← Diabetes Core Update
Diabetes Core Update
The Points of CARE - Introducing Diabetes, Obesity, and Cardiometabolic CARE with Alissa Segal, the ADA's Obesity Association & Standards of Care in Overweight and Obesity with Samar Hafida, and more!
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- [00:09]
A
I'm Dr. Neal Skolnick and I have got some great news for our listeners today. We're introducing the first episode of the Points of Care, a companion podcast to the American Diabetes Association's new journal, Diabetes, Obesity and Cardiometabolic Care. This new podcast is hosted by Dr. Richard Beezer and will feature practical insights on diabetes, obesity and cardiometabolic disease from Ada's new journal. You can find a link to the new journal and learn more about this new podcast right in the episode notes. So with that, here's the inaugural episode of Points of Care.
- [01:07]
B
Welcome to the Points of Care, the official podcast of Diabetes, Obesity and Cardiometabolic Care, the American Diabetes Association's new journal for clinicians, educators and advanced practice professionals. I'm Dr. Richard Beezer, your podcast host. Today's kickoff podcast will introduce the journal as well as tell you about the American Diabetes Association's Obesity association, with which the Journal is affiliated. We'll talk to the leaders of both and get their perspectives on the missions of both the Journal and the Association. We'll also highlight a few key articles appearing in this first edition, which published on February 10, 2026. Then, in each subsequent podcast episode, you'll hear directly from the authors of featured articles. In the upcoming issue, we'll discuss clear, practical insights about the articles, their results and conclusions, important firsthand research and clinical perspectives from the intersection of diabetes, obesity and cardiometabolic care. Let me start by introducing myself. As I said, I'm Dr. Richard Beser, and for 41 years I was on the clinical staff of the Joslin Diabetes center and Harvard Medical School in Boston. My interest in diabetes began quite early during childhood. My father, Dr. Sam Beezer, was a diabetes specialist at the Beth Israel Hospital in Boston and was involved in early research into the diabetes oral agent in the 1950s. He was probably the first to report the concept of combination oral diabetes therapy with the sulfonylurea chlorpropamide and by guanine fenformin, a forerunner of metformin in 1958. You can just imagine what dinner table conversations were like when I was a kid, but it did pique my interest, and I'd often tag along with him to some of his lectures, working the slide projector, the old lantern slides. Back then I listened also to him participate in a panel presentation at a big international meeting with Dr. Auguste Labo, the French physician who discovered sulfonylureas. Now remember, I was 16 with no medical training, and Dr. Laboatier was speaking French, which I didn't understand a word of but hey, I can say I was there in my first international meeting. But as for me, in my own career at Joslin, I participated in a number of trials such as the Diabetes Control and Complications Trial dcct. But for the remainder of my career, in addition to practicing adult diabetology, I served as the Medical Director of the Joslyn Continuing Medical Education Program. We developed and produced live and then web based educational programs throughout the United States and beyond. I retired from patient care in 2023, but have continued participating in a variety of educational activities and and I'm really thrilled and honored to have been asked to host these podcasts. But enough about me. Let's get started with today's program and it's with great pleasure that I introduce my colleague and friend, Dr. Alyssa Siegel, editor in Chief of Diabetes, Obesity and Cardiometabolic Care.
- [04:25]
C
Alyssa hi Rich, thanks for having me on.
- [04:30]
B
Thank you for inviting me. So Luca, first, let's just start briefly tell the listeners a little bit about yourself. To introduce yourself, you're from Chicago, where you went to school, those sorts of things.
- [04:44]
C
Oh wow. It's been a while since I lived in Chicago. So yeah, I started in the Midwest. I actually started in pharmacy in an independent pharmacy when I was in high school working there and loved medicine, loved science but hated blood. So went to pharmacy school instead of med school and was lucky enough to go to pharmacy school at Drake University in the middle of Des Moines, Iowa and really progressed there. I during my last year of school worked with some physicians actually that had been pharmacists and put themselves through med school working as pharmacists. And the care that I was able to see and work with them to help their patients led me on a kind of a travel around the US went to New Jersey, down to South Carolina, out to New Mexico, in Albuquerque. I in my training was able to have the opportunity to be a site coordinator for phase 3 clinical trial for oh goodness, I'll age myself Nuteglinide, which is now generic and has been for years. So that tells you how long ago it was. And also when I was out in New Mexico as well as the other places and also up in Boston working with a huge variety of healthcare professionals and patients, people with various chronic conditions. That taught me a lot about how people approach their own care as well as how clinicians approach care and how that is different in different places and how important it is to understand that both in how we approach care with the people we are trying to help in our own practices, how it's important to understand that from a research aspect as well as a health policy aspect in population health. After New Mexico for a few years I moved up to Boston and worked with Rich. Had the lucky happenstance to work with Rich at Joslin for many years.
