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Taking Control Of Your Diabetes® - The Podcast!
The Link Between the Heart and the Kidneys: Cardiovascular Kidney Metabolic Syndrome
00:38:18
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- [00:20]
A
Your heart and your kidneys are like a married couple. What one does always affects the other. In sickness and in health. To death do them part. And if you have diabetes, the relationship is even stronger. So we're going to get into to all of this on this edition of the Taking Control of youf Diabetes podcast. I am one of your hosts, Dr. Jeremy Pettis, joined as always by my good friend and colleague, Dr. Steve Edelman. And if you're just tuning in for the first time, Steve and I have both been living with type 1 diabetes since we were 15. We both work at the University of California, San Diego, as adult endocrinologists. We see patients do research and, of course, work for taking control of your diabetes, which Steve founded almost 30 years ago. So welcome. Now, today's podcast, as I mentioned, is talking about, get ready for this, the cardiorenal metabolic syndrome. So what does that mean? Well, cardio means heart, renal means your kidneys, and metabolic means metabolism, and it can also mean diabetes. So it's really this connection between what's going on in the heart, what's going on in the kidney, and how that relates to people with diabetes. Because if you're listening, you have diabetes, you hear all this kind of doom and gloom. You have diabetes, you got to worry about your kidneys, you got to worry about your heart, all these complications. So clearly they're very interconnected. And we want to talk about what this syndrome is, informing yourself about it, and then how to stay healthy when you're talking with your providers about keeping your heart and kidneys working. Steve?
- [01:50]
B
Yeah. This relationship between the heart and the kidneys, it's not a new relationship, but it's a newly talked about relationship. And you said it's like a married couple. My marriage was way worse than the heart and the kidney, but we'll spare you guys on that. But it's a topic that's discussed with healthcare professionals, cardiologists, endocrinologists, kidney specialists, but it hardly ever gets discussed right directly to people living with diabetes. So we felt this is important. This is not gonna be a comedy podcast like some of our prior ones.
- [02:24]
A
Well, you always find a way to say something ridiculous.
- [02:26]
B
I already did, but it's. And we also don't want to freak you guys out.
- [02:31]
A
Yeah, well, Steve and I, we know a bit about this, but we're not experts on this topic. So we're joined by a very special guest, Dr. Jennifer Green, who's an endocrinologist at the Duke, who has a real special background in this exact topic. So, Steve, I know you've known Jennifer for quite a while. Do you want to give an intro?
- [02:48]
B
Yeah, I'll do a brief intro. But she's a very impressive woman. I met her many, many years ago when we put on the Face to Face Taking Control youl Diabetes conferences in North Carolina with Dr. John Buce as one of her mentors. And we loved the way she presented, especially to people living with diabetes. She did a couple there. We flew her out to do one in our San Diego tcoid. And from there she just has a big career in mostly endocrinology cardiology at the Duke Research Center. So we couldn't have had a better person discuss this important topic with us today.
- [03:25]
A
So say hi, Jennifer.
- [03:27]
C
Hi. Thanks so much for having me. I'm really excited to be here. And I agree. I don't think that we talk directly enough about this topic to people living with diabetes, and we kind of probably dance around the subject matter, but I think it is nice to talk about where the field is headed. So thank you for inviting me.
- [03:47]
A
Yeah, absolutely. Thank you for being here. So this reminds me that Jennifer's zooming in right now. So if you're listening on one of the podcast apps, we're. We also do film this on YouTube, so if you want to see what Steve and I are wearing. Steve gave me a lot of crap about my outfit today. He said it looked like I woke up on my front lawn.
- [04:02]
B
He can't call that an outfit.
- [04:04]
A
So if you want to see my outfit, you can watch on YouTube and you can see Jennifer joining us. So, Jennifer, again, thanks so much. Really, truly the perfect person to talk about this. Give people some context of what your day to day is. What is your job? What type of patients are you seeing? Do you have a specialized clinic in this area? Is this just a research. Not just. Or is this more of a research interest? Just kind of walk us through that.
