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1. What is the biggest change in diabetes management today?

I consider the multiple programs for the prevention and early diagnosis of diabetes mellitus to be the most significant change.

2. What do you consider the most important achievement in diabetes treatment?

Regarding its management, I believe the greatest achievement is that, as of 2023, the Cardiology Society established the “cardio-nephro-hepato-metabolic syndrome” framework. This represents a holistic approach to diabetes mellitus, addressing its metabolic effects as well as its complications affecting key organs such as the heart, kidneys, and liver.

3. Which patients benefit most from the newer injectable therapies?

I believe all patients with type 2 diabetes who are overweight or obese benefit, as well as non-diabetic individuals with mild to severe obesity, hypertension, or renal and cardiac strain.

4. Has the role of