Know Diabetes by Heart™ Professional Education Podcast Series

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Listen to Dr. Boris Draznin, an endocrinologist and specialist in diabetes and internal medicine, and Dr. Pam Kushner, a specialist in family medicine discuss how the new American Diabetes Association’s 2021 Standards of Care have changed and implications for practice.
Patients with T2D and CKD have a very high risk of CV events. Listen as Dr. Jorge Plutzky and Dr. Neha Pagidipati discuss new therapies to manage cardiovascular and renal risk in patients with T2D. Their discussion is based on new science presented during AHA Scientific Sessions 2020.
Listen as Dr. Eduardo Sanchez from the American Heart Association and Dr. Robert Gabbay from the American Diabetes Association discuss social determinants of health and disparities in health and health care in individuals with type 2 diabetes at risk for cardiovascular disease and COVID-19 and what can be done to improve their outcomes.
Listen to leading experts discuss the new Scientific Statement from the American Heart Association, “Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease,” where two newer groups of medications prescribed primarily for Type 2 diabetes treatment (SGLT2 inhibitors and GLP-1 receptor agonists) could significantly reduce risks associated with chronic kidney disease (CKD) and heart disease.
Listen to Dr. Jay Shubrook, DO, a primary care physician and Dr. Bankim Bhatt, MD, an adult endocrinologist discuss diabetes management, telemedicine, and lessons learned in the time of COVID-19.
Listen to members of the writing group for the new AHA statement on the clinical management of stable coronary artery disease in patients with T2D. Dr. Suzanne Arnold, Chair, and fellow writing group members, Dr. Prakash Deedwania and Dr. Mikhail Kosiborod will review highlights from the statement, including recent clinical trials which uncovered several new drugs that not only reduce glucose, but also improve cardiovascular and renal outcomes.
People with type 2 diabetes and chronic kidney disease are at three times higher risk of dying from a cardiovascular event. According to the National Kidney Foundation, the two main causes of chronic kidney disease are diabetes and high blood pressure. These two conditions were the primary diagnosis in 75% of kidney failure cases between 2015-2017. Listen to Dr. George Bakris, a nephrologist with expertise in diabetes-related kidney disease, and Dr. Peter McCullough, a cardiologist who is also board certified in internal medicine, discuss how to better screen and manage patients with type 2 diabetes who are at risk for cardiovascular disease and renal disease.
Listen to Dr. Nancy Albert, a clinical nurse specialist and lead researcher in heart failure and Dr. Mikhail Kosiborod, a cardiologist and expert in the fields of diabetes, cardiovascular diseases, cardiometabolic and cardiorenal syndromes, and quality care and outcomes discuss heart failure management in patients with type 2 diabetes and cardiovascular disease.
Studies on COVID-19 are revealing that patients diagnosed with COVID-19 and who have type 2 diabetes and history of cardiovascular disease are showing increased complications. Listen to Dr. Anne Peters, an endocrinology, diabetes and metabolism specialist and Dr. Diana Issacs, an endocrine clinical pharmacy specialist discuss tackling COVID-19 in their practices, including telehealth tips on getting started, treatment plan considerations, and ways to help patients prepare.
Listen to Dr. Jorge Plutzky, a cardiologist, and Dr. Joshua Joseph, an endocrinologist, discuss with patients the challenges and barriers they face living with T2D and CVD, and how health care providers can best support them.
Listen to Dr. Jennifer Green, an endocrinologist and diabetes and metabolism specialist and Dr. David Aguilar, a cardiologist and board certified in internal medicine, discuss how the new American Diabetes Association’s 2020 Standards of Care have changed and implications for practice.
Goal setting and discussing lifestyle management with your patients is critical in managing the link between diabetes and heart disease. Listen to Dr. Nathanial Clark, an endocrinologist, and Melissa Magwire, a nurse and CDE (Certified Diabetes Educator) discuss how to initiate the conversation and set your patient up for success.
