Explore every episode of the podcast Endo in a Bite

In this episode, we review the 2026 Consensus Statement on the use of diabetes technology for management of adults with diabetes, focusing on automated insulin delivery. Topics include automated insulin delivery systems, the three main components of AID, hybrid closed loop function, meal related insulin dosing, temporary activity settings, standardized AID reports, prescribing and clinician training, manufacturer support, evidence in type 1 diabetes, AID as a standard of care option, use in older adults, functional assessment, patient selection, and requirements for safe and effective AID use.

In this episode, we review the 2026 Consensus Statement on the use of diabetes technology for management of adults with diabetes, focusing on continuous glucose monitoring in the inpatient setting. Topics include the regulatory status of inpatient CGM, guideline support for continued personal sensor use during hospitalization, hybrid CGM and point of care glucose monitoring, clinical outcomes, factors that reduce CGM accuracy, medication related interference, CGM use during imaging, surgery, and other procedures, inpatient glucose targets, institutional requirements, and electronic health record integration.

In this episode, we review the 2026 Consensus Statement on the use of diabetes technology for management of adults with diabetes, focusing on continuous glucose monitoring during pregnancy and the postpartum period. Topics include pregnancy specific CGM targets, time in range and hypoglycemia thresholds, the role of CGM in type 1, type 2, and gestational diabetes, why glucose management indicator is not validated in pregnancy, evidence for maternal and neonatal outcomes, and CGM management during the postpartum and breastfeeding periods.

In this episode, we review the 2026 Consensus Statement on the use of diabetes technology for management of adults with diabetes, focusing on continuous glucose monitoring across key patient populations. Topics include CGM use in insulin treated diabetes, non insulin treated type 2 diabetes, chronic kidney disease, individualized management in CKD, compression lows, the lag between blood and interstitial glucose, and substances that may interfere with CGM accuracy.

In this episode, we review the 2026 Consensus Statement on the use of diabetes technology for management of adults with diabetes, focusing on continuous glucose monitoring fundamentals, CGM data quality, time in range targets, and glycemic variability. Topics include CGM components and interstitial glucose measurement, key glucose thresholds, the 5-25-70-4-1 CGM targets, hypoglycemia prioritization, coefficient of variation, time in tight range, glucose management indicator, GMI and laboratory A1C discordance, and individualized glucose targets.

In this episode, we review the major islet autoantibodies used in type 1 diabetes, focusing on GAD65 in adults, IAA in young children, IA-2 and progression risk, and ZnT8 for additional diagnostic sensitivity. Topics include antibody testing strategies, presymptomatic screening and staging, single versus multiple autoantibody positivity, type 1 diabetes stages, factors affecting antibody interpretation, and the role of C peptide in evaluating autoimmune diabetes.

In this episode, we review the 2026 Consensus Statement algorithm for selecting glucose lowering therapy in adults with type 2 diabetes, focusing on cardiovascular, heart failure, kidney, liver, weight, hypoglycemia, adverse effect, and cost considerations. Topics include medication efficacy, cardiovascular and cardiorenal benefits, weight effects, MASLD and MASH, renal dosing, adverse effects, and individualized treatment selection.

In this episode, we review the 2026 Consensus Statement algorithm for insulin management in adults with type 2 diabetes, focusing on the transition beyond basal insulin. Topics include recognizing overbasalization, initiating and titrating prandial insulin, basal bolus insulin therapy, hypoglycemia classification and treatment, glucagon prescribing, the role of CGM in identifying glucose patterns, premixed insulin therapy, and practical strategies for optimizing glycemic control while minimizing hypoglycemia.

In this episode, we review the 2026 Consensus Statement algorithm for insulin management in adults with type 2 diabetes, focusing on basal insulin initiation and titration. Topics include selecting the initial basal insulin dose based on A1C, structured titration strategies, dose reduction for hypoglycemia, titration intervals for different basal insulin preparations, once weekly insulin icodec, recognition of overbasalization using glucose patterns and the BEAM score, and when to consider prandial insulin rather than further basal insulin escalation.

