scoring system for noninvasive fibrosis, which the study concludes is a promising prognostic biomarker of liver and cardiovascular events in adults with type 2 diabetes.  

She then turns to a clinical study that evaluated whether the 2018 EASD/ADA routine treatment recommendation algorithm is associated with decreasing cardiovascular events and death in type 2 diabetes. The study found that nonadherence to the recommendations was associated with an increase in major adverse cardiovascular events and mortality.

--

Carol Wysham, MD, Clinical Professor of Medicine, Department of Medicine, University of Washington School of Medicine; Clinical Endocrinologist, Rockwood Center for Diabetes and Endocrinology, MultiCare Health Systems, Spokane, Washington 

Carol Wysham, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Endocrine Society; MultiCare Health Systems 

Received research grant from: Allergan; Abbott; Corcept; Eli Lilly; Mylan; Novo Nordisk; Regeneron 

Key data on chronic conditions in type 2 diabetes, presented at the 2022 European Association for the Study of Diabetes (EASD), are discussed by Dr Carol Wysham, from the University of Washington School of Medicine. 

Focusing on nonalcoholic fatty liver disease (NAFLD), Dr Wysham reports on a large national registry out of Sweden that explored the rates of microvascular complications in patients with NAFLD. The study showed that NAFLD is independently associated with chronic kidney disease and retinopathy. Coupling the findings with the rise in diabetes risk per population, the presence of NAFLD may represent an additional risk factor for microvascular complications.  

Next, Dr Wysham comments on another large, real-world study using data from the UK National Health Service (NHS), investigating a scoring system for noninvasive fibrosis, which the study concludes is a promising prognostic biomarker of liver and cardiovascular events in adults with type 2 diabetes.  

She then turns to a clinical study that evaluated whether the 2018 EASD/ADA routine treatment recommendation algorithm is associated with decreasing cardiovascular events and death in type 2 diabetes. The study found that nonadherence to the recommendations was associated with an increase in major adverse cardiovascular events and mortality.

--

Carol Wysham, MD, Clinical Professor of Medicine, Department of Medicine, University of Washington School of Medicine; Clinical Endocrinologist, Rockwood Center for Diabetes and Endocrinology, MultiCare Health Systems, Spokane, Washington 

Carol Wysham, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Endocrine Society; MultiCare Health Systems 

Received research grant from: Allergan; Abbott; Corcept; Eli Lilly; Mylan; Novo Nordisk; Regeneron 

Key data on chronic conditions in type 2 diabetes, presented at the 2022 European Association for the Study of Diabetes (EASD), are discussed by Dr Carol Wysham, from the University of Washington School of Medicine. 

Focusing on nonalcoholic fatty liver disease (NAFLD), Dr Wysham reports on a large national registry out of Sweden that explored the rates of microvascular complications in patients with NAFLD. The study showed that NAFLD is independently associated with chronic kidney disease and retinopathy. Coupling the findings with the rise in diabetes risk per population, the presence of NAFLD may represent an additional risk factor for microvascular complications.  

Next, Dr Wysham comments on another large, real-world study using data from the UK National Health Service (NHS), investigating a scoring system for noninvasive fibrosis, which the study concludes is a promising prognostic biomarker of liver and cardiovascular events in adults with type 2 diabetes.  

She then turns to a clinical study that evaluated whether the 2018 EASD/ADA routine treatment recommendation algorithm is associated with decreasing cardiovascular events and death in type 2 diabetes. The study found that nonadherence to the recommendations was associated with an increase in major adverse cardiovascular events and mortality.

--

Carol Wysham, MD, Clinical Professor of Medicine, Department of Medicine, University of Washington School of Medicine; Clinical Endocrinologist, Rockwood Center for Diabetes and Endocrinology, MultiCare Health Systems, Spokane, Washington 

Carol Wysham, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Endocrine Society; MultiCare Health Systems 

Received research grant from: Allergan; Abbott; Corcept; Eli Lilly; Mylan; Novo Nordisk; Regeneron 

Dr Anne Peters, of the Keck School of Medicine of the University of Southern California, reports on the latest guidelines and updates in glycemic control for persons with type 2 diabetes, as presented at the 2022 European Association for the Study of Diabetes (EASD).  

Dr Peters opens by reporting on the eagerly awaited joint ADA/EASD guidelines on the management of hyperglycemia in type 2 diabetes. The updated guidelines emphasize weight goals and holistic person-centered care as essential components of comprehensive management.  

Next, Dr Peters comments on the report of the 44-year UK Prospective Diabetes Study (UKPDS), which demonstrated the benefits of early intensive blood glucose control over decades. The study began tracking volunteers in 1977 and continued until 2021.  

Finally, Dr Peters reports on a real-world data study examining gender disparities in the time to initiation of cardioprotective glucose-lowering drugs in patients with type 2 diabetes and cardiovascular disease. The study showed that although the therapeutic initiation rate for woman and men is comparable after stroke and peripheral arterial disease, men are prescribed cardioprotective glucose-lowering drugs faster than women when diagnosed with heart failure or ischemic heart disease.  