In a recent survey of people age 45 and older with type 2 diabetes, conducted online by The Harris Poll, only half recognize their cardiovascular risk or have discussed their risk of heart attacks or strokes with their health care providers. Listen to cardiologist, Dr. Tracy Wang and endocrinologist, Dr. Robert Eckel discuss how a cardiologist can play a pivotal role in helping his/her patients with type 2 diabetes better manage their cardiovascular disease risk.
The management of type 2 diabetes to prevent cardiovascular disease has been focused on glycemic control and the use of drugs based on their ability to lower levels of glycemia. Listen to Dr. Robert Eckel and Dr. Chris Cannon discuss the use of anti-hyperglycemic agents with CVD benefits.
Diabetes education has positive effects not only on psychosocial and behavioral aspects of diabetes care, but also known to be a cost-effective treatment by reducing hospital readmissions and lowered risk for complications. Yet, many patients often do not receive DSMES (Diabetes Self-Management Education and Support) referrals. Listen to Nancy D’Hondt, a certified diabetes educator and registered pharmacist, Dr. Lillian Khor, a cardiologist and Dr. Jay Shubrook, an osteopathic family physician, discuss how they work with CDEs and the benefits found from referring patients to diabetes self-management programs and a certified diabetes educator.
Identifying and implementing optimal treatment strategies for patients living with diabetes and heart failure is critical to improving outcomes for this population. Shannon Dunlay, MD, MS discusses managing patients with diabetes who are at risk for heart failure or those that have heart failure. This podcast is based on the new scientific statement from the American Heart Association and the Heart Failure Society of America. *   *Type 2 Diabetes Mellitus and Heart Failure
The ASCVD Risk Calculator is a tool that enables healthcare providers and patients to estimate 10-year risk for atherosclerotic cardiovascular disease or ASCVD. Salim Virani, MD discusses the ASCVD risk calculator and why this assessment needs to be performed in patients with diabetes.
Shared decision-making is an effective approach to ensure patient and family involvement in decision-making and tailoring of treatment plans to meet goals. Jay Shubrook, DO, Robert Eckel, MD, and Patricia Montesinos, CRNP, CDE discuss how to interview and bring their patients to a collaborative discussion and joint treatment plan.
For people with diabetes, blood glucose isn’t the only important factor to track. New guidelines suggest the more than 110 million U.S. adults with diabetes or prediabetes should also manage their cholesterol as well as their blood glucose. Drs. Ronald Goldberg and Robert Eckel discuss the new American Heart Association’s 2018 Cholesterol Guidelines, released in November 2018, and the implications for type 2 diabetes along with pharmacotherapy and lifestyle interventions.
Christopher Cannon, MD and Ronald Goldberg, MD discuss the management and treatment of diabetes to prevent cardiovascular disease in the new American Diabetes Association’s 2019 Standards of Care.
Eduardo Sanchez, MD and William Cefalu, MD discuss the link between CVD and T2D    
Speaker 1:                    Welcome, and thank you for joining us as we launch a new and informative podcast series on cardiovascular disease and diabetes for healthcare professionals. The series is being developed by the American Heart Association and the American Diabetes Association with the goal of reducing cardiovascular death and incidents of heart attacks and strokes in people with diabetes. I'd like to introduce Dr. Eduardo Sanchez, Chief Medical Officer for Prevention and Chief of the Center for Health Metrics and Evaluation from the American Heart Association, and Dr. William Cefalu, Chief Scientific, Medical and Mission Officer from the American Diabetes Association, who will kick off this podcast series based on the new collaborative initiative between the American Heart Association and the American Diabetes Association, Know Diabetes by Heart. Speaker 1:                    The American Heart Association and the American Diabetes Association's Know Diabetes by Heart professional education podcast series is brought to you by founding sponsors Boehringer Ingelheim, and Eli Lilly and Company Diabetes Alliance, and Novo Nordisk. Eduardo Sanchez:         Thank you all for joining us today. I'm Eduardo Sanchez, and Will Cefalu and I are going to chat about this awesome initiative that we're involved with. Will, why don't you explain it? And then we'll just go back and forth. William Cefalu:             Okay. Thank you, Eduardo. Yeah, I am actually quite honored, as Chief Scientific, Medical and Mission Officer to represent the American Diabetes Association in partnership with the American Heart Association for this diabetes and cardiovascular disease initiative. As you know, the goal is really to help people with type 2 diabetes reduce their risk of disability and death due to cardiovascular events such as heart attacks and strokes. It's really designed to improve patients' public awareness and understanding about the link between type 2 and cardiovascular disease. It's