In this episode, we review the 2026 Consensus Statement algorithm for insulin management in adults with type 2 diabetes. Topics include individualized glycemic targets, the role of continuous glucose monitoring (CGM), key CGM metrics and glycemic variability, recognition of severe hyperglycemia, when to initiate insulin, the role of GLP-1 based therapy before insulin in clinically stable patients, and practical strategies for optimizing insulin therapy while minimizing hypoglycemia.

In this episode, we review the 2026 Consensus Statement algorithm for glucose centric management in adults with type 2 diabetes. Topics include identifying patients appropriate for a glucose centric approach, metformin as foundational therapy, individualized medication selection based on weight, hypoglycemia risk, cost and access, early combination therapy, management of severe hyperglycemia, appropriate insulin initiation, avoiding inappropriate incretin combinations, and practical strategies for treatment intensification and reducing therapeutic inertia.

In this episode, we review the 2026 Consensus Statement algorithm for metabolic dysfunction associated steatotic liver disease (MASLD) management in adults with type 2 diabetes. Topics include the epidemiology and diagnosis of MASLD, progression to metabolic dysfunction associated steatohepatitis (MASH), lifestyle interventions and weight loss goals, the role of resmetirom, GLP-1 receptor agonists, tirzepatide, pioglitazone, and SGLT2 inhibitors, and practical evidence based strategies to improve liver health and reduce cardiovascular, renal, and hepatic complications.

In this episode, we review the 2026 Consensus Statement algorithm for stroke and transient ischemic attack management in adults with type 2 diabetes. Topics include stroke risk in type 2 diabetes, evidence supporting GLP-1 receptor agonists for stroke risk reduction, and cardiovascular outcomes with dulaglutide, liraglutide, injectable semaglutide, tirzepatide, and pioglitazone. We also discuss secondary stroke prevention in adults with insulin resistance, prediabetes, or type 2 diabetes, lower dose pioglitazone to improve tolerability, the limited role of SGLT2 inhibitors in stroke prevention, and practical evidence based strategies for reducing stroke risk in clinical practice.

In this episode, we review the 2026 Consensus Statement ASCVD management algorithm for adults with Type 2 Diabetes. Topics include cardiovascular risk reduction, major adverse cardiovascular events, and the evidence supporting GLP-1 receptor agonists and SGLT2 inhibitors for cardiovascular protection. We discuss semaglutide, liraglutide, dulaglutide, tirzepatide, and the cardiovascular safety of DPP-4 inhibitors. We also review treatment recommendations for adults with established ASCVD or high cardiovascular risk, the role of SGLT2 inhibitors in heart failure and chronic kidney disease, and practical evidence based strategies for cardiovascular risk reduction in clinical practice.

In this episode, we review the 2026 Consensus Statement algorithm for the management of chronic kidney disease in adults with Type 2 Diabetes. Topics include SGLT2 inhibitors as foundational renoprotective therapy, evidence based pharmacologic management of diabetic kidney disease, and strategies to reduce CKD progression, kidney failure, and cardiovascular events. We discuss canagliflozin, dapagliflozin, empagliflozin, finerenone, and GLP-1 receptor agonists, including semaglutide and the FLOW trial, along with eGFR initiation thresholds, albuminuria guided treatment, and combination therapy for persistent residual kidney risk. We also review therapeutic sequencing, cardiorenal protection, monitoring of eGFR, albuminuria, and serum potassium, board relevant treatment recommendations, pivotal clinical trials, and high yield facts for ABIM certification, recertification, LKA, and clinical practice.

In this episode, we review the 2026 Consensus Statement algorithm for heart failure management in adults with Type 2 Diabetes. Topics include the foundational role of SGLT2 inhibitors, heart failure with reduced and preserved ejection fraction, and evidence based pharmacologic therapy. We discuss dapagliflozin, empagliflozin, sotagliflozin, GLP-1 receptor agonists, and the role of semaglutide, tirzepatide, and liraglutide in different heart failure phenotypes. We also review medications that may worsen heart failure, including thiazolidinediones and selected DPP-4 inhibitors, therapeutic priorities for reducing hospitalization and cardiovascular mortality, and board relevant treatment recommendations, key clinical trials, and high yield facts to remember for exam preparation and clinical practice.

