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S1-E3 - Diabetes Drug Choices With Benefits For NAFLD

S1-E3 – Diabetes Drug Choices With Benefits For NAFLD

Hepatologist Naim Alkhouri and Endocrinologist Scott Isaacs join Ken Cusi and Roger Green to discuss drug choices prescribers can make TODAY for patients with Type 2 Diabetes Mellitus and obesity that have positive impact on Fatty Liver disease.

The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide is a four-part series focusing on what front-line providers treating patients with Type 2 diabetes and obesity can do to help their patients avoid the serious consequences of severe, progressive Fatty Liver disease. This episode looks at drug choices prescribers can make TODAY for patients with Type 2 Diabetes Mellitus and obesity that have positive impact on Fatty Liver disease. In addition to co-hosts Dr. Ken Cusi and Roger Green, panelists for this discussion include endocrinologist Dr. Scott Isaacs, second author of the recent AACE guidelines, and hepatologist Dr. Naim Alkhouri.

Diabetes Drug Choices With Benefits For NAFLD

Ken and Roger introduce the conversation by previewing the episode. KEY POINT: Ken notes that we are living in a period where the paradigm around treating chronic metabolic conditions is shifting. In a world where one in five patients with T2DM lives with clinically significant fibrosis, Ken states providers can no longer ignore the liver when making treatment decisions about diabetes. He also suggests that hepatologists need to become more comfortable using medications that were previously reserved for diabetes.

At this point, Naim and Scott join the conversation. Naim kicks off the conversation by discussing EDICT, a trial that compared the standard T2DM regimen of the day (metformin, followed by the sulfonylurea glipizide, and then insulin) to a first-line combination therapy of metformin, the GLP-1 agonist exenatide and the PPAR pioglitazone. At the end of this six-year period, the researchers found meaningful, statistically significant differences in three key Fatty Liver parameters: prevalence of NAFLD (69% vs. 31%); clinically significant fibrosis (26% vs. 7%); and percentage fat in the liver (12.5% vs. 8.5%). It also found that patients achieved a lower HbA1c level (6.0% with the combination, vs. 6.8% in the standard treatment group).

In response to a question from Roger, Ken identifies three majors lessons of the last 10 years:

7 of 10 Americans with T2D have a fatty liver; those with NAFLD but not T2D see their chances of becoming diabetic and , separately, developing cardiovascular disease double.
15-20% of Americans with T2D also exhibit moderate-to-advanced cirrhosis.
GLP-1s, as a class, address multiple factors of chronic metabolic disease. They reduced HbA1c, promote and maintain significant weight loss, and slow progression of fibrosis.
Now, Ken adds, he newer class of GLP-1/GIP dual agonists promote more weight loss, which might suggest a stronger effect against NASH.

Naim expresses a concern that many doctors treating patients with T2D do not consider NASH. A Cleveland Clinic assessment of ICD-10 codes demonstrated that only 5% of T2D patients were coded for NAFLD. This means the 2/3 of the T2D patients in that system have fatty livers and were never evaluated! Similarly, ~2/3 of the patients who present with cirrhosis in his clinic were never told that they had NAFLD. In Naim’s view, NAFLD should be a disease for primary care and endocrinology to treat, while it should be hepatologists that treat NASH.

Roger raises a paradox: primary care and endocrinology avoid Fatty Liver disease because they fear having to treat cirrhosis, but this avoidance leads to a large number of cirrhosis cases that might have been avoidable. Scott agrees and says one reason is that physicians hear “there is nothing to be done.” Scott disagrees with the last point, noting that drugs are available and the prescription of diet and exercise can be “incredibly motivating.”

The rest of the discussion centers around why primary care, endocrinologists and hepatologists do not treat the combined metabolic package more aggressively and what Fatty Liver advocates can do to drive earlier, more aggressive treatment.

S2-5 – Key Insights from the American Diabetes Association 83rd Scientific Sessions

Ken Cusi and Roger Green are joined by family practice researcher and KOL Eric Johnson and diabetologist and primary care KOL Jay Shubrook in a discussion around exciting news emerging from the ADA 83rd Scientific Sessions meeting. Layering in practical takeaways, the group explores their impressions from the meeting, the utility of FIB-4 as a frontline screening tool, guidelines and recommendations, therapeutic options both now and in the imminent future, and lastly the new nomenclature rollout for Fatty Liver disease.

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S2-E3 – Why Clinical Care Pathways Matter

In this episode of the Rising Tide series, co-hosts Ken Cusi and Roger Green are joined by KOL in public health, Jeff Lazarus, and physician and associate professor of internal medicine, Jeff Budd. The panelists focus on why clinical care pathways matter and drive the message that primary care plays an integral role in fighting fatty liver.

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S2-E2 – A Deeper Dive Into Fatty Liver, NAFLD, and NASH

In this episode of the Rising Tide series for frontline professionals, the patients themselves and caregivers, co-hosts Ken Cusi and Roger Green are joined by KOL in hepatology, Manal Abdelmalek and KOL in endocrinology, Scott Isaacs for a deeper dive into Fatty Liver, NAFLD and NASH. The group discusses: morbidities and mortalities related to fatty liver disease, paradigm-shifting data, screening for risk stratification, pediatric and adolescent populations, unique key takeaways and much more.

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S2-1 – Combating Swelling NAFLD and NASH Prevalence: Drugs, Diagnostics and Guidelines for the Frontline

In the Season 2 debut of the Rising Tide series for healthcare professionals who treat diabetic patients, the patients themselves and their caregivers, co-hosts Ken Cusi and Roger Green are joined by Mazen Noureddin to talk about prevalence and taking action on the frontlines today. The trio explore emerging NASH drugs, noninvasive testing and guidelines for treating different stages of disease progression.

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S1-E2 — What’s Behind The New AACE Fatty Liver Guidelines?

Drs. Mary Rinella, Zobair Younossi and Diana Barb join co-hosts Dr. Ken Cusi and Roger Green to explore the new AACE Fatty Liver guidelines. Learn about the epidemiology and research behind the guidelines and what they recommend for endocrinologists, primary care physicians and allied health professionals when screening, diagnosing and managing Type 2 Diabetes patients for Fatty Liver disease.

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S1-E1.1 – Fatty Liver Prevalence May Be Higher Than Previously Thought, Especially Among Type 2 Diabetes Patients

Hepatology Researcher and Key Opinion Leader Stephen Harrison discussed results of his 2021 publication in the Journal of Hepatology that reported, in a prospective random sample of 835 people with a median age of 55, NAFLD prevalence as being 37%, NASH as being 14% and advanced fibrosis as being 6% in a random asymptomatic patients. Among patient with Type 2 Diabetes, NAFLD prevalence was 70% and NASH was 35%.

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S1-E1 – New Podcast: Growing NAFLD-Diabetes Dual Prevalence Increases CVD Risk for Diabetics

In this Premier episode of The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide, key opinion leaders Doctors Stephen Harrison, Kathleen Corey and Kay Pepin join co-hosts Dr. Ken Cusi and Roger Green to discuss key issues related to the NAFLD-Diabetes Link, NAFLD-Diabetes Dual Prevalence: very high NAFLD and NASH prevalence in diabetics leads to increased CVD risk and other metabolic issues.

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