Advancing Care in Type 2 Diabetes and Obesity: A Coordinated, Guideline-Driven Approach

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.

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.

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.

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.

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.

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.

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.

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.

Panelists discuss how effective provider-patient communication about weight requires opening conversations with empathy and collaboration, using phrases like "I'm concerned about your weight" and avoiding stigmatizing language while understanding patient motivations and readiness for change.

Panelists discuss how unconscious bias and weight stigma create barriers to care, requiring providers to acknowledge their own biases, create welcoming clinical environments with appropriate accommodations, and approach patients with compassion rather than judgment about willpower.

Panelists discuss how organizations must create system-wide cultural changes through staff training, appropriate clinical environments, evidence-based treatment access, and incentive structures that support rather than punish providers for addressing obesity as a chronic disease.

Panelists discuss how data systems and registries should focus on improving care quality rather than just reimbursement, with patient empowerment strategies that encourage individuals to advocate for better treatments like de-prescribing harmful medications.