In this special episode of Diabetes Core Update, our host, Dr. Neil Skolnik, discusses with two expert guests the recommendations for respiratory vaccinations in people with diabetes, the rise in vaccine hesitancy and some of the possible reasons for this hesitancy, and several ways to address vaccine hesitancy in the office.

This special edition is sponsored by Sanofi.

Presented by:

Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington–Jefferson Health

John J. Russell, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair, Department of Family Medicine, Abington–Jefferson Health

Aaron Sutton, LCSW, BCD, CAADC, Behavioral Health Faculty at the Family Medicine Residency Program at Abington–Jefferson Health; Chief Wellness Officer for Graduate Medical Education at Abington–Jefferson Health

Select references mentioned in the podcast:

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024–25 Influenza Season. MMWR Recomm Rep 2024;73:1–25. DOI: 10.15585/mmwr.rr7305a1

Recombinant or Standard-Dose Influenza Vaccine in Adults Under 65 Years of Age. N Engl J Med 2023;389:2245–2255. DOI: 10.1056/NEJMoa2302099

Influenza Vaccine as a Coronary Intervention for Prevention of Myocardial Infarction. Heart 2016;102:1953–1956. DOI: 10.1136/heartjnl-2016-309983

Welcome to the first episode in a special three-part series of the Diabetes Core Update podcast, focused on heart screening in people with diabetes. Sponsored by Roche, this series explores "heart failure with preserved ejection fraction" (HFpEF), providing primary care clinicians and healthcare professionals with essential insights into screening, diagnosis, and management of this increasingly recognized condition.

Episode Summary

In this episode, host Dr. Neil Skolnik introduces the growing importance of HFpEF in diabetes care and is joined by two esteemed experts:

• Rodica Busui, MD, PhD, professor and chief of the division of endocrinology at the Oregon Health and Science University and past president of the American Diabetes Association for Medicine and Science.
• James Jannuzzi, MD, professor of medicine at Harvard Medical School, staff cardiologist at Massachusetts General Hospital, and senior cardiometabolic faculty at Baim Institute for Clinical Research.

The discussion explores:

1. HFpEF Basics: Definition, prevalence, and how it differs from heart failure with reduced ejection fraction (HFrEF).
2. Pathophysiology: The multifactorial causes of HFpEF, including aging, obesity, diabetes, and more.
3. Diabetes and HFpEF: Why HFpEF should be considered a major complication of diabetes alongside atherosclerotic and microvascular diseases.
4. Screening Recommendations: Insights from the 2022 ADA/ACC Consensus Report, emphasizing early detection through biomarkers like NT-proBNP and annual testing for at-risk patients.

Key Takeaways

• Epidemiology: HFpEF affects at least half of heart failure patients and is increasingly prevalent due to aging, obesity, and diabetes.
• Screening Guidelines: Every person with diabetes, especially those with chronic kidney disease, hypertension, or obesity, should be considered for HFpEF screening.
• Biomarkers: NT-proBNP thresholds are key tools for early diagnosis, with tailored considerations for obesity and other conditions.
• Prevention and Collaboration: Effective risk factor management and team-based care can prevent HFpEF progression and improve outcomes.

Thank you for joining us on this first of a multipart series on early detection and treatment of heart failure with preserved ejection fraction. In the first part of this series, we focused on basics—epidemiology, pathophysiology, and staging—as well as the critically important new recommendations around screening people with diabetes for heart failure.

In the second part of the series, we’ll explore treatment strategies for HFpEF.

This special edition of Diabetes Core Update is sponsored by Roche.

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals.

Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting.

Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.

This issue will review:

1. Association of semaglutide with first-time diagnosis of Alzheimer’s disease in patients with type 2 diabetes

2. Increasing Medication Use and Polypharmacy in Type 2 Diabetes

3. Association of Energy Intake and Dietary Glycemic Load in Different Time Periods With Cardiovascular Disease Mortality Among U.S. Adults With Type 2 Diabetes

4. Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors for recurrent nephrolithiasis among patients with pre-existing nephrolithiasis or gout

5. GLP-1 Receptor Agonists and the Path to Sustainable Obesity Care

For more information about each of ADA’s science and medical journals, please visit.www.diabetesjournals.org.

Hosts:

Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health

John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health