Op-Med is a collection of original articles contributed by Doximity members.
During this unprecedented time of the COVID-19 pandemic, the staff and leadership at the American Diabetes Association pulled off an impressive Virtual Scientific Sessions, engaging clinicians and scientists from all over the world to highlight the latest in diabetes research and clinical practice. For me, as a former President of the ADA for Medicine and Science, a few of the highlights included the WIN ADA networking session, updates on the Molecular Transducers of Physical Activity Consortium for the exercise interest group, and a series of robust conversations about optimal cardiovascular risk factor prevention and therapeutic pharmacology for people with, and at risk for, type 2 diabetes.
Women's Interprofessional Network of the ADA (WIN ADA): This ADA members-only forum supports the careers of women throughout the field of diabetes. Held as an innovative Zoom networking session, it highlighted the accomplishments of the Lois Jovanovich Transformative Woman in Diabetes award winner, Dr. Judy Fradkin, followed by breakout sessions for career support. Dr. Darleen Sandoval initiated this event by aligning the issues women across our society face, including bias and oppression, and enlisted all of us to work for meaningful change. One of the major goals of WIN ADA is to enhance the career effectiveness of women in the field of diabetes. As part of the reception, we held several breakout sessions: Self-Care and Preventing Burnout, Career Trajectories and Regaining Your Footing, Professional Development in Teams, Career Transitions, and Advocating for Ourselves and Each Other. Future virtual and live events will address constructive approaches to handling sexist situations that sideline our objective to “improve the lives of all people affected by diabetes.” WIN ADA is an important new forum for women in diabetes to gain the support they need to navigate difficult issues in their careers that are interfering with the impactful and effective use of their skills. This resource should improve research and care for people with diabetes.
Molecular Transducers of the Effects of Physical Activity Consortium (MoToPAC): The mini-symposium hosted by the Exercise Interest Group highlighted the ongoing work of the NIH-sponsored MoToPAC investigators, including studies in sedentary and highly trained people and rat models. The consortium is intended to support all research on the molecular transducers of exercise, which will be of great importance for the field of diabetes, where exercise is a foundational management tool. This consortium will be generating “omics” platforms that will be publicly available to enhance discovery in the field of exercise and inform future research in diabetes and exercise. Exercise is one of the most impactful beneficial interventions for people with diabetes and cardiovascular disease. Until MoToPAC (and similar consortiums across the world), it has not had this type of a concerted effort to define the biology behind it. This rigor will change the conversation and enable clearer understanding to support the statement, "exercise is medicine."
Debates: Throughout the meeting, there were a series of debates on the use and timing of pharmacological interventions for people with and at risk for diabetes. I will highlight a few of the debates which discussed the use of metformin as first-line treatment, the use of newer agents with established cardiovascular benefits (GLP-1 RA and SGLT2 inhibitors, initially developed as antihyperglycemic agents), and questions regarding whose job it is to manage cardiovascular risk in people with diabetes. Each of these issues is of high clinical significance with implications for the outcomes of the nearly half-billion people worldwide affected by diabetes. In my opinion, polarizing these issues using a debate format, while fun, is disruptive to a harmonized message of comprehensive cardiovascular risk factor reduction for all people with diabetes. New and exciting data with these agents for cardiovascular disease, including atherosclerotic cardiovascular disease, heart failure, and renal disease progression, should and are transforming care. These data are revolutionary and have already led to refinements in proposed society management guidelines, which differ subtly by society. Much like the inappropriate debate on vaccines, embedding these discussions in a debate format can detract from a robust message to the primary care provider. The message to all providers of diabetes care and prevention needs to be: These new agents (GLP-1 RA and SGLT2 inhibitors) are a component of comprehensive management of cardiovascular risk reduction and renal protection for millions of people worldwide. Guidelines and treatment algorithms that affect millions and the health care systems that support the enactment of guidelines evolve. People with, and at risk for, diabetes need comprehensive CV and renal risk reduction; this objective will be enabled by awareness, prevention, detection, treatment, and support (pharmacological, behavioral, and societal).
Illustration by April Brust