- [04:25]
B
Yeah. And somewhere in there, define what the cardiorenal metabolic syndrome is. So good luck on that. It's tough.
- [04:35]
C
Oh, that's okay. That's okay. So thank you very much for asking me to describe how I spend my time. Now. Every day is different, but I spend part of my time doing clinical research and part of my time caring for patients. And at this point in my career, for the most part, I care for patients at our associated VA Hospital center. So I will tell you right off the bat that the patients that I see tend to be a bit older. They've had type 2 or type 1 diabetes often for many Years. And they may already have some of the organ complications that we talk about as being part of this CK or CRM syndrome. Sometimes people use a K for kidney instead of the R for renal. So I apologize if I mix it up a little bit. And, and you've already alluded to what the CKM stands for. I think the cardiovascular is pretty straightforward. Kidney damage and conditions are the K. The M part of the CKM syndrome is a little bit more of a waste. I hate to call it a wastebasket, but a bucket that can comprise lots of different metabolic or metabolic related conditions like diabetes, pre diabetes or overweight or obesity or even liver disease. And my guess is that that will expand over time as we learn more about how these conditions are interrelated. But I've been very fortunate in that my research and the types of patients that I see really link up very, very nicely. So the kind of research that I do that is really focused on keeping people in particular with diabetes, keeping their hearts healthy, keeping their kidneys and their livers healthy, helping them longer, healthier lives, is something that I can directly do in clinic the next day. So to me it's been very, very meaningful.
- [06:34]
A
Yeah. So thank you for that. Does this syndrome have like a strict definition or is it just kind of recognizing that these things are interrelated? Like, how would you describe that?
- [06:46]
C
Yeah, I don't think that there is a strict definition. I think these are linked together probably because they have several common pathophysiologic pathways or that there may be risk factors that tend to result in a variety of different complications, and that these complications can occur along a similar timeframe, particularly in the life of people with diabetes. So I don't think there's a specific definition. What we have definitions for are the presence of organ specific complications. So we know that we can diagnose cardiovascular disease in certain ways, kidney disease in certain ways, and liver disease in certain ways. So I think there isn't one test that you can do, but what we do need to be aware of is that all of these conditions are linked. And you mentioned doom and gloom in your intro. And I definitely want to have this be a doom and gloom type situation because in fact, I think the opportunities to intervene effectively in people's lives and in fact to, with a single intervention, improve a whole variety of potential adverse outcomes in someone's life. I think of this as an opportunity and really an exciting time rather than just talking about all the bad things that can happen. I think that's what's really changed.
- [08:20]
B
Yeah, you Know, as an endocrinologist, I work at the VA in San Diego, and I would say that our physicians in our division, we're focused on the diabetes. And I don't think we really think about liver disease very much. And we know a little bit about heart disease, but we can easily refer them to cardiology. So we've been. I think these conditions are treated in silos, and I think that's one of the problems. And we're going to do a podcast a little later with Dr. Juan Frias on fatty liver and all the things that go along with that. And I realized when we were putting together the questions, the basic defect is the same, you know, the M, the famous M, and that's type 2 diabetes, that's obesity, you know, and then all the fancy terms like, you know, inflammation, oxidative stress, you know, vascular dysfunction. I don't want to get too technical on the podcast here, but we have to get some respect from our listeners that we are doctors.
- [09:17]
A
So I think maybe the question there is, do you view diabetes and the metabolic part of this as causing these other things? Is that where it starts? I know obviously they're all interrelated, but is your role when you see these people mostly to prevent these other issues? How do you help them understand this condition and what to do about it?