In this episode, we review the 2026 Consensus Statement hypertension algorithm for adults with Type 2 Diabetes. Topics include blood pressure targets, screening for secondary causes of hypertension, proper blood pressure measurement techniques, lifestyle interventions, and evidence based pharmacologic therapy. We discuss ACE inhibitors, ARBs, thiazide diuretics, calcium channel blockers, resistant hypertension management, mineralocorticoid receptor antagonists including spironolactone and finerenone, and the role of GLP-1 receptor agonists and SGLT2 inhibitors in blood pressure reduction. We also highlight board relevant treatment thresholds, cardiovascular risk reduction strategies, and key numbers to remember for exam preparation and clinical practice.

In this episode, we review the 2026 Consensus Statement on Lipid Management in Adults with Type 2 Diabetes. Topics include ASCVD risk assessment, LDL-C treatment targets, statin therapy, coronary artery calcium scoring, nonstatin lipid lowering therapies, triglyceride management, and key differences between ACC/AHA and AACE recommendations. We also discuss practical treatment strategies and board relevant pearls for cardiovascular risk reduction.

In this episode, we review the 2026 Consensus Statement on Diabetes Classification in Adults. Topics include diagnostic criteria for diabetes, distinguishing type 2 diabetes from autoimmune, pancreatogenic, monogenic, endocrinopathy associated, and medication induced diabetes, and the role of phenotype, autoantibody testing, and C-peptide measurement in establishing the correct diagnosis. We also discuss key clinical features that should prompt reconsideration of a diabetes diagnosis and how accurate classification can guide appropriate treatment selection and improve patient outcomes.

In this episode, we review the latest 2026 Consensus Statement recommendations for the evaluation and management of prediabetes. Topics include updated diagnostic criteria, the recognition of prediabetes as a cardiometabolic disease state, lifestyle interventions as the foundation of therapy, and strategies to prevent progression to type 2 diabetes. We also discuss comprehensive cardiovascular risk reduction, weight loss goals, the role of anti obesity medications and bariatric surgery, evaluation of lean prediabetes, pharmacologic options for diabetes risk reduction, and key clinical pearls for optimizing long term patient outcomes. Learn how early identification and comprehensive management can reduce future diabetes and cardiovascular disease burden.

This episode reviews major updates in ASCVD risk stratification and lipid management from the AHA/ACC lipid guideline. Topics include cumulative apolipoprotein B exposure assessment, updated low density lipoprotein cholesterol estimation methods, expanded clinical use of apolipoprotein B and lipoprotein(a), integration of cardiovascular kidney metabolic syndrome into preventive cardiology, revised triglyceride referral thresholds, PREVENT ASCVD risk equations, high sensitivity C-reactive protein guided statin therapy considerations, and the evolving role of coronary artery calcium scoring in refining lipid lowering intensity and individualized cardiovascular risk reduction.

This episode reviews major updates in lipid management for ASCVD risk reduction. Topics include revised LDL-C estimation equations, expanded clinical application of apolipoprotein B for residual atherogenic risk assessment, universal lipoprotein(a) screening, and cardiovascular kidney metabolic syndrome as a risk enhancing condition. The episode also discusses triglyceride referral thresholds, reproductive and inflammatory ASCVD risk enhancers, high sensitivity C-reactive protein guided statin considerations, and the role of coronary artery calcium scoring in refining lipid lowering therapy and cardiovascular risk stratification.

This episode applies risk based lipoprotein targets across specific clinical scenarios for atherosclerotic cardiovascular disease risk reduction. It highlights how severe hypercholesterolemia, diabetes, subclinical atherosclerosis, hypertriglyceridemia, and clinical ASCVD are stratified using the same three tier framework of 100/130/90, 70/100/70, and 55/85/55. It emphasizes the role of coronary artery calcium in refining risk, the use of apoB to assess atherogenic particle burden, and the distinction between patients with and without established ASCVD. It also reinforces that diabetes without ASCVD does not meet criteria for the most intensive targets and that consistent numeric thresholds guide management across varying clinical presentations.

