Diabetes Core Update – December 2025

Podcast by the American Diabetes Association
Hosts: Dr. Neil Skolnik & Dr. John J. Russell
Date: November 25, 2025
Duration: ~33 minutes

Overview

This December 2025 episode features Dr. Skolnik and Dr. Russell discussing the latest clinically relevant articles from ADA journals, covering topics including heart failure prediction in diabetes, pancreatitis and biliary risk from incretin-based meds, CGM use and glycemic control, AI-powered vs. human lifestyle interventions, a new approach for liver fibrosis screening, and the clinical value of changes in albuminuria in CKD with diabetes. Designed for health professionals, the discussion is application-focused, highlighting meaningful research findings for front-line diabetes care.

Key Topics and Insights

1. Screening Natriuretic Peptide Levels to Predict Heart Failure and Mortality

(Diabetes Care)
Timestamp: 01:46–03:39

• Study Population: >116,000 adults with type 1 or type 2 diabetes, no known HF, with outpatient natriuretic peptide test (2017–2023). Median age: 64; 54% female; median A1C: 7.1.
• Results: Elevated natriuretic peptides predicted higher risk for incident heart failure or death in both diabetes types, with hazard ratios increasing with peptide levels (e.g., HR 4.48 in T2D for NT-proBNP >300).
• Clinical Takeaway: Annual BNP or NT-proBNP screening is supported for earlier HF detection in diabetes, echoing ADA guidelines.

“This is a huge cohort ... supporting that recommendation and showing that in both people with type 1 and type 2 diabetes, heart failure and high risk for heart failure is very common.”
— Dr. Skolnik (03:39)

2. Incretin Therapies and Risk of Acute Pancreatitis & Biliary Events

(Diabetes Care)
Timestamp: 03:39–08:01

• Study Design: Large claims data comparing incident pancreatitis and biliary events in type 2 diabetes using GLP-1s, DPP4s, or SGLT2s.
• Outcomes:
  • Pancreatitis: No increased risk in GLP-1 or DPP4 users vs SGLT2 (HR near 1).
  • Biliary Disease: Slight increase in GLP-1s (HR 1.15) and DPP4s (HR 1.22) vs SGLT2—fewer than 1 extra event per 1,000 patient-years.
• Clinical Reassurance: Elevated risk for pancreatitis is inherent to diabetes, not necessarily exacerbated by these drugs; slight biliary risk is small and may not alter clinical decisions.

“So, I would feel good in that risk. The person with a history of pancreatitis ... I’m not sure I would make that a contraindication forever.”
— Dr. Russell (08:01)

3. CGM Frequency and Glycemic Control in Type 2 Diabetes

(JAMA Network Open)
Timestamp: 08:01–13:54

• Study Details: >9,200 adults with T2D (HbA1c 7–15%), matched controls; CGM use stratified by yearly frequency.
• Findings: High CGM use (>270 days/year) led to a larger mean HbA1c reduction (1.52%) vs non-users (0.63%). Reductions sustained in high-frequency users. Most benefit plateaued after 6 months with moderate frequency.
• Mechanism: Likely due to timely therapy adjustments, real-time behavior feedback for patients.

“CGM matters. It helps people get better control … using it for much of the year is better than using it now and then.”
— Dr. Skolnik (13:54)

4. AI-Powered vs. Human Coaching for Diabetes Prevention

(JAMA)
Timestamp: 13:54–19:38

• Study Design: Non-inferiority RCT, 368 adults with prediabetes/overweight/obesity. Compared fully AI-driven mobile program with human remote coaching.
• Key Results: Both AI and human-led DPP groups had equal rates meeting primary weight-loss and A1C-reduction goals (31% in each group). Initiation rates favored AI (93% vs 82%).
• Technology: AI program personalized engagement based on data, meal logs, location, activity.
• Implications: AI-driven programs are as effective as human coaches for structured interventions like DPP, offering scalable, resource-efficient options.

“Maybe if I got something to my phone, I would be. Because people are doing an awful lot of stupid stuff based on what’s coming across their phone. Maybe something coming smart and helpful ... Wouldn’t that be revolutionary?”
— Dr. Russell (19:38)

5. Two-Tier Screening for Liver Fibrosis in Type 2 Diabetes

(Diabetes, Obesity, and Metabolism)
Timestamp: 19:38–24:30

• Approach: >1,200 Italian outpatients with T2D assessed with FIB-4 index and VCTE (elastography).
• Findings:
  • FIB-4 alone missed ~17% of those with significant fibrosis.
  • Elevated weight and AST increased odds of fibrosis.
• Clinical Nuance: Guidelines recommend initial FIB-4. However, patients with higher risk (class III obesity, high LFTs, or younger age with borderline scores) may merit further elastography even if their FIB-4 is “normal.”

“The issue though ... is that the FIB4 doesn't have anywhere near perfect negative predictive value ... would miss about 17% of people with significant liver fibrosis.”
— Dr. Skolnik (24:30)

6. Change in Urine Albumin:Creatinine Ratio & Clinical Outcomes in CKD + T2D

(BMJ Open Diabetes Research and Care)
Timestamp: 24:30–32:10

• Design: Optum EHR data; adults with T2D, CKD, elevated UACR. Tracked UACR change over 6–24 months.
• Defining Change: “Improved” = >30% decrease; “Worsened” = >30% increase; “Stable” = in between.
• Outcomes: >30% decrease in UACR linked to significantly lower all-cause mortality and adverse cardiorenal outcomes.
• Practice Impact: Monitoring and striving for >30% reduction in albuminuria matters, even if eGFR stable—should adjust ACE/ARB or add SGLT2s/MRAs accordingly.

“If we can make people's kidneys better in the setting of diabetes here, we're probably going to decrease their chance of having cardiovascular disease. ... I think this is going to be more and more of the challenge for those of us in primary care.”
— Dr. Russell (32:10)

Notable Quotes and Memorable Moments

• On natriuretic peptide screening:
  "This is further support for what is already embedded in the recommendations to check either a BNP or an NT pro BNP on an annual basis."
  – Dr. Skolnik (03:39)
• On the practicality of biliary risk with GLP-1/DPP4s:
  "The increased case of biliary disease, one per thousand patient years doesn't seem like a whole lot ... So I would be reassured."
  – Dr. Russell (08:01)
• On CGM feedback:
  "We all respond to natural feedback that is close in time to the behavior that caused that feedback to occur."
  – Dr. Skolnik (13:54)
• On AI health tech’s potential:
  "Instead of another TikTok or whatever people are wasting ... Maybe something coming smart and helpful coming across their phone."
  – Dr. Russell (19:38)
• On fib-4 screening's limitations:
  "We do the fib 4, but we don’t adhere to it religiously."
  – Dr. Skolnik (24:30)

Timestamps for Important Segments

• [01:46–03:39] Natriuretic peptides predicting HF & mortality
• [03:39–08:01] Incretin therapies and pancreatitis/biliary risk
• [08:01–13:54] CGM use and glucose control outcomes
• [13:54–19:38] AI vs human DPP coaching RCT
• [19:38–24:30] Two-tier fibrosis screening
• [24:30–32:10] UACR changes and outcomes in CKD + T2D

Announcement

Upcoming Change:
Podcast will rebrand as Diabetes, Obesity and Cardiometabolic Update (DOC Update) to reflect the broadening scope.

For more details and article links, visit: www.diabetesjournals.org