- [09:38]
C
Well, that's a great question. And I think what comes first is not particularly well understood. And depending on the certain person that you're. That is in front of you that you're caring for, they might have had something like a heart attack first and then later were diagnosed with, for example, some degree of hyperglycemia or diabetes. So I think the sequence with which these things can occur is highly variable. What I tend to see most often, though, is a person who is diagnosed with diabetes and who has been living with diabetes for quite some time, and then it becomes apparent that the other organs, the other components of this CKM syndrome, are also present. But I think as endocrinologists, at minimum, we need to be aware of these risks and to start looking for problems early. And not necessarily because we want our patients to know how at risk they are, but if you can identify problems early and intervene in effective ways, that has the potential to make a very, very significant difference in how a person does for the rest of their life. So at minim on, that's what endocrinologists need to do. I will tell you in my personal practice, probably because my research focuses primarily in this area, and I've worked on guideline writing, groups that talk about cardiovascular and kidney health and diabetes. I see myself as a physician who can treat those conditions, too. I need to first look for them so that I know if someone is affected by kidney disease or cardiovascular disease or liver disease. But for many of these conditions, there are many multiple steps that I can take once I've identified that those problems are present that really aren't too much of a stretch, that don't. The treatments don't necessarily extend dramatically beyond what we can do to help a person manage their blood sugar. So it's. I feel very comfortable. But I agree that this often tends to be a siloed approach.
- [11:41]
A
Yeah. And I, you know, I want to ask you because I think this is a big problem because when patients come to see me, clearly I own their diabetes, Right? Type one, type two, doesn't matter. That's my thing. But I know a bit about blood pressure and I know a bit about cholesterol, and those are so important to the heart and kidneys and everything. But it becomes a real problem of kind of who owns that. They might be seeing a cardiologist or a primary care doctor or nephrologist. And a lot of times providers will say, well, I don't want to bring up their cholesterol if somebody else is dealing with that. And I think as a result, it never gets dealt with. So how do you approach that? Do you have a conversation with the patient, the other providers, who's managing these different conditions? I think, as Steve mentioned, because these are in silos, that also means a lot of times things fall through the cracks.
- [12:29]
C
Yes, I completely agree. I think my perspective is that risk reduction is not a hot potato that we can just tossed to the next doctor that the person is going to see or the next provider. It's a shared responsibility. And although there are certain conditions that I am not qualified to manage, such as advanced liver disease, if I see that a person is not being treated as per contemporary standard of care guidelines, I will reach out to whoever the. The more responsible doctor is or refer the person directly to the relevant specialist. So I. When I see a person who's for diabetes, whose blood pressure is not well controlled, or whose cholesterol is not well controlled, that's my responsibility, too. And it can make visits and appointments very, very busy. There's a lot to talk about, but sometimes you need to see your provider fairly often at first or for a period of time until you get all these various risk factors or issues appropriately managed. So again, I'm happy to hold the hot potato. I Don't need to necessarily, you know, wait for someone else to take action, because in my experience, that generally does not happen.
- [13:53]
B
You know, even in 2025 with electronic medical records and you could read notes from other specialists, I find communication is still not. Not that good.
- [14:06]
C
I almost think it's worse because the notes are filled with so much, I hate to say irrelevant information, but it's hard to get to what is really important at a particular visit because there are just so many words in the notes. So I almost think it's harder.
- [14:28]
B
You know, that's one of my pet peeves, too, which we won't get into. But so much in our medical notes is really a waste of time. And ink, you know, if you're using ink. But yeah, they have to do the perfunctory characteristic, you know, history of present illness, physical exam, all that kind of stuff. They copy and paste all the labs, and then you don't really get to the meat of the problem. But, Jennifer, I wanted to ask you if you had to go back in time and look to the time course of action. Let's say someone develops, and I'm assuming we're talking mostly type 2 diabetes, but Jeremy and I are real concerned about us type 1s. But let's say someone gets type 2 diabetes, age 40, and they get diagnosed relatively early, not like the kind that get undiagnosed for 10 years. What happens over time? What comes first? And then how does that interaction occur? And do people just get heart disease with no kidney disease and vice versa? And does that make, for lack of a better word, does that make the prognosis worse when these two are together?