This episode reviews risk based lipoprotein targets for atherosclerotic cardiovascular disease risk reduction. It highlights LDL-C, non-HDL-C, and apolipoprotein B as key parameters, with goals stratified by overall ASCVD risk category. It emphasizes the three tier framework of 100/130/90 for low risk, 70/100/70 for intermediate risk, and 55/85/55 for high or very high risk patients. It also covers primary versus secondary prevention targets, the role of apoB in refining atherogenic burden, especially in hypertriglyceridemia, and the importance of assigning risk first before applying lipid goals in clinical practice.

This episode reviews the clinical application of lipoprotein(a) and apolipoprotein B in cardiovascular risk assessment based on AHA ACC guidance. It emphasizes the genetic determination and stability of lipoprotein(a), supporting its role as a one time measurement for risk stratification, along with the importance of cascade screening in identifying inherited risk. The discussion outlines how lipoprotein(a) levels correlate with graded increases in cardiovascular risk and contribute to atherosclerosis, thrombosis, and calcific aortic valve disease. It also highlights apolipoprotein B as a direct measure of atherogenic particle burden, providing additional risk refinement beyond traditional cholesterol metrics, particularly in patients with metabolic disease or discordant lipid profiles. Key takeaways include appropriate use of advanced lipid markers, integration with PREVENT risk estimation, recommended monitoring strategies during lipid lowering therapy, and evidence based thresholds for treatment intensification to reduce long term cardiovascular risk..

This episode reviews standard lipid measurements for cardiovascular risk assessment based on AHA/ACC guidelines. It highlights the use of non-fasting lipid testing for most patients, key indications for fasting testing, and modern LDL cholesterol calculation methods. It also covers the role of non-HDL cholesterol and the limited utility of advanced lipoprotein testing in clinical practice.

This episode reviews the importance of dyslipidemia screening across both pediatric and adult populations based on AHA ACC guidelines. It highlights the epidemiology and clinical impact of dyslipidemia, emphasizing the role of cumulative low density lipoprotein cholesterol exposure in determining lifetime cardiovascular risk. The discussion covers universal screening strategies, limitations of family history based screening, and practical approaches to identifying high risk individuals, including those with familial hypercholesterolemia. Key takeaways include recommended screening intervals, age based strategies, appropriate use of lipid testing, and the importance of early detection and intervention to reduce long term cardiovascular morbidity and mortality.

This episode reviews the clinical significance of hypoglycemia in diabetes care, including its classification into Level 1, Level 2, and Level 3 events. The discussion highlights early recognition, variability in symptom thresholds, and the importance of prompt treatment to prevent severe outcomes. Key takeaways include the use of 15 to 20 grams of fast acting carbohydrates for conscious patients, appropriate use of glucagon in severe cases, and strategies to reduce recurrence through patient education and individualized care.

This episode reviews the evolution of vitamin D management frameworks, highlighting the shift from intake based recommendations by the National Academy of Medicine to the 2011 Endocrine Society’s laboratory driven approach, and back to a modern intake focused strategy in the 2024 guideline. The discussion emphasizes when vitamin D testing is appropriate, the role of 25 hydroxyvitamin D in assessing stores, and why routine screening is no longer recommended in healthy individuals. Key clinical takeaways include evidence based supplementation for specific populations such as older adults, pregnancy, and high risk prediabetes, along with a preference for consistent daily dosing over intermittent high dose regimens.

This episode reviews clinical management of gastrointestinal symptoms associated with semaglutide therapy and strategies to maintain treatment when intolerance occurs. The discussion explains the role of delayed gastric emptying in nausea and highlights practical approaches including dietary modification, slower dose titration, and symptom directed therapy.
Additional topics include pregnancy planning with the recommended 8 week washout period before conception and emerging evidence for kidney protection from the SUSTAIN 6 and FLOW trials demonstrating reduction in nephropathy progression and cardiovascular events in patients with type 2 diabetes.

This episode reviews the cardiovascular kidney metabolic (CKM) syndrome framework introduced by the American Heart Association, which describes the interconnected progression of obesity, type 2 diabetes, chronic kidney disease, and cardiovascular disease. The discussion highlights CKM staging and emphasizes early cardiometabolic risk recognition and preventive therapy including statins, blood pressure control, glucagon like peptide 1 receptor agonists, sodium glucose cotransporter 2 inhibitors, and renin angiotensin system blockade to reduce cardiovascular and kidney complications.