designed to educate patients, it's designed to train healthcare providers, and support quality improvement all in the goal to ultimately reduce events rates from cardiovascular disease. This is a multi-year initiative, and many platforms are involved. William Cefalu:             But the bottom is, we do know that the number one killer of those with diabetes is going to be cardiovascular events, and this program, in partnership with our sponsors Novo and BI and Lily, is designed to put together this collaboration so that we can educate patients, increase awareness toward that goal of reducing cardiovascular disease. Eduardo, would you like to add anything to that? Eduardo Sanchez:         Sure. I think it's safe to say that our two organizations are each committed to the things that we do. ADA, the treatment of people with diabetes, type 1, type 2, and other forms of diabetes. And the American Heart Association is dedicated to addressing the risk factors associated with cardiovascular disease and stroke with reducing death from cardiovascular disease and stroke, and here recently with promoting ideal cardiovascular health. But having said all that, the Venn diagram, if you will, of AHA and ADA has a group of people inside of it that we both feel it's critically important to double down and focus more attention than we have. Eduardo Sanchez:         We know that, as Will said, people with type 2 diabetes are at increased risk, and the number one cause of death among people with type 2 diabetes, cardiovascular disease and stroke. But what maybe we don't know and share enough is that the degree to which we manage blood glucose, blood pressure, and cholesterol is the degree to which we can dramatically reduce the risk of cardiovascular disease and stroke in persons with type 2 diabetes. Eduardo Sanchez:         When you add to that the advent of new medications that had been demonstrated to be cardio-protective, that is those people on those drugs who have type 2 diabetes to control their blood glucose see a reduction in major cardiovascular events. That includes heart attacks, stroke, heart failure, all the things you don't want to have. So there's no better time than now for the American Heart Association and the American Diabetes Association to be working together to deliver the message to patients with type 2 diabetes that getting cardiovascular disease risk factors under control is very important, and getting the message to providers that paying attention to all three and making evidence-based, algorithm-based decisions about medications will result in a dramatic reduction in the likelihood that their patients will develop cardiovascular disease, advanced cardiovascular disease, or death from cardiovascular disease. William Cefalu:             So I appreciate that, Eduardo. I think the most important thing, and really, I guess, a cornerstone of this initiative is the science behind it, and you alluded to that, but it's really the science that's driving this initiative. Again, the studies to cardiovascular outcome studies over the many past years have demonstrated that we have agents now that not only improve glucose control, but can reduce cardiovascular mortality, and many of our treatment algorithms are changing to reflect that direction. William Cefalu:             The other important thing about this initiative is, again, when we look at the number of individuals in this country that are living with diabetes today, over 30 million. And again, as we've stated, they're twice as likely to die from a cardiovascular event, the leading cause of death in this population. So the idea is to educate regarding this link between cardiovascular disease and diabetes, and hopefully, again, to shift this toward where there's increased public awareness and better treatment. William Cefalu:             The other important factor to know is that someone with diabetes, although having twice the risk, is expected to have a life expectancy about 12 years shorter than someone without diabetes, due to cardiovascular disease. So if anything, this initiative is designed to help those people live longer and happier lives, and reduce the incidence, and that is, again, a fact that I think most of our patients don't appreciate, a fact that most providers don't know the proper way to treat or advise on cardiovascular disease. William Cefalu:             So again, about two thirds of people living with diabetes say they're at increased risk for cardiovascular disease, so they recognize that. But less than half say they've actually discussed this risk with their healthcare provider. So really the goal of this initiative is to reverse that, and to change that, and to get patients and physicians talking about this increased risk and actually putting in management strategies to address it. Eduardo Sanchez:         Well, Will, those are such important things to highlight. I think another really important point, just a reminder to our clinician brethren, is that people don't walk around with just one thing, and when we look at the numbers or the percentages of people who, as an example, have diabetes and hypertension, that represents about 10% of the adult population in the United States. And when we look at the