- [15:34]
C
Well, I'll start with your last question first. So, yes, having multiple of these conditions increases your risk of adverse outcomes of not doing well. But it may not be as bad as the listeners think. So I'll clear that up. But it's very important in particular, when we're talking about people who have been recently diagnosed with type 2 diabetes, we need to recognize that screening for these types of complications needs to happen immediately, and we're not doing a particularly good job at that, even where the screening recommendations are really straightforward and easy to follow. So, for example, if we're talking about kidney disease in particular in the United States, doctors or providers do a pretty good job at measuring creatinine with a blood test and looking at kidney health in that way. But what is forgotten about half the time is to get the urine sample to see if the levels of albumin in the urine, which is a Sign of kidney damage, we forget to do that. That's is really equally as important in looking for kidney disease as doing the blood test. And you know, I know it's sometimes hard to do the urine sample. People are always telling me I just went to the bathroom or they go to the lab and they walk out without leaving a sample. We would do such good if we could actually get everyone's urine sample tested once a year and then we would know who had kidney disease early at this point, sometimes it's not recognized in the medical record, for example, that some someone has kidney disease until their disease is very, very advanced. So we need to do better. We'd already talked about blood pressure and lipids, and even though those are not technically part of what we call the CKM syndrome, these are risk factors for which we can intervene very, very, very effectively to reduce the risk of end organ damage. So that's kind of a long winded answer. But I think the K disease is the easiest to screen for When I order a GI panel. So liver enzymes, for example, on a patient of mine, my lab will automatically calculate what's called a fib four score. So that's a score that if elevated, can tell me if my patient is at high risk or intermediate risk for having liver fibrosis. So we have some easy tools that are really at our fingertips and that we don't need to do a lot of special testing for that we're not taking full advantage of yet. Some of these other components are a little bit harder to screen for, per se.
- [18:35]
A
Well, you know, as you're talking about the urine sample, I mean, it still blows my mind. I mean, this has been a recommendation for what, 20 years and that's still not getting done. I think just speaks to kind of our whole message here at TCOID of educating people, empowering them to advocate for themselves, and knowing kind of what the, you know, not all the details necessarily, but every year I need to get a blood and a urine test and my doctor should know what that is to be kind of preventative. And the other thing I wanted to ask you is getting a little bit into some specifics. We've done a lot of like direct to patient education on these preventative measures. And we always talk about the ABCDs, A being getting your A1C under control, B for blood pressure, C for cholesterol, and now D for these new diabetes drugs that might, might have beneficial effects on heart, kidney, these kinds of things. So I wanted to ask, is that kind of how you still approach this? Is that too overly simplistic. How do you kind of break that down in your visits and with the patients of maybe what their targets are? How specific do you get? Hey, here's where I want your A1C. Here's where I want your blood pressure, cholesterol. How do you do that?
- [19:43]
C
You know, I'm probably not spelling it out as clearly for the patient as I should be. That is a wonderful point there. There's a lot that I'm thinking about when I look at a person's chart, when I look at their lab results, when I look at what their blood pressure was when they walked into clinic that day. And I'm running a mental checklist. Yes. Of all of those things, but I probably don't communicate that I'm thinking about all of that to the person. Often we'll focus on one or two of those things and maybe just the things that need attention. But I think that's a wonderful idea, that we really should be talking about all of those components of care at every visit, at least briefly, and to congratulate people for doing well and managing one or more of those things. So, yes, I think about all of that at every visit. Absolutely.
