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Advancing Care in Type 2 Diabetes and Obesity: A Coordinated, Guideline-Driven Approach
Nihar Desai, MD, MPH; Kenny J. Cole, MD, MS; Jacinda Mawson Nicklas, MD, MPH, MA; Esra Karslioglu French, MD, MBA, and Goutham Rao, MD, discuss how recent advances in GLP-1 receptor agonists and other therapies are transforming the treatment of type 2 diabetes and obesity by enabling a paradigm shift from reactive glucose management to proactive weight-focused care that addresses the root causes of cardiometabolic disease, while emphasizing the critical need for multidisciplinary teams, bias-free patient communication, and systematic healthcare delivery changes to overcome barriers like provider time constraints, medication access, and weight stigma.
EP. 1: Hormonal Adaptations in Type 2 Diabetes and Obesity
Panelists discuss how hormonal adaptations during weight loss in diabetes patients improve insulin sensitivity, while the DiRECT trial demonstrates that structured weight management programs can achieve diabetes remission in nearly half of newly diagnosed patients.
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EP. 2: Importance of Clinical Trials and Guideline Recommendations
Panelists discuss how ADA recommendations emphasize treating diabetes as part of overlapping conditions requiring cardiovascular and kidney protection, moving beyond just glycemic control to comprehensive care that addresses the whole person.
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EP. 3: Barriers Associated with Guideline-Directed Care
Panelists discuss how barriers to implementing evidence-based obesity and diabetes care include limited provider time, lack of multidisciplinary teams, insufficient education about obesity physiology, and high costs of medications and programs.
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EP. 4: The Role of Weight Management and Glycemic Control in the Management of Type 2 Diabetes
Panelists discuss how treating obesity as the root cause can create a "virtuous cycle" where weight loss improves insulin resistance, reduces medication needs, and enables better physical activity, breaking the traditional reactive approach to diabetes management.
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EP. 5: Improving Patient Outcomes Beyond Glycemic Control
Panelists discuss how GLP-1 receptor agonists represent a paradigm shift by providing weight loss, glycemic control, and cardiovascular protection simultaneously, moving focus beyond A1C control to comprehensive risk reduction.
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EP. 6: Taking a Cardiometabolic Health Approach in Patients with Type 2 Diabetes
Panelists discuss how implementing cardiovascular-kidney-metabolic health requires a team-based approach using the analogy of football, where physicians coach multidisciplinary teams to help patients overcome barriers and achieve health goals.
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EP. 7: Seamless Management Between Primary Care Providers and Specialists
Panelists discuss how UPMC's integrated delivery and financing system enables coordinated care through e-consults, proactive outreach to primary care physicians, case management, telemedicine, and streamlined referral processes that reduce friction for patients and providers.
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EP. 8: Supporting Patients and Primary Care Providers
Panelists discuss how supporting primary care providers requires moving beyond passive quality measures to peer-to-peer education, transparent performance feedback, multidisciplinary team resources, and creative care delivery models that address the "27-hour day" problem.
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