- [07:12]
B
The luck went both ways.
- [07:16]
C
And as a faculty member at the Massachusetts College of Pharmacy and Health Sciences, I get to interact with future healthcare practitioners and see them grow into their careers. So I come at Care Research, the journal, from so many different aspects.
- [07:40]
B
Yeah. And your role in the clinical care with me in the clinic was really quite valuable. And I think as we talk more during this podcast and you see some of the things that come out in the journals, you'll see the clear stamp of Alyssa's experience in the articles that are appearing. You then went on to work for the Professional Practice Committee of the ada. Briefly, tell us a little bit about that experience.
- [08:06]
C
It was an incredible honor to spend the last three plus years working on the professional Practice committee for ada. Now that was the Professional Practice Committee for Diabetes. There is a professional practice committee for obesity as well. But my work on the Professional Practice Committee for Diabetes, the primary focus is to update the standards of care in diabetes to help clinicians and policymakers help us take the best care of individuals that have diabetes or are caring for people with diabetes. It's a lot of work. There's a lot that goes into it that I had no idea. But it was an incredible experience and truly does help as I come into this new role.
- [09:03]
B
Observing what you did during those three years you were on it, I really never appreciated all the intricacy and work that goes into these standards. So it was really quite a job. Alyssa, now tell us a little about this new journal, Diabetes, Obesity and Cardiometabolic Care.
- [09:20]
C
As you know, the American Diabetes association already has a number of academic journals and have evolved their journals over time as needs change, care changes. They started with just diabetes and now that journal is primarily is focused on the physiology, the preclinical or early clinical studies dealing with diabetes. They have diabetes Care, which is focused on the clinical care of people with diabetes and providing evidence based guidelines for people with diabetes. We, or ada, I should say not me, I wasn't involved at that point. Recognized that there's a need and a space where individuals who care for and study the issues related to obesity, diabetes and their interconnected, interrelated cardiometabolic conditions need a platform for how we can improve care. New ideas, new data, new methods of caring for individuals and thus the new journal was created in order to provide that platform.
- [10:54]
B
And what sort of audience are you looking for? Who do you expect to be reading this journal?
- [10:59]
C
I mean, I think a great thing is that the journal's tagline really addresses that. The tagline of cares actually represents community access, research and education. You can think of each of those pieces. We're looking at primary care, weight management clinicians, endocrinologists who take care of people with diabetes with all those conditions, as well as health educators, the pharmacists, behavioral health professionals, advanced practice nurses, dietitians or nutritionists, exercise physiologists, and all sorts of others that are involved in the care of people with these conditions.
- [11:43]
B
Very, very broad based is what it sounds like. And we're going to hear from Summer Hafida in a moment. But from your perspective, how do you see the relationship between diabetes, obesity and cardiometabolic care and the Obesity association of the ada?
- [12:00]
C
I expect it to be an independent but also connected relationship. So obviously each journal is independent from has editorial independence from the association, but we also work with the association to highlight their evidence based guidelines that come from the association as well as advocacy initiatives that are also important to the association.
- [12:36]
B
Well, great. And Eliza, I just want to take this moment to congratulate you on your accomplishments in launching this really exciting new journal. I know it was a birthing process of some, some challenge over the last year as we've talked, but I'm really thrilled that you're able to do it. I know you must feel good about it at this point as you start out. I just wish you the best of luck in the challenges that lay ahead for you. Let's bring in Summer Hafida. It's great to include you today as well. And congratulations to you in being appointed as vice president of the Obesity association and a subdivision of the ada. It's really a marvelous honor. And let's start off by letting you let the listeners know a little bit about your background and the career path that took you to this position.