- [20:39]
B
And we know you think about it. That's great. Well. Well, you know what? I think everyone listening knows that time is of the essence with these short doctor visits as well. But the whole concept of taking control of your diabetes, which is what I want to get into next, is we want people to be aware of this syndrome, to know what it's about, and to create a conversation between he or she and their healthcare professionals. So, you know what, what would you tell a patient to know and things to ask? So that way you have it from both ends. And I'm sure you're the kind of physician that would love being reminded on something that you maybe should have covered during the meeting. But back on the kidney test, I mean, Jeremy and I have been preaching the urine albumin to creatinine ratio for, like, centuries. And I wouldn't give doctors credit about ordering the. The creatinine and the egfr, because that's just a chem panel. They get that whether they ask for it or not. So they really have to have a higher level of awareness. And that, as you said, Jennifer, is one of the most important indicators of kidney dysfunction. So from the eyes of a patient, what should they be looking at and asking their healthcare professional?
- [22:00]
C
Well, one of the things that people, first of all, that they could start thinking about, because we're talking about the CKM syndrome today is if you are going to see your provider for a diabetes management visit to ask the provider, do I have any of these other components of the CKM syndrome? How's my heart health? How's my kidney health? How's my liver health? You can start there. And your doctor should have some pretty good answers about that. We've talked a little bit about the screening tests in particular for kidney disease and liver disease. Ask about those things, go down that ABCD checklist and you might need to take in, you know, a piece of paper with some notes on it or a little list on your phone so that you can remember to do it. But ask about how's my A1C? That usually is covered. I would say, how's my blood pressure? Is my blood pressure as well controlled as it should be? How's my cholesterol or my triglycerides, if that's been an issue for you? And then the D is really, really important. And if I have these conditions or if I am at risk for these other conditions, am I on a medicine or medicines that will improve my health over time or reduce my risk of progressive kidney or cardiovascular disease over time? So it's really, I hope, pretty straightforward. But you're right. Oftentimes the visits are so busy and so brief that it is up to the person who's there for the appointment to bring up some of these topics.
- [23:52]
A
Yeah. And let's talk about the drugs because I think, honestly, that's what has ushered in this new era of talking about these things altogether that it used to be you had drugs for diabetes, you had drugs for the heart, you had drugs for the kidney. Now a lot of these medicines, SGLT2 inhibitors, GLP1s, they work in everything. And we always say with especially GLP1s like Ozempic, I mean, you can't read something without a new thing. It does. It helps with weight and addiction and all these things. Kidney. Yeah. And now we have cardiologists prescribing these drugs and nephrologists. So how have you seen that evolution being really in the forefront of these studies and things like that? That must have been an interesting evolution for you in kind of clinical and research care.
- [24:39]
C
Really, it's been really incredible and incredibly rewarding to see that these drugs that were first being tested essentially to make sure that they didn't cause cardiovascular harm, that many of them ended up being actually very, very good for the cardiovascular system and the kidneys and probably a whole host of other things that we don't know about yet. So it's a very exciting time, and it is. It provides us with the ability to treat people with what I consider to be great efficiency. So I can prescribe a certain medicine, or maybe I have prescribed a certain medicine, like a GLP1 receptor agonist for someone to control their blood sugar. But in fact, what we've learned over time is it's good for their heart, and now it's good for the kidneys, too. And so all these new clinical trials showing that these drugs have really can improve a landscape of problems faced by our patients. I mean, recently, I'm just like, great, already doing it. It's a tremendous time, and it's a time that really I would consider to provide a lot of opportunity to be very thoughtful in the medicines that we're choosing to treat people with, because the time is now. I think even though it's really never too late to introduce or start some of these beneficial medicines, it's probably true that earlier is better.
- [26:16]
B
You know, Jeremy, what you just said really was genius. I think because of drugs like Ozempic and Mounjaro and Trulicity, because of their development, it put together more communication between these subspecialists. And I think that that is sort of when this, you know, cardiorenal metabolic syndrome really took off in terms of, you know, being a hot topic. So I think you're right, you know, and I think, you know, I don't want to insult any doctors listening, but.
- [26:48]
A
You do it all the time.
