In this episode, we examine the concept of "therapeutic inertia" in diabetes care. Dr. David Ahn is joined by Dr. Grazia Aleppo, Professor of Medicine at the Feinberg School of Medicine, Northwestern University, to explore how inhaled insulin can help address the clinical and behavioral barriers often associated with insulin initiation.

Key discussion points:

• Defining therapeutic inertia in the context of insulin initiation.

• Common clinician and patient-related barriers that contribute to treatment delays.

• Practical strategies for introducing inhaled insulin to hesitant patients.

• System-level considerations, including workflow and reimbursement challenges.

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#DiabetesCare #Endocrinology #InhaledInsulin #ATTD #MedicalPodcast

Chapters:

00:00 Why Inhaled Insulin Matters

00:34 Show Intro and Guest

01:22 Defining Therapeutic Inertia

02:19 Clinician Barriers to Insulin

03:49 Patient Fears and Hesitation

05:28 How Inhaled Insulin Helps

07:00 Best Fit Patient Scenarios

08:22 Talking to Hesitant Patients

10:39 Workflow and Coverage Hurdles

13:35 PFT Testing and Side Effects

14:47 Future Role and Wrap Up

In our new series, The Role of Inhaled Insulin, host Dr David Ahn looks at the practical implementation of inhaled insulin in clinical practice. He is joined by Dr Irl Hirsch.

They discuss:

• Where inhaled insulin fits today within the overall insulin therapy landscape

• The best candidates for inhaled insulin in routine clinical practice

• Key clinical factors to guide decision-making

• Practical first steps to initiating inhaled insulin

• Approaches to titration

• Monitoring strategies, particularly regarding pulmonary safety and glycemic outcomes

• Shared decision-making and engaging patients

Dr Irl Hirsch is Professor of Medicine, in the Division of Metabolism, Endocrinology and Nutrition at the University of Washington School of Medicine. 

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In today’s episode, Dr Bob Gabbay is joined by Dr Elena Toschi to address the most common questions clinicians have when it comes to insulin therapy.

They discuss:

• The most common mistakes or misconceptions in basal insulin initiation and management

• Intensification strategies such as titration, adding prandial insulin, or using fixed-ratio combinations

• Leveraging technologies to improve insulin adherence and outcomes

• Managing hypoglycemia concerns and achieving glycemic targets

• Addressing psychological and behavioral barriers to insulin use in everyday clinical practice

Dr Elena Toschi is Assistant Professor of Medicine at Harvard Medical School. She’s also Director of the Young Adult Program and a member of the Diabetes Technology Program at the Joslin Diabetes Center.

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In today’s episode, Dr Bob Gabbay is joined by Dr Anne Peters to discuss personalized insulin approaches for complex populations.

They discuss:

• Why personalization is particularly important in insulin therapy

• The patient groups most in need of a tailored approach

• How comorbidities or frailty influence insulin decision-making

• Guidelines, flexibility, and local solutions

Dr Peters is a Professor of Medicine at the Keck School of Medicine of USC, and Director of the USC Clinical Diabetes Programs.

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In this episode, host Bob Gabbay and his guest, Diana Isaacs PharmD, break down common barriers to insulin adherence; from the common reasons people may struggle with insulin, to behaviour change approaches that can help clinicians support their patients.

They discuss:

• The barriers most misunderstood by clinicians

• Communication and motivational interviewing with patients

• Emotional burden and fear of hypoglycemia

• Practical strategies clinicians can use to support patients more effectively

• The role of the wider diabetes healthcare team

Diana Isaacs is an Endocrine Clinical Pharmacist and Director of Education and Training in Diabetes Technology at the Cleveland Clinic.

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In this episode, host Bob Gabbay and his guest, Professor Simon Heller, discuss preventing and managing hypoglycemia, with a focus on the risks, recognition, and safety education.

They discuss:

• Why hypoglycemia remains a major concern in insulin therapy

• Key risk factors to keep in mind

• Clinical signs or patient-reported symptoms

• Prevention strategies

• Importance of patient education

• Balancing glycemic targets with hypoglycemia risk

Prof. Simon Heller is Professor of Clinical Diabetes at the University of Sheffield, and Director of Research & Development at Sheffield Teaching Hospitals, NHS Foundation Trust.

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In this episode, host Bob Gabbay and his guest, Professor Tadej Battelino, Co-Chair of ATTD, discuss the latest technological innovations in diabetes, including delivery innovations, connected devices, titration support.

They discuss:

• The new technologies making the biggest difference in insulin therapy today

• The role of smart pens, connected devices, and apps

• Biggest clinical impact - including adherence, titration and outcomes

• Accessibility of these tools in real-world practice

• Advisor role of AI

• The promising future of technology in insulin therapy and a functional cure

Professor Tadej Battelino is Co-Chair of ATTD and Chair of International Diabetes Federation Europe.

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In this episode, host Bob Gabbay and his guest, Dr George Grunberger, Chairman of the Grunberger Diabetes Institute, discuss best practice and guidance around basal insulin and GLP-1 combinations.

They discuss:

• What exactly fixed-ratio combinations are and the problems they tackle

• Identifying patient candidates and timelines for starting FRCs

• Meaningful benefits of FRCs compared with basal insulin alone

• Concerns and limitations of FRCs

• How guideline recommendations currently position FRCs in diabetes management

Dr George Grunberger, Chairman of the Grunberger Diabetes Institute in Michigan. George is also Clinical Professor of Internal Medicine at Wayne State University School of Medicine, and Professor of Internal Medicine at Oakland University William Beaumont School of Medicine.

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In this episode, host Bob Gabbay and his guest, Dr William Polonsky discuss safe and effective titration strategies, and the importance of collaborating with your patient.

They discuss:

• The importance of titration in successful insulin therapy

• Barriers to titration, including patient self-management

• How clinicians can collaborate with patients in their titration journey

• The importance of language used by clinicians

• Practical tips for simplifying titration in busy clinical settings

Dr. Polonsky is President and Founder of the Behavioral Diabetes Institute, and Associate Clinical Professor in Psychiatry at the University of California.

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In this episode, host Bob Gabbay and his guest, Dr Osama Hamdy, discuss how clinicians can identify patients for insulin initiation in Type 2 diabetes.

They discuss:

• When clinicians should consider insulin for patients with T2D

• Addressing concerns of weight gain with insulin

• ADA/EASD recommendations

• Barriers to insulin therapy and Type 2 diabetes

• Advice on communication with patients

Dr Osama Hamdy is Associate Professor of Medicine at Harvard Medical School, and Director of the Obesity Clinical Program at the Joslin Diabetes Center.

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