--

Anne L. Peters, MD, Professor, Department of Clinical Medicine, Clinical Scholar, Keck School of Medicine of the University of Southern California; Director, USC Clinical Diabetes Programs, University of Southern California Westside Center for Diabetes, Los Angeles, California 

Anne L. Peters, MD, has disclosed the following relevant financial relationships:  

Serve(d) as a director, officer, partner, employee, advisor, consultant, or a trustee for: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi 

Received research grant from: Insulet; Dexcom; Abbott  

Received income in an amount equal to or greater than $250 from: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi; Insulet; Dexcom 

Stock options from: Teladoc; Omada Health (not even close to 5% equity) 

Dr Anne Peters, of the Keck School of Medicine of the University of Southern California, reports on the latest guidelines and updates in glycemic control for persons with type 2 diabetes, as presented at the 2022 European Association for the Study of Diabetes (EASD).  

Dr Peters opens by reporting on the eagerly awaited joint ADA/EASD guidelines on the management of hyperglycemia in type 2 diabetes. The updated guidelines emphasize weight goals and holistic person-centered care as essential components of comprehensive management.  

Next, Dr Peters comments on the report of the 44-year UK Prospective Diabetes Study (UKPDS), which demonstrated the benefits of early intensive blood glucose control over decades. The study began tracking volunteers in 1977 and continued until 2021.  

Finally, Dr Peters reports on a real-world data study examining gender disparities in the time to initiation of cardioprotective glucose-lowering drugs in patients with type 2 diabetes and cardiovascular disease. The study showed that although the therapeutic initiation rate for woman and men is comparable after stroke and peripheral arterial disease, men are prescribed cardioprotective glucose-lowering drugs faster than women when diagnosed with heart failure or ischemic heart disease.  

--

Anne L. Peters, MD, Professor, Department of Clinical Medicine, Clinical Scholar, Keck School of Medicine of the University of Southern California; Director, USC Clinical Diabetes Programs, University of Southern California Westside Center for Diabetes, Los Angeles, California 

Anne L. Peters, MD, has disclosed the following relevant financial relationships:  

Serve(d) as a director, officer, partner, employee, advisor, consultant, or a trustee for: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi 

Received research grant from: Insulet; Dexcom; Abbott  

Received income in an amount equal to or greater than $250 from: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi; Insulet; Dexcom 

Stock options from: Teladoc; Omada Health (not even close to 5% equity) 

Dr Anne Peters, of the Keck School of Medicine of the University of Southern California, reports on the latest guidelines and updates in glycemic control for persons with type 2 diabetes, as presented at the 2022 European Association for the Study of Diabetes (EASD).  

Dr Peters opens by reporting on the eagerly awaited joint ADA/EASD guidelines on the management of hyperglycemia in type 2 diabetes. The updated guidelines emphasize weight goals and holistic person-centered care as essential components of comprehensive management.  

Next, Dr Peters comments on the report of the 44-year UK Prospective Diabetes Study (UKPDS), which demonstrated the benefits of early intensive blood glucose control over decades. The study began tracking volunteers in 1977 and continued until 2021.  

Finally, Dr Peters reports on a real-world data study examining gender disparities in the time to initiation of cardioprotective glucose-lowering drugs in patients with type 2 diabetes and cardiovascular disease. The study showed that although the therapeutic initiation rate for woman and men is comparable after stroke and peripheral arterial disease, men are prescribed cardioprotective glucose-lowering drugs faster than women when diagnosed with heart failure or ischemic heart disease.  

--

Anne L. Peters, MD, Professor, Department of Clinical Medicine, Clinical Scholar, Keck School of Medicine of the University of Southern California; Director, USC Clinical Diabetes Programs, University of Southern California Westside Center for Diabetes, Los Angeles, California 

Anne L. Peters, MD, has disclosed the following relevant financial relationships:  

Serve(d) as a director, officer, partner, employee, advisor, consultant, or a trustee for: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi 

Received research grant from: Insulet; Dexcom; Abbott  

Received income in an amount equal to or greater than $250 from: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi; Insulet; Dexcom 

Stock options from: Teladoc; Omada Health (not even close to 5% equity) 

Dr Anne Peters, of the Keck School of Medicine of the University of Southern California, reports on the latest research on insulin therapy in adults with type 2 diabetes, presented at the European Association for the Study of Diabetes (EASD). 

Dr Peters highlights a clinical study evaluating whether bedtime is optimal for the administration of neutral protamine Hagedorn (NPH) insulin, also known as isophane insulin. The results indicate that titration of NPH plays an important role in avoiding nocturnal hypoglycemia.

Next, Dr Peters discusses the ONWARDS 2 study, a phase 3a trial looking at once-weekly insulin icodec vs once-daily insulin degludec in basal insulin–treated type 2 diabetes. The trial found insulin icodec to be superior to insulin degludec in reducing A1c.