percentage of people who have hypertension, diabetes, and high cholesterol, that represents about 6% of the population. Eduardo Sanchez:         Now, admittedly, this initiative is focused first on people with type 2 diabetes, but let's remind all of us that of adults with diabetes, 90 plus percent have type 2 diabetes. The important thing there is that managing those various contributing, concurrent diseases is critically important. Eduardo Sanchez:         Some data that comes from a diabetes care paper just a couple of years ago reminds us that the degree to which we control the risk factors or the conditions involved, blood glucose, blood pressure, blood cholesterol, if any one of the three are controlled, cardiovascular disease event risk is lowered by 36%. Any two of the three, that risk reduction goes to 52%. And if you are controlling all three of three, that risk reduction goes to 62%, so it is critically important that we manage blood glucose, blood pressure, and lipids in our patients. Eduardo Sanchez:         So, Will, would you mind sharing with me, so I can hear it again and just with the folks listening, the new algorithm which will provide additional guidance to individuals taking care of people with type 2 diabetes so that in addition to managing blood pressure, and blood cholesterol, and blood glucose, choice of any hyperglycemic agents is now informed by a new algorithm. William Cefalu:             Absolutely, and actually the newer algorithm was released at the European Association for the Study of Diabetes on October 5th. About every three years, the ADA and the EASD have a consensus conference and statement on treatment of hyperglycemia. In this past year it was really a paradigm change, again, based on the direction of the recommendations, and based on the evidence over the past few years. William Cefalu:             About a year ago, in our standards of care, we suggested that treatment of individuals with type 2 diabetes, if they're not at goal obviously should be on metformin, but that was the first time the ADA actually recommended that if there's underlying atherosclerotic disease that you consider one of two classes of compounds, an SGLT2 inhibitor or a receptor agonist, based on the evidence to date. William Cefalu:             Well, the new consensus statement actually takes it a step further. What I really like about the consensus statement is, first and foremost, is this is a patient-centered approach. The goal is not only to reduce complications, complications being small vessel disease, that's eye disease, kidney disease, and nerve disease, but also macrovascular complications, the heart disease and the stroke. So the first order of business is to actually have that discussion with the patient, assess underlying cardiovascular risk factors, assess psychosocial conditions, age, gender, and at that particular point there should be shared decision-making with the patient on what's the best treatment option for that particular patient. William Cefalu:             Now, if the patient is not at goal, and the lifestyle is a cornerstone of treatment, metformin is added. But the patient is not at goal. Then, it's further stratified, further stratified if the atherosclerotic cardiovascular disease predominates, or whether heart failure and chronic kidney disease predominates. Again, you would choose either a receptor agonist in that class, or the class of SGLT2 inhibitors. So the decision point is made early on in talking to the patient whether one of these new agents is going to be utilized. William Cefalu:             Another important thing is the decision on hypoglycemia that reduces quality of life. You will have options as to which classes are used and recommended to reduce hypoglycemia. Another recommendation may be, if it's important, about weight gain. There'll be options suggested for weight gain, or for that matter, if you're in resource-constrained areas, options for glucose improvement based on resource-constrained areas. William Cefalu:             So the algorithm basically starts stratifying treatment based on the underlying conditions, and the preferences, and a choice between the patient and the physician. So really, this is a paradigm change, and I really like the fact that early on in discussions with the patient they have the discussion of cardiovascular disease, cardiovascular risk, and talking about all the risk factors that you alluded to, Eduardo. Blood pressure, weight, and have all those factors accounted for in a treatment strategy for type 2 diabetes. William Cefalu:             Again, type 2 diabetes and cardiovascular disease is linked. It's time that we heighten awareness for the patients. It's time that we provide the tools for the provider, because this, again, is a paradigm change as far as treatment strategies moving forward. Eduardo Sanchez:         So, Will, one of the things you mentioned a moment ago was about lifestyle being the cornerstone. I mean, I think it's worth us reminding ourselves that lifestyle is critically important across the three conditions that we've been talking about. Type 2 diabetes, high blood pressure, dyslipidemia. And in all of those instances, it is fundamentally about eating more healthfully