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Presenter Profile: Updates in ADA’s Standards of Care in Diabetes—2023


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Updates in ADA’s Standards of Care in Diabetes—2023

Sunday, June 25, at 8:00 a.m. PT
Ballroom 20A-C
San Diego Convention Center
(Livestream Available)

Kenneth Cusi, MD, FACP, FACE
Kenneth Cusi, MD, FACP, FACE

Kenneth Cusi, MD, FACP, FACE

Professor of Medicine,
University of Florida

What is your presentation about?
Among the changes in the 2023 ADA Standards of Care, the new recommendations for management of nonalcoholic fatty liver disease (NAFLD) are of paramount relevance. NAFLD is a growing public health problem, that in particular, affects people with prediabetes or diabetes who are insulin resistant and/or obese. This increases their risk of liver cirrhosis, hepatocellular carcinoma (HCC), progression from prediabetes to type 2 diabetes and cardiovascular disease (CVD). New recommendations for screening and management will be presented at the session.

What makes this topic important in 2023?
NAFLD in people with prediabetes or diabetes is reaching epidemic proportions but currently most of those affected go undiagnosed. Clinicians will learn during the session how to use a simple diagnostic algorithm for the early identification of those at the highest risk of cirrhosis. Recommendations will be presented about intervention with lifestyle modification and use of available pharmacological agents (i.e., pioglitazone, GLP-1RA) shown in RCTs to reverse or halt liver disease in the majority of patients with steatohepatitis (NASH). Every physician should know how to screen and treat their patients with NAFLD/NASH.

How did you become involved with this area of diabetes research or care?
About 20 years ago, gastroenterology colleagues reported to me seeing in clinic an increasing number of patients with hepatitis without any other cause of disease other than obesity and/or type 2 diabetes, less often in non-obese individuals. It soon became obvious that NAFLD/NASH was an overviewed comorbidity that deserved urgent attention. Since then, we have learned much more, and in the past two years, several medical societies have recommended screening for people with prediabetes and type 2 diabetes, obesity with metabolic risk factors, incidental finding of liver steatosis, or if plasma aminotransferases are elevated. In several studies, pioglitazone and GLP-1RA have shown benefit, and many drugs are under development.

How do you think your presentation will impact diabetes research or care?
The recommendation to screen with FIB-4 all patients with prediabetes or type 2 diabetes is a major paradigm shift in our care for people with type 2 diabetes. It should be viewed as important as screening for microvascular disease (eye, kidney, nerve damage) or CVD, as it is as common as them. This is the first time that such formal recommendations have been elicited and will save millions of people with diabetes from cirrhosis, HCC, and perhaps from CVD too.

What are you most looking forward to at the 83rd Scientific Sessions?
To engage with attendants through our laboratory work (i.e., several posters) and these new recommendations to mark a new standard of care with large implications for millions of people with diabetes.