Dr Peters also examines the SoliMix trial, which compared iGlarLixi once daily to twice-daily premix BIAsp 30 in suboptimally controlled type 2 diabetes. The trial evaluated whether patients currently on a basal-bolus regimen would have an equal or more effective response to once-a-day combination therapy. Results showed that iGlarLixi provided better glycemic control and weight benefit than the twice-daily BlAsp 30.

Finally, Dr Peters evaluates a study that looked at switching from a basal-bolus insulin treatment to insulin degludec + liraglutide combination. The combination proved at least as effective as the basal-bolus approach. 

--

Anne L. Peters, MD, Professor, Department of Clinical Medicine, Clinical Scholar, Keck School of Medicine of the University of Southern California; Director, USC Clinical Diabetes Programs, University of Southern California Westside Center for Diabetes, Los Angeles, California

Anne L. Peters, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or a trustee for: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi

Received research grant from: Insulet; Dexcom; Abbott

Received income in an amount equal to or greater than $250 from: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi; Insulet; Dexcom

Stock options from: Teladoc; Omada Health (not even close to 5% equity)

Dr Anne Peters, of the Keck School of Medicine of the University of Southern California, reports on the latest research on insulin therapy in adults with type 2 diabetes, presented at the European Association for the Study of Diabetes (EASD). 

Dr Peters highlights a clinical study evaluating whether bedtime is optimal for the administration of neutral protamine Hagedorn (NPH) insulin, also known as isophane insulin. The results indicate that titration of NPH plays an important role in avoiding nocturnal hypoglycemia.

Next, Dr Peters discusses the ONWARDS 2 study, a phase 3a trial looking at once-weekly insulin icodec vs once-daily insulin degludec in basal insulin–treated type 2 diabetes. The trial found insulin icodec to be superior to insulin degludec in reducing A1c.

Dr Peters also examines the SoliMix trial, which compared iGlarLixi once daily to twice-daily premix BIAsp 30 in suboptimally controlled type 2 diabetes. The trial evaluated whether patients currently on a basal-bolus regimen would have an equal or more effective response to once-a-day combination therapy. Results showed that iGlarLixi provided better glycemic control and weight benefit than the twice-daily BlAsp 30.

Finally, Dr Peters evaluates a study that looked at switching from a basal-bolus insulin treatment to insulin degludec + liraglutide combination. The combination proved at least as effective as the basal-bolus approach. 

--

Anne L. Peters, MD, Professor, Department of Clinical Medicine, Clinical Scholar, Keck School of Medicine of the University of Southern California; Director, USC Clinical Diabetes Programs, University of Southern California Westside Center for Diabetes, Los Angeles, California

Anne L. Peters, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or a trustee for: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi

Received research grant from: Insulet; Dexcom; Abbott

Received income in an amount equal to or greater than $250 from: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi; Insulet; Dexcom

Stock options from: Teladoc; Omada Health (not even close to 5% equity)

Dr Anne Peters, of the Keck School of Medicine of the University of Southern California, reports on the latest research on insulin therapy in adults with type 2 diabetes, presented at the European Association for the Study of Diabetes (EASD). 

Dr Peters highlights a clinical study evaluating whether bedtime is optimal for the administration of neutral protamine Hagedorn (NPH) insulin, also known as isophane insulin. The results indicate that titration of NPH plays an important role in avoiding nocturnal hypoglycemia.

Next, Dr Peters discusses the ONWARDS 2 study, a phase 3a trial looking at once-weekly insulin icodec vs once-daily insulin degludec in basal insulin–treated type 2 diabetes. The trial found insulin icodec to be superior to insulin degludec in reducing A1c.

Dr Peters also examines the SoliMix trial, which compared iGlarLixi once daily to twice-daily premix BIAsp 30 in suboptimally controlled type 2 diabetes. The trial evaluated whether patients currently on a basal-bolus regimen would have an equal or more effective response to once-a-day combination therapy. Results showed that iGlarLixi provided better glycemic control and weight benefit than the twice-daily BlAsp 30.

Finally, Dr Peters evaluates a study that looked at switching from a basal-bolus insulin treatment to insulin degludec + liraglutide combination. The combination proved at least as effective as the basal-bolus approach. 

--

Anne L. Peters, MD, Professor, Department of Clinical Medicine, Clinical Scholar, Keck School of Medicine of the University of Southern California; Director, USC Clinical Diabetes Programs, University of Southern California Westside Center for Diabetes, Los Angeles, California

Anne L. Peters, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or a trustee for: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi

Received research grant from: Insulet; Dexcom; Abbott

Received income in an amount equal to or greater than $250 from: AstraZeneca; Lilly; NovoNordisk; Abbott; Vertex; Zealand; ShouTi; Insulet; Dexcom

Stock options from: Teladoc; Omada Health (not even close to 5% equity)