This episode reviews the American Heart Association PREVENT™ cardiovascular risk calculator and its role in modern primary prevention. The discussion highlights the shift from the pooled cohorts equation to contemporary risk prediction models that incorporate kidney function, cardiometabolic risk staging, and updated population data. Emphasis is placed on risk refinement strategies including coronary artery calcium scoring and lipid biomarkers such as apolipoprotein B and lipoprotein(a). These tools help identify hidden cardiovascular risk and guide preventive lipid lowering therapy before clinical cardiovascular disease develops.

This episode reviews the 2025 ACE consensus framework for individualized obesity pharmacotherapy, moving beyond standardized algorithms toward condition based medication selection. Emphasis is placed on comorbidities, organ specific risk stratification, safety monitoring, and long term therapeutic benefit to support precision management of adiposity based chronic disease.

This episode reviews the 2025 ACE consensus approach to cost conscious obesity pharmacotherapy, emphasizing access driven treatment sequencing, payer mandated step therapy, and stage based medication selection for adiposity based chronic disease. Focus is placed on balancing clinical efficacy, affordability, and long term sustainability, with escalation and override strategies guided by therapeutic response and the presence of obesity related complications.

This episode reviews the 2025 ACE consensus on complication centric obesity management, with a focus on organ system based medication prioritization. Topics include pharmacologic selection across cardiometabolic, renal, hepatic, cardiovascular, and biomechanical complications, emphasizing outcome driven therapy rather than weight alone in adiposity based chronic disease (ABCD).

This episode reviews the 2025 ACE consensus on biologically informed lifestyle therapy for obesity and adiposity based chronic disease (ABCD), including personalized nutrition strategies to achieve and sustain an energy deficit, protein and micronutrient requirements to preserve lean mass and metabolic health, physical activity and resistance training targets for weight maintenance, the role of sleep and circadian regulation in energy balance, and the importance of addressing weight bias, stigma, and psychological comorbidities in long term obesity management.

This episode reviews the 2025 ACE consensus on therapeutic weight loss response, threshold based outcomes, early pharmacologic response assessment, and how to align intervention intensity with disease severity in adiposity based chronic disease (ABCD).

This episode reviews the clinical component of the 2025 ACE consensus, shifting from identifying excess adiposity to staging adiposity based chronic disease (ABCD). It explains how clinicians assess obesity related complications, apply disease staging independent of BMI, and account for contributing factors such as medications, endocrine causes, genetics, psychological influences, and social determinants. The episode then connects staging to individualized treatment planning and long term management within a chronic disease framework.

This episode examines the anthropometric component of the 2025 ACE consensus on obesity, emphasizing the role of BMI as a screening tool rather than a diagnostic endpoint. It outlines population specific BMI thresholds, the clinical need for assessing abdominal adiposity, and the importance of standardized waist circumference and waist to height ratio measurements in evaluating cardiometabolic risk. The discussion reinforces why body fat distribution, rather than total body weight, drives disease risk and explains when body composition testing is indicated to clarify clinical ambiguity. The episode situates these measurements within the broader ACE framework for adiposity based chronic disease (ABCD), supporting more accurate risk stratification and individualized management.

This episode introduces the 2025 ACE consensus framework for obesity, reframing the condition as adiposity based chronic disease (ABCD) rather than a numeric weight diagnosis. It reviews the shift toward person centered, complication centric care, emphasizing the role of both anthropometric and clinical assessment in diagnosis and staging. The discussion highlights obesity related complications as the primary driver of disease severity, the limitations of body mass index as an endpoint, and the importance of shared decision making and longitudinal management using lifestyle, pharmacologic, and surgical therapies to improve health outcomes and quality of life.

This episode reviews the management of dyslipidemia in special populations using an individualized, risk based framework. It emphasizes ASCVD risk assessment in older adults, patients receiving gender affirming hormone therapy, individuals living with HIV, those with chronic inflammatory or autoimmune diseases, adult survivors of childhood cancer, and solid organ transplant recipients. The discussion highlights statin selection, drug drug interactions, use of non statin therapies, and the limitations of traditional risk calculators, underscoring the importance of shared decision making and tailored lipid lowering strategies in populations with complex and often underestimated cardiovascular risk.

