Opinion
Video
Barriers Associated with Guideline-Directed Care
Author(s):
Panelists discuss how barriers to implementing evidence-based obesity and diabetes care include limited provider time, lack of multidisciplinary teams, insufficient education about obesity physiology, and high costs of medications and programs.
ADA Guidelines and Risk Stratification
Current ADA recommendations emphasize moving beyond BMI alone to consider multiple overlapping conditions in what can be viewed as interconnected Venn diagrams of diabetes, obesity, cardiovascular disease, and chronic kidney disease. While glycemic control remains important, whole person-centered care requires attention to lipid management, blood pressure control, and selection of diabetes medications that provide cardiovascular and kidney benefits.
People with diabetes typically don't die from hypoglycemia but rather from cardiovascular complications, making lipid management a critical pillar of care. The challenge extends beyond prescribing appropriate medications like statins to ensuring patient adherence, which requires building trust and understanding what matters most to each patient. The approach emphasizes that how clinicians manage diabetes, lower cholesterol, and control blood pressure matters significantly.
Recent research demonstrates that the specific antihypertensive agents used can impact outcomes differently, highlighting that medication selection should prioritize cardio-renal protective effects. The focus must shift from solely lowering blood glucose to providing comprehensive care that addresses the interconnected nature of these conditions and offers patients the cardiovascular and kidney protection they need and deserve.
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