As the age of diagnosis for pre and type 2 diabetes continues to decrease, Dr. Tina Thethi believes in focusing on reducing risk factors to prevent further complications.
At Pri-Med Midwest 2022, talk about treating clinical obesity was prevalent. Robert Kushner, MD, Professor of Medicine at Feinberg School of Medicine Northwestern University explained that less than 2-3% of patients with obesity receive medication for it, despite being eligible for pharmacotherapy.
In this interview, Tina Thethi, MD, MPH, Associate Investigator, AdventHealth Research Institute, elaborated on the possible contributing factors of this gap in care. She began by addressing the importance of understanding the basics of obesity management and how it starts with initiating a conversation about the patient's Body Mass Index (BMI).
"Many times it is difficult for the patient to even accept that the weight that they have been living with for a long time is not normal, and in fact, needs to be reduced," she said.
When treating obesity, the goal is to reduce weight in the patient, regardless of the presence of glucose abnormality.
"Obesity by itself is a risk factor for diabetes," she explained. "Obesity is a risk factor for cardiovascular disease. It is also an independent risk factor for chronic kidney disease, regardless of whether you have diabetes or not."
An indicator that it's time to speak with a patient about weight management should be any increase in blood sugar, according to Thethi. For example, she noted that a blood sugar level or 101 or 102 is referred to as impaired fasting and is abnormal.
"The notion that obesity should be treated only if there is metabolic disarrangement—as in, either pre diabetes, impaired fasting glucose or diabetes—I think we now need to shift the focus back and say, 'let's treat them earlier rather than later,'" she said.
Additionally, insurance coverage or cost associated with weight loss agents is another barrier, particularly for those with obesity and without a diagnosis of diabetes.
"Across the board, everyone in the medical community would agree that insurance can also definitely be a barrier for clinicians to treat patients who are receptive to the treatment," Thethi continued.
Efforts have been made to improve affordability of GLP-1 receptor agonists (RAs), which aid in weight loss and have indications for type 2 diabetes, but cost-effectiveness remains as an obstacle. As the age of diagnosis for pre diabetes and type 2 diabetes continues to decrease, Thethi believes that focus should be placed not only on the levels of A1c, but on reducing the risk factors to prevent further complications.
"It is quite discouraging," she said. "I know efforts are ongoing—efforts have been made. Yes, we've made some progress, but I do think we have more progress to make in this field, so we can make our drugs much more accessible to the people that need them."
At the primary care meeting, Dr. Tina Thethi spoke on "Where Are We Now? The Integral Role of GLP-1 RAs in the Treatment of Type 2 Diabetes Mellitus” with Frank Lavernia, MD.