and engaging in more physical activity than probably one is currently engaged in. And both of those things contribute to weight maintenance, and maybe even weight loss when that's appropriate, and in some instances there is some specific instruction given to what one should eat and what one shouldn't eat. Eduardo Sanchez:         But let's not forget that how you eat, and what you eat, and how much you eat affects every one of these conditions, and affects even how well your medications are going to work, and affects your weight, and how physically active you are is also one of the factors that we want to make sure that we are highlighting as a cardiovascular risk factor modification on the one hand, or type 2 diabetes management on the other hand. It's two sides of the same coin. Very, very important part of the treatment regimen. Eduardo Sanchez:         That extends, then, to another thing that we've talked about in our partnership, and that is a team-based approach to care. So Will and I do not believe that all of this can or should fall on the shoulders of the physician or the other non-physician provider who is doing the direct patient care, that this will take a team-based approach. It may, and should, involve diabetes educators, dieticians, perhaps even exercise trainers, working with pharmacists and pharmacies. So really a systems approach to accomplishing the goal, the ultimate goal, which is saving lives by managing diabetes and cardiovascular disease risk to the maximum. William Cefalu:             So, Eduardo, you make a very good point as far as the focus of this initiative is to address that the primary care level, as we recognize most of diabetes is going to be treated at the primary care level, and your point is very well-taken that we're not talking about just primary care providers, but allied health is incredibly important in this fight. When we talk about certified nurse educators, physicians assistant, nurse practitioners, et cetera, and providing them the tools they need, first and foremost, to recognize the risk is going to be incredibly important. But equally important is what management strategy needs to be put in place, and how you discuss this with your patient and bring it up with your patient is going to be incredibly important. William Cefalu:             We know that primary care providers are incredibly busy, so it's going to be very important that we provide the tools appropriate at that level so that they can assess cardiovascular risk, discuss it with the patient, and then put in place a management strategy. Eduardo Sanchez:         Will, that's perfect. Our initiative has four pathways. One is to raise awareness among the general population that type 2 diabetes and cardiovascular disease go together, and people should be paying attention to both, and that's the general population. It's not just people with type 2 diabetes, but people who know people with type 2 diabetes, which is probably the entire adult population. Eduardo Sanchez:         The second pathway is raising awareness among patients themselves that, yes, if you have type 2 diabetes, managing diabetes is critically important, but as we've said over and over, lifestyle's important, managing your blood pressure's important, managing your cholesterol, your lipids is also important. The third pathway is providers themselves to raise awareness again with this, perhaps, new knowledge to them, or a reminder to them that managing all three well equals much better outcomes for those patients. Eduardo Sanchez:         And then the fourth pathway is really part of what you were talking about before, Will, which is the pathway that is about health systems. Those are the practices, or the multiple practices, or the health systems that the providers are working in, because what we know is that process changes and helping not only by providing tools, but by providing new pathways, new processes to get things done that might offload some of the work from provider to other members of the team, that might streamline the process for patients and the team can result in more effective care and better outcomes. So it's all four of those things. William Cefalu:             So one of the questions that we've been asked, Eduardo, and I think you and I have been present when this has been asked, it's the question of, okay, why now? Why has the American Diabetes Association and American Heart Association come together at this time? And I think we recognize that the problem is just too big for each one of us to do it alone. I think we both recognize from the work that's been done at the American Heart, and you've mentioned the control of risk factors and what that has done, and what the American Diabetes has proposed as far as management for diabetes in general. William Cefalu:             But again, as a medical community we've made great strides in reducing the rate of complications, be it a large vessel or small vessel disease, that we've seen the medical advances over the last couple of years. Even though we have the medical advances and dramatic reductions in complication rates, when you look at mortality due to cardiovascular disease, either in an individual with type 1 or an individual with type 2 