Closing the Gap in Type 2 Diabetes Care: John Anderson, MD

Advances in type 2 diabetes care are transforming outcomes for patients, but gaps in implementation and access mean many are still not benefiting from lifesaving therapies. In a recent discussion, John Anderson, MD, an internal medicine and diabetes specialist at the Frist Clinic and past president of medicine and science for the American Diabetes Association (ADA), outlined how primary care teams and specialists can work together more effectively—and why system-level change is urgently needed.

An estimated 90% of type 2 diabetes care in the US occurs in primary care settings, placing frontline clinicians at the center of disease management, according to Anderson. When patients are not reaching glycemic targets, particularly when basal or basal–bolus insulin is needed, primary care clinicians should not hesitate to refer to endocrinologists or other specialists. The guiding question should always be asking if the patient is meeting their goals. If not, collaboration is essential.

Anderson urged clinicians to proactively brief specialists before the first visit, especially about any issues the patient is struggling with. A simple phone call to a colleague, he noted, can set up that first specialist encounter for success and model good habits for younger clinicians.

The interview also highlighted the rapid evolution of therapies for heart failure and chronic kidney disease (CKD). Beyond traditional angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, clinicians now have sodium-glucose cotransporter 2 (SGLT2) inhibitors and nonsteroidal mineralocorticoid receptor antagonists, which have demonstrated significant benefits in slowing CKD progression—even in patients without diabetes. Despite this, use of these agents in populations who do not have diabetes remains in the single digits.

For diabetes specifically, the impact of glucagon-like peptide-1 (GLP-1) receptor agonists, dual agonists, and SGLT2 inhibitors has been described as “nothing short of profound,” with data showing reduced hospitalizations for heart failure and fewer major adverse cardiovascular events. Yet high costs and limited insurance coverage mean many patients cannot access these medications, while affluent patients face few barriers.

Ultimately, Anderson argued, these therapies are cost-saving at a global level, even if pharmacy costs appear high. Ensuring equitable access and embedding kidney and heart protection into routine primary care are, in their view, now core responsibilities of modern clinicians.