This episode reviews guideline directed statin therapy and LDL lowering strategies using ASCVD risk based statin benefit groups. It emphasizes selection of statin intensity, LDL C treatment targets, and appropriate escalation to non statin therapies, including ezetimibe, PCSK9 inhibitors, and bempedoic acid. The episode also addresses statin associated muscle symptoms, CK based management thresholds, and evidence based approaches to true statin intolerance with shared decision making for optimal cardiovascular risk reduction.

This episode reviews the management of hypertriglyceridemia in pregnancy using a triglyceride level guided framework. It emphasizes risk stratification for maternal ASCVD versus pancreatitis, identification of secondary and genetic dyslipidemias, and implementation of lifestyle, dietary, and pharmacologic interventions with multidisciplinary oversight throughout gestation and lactation.

This episode reviews the evaluation and management of adult hypertriglyceridemia using a triglyceride level driven framework. Emphasis is placed on risk stratification to distinguish ASCVD risk reduction from pancreatitis prevention, identification and treatment of secondary and genetic contributors, and implementation of evidence based lifestyle and dietary interventions to guide therapy.

This episode breaks down hypertriglyceridemia in adults, covering classification by level, etiology, particle type, and clinical risk orientation.

This episode reviews the evaluation of adults with severe hypertriglyceridemia, according to the 2025 AACE Algorithm.

• Severe Hypertriglyceridemia: Understand impaired triglyceride clearance, chylomicron accumulation, and increased pancreatitis risk, including multifactorial causes.

• Familial Chylomicronemia Syndrome: Recognize this rare, early onset disorder with persistent hypertriglyceridemia despite low fat intake.

• Dysbetalipoproteinemia (APOE E2/E2): Learn about equal elevations of TG and cholesterol, tuberous xanthomas, low Apo B, and excellent response to fibrates.

This episode reviews how to evaluate and manage adults with extremely low or extremely high HDL cholesterol according to the 2025 AACE Algorithm.

• Identifies secondary causes of abnormal HDL, such as renal disease, low estrogen states, hyperandrogenism, medications (fibrates, TZDs, niacin, anti epileptics), alcohol excess, estrogen therapy, or pesticide exposure.

• Explains key genetic disorders linked to HDL extremes, including ABCA1 (Tangier disease), LCAT (fish eye disease), APOA1 deficiency, CETP deficiency, SCARB1 deficiency, LIPC deficiency, LIPG deficiency, and APOC3 variants.

• Summarizes diagnostic clues and next steps, such as examination for corneal clouding, orange tonsils, xanthomas, neuropathy, kidney evaluation, fasting lipid profile confirmation, and targeted genetic or family screening.

This episode reviews how to evaluate and manage adults with very low LDL cholesterol (<40 mg/dL) according to the 2025 AACE Algorithm.

• Identifies secondary causes such as lipid lowering therapy, malnutrition, malabsorption, and chronic diseases.

• Explains key genetic disorders linked to low LDL. Including MTTP, APOB, PCSK9, ANGPTL3, and SAR1B mutations.

• Summarizes diagnostic clues and next steps, such as liver ultrasound, vitamin level assessment, and genetic or family screening.

This episode explores the next step in the 2025 AACE Dyslipidemia Management Algorithm, focusing on adults with LDL cholesterol levels of 190 mg/dL or higher.

• Discusses how to evaluate for Familial Hypercholesterolemia and rule out secondary causes.

• Reviews diagnostic tools such as the Dutch Lipid Clinic Network, Simon Broome, and Welsh criteria.

• Outlines a stepwise approach to assessment, genetic testing, and family screening for early prevention

This episode serves as the introduction to the series on the 2025 AACE Dyslipidemia Management Algorithm, focusing on patient centered risk assessment and lifestyle based prevention strategies.

• Covers ASCVD and pancreatitis risk evaluation, lifestyle modification, and shared decision making.

• Introduces ASCVD risk classification, validated risk calculators, and integrated cardiometabolic management.

• Highlights the importance of equity, medication access, and long term adherence.