- [13:31]
D
Good morning, Rich and hi Alyssa. I will let the viewers know candidly that I'm here with friends, longtime friends. We've had the privilege, I have had the privilege of working with both of you and doing some just wonderful things. And I've learned so much from my time while working at Jocelyn, but before that my home origin country is Libya. I was born in Tripoli, Libya, but before I was aware of anything I was mere months old. My family moved to Eugene, Oregon, so my formative years were spent over there in the west coast, beautiful, Oregon. That's, you know, my, I guess, where my character developed and my thoughts and. And my. My aspirations really were influenced by my childhood living on the west coast there. I did my medical school in Tripoli, and like Alyssa, I sort of have ended up all over the place. My residency was in University of Nevada, Las Vegas. My fellowship, endocrine fellowship was in Detroit, Michigan, where I, you know, I did my clinical endocrinology fellowship, and I dabbled in research for a couple of years as well. So at the time, I didn't realize it was very painful to work with cells and mice and things that I haven't experienced before. But I am so glad that I did that. During those years that I was doing both. I had a clinical responsibility and a research responsibility. I realized that a clinician really should be engaging in the molecular aspect of human life. And so I just became fascinated by how energy metabolism works. That my. My focus at the time was in lead exposure and, and rodents and what that does to the. To the beta cells. But I just thought it's just so, you know, amazing how there's so much variability in energy storage and energy expenditure and energy consumption. And so I thought, like, I. I just need to do an obesity fellowship that I. I have to do it.
- [15:45]
C
Yeah.
- [15:45]
D
That's why. That's how I came to Boston.
- [15:47]
B
Yeah. Yeah. And it's been. Been great having you work with us. What would you state the mission of the Obesity association is? You know, a couple of points, and then I want to hear about this standards. But tell us first about the mission.
- [16:03]
D
It's fortunate that the Obesity association has an anchor mission already at the ADA. And it just really rolls off of the ADA's mission of improving lives of people living with diabetes. And so that also applies to obesity. We know that the obesity epidemic has been going on for quite some time now, and nobody seems to be immune from living with obesity, from this chronic, sometimes really disabling medical condition. So I would say the mission of the Obesity association is to improve the lives of people living with obesity wherever they are.
- [16:40]
B
Yeah. And what about the providers that are helping them? I know a lot of providers are feeling lost in terms of strategies. A typical provider will say, well, lose weight. And is there going to be some guidance for that sort of frustrated clinician?
- [17:00]
D
I will acknowledge everyone who's felt that frustration that your feelings are real. It is a very hard medical condition to wrap one's head around. There's just so much going on and so much changing as we speak. We have new studies Phase two in the pipeline, phase ones, and all of the basic science that goes into it. So it's really, really, really hard to keep up with. But you know what? We decided that we take upon ourselves to make it easier for healthcare professionals to provide scientific evidence based care to the people that they care for. And we will help guide them through that process and, you know, just offering things, listening to them, offering things that they need and they want and just helping everyone keep up with the demand.
- [17:55]
B
Here now, the standards of care. Starting off the first standards that we, we're going to be publishing in this first issue relate to pharmacology. And listeners can look at this over. I don't want you to necessarily go through all the details, but just tell us briefly what the standards are intending to accomplish and how people should look at them when they read them.
- [18:18]
D
Yeah, thank you for that question. So this will be the third chapter. The first was on the methodology and the second was on addressing weight stigma and bias. But this one is particularly cool, I think, because it really does offer a practical approach to how do you even start with pharmacotherapy. Obesity medications is how we reference it in the, in this chapter, where do you start, who do you start for, what are the things that you're looking for, and so on and so forth. So instead of it being the centers of care, being a, you know, 20 page document about the latest evidence, instead what the committee did so brilliantly is made it applicable, made it something a clinician could take and apply to their own practices in no uncertain terms. It is a, you know, a tremendous feat that they've accomplished and I commend all of them for sticking with it. It's not easy, but any, any person in the clinical field, and for that matter, any person interested in knowing what obesity medications are and what they're about, will be able to find that information there in an easy way in that chapter.
- [19:34]
B
Excellent. I'm excited about this. And in conclusion, I want to congratulate you on your work, your position of leadership in this important new association, and I'm confident that under your leadership and the mission of the Obesity association will be met and will educate people over time going forward. And hopefully we can invite you back to a future podcast so we can highlight some of the things that you've accomplished. Thank you, Sommer. We have a few minutes at the end now and I'd like to mention a couple of other articles. Alyssa's here with us and this will give you a sense as to what's in the journal. It's not just these articles. There's a lot. You should look at the table of contents, look at the journal itself, but this will give you a flavor for what's out there. This one is titled association of Type 2 Diabetes Subgroups with incident Peripheral Neuropathy Kalia Simkins et al. And the Look Ahead Study Group the authors wanted to determine whether type 2 diabetes subgroups differ in the incidence of peripheral neuropathy and whether the effect of intensive lifestyle intervention on prevention of peripheral neuropathy differs by the type 2 diabetes subgroup. Within the Look Ahead study, they classified Look Ahead participants with type 2 diabetes in overweight or obesity into four subgroups distinguished by high A1C, younger age of onset, severe obesity and older age of onset. Look Ahead, of course, was a large long term clinical trial designed to see whether intentional weight loss through lifestyle changes would reduce major cardiovascular events in people with type 2 diabetes. It concluded in 2012. In this particular study, they assessed peripheral neuropathy through screening questions and physical exams and estimated marginal probabilities for peripheral neuropathy according to type 2 diabetes subgroup with adjustment for potential confounders and attrition, and examined whether intensive lifestyle intervention modified any associations. They found that the incidence of peripheral neuropathy differed by type 2 diabetes subgroup. Specifically, the younger onset type 2 diabetes subgroup had the lowest risk of and the high A1C had the highest risk for peripheral neuropathy. Lifestyle interventions were not associated with peripheral neuropathy risk overall or differentially by type 2 diabetes subgroup. The authors concluded that there's variation in long term peripheral neuropathy risk among type 2 diabetes subgroups. The lack of differential effect of lifestyle intervention on peripheral neuropathy risk by diabetes subgroups suggests that while intensive lifestyle intervention may have general benefits for cardiometabolic health, additional strategies may be needed to address neuropathy prevention. That's particularly true for phenotypes with higher risk for peripheral neuropathy. These results support ongoing efforts to identify effective strategies for prevention of peripheral neuropathy for individuals with type 2 diabetes and move towards a more personalized, subtype, informed approach to diabetes management and complication screening. Alyssa, do you want to mention this next article, the benefits and cost of treating obesity amongst adults in the Medicaid program?
- [23:08]
C
Thank you Rich. Actually, this is an incredibly important manuscript. In this day and age. We know that a lot of coverage decisions are made solely based on the cost of the treatment alone, and this manuscript actually addresses not just the evidence on the economic value of the treatment, but also sought to evaluate the claim clinical and the social impacts of evidence based obesity medications amongst the population of adults that receive care through Medicaid over a five year period. What they actually found was that although we know obesity treatments are expensive and they could cost approximately 5 billion plus dollars nationally, but they could also generate 20 billion in social value through medical savings, through productivity gains, through quality life improvements and through reduction in mortality. This actually yields over $3 per dollar invested return on investment.
- [24:37]
B
That sounds pretty good to me.
- [24:39]
C
The implications of this, even according to the authors, are huge. Right? Where it really looks at how obesity treatment not only again, we know a lot of them are expensive, but what are those social benefits and putting them into a cost equation to help decision makers in terms of those coverage decisions. Think about it in a broader scale and think about the strategic investment in public health and population well being rather than just a budget line item.
- [25:20]
B
Alyssa, you know I'm impressed also with an article like this in that it reflects the fact that the journal is looking at obesity issues from multiple perspectives with all sorts of innuendos, more than just strictly scientific outcomes. But beyond that into the social implications. I commend you and I know Summer was also involved in that study. So both of you for this effort. Briefly, there are a couple of other articles we just wanted to highlight. One is effectiveness of using patient defined meal sizes to determine Bolus doses of insulin by Mayor Davidson et al. The authors noted that some people with diabetes requiring bolus insulin doses don't have access to dietitians to teach advanced carbohydrate counting. This is probably quite common and particularly true in minority low socioeconomic status populations, et cetera. In that situation, meal size is defined by by the persons taking bolus insulin themselves were used to determine the doses and this observational study evaluated its effectiveness. The results. In conclusion, the authors showed that 95% of participants achieved the targeted A1C of 7.5% and concluded that experienced clinicians with frequent contact with the individuals that are doing this, using patient defined meal sizes to help determine the bolus insulin doses really can optimize glycemic control in minority low socioeconomic status populations that start off with higher A1C. I think this is a very important finding to guide clinicians in the real world.
- [27:11]
C
It's such a common issue. So many people have numeracy issues or they just, they don't, as you said, don't have access to individuals with expertise in nutrition or expert, even educators to teach that carbohydrate counting. And we know, we know both from our technological advances in using meal sizes or meal announcements based on size that we're going in that direction. So I think it's great to, to see this, this information and many people.
- [27:49]
B
Just fatigue from the carb counting. You know, it's great for a month or two and then oh my gosh, I got to do it again.
- [27:56]
C
Or it helps with restaurant like eating out or when they travel and don't have access to nutrition labels in the same way that we have access here.
- [28:05]
B
Right, Go on, Melissa.
- [28:07]
C
I'm going to highlight an article called Patterns of Prescription Prescription Discontinuation, Reinitiation and Switching of Subcutaneous Semaglutide and Tirzepatide in Adults with Obesity. Obviously as a pharmacist we see, well, medication's kind of at the heart of what I do. This looked at a huge population. It looked at over 9,000 individuals and they really sought to describe the real world pattern of what was going on with these agents with individuals with obesity without diabetes. Granted it was in an academic medical center, but over a full year's time and found that over a third of individuals discontinued treatment within the first month and less than 20% had a persistent use over the entire observation period, indicating that a substantial portion of individuals with obesity without diabetes discontinued treatment and were not switched to either an alternative GLP1 based therapy or even a first generation obesity medication. So it really highlights the importance of working with patients keeping maybe even frequent follow up all the different barriers that likely these individuals face in their care, whether it's coverage issues we don't know or it's adverse effects and you know, stigma that can impact their ability and their desire for these treatments.
- [29:53]
B
All right, all right, I'll take this one. Type 2 diabetes treatment and experience with hospitalization in older adults. A mixed method study. Steven Maciano et al. Older adults, we're getting more and more of us getting into that age group. This study explores the changes in type 2 diabetes treatment during hospitalization and seeks to better understand the experiences of providers and patients and in managing type 2 diabetes related to hospitalization. It also seeks to assess type 2 diabetes control for a six month period post discharge and concluded that the hospitalization period presents a unique opportunity to treat uncontrolled type 2 diabetes. And as I make an interesting personal comment on this, I always would joke that when I would go into the hospital and see the workup of a patient by a house staff team, there were at least eight or ten problems listed at the bottom would say diabetes and invariably it said stable, meaning they weren't comatose. But really the hospital is an excellent opportunity to assess things and begin a process that can extend out to the outpatient setting. It's good that this topic is being addressed. Alyssa, why don't you take the final one that we're going to talk about?
- [31:15]
D
Sure.
- [31:16]
C
I want to take the time to highlight an article from some colleagues of mine, led by Dr. Young, highlighting the critical role of diabetology pharmacists in improving cardio kidney metabolic care and outcomes. So this is a statement from a group of individuals through the American College of Diabetology on how diabetology pharmacists, individuals trained specifically on helping in the management of people with diabetes and related conditions, can assist in the complex needs of this population. We can offer numerous touch points and guidance that's evidence based and provided by very skilled team that's used to working in an interprofessional environment with multiple clinicians and have demonstrated in several studies that we can consistently improve patient outcomes. So I was really happy when some of my colleagues pulled together this manuscript and highlighted a strategic plan on how diabetology pharmacists can bridge the current gaps that exist in care and how we can play an optimal role in that care. I hope many will take a look at that. If you haven't had the opportunity to work with a clinical pharmacist in your practice or are considering it, or there are things that you can't do with the individuals that you're trying to provide care for, there may be opportunities when you work with individuals. Again, this highlights diabetology pharmacists, but I hope in the future we highlight other areas of care and other care professionals because an interprofessional team we know can be much, much more successful in advancing the care of the individuals with diabetes, obesity and related conditions, including cardiometabolic conditions.
- [33:41]
B
I just want to second what Alyssa said because having worked with Alyssa in clinic for quite a number of years, carpooled with her and chatted in the car as well, what she brings to the table and people like her is just phenomenal. The insight into the interactions of pharmaceuticals and how to make them more effective, how to have patients accept them more so again, I think it's something that we should all think about if we haven't already. With that, we come to the conclusion of this inaugural episode of our podcast, the Points of Care. I'd really like to thank my two colleagues and friends, Dr. Alyssa Siegel, editor in Chief of Diabetes, Obesity and CardioMetabolic Care, and Dr. Sumara Fida, Vice President of the Obesity Association, a subdivision of the ada. Also, to all of our listeners, please, please be sure to look at the inaugural issue of the Journal. You'll find the articles that we highlighted today, plus many more. An array of interesting content that I think many of you, most of you, all of you would appreciate tremendously. The full contents of Diabetes, Obesity and Cardiometabolic Care can be found@diabetes journals1word diabetesjournals.org docm car with a link to the episode notes. Be sure to look for our next Journal issue and the next episode of this podcast, both of which will drop in mid April 2026. And do subscribe to the Points of Care on your favorite podcast app so you won't miss what's next in Diabetes, Obesity and CardioMetabolic Care. I'm Dr. Richard Beezer. Thank you for joining us.