- [26:49]
B
Okay, well, you know, if someone starts an SGLT2, like Jardiance or Farziga for glucose control and maybe prevention of heart failure, we know that they're preventing the progression of chronic kidney disease, even if they have no clue and they haven't read the studies. And then you look at GLP1s, oh, my God. Now, you know, affects the kidney. And there's a whole body of literature on reducing fatty liver and even reducing congestive heart failure that we thought was due just to the SGLT2. So even if you're not up on all the studies, you use one of those two together or either alone or together, you're giving that patient a tremendous benefit. And I'll just say the other thing I worry about is patients who stop taking these things.
- [27:39]
A
Yeah, that's what I was gonna ask you, Jennifer, is that I see patients and I say with these drugs, it's actually atypical with drug development that after drugs are prescribed and used that additional positive things come out. You know, it's usually we hear some negative thing and then we don't use that drug anymore. As time goes on, you know, I was joking, but I'm serious. We find that they do more and more and more and more. And so it can become more frustrating for providers when we have patients that say, well, I took it, I lost ten pounds, so now I want to stop it. And so we're struggling a lot with getting people to maintain on it on any of these drugs. And Steve, you always say that people should want to stay on these drugs because of all the benefits. And on a side note, we see a lot of people with type 1 diabetes who can't get access to these drugs and would kill to be on them. So it makes it additionally painful when people want to stop them. So what are conversations you have with people about? If you want to talk about starting them, great. But also how this is, you're in it for the long term. You might be on this drug for decades.
- [28:42]
C
Right. So you mentioned a lot of really important topics, and one is, one is this realization that one intervention that we think is good for one thing positively affects the other components of the CKM syndrome. I think that just really reinforces the concept that these are very closely intertwined conditions and they have lots of similar pathophysiologic drivers or drivers of disease. So it all fits together. One thing that was mentioned earlier was, you know, now cardiologists are prescribing these medicines, and that all seems very obvious right now, but it was not the case. And I would say once we started learning about the benefits of these newer medicines, even endocrinologists had to be dragged along kicking and screaming to really buy into the concept of using these drugs for reasons other than glucose lowering. So it has not been an easy transition. I think as more and more evidence of cardiovascular outcomes benefit has accumulated, the cardiologists have become more comfortable prescribing these drugs. But again, I work at an academic medical center. I primarily interact with academic doctors. And that is probably not true out in communities, particularly rural communities. So not every cardiologist, not every nephrologist is going to be covered completely, up to speed, or comfortable prescribing these drugs. But to get back to your point about going on and off the medications, this is an issue and we hear people ask all the time, do I need to be on this forever? I have to say, in my experience treating people with type 2 diabetes, I don't get that question very often because when I start them, for example, at a GLP1 receptor agonist. They're very potent and effective medicines for people who can tolerate them at reasonably high doses. And often I can control their blood sugar, for example, with that intervention. Sometimes I'm able to stop other medicines that they're on. And so a person with diabetes, type 2 diabetes, is often already used to being on a medicine or more medicines that they need to be on long term to control their blood sugar. So the concept of taking a different one in place of one or more other ones is a little bit easier. Where it gets tricky is for the person without diabetes who is taking, for example, a GLP1 receptor agonist for weight management or other reasons. Now of course there's an indication to use one of them for treatment of obstructive sleep apnea. You know, what we have seen in trials of these medicines is that they absolutely work while you're on them from a weight management management perspective. But if, when people stop the drugs, the weight tends to creep back up. And in the studies that have been completed so far, when they followed people out long term, the people who stopped the medicine, their weight crept back up, maybe not to quite what they weighed at the beginning of the study, but it sort of looked like they were going to get there eventually. There may be exceptions to that. There may be a person who is able to get their weight weight to their individual goal with a medicine who could come off of it and successfully keep their weight there. But that does not seem to be the experience to date. Our bodies probably have, our brains probably have a weight set point that our brains are comfortable with. And when we're not on a medicine that helps our body to our brain to readjust that set point, then when we stop the medicine, our brain kind of wakes up and says, oh yeah, you're supposed to weigh 220 pounds, let's get back up there. So our body's physiology is working against us. And so I would encourage people to think about these medicines if they are medically indicated for them to be long term, indefinitely used treatments. But of course, if people get to their ideal weight or their circumstances change, they certainly may be able to take lower doses over time. So we need to be thinking about this from a long term perspective.