compared to individuals that do not have diabetes, there's still increased residual risk. So even today you look at the increased between an individual with diabetes and someone who doesn't have diabetes, we've stated, again, at least twice the risk, and maybe a reduction of 12 years of quality life. But given the fact that there's so many more individuals with diabetes in this country and around the world, despite the reduction in rate of complications the overall burden is tremendous. Eduardo Sanchez:         I think it's fair to say that this initiative, Know Diabetes by Heart, is the first step in our finding the opportunities where working together makes really good sense. There is the one out of three adults who have pre-diabetes, who are on the path to developing type 2 diabetes, who are probably on the path to have high blood pressure, and have dyslipidemia, and be defined as people with metabolic syndrome, and to your point, if as we go forward with this initiative we don't find the way, over time, to expand our initiative to pre-diabetes, and I would love to see us talking about persons with type 1 diabetes as well, because those risk factor realities are true for people with type 1 diabetes, we won't be fulfilling the promise that our working together might be able to achieve and address. Eduardo Sanchez:         One of my favorite quotes, it's an African proverb that says, “If you want to go fast, go alone. If you want to go far, go together.” We want to go far, and actually the American Heart Association and the American Diabetes Association are but two of the organizations that will be working on this. We've reached out and had conversations with some other organizations that are interested in advocating for patients or advocating for reducing the burden of diseases and the outcomes of those diseases. Those strategic alliances will be pursued. They will be a part of what we're doing. Eduardo Sanchez:         I do want to add one more thing. As we talk about reducing mortality among people with type 2 diabetes, particularly reducing cardiovascular disease mortality among people with type 2 diabetes, and we look at at least one study that looked at the percent of persons who were at target levels for any one, two, or all three of blood pressure control, LDL control, that would be cholesterol, or hemoglobin A1C, blood glucose, here are the numbers. They're pretty striking. And this is from a study published in Diabetes Care in 2016. Any one of the three, 41% of patients were there. Any two of the three, that number goes down to 26.5%, roughly one quarter. But all three of three, only 7.2%. Eduardo Sanchez:         Now, glass half empty would say, “That's awful.” Glass half full would say, “There's opportunity to do a much better job.” We can improve on the any one of three, we can definitely improve on any two of three, and we must, we must improve on three of three. We're below 10% of persons with type 2 diabetes, at least in this study looking at three different, pretty large cohorts of individuals. Only less than 10% have blood pressure, cholesterol, and glucose, hemoglobin A1C, actually, at target levels. There is real opportunity to make improvements, and I think that's part of the why now. We'd been doing this independently, or as separate organizations, and while things are better, there's no doubt things are better than they've been, there is so much opportunity to do even better than we've done that we've come together and said, “Let's partner up.” William Cefalu:             I think what I'm most excited about is leveraging the strength of both organizations, and actually the architecture that we've put in place. As we stated earlier, the consumer activation campaign that is going to increase awareness and is going to be one of the first things we roll out, but providing patient resources, professional resources, and quality improvement is really going to get us where we need to be. But down the road we have an architecture in place that hopefully is going to bring in other partners and strategic alliances to help us achieve our goals, again, as far as what we're going to do for policy. So the sky is unlimited as far as what we can do with this initiative over three years. We've only been together just a few short months, and have already put together, I think, an exciting program, so I'm really ready to get started. William Cefalu:             And again, for us, we know that we're going to be launching this in November, and we'll anxiously await what the outcomes would be, but I think this is an exciting time that the leading organization for cardiovascular disease and the leading organization for diabetes partner and show the importance of the link between diabetes and cardiovascular disease. Eduardo Sanchez:         Well said, Will. Speaker 1:                    Thank you very much for listening, and stay tuned for upcoming podcasts.  
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Podcast Details

Created by
ADF Editor
Podcast Status
Active
Started
Oct 22nd, 2018
Latest Episode
Mar 2nd, 2021
Release Period
Monthly
Episodes
23
Avg. Episode Length
27 minutes
Explicit
No
Order
Episodic
Language
English

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