ATTD: Advanced Technologies and Treatments for Diabetes

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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