- [33:14]
B
Yeah, it takes time to talk to your patients, reinforce that. And the other thing to tell them would be, and the listeners is that, you know, not all the benefits we see with these drugs are due directly to weight loss. So they have benefits way beyond losing weight. So you can't, when you gain the weight back, you know that's not good, but you're losing the benefit that you'd have on the heart, the kidneys, the joints in your knee, the liver, so.
- [33:44]
C
Yeah, exactly. And you know, I forgot to you mentioned people with type 1 diabetes. And I completely agree that, that that's a group of people who really have largely not benefited from all this tremendous amount of information that we're learning about the benefits of these newer medications. There are some smaller studies that are either ongoing or that are planned to look specifically about the effects of these medicines on organ health and people with type 1 diabetes. And I believe there's a study in Denmark that will be comparing in people with type 1 diabetes the cardiovascular and kidney effects of multiple classes of newer medications. So stay tuned. Unfortunately, we don't seem to have much information to go on at the present time, but there should be more in the relatively near future. But it's really not.
- [34:42]
B
This is the time that Jeremy starts crying.
- [34:44]
A
Well, yeah, I was going to say.
- [34:45]
B
Steve, Eric, pass the tissues.
- [34:47]
A
Not for me to get out of my soapbox, but we talk about this a lot. The type ones, they need access to these medications. And I do think it's coming. But I think to kind of wrap it up, this is a lot for people to hear. But we're not saying that this is just you are going to get these conditions. A lot of times people can say, well, I have diabetes, there goes my heart, my kidneys, kind of everything and can kind of give up. But there is a lot of options, opportunity here. I think there's been so much development in these medications and communication between these subspecialties. I would leave people kind of thinking that use their endocrinologist or diabetes specialist as the kind of the center spoke of the tire, you know, and, you know, talk to them about, you know, your diabetes, but all these other things to keep their hearts and kidneys healthy. And if they need to kind of go on to cardiologists or other specialists, of course is okay. But I do think that we're well suited in this metabolic space to oversee a little bit of all of this. So to kind of think beyond just your blood sugar control when you do see your diabetes doctor, and that people can live very long and healthy lives, which is something that we talk about. If you recognize these things, put in the work to kind of keep them under control. So anything, parting words, Jennifer, that you want to leave your patients with or people listening.
- [36:06]
C
Well, it's been a great conversation and honestly, we've only scratched the surface of this subject matter. So I wish we had more time to talk about more of the aspects of the CKM syndrome and the tools that we have to address that. But again, I would echo that this is not a doom and gloom or a depressing type subject matter. I think it's an exciting time and I really feel like we have the opportunity to intervene meaningfully in people's lives and keep them healthy for the long term. And I hope that this is an enthusiasm that the providers caring for patients feel. And I want people with diabetes to know that as well. But they may need to serve as their own advocates and feel free to ask questions about these kinds of complications in order to really get the treatment that they need and deserve.
- [37:08]
B
Take control of your CKM syndrome. You know what, I'm a firm believer, and Jeremy touched on it, that if you're aware as someone Living with type 2 or type 1 to ask your physician, get diagnosed early or screen until that abnormality just starts, treat it and you can live a longer and healthy life for it. So you're right. Make a positive out of it.
- [37:34]
A
Yeah, well, I agree. So much more to talk about, but we appreciate the time that we had with you and if you are listening, make sure to like subscribe, share with friends, all those kinds of things. Just want to say thanks again to Dr. Green and for all of you listening, we'll catch you on the next podcast. Sam.