Ralph DeFronzo, MD

Ralph A. DeFronzo, MD discusses the Noxious Nine and the impact of hypercortisolism on difficult-to-control type 2 diabetes.

Panelists discuss how treating hypercortisolism in patients may have long-term effects on glycemic control and overall health, potentially influencing future standards of care for difficult-to-control Type 2 diabetes, while emphasizing the need for clinicians to carefully manage such patients as ongoing research continues.

Experts discuss the CATALYST study's evaluation of mifepristone for hypercortisolism patients with hard-to-manage type 2 diabetes, its mechanism of action, suitable patient populations, treatment approaches for those with adrenal tumors, and factors determining surgical candidacy.

Key opinion leaders explore the diverse clinical manifestations of hypercortisolism across its spectrum of presentations.

Medical experts explore why findings from this study are crucial for clinicians managing diabetes, particularly those in primary care settings, and how these insights can impact their approach to patient care.

Medical experts discuss the implications of finding hypercortisolism in one-third of patients on three or more hypertension medications, the linkage between hypercortisolism and type 2 diabetes as presented in the ‘Pathologic Mechanisms of Hypercortisolism in Type 2 Diabetes’ session, and how hypercortisolism affects diabetes management, including the importance of addressing it and its consequences for patients with difficult-to-control diabetes.

The panel of medical experts discuss the prevalence of hypercortisolism based on the CATALYST trial.

The expert panel analyze data from the CATALYST trial.

Key opinion leaders navigate challenges associated with diabetes management.

The CATALYST study is discussed by a panel of experts led by Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES.

The panel concludes by discussing the long-term outcomes for patients treated for hypercortisolism, emphasizing the need for further studies and data, and sharing their final thoughts on the disease and its future management.

Medical professionals discuss their ideal patients for surgery, and who would be best suited for pharmacologic intervention.

Panelists review current guidelines for treating hypercortisolism, noting the need for guidelines to align with recent advancements, and share their own clinical practice approaches.

Panelists emphasize the importance of addressing underlying hypercortisolism, as it can lead to the development of osteoporosis and cardiovascular complications.

Medical experts offer a comprehensive overview of the pathophysiology of hypercortisolism, detailing its impact on β-cell dysfunction and reduced insulin sensitivity, and discuss the potential role of GLP-1 treatment in managing the condition.

Ralph DeFronzo, MD, leads a discussion on the evolving perception of autonomous adrenal hypercortisolism, highlighting that its prevelance is significantly greater than previously understood.

The panel emphasizes the importance of early identification of patients based on subgroups, such as those with difficult-to-control diabetes, hypertension, and bone issues, highlighting that the inability to lower a patient's insulin dosage is a significant risk factor for hypercortisolism.

Christopher Lucci, MD, reviews the current diagnostic tests for hypercortisolism, which include the Dexamethasone Suppression Test, DHEA level tests, and ACTH assessments.

Key Opinion Leaders address the psychiatric issues associated with hypercortisolism and highlight crucial clinical symptoms to look for when diagnosing the condition, such as hypertension in patients under 30 without a family history, diabetes in those under 40 with no family history, and bone issues among other signs.

Medical experts underscore disparities in diabetes treatment access, stressing the impact of insurance plans on treatment decisions, which can hinder patients and providers, especially when considering newer medications like GLP-1 agonists.

The expert panel addresses the common assumption of medication non-adherence in patients with resistant diabetes, provides strategies to differentiate non-adherence from underlying comorbidities contributing to resistance, and discusses the challenges of patients who are post-metabolic surgery, yet experience weight gain and symptom recurrence.

Hanford Yau, MD, Ralph DeFronzo, MD, Pam Kushner, MD, Honey East, MD, and Christopher Lucci, MD, explore resistant diabetes, share their clinical experience regarding the frequency of this condition, and highlight the role of continuous glucose monitoring in identifying patients who may be resistant, as indicated by prolonged periods of blood glucose levels outside the target range.