Dr Diana Isaacs Surveys Emerging Diabetes, Obesity, and Cardiometabolic Treatment Landscape

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP, Cleveland Clinic, recently joined for an interview regarding the recent Institute for Value-Based Medicine® event hosted in conjunction with Cleveland Clinic titled, "Future Perspectives and Controversies in Diabetes, Obesity, and Cardiometabolic Health."

In the interview, Isaacs discussed the notable interventions being developed in this field and dives into what she sees as the most prevalent challenge that needs to be addressed for the betterment of patient health.

Transcript

This transcript has been lightly edited for clarity and length.

Which emerging treatment modalities or technologies do you foresee making the most significant impact in the management of diabetes, obesity, and cardiometabolic diseases, and how might they address current challenges in patient care?

In terms of new and emerging treatment modalities, I think that the big one—and a big focus of our conference—is on the GLP-1 receptor agonist or the incretin therapies, like the dual agonist and, now, we've got things in the pipeline, like triple agonist. And so I think those have been huge game changers in terms of the glucose-lowering as well as the weight loss. And now we're seeing those agents just really expand in the whole cardiometabolic space, we're seeing them being used or investigated for other conditions like heart failure, kidney disease, they're even being investigated for things like dementia. And so, it's really a very exciting time.

And in terms of technology, I think continuous glucose monitoring (CGM) just continues to explode. It really is the standard of care for anyone on any type of insulin. But we're also seeing it greatly expand now, for people on non-insulin therapies. And I think especially as we use, like a lot of times we use these GLP one therapies, and people are already on insulin, and we have to be very careful that we are decreasing insulin as they're losing weight and their glucose is lowered so that they don't experience hypoglycemia. And so the CGM is an amazing tool to help us to be able to do that.

And then of course, the virtual care and CGM now with the smartphone apps and being able to view the data remotely so we can do virtual visits, and someone doesn't need to come in so frequently with all the inconvenience of parking and everything. So the tech and the therapies are just very exciting.

What are some of the most pressing challenges in the field of diabetes and cardiometabolic health that need to be addressed? How do you propose navigating these to ensure optimal patient outcomes and public health initiatives?

One of the biggest challenges is cost and access. So these therapies, especially the incretin, the GLP-1 therapies are quite expensive. They're generally at least $1,000 a month. So in terms of having insurance coverage for it, or the prior authorization process, which takes extra time and extra hurdles to obtain it for our patients, and then sometimes even when it is covered, the copays the person has to pay—I mean, I've got patients that have $100 copays, which sounds like a bargain compared to $1000 a month, but that's too much for some people to pay. And so that is a huge concern because we've got people that clearly would benefit tremendously from these therapies that are just not able to obtain them.

Then, probably the second big issue is with the shortages that have occurred because of how well these drugs work and the popularity of them they just haven't been able to make them quickly enough. And so we see that, at any given time, a certain drug or a certain dose of a drug can be in shortage and that creates a real challenge for us to figure out “Okay, well, what do we do? Do we try to just send it to a different pharmacy that maybe has it? Do we need to go to a lower dose or go to the next higher dose or do we need to switch?" And so it's very challenging.

And then this has also led to this kind of whole separate market of compounding these drugs. And depending on who's doing it, I mean, it's a challenging world to navigate. It is technically legal. If there's a shortage and there's a reason to do it, it can be legal for pharmacies to do but the problem is that the oversight and regulation of the compounded products is not there. It's not like the FDA-approved product. And so we don't know necessarily that patients are getting the right dose when they're getting compounded formulations. We know they're saving money, usually. Usually, the compounded ones cost less, but they also, many times, are more challenging to use. They may come in a vial with a syringe someone has to draw up. And so it's just the safety then, you worry about the safety of that, too. So I would say those are some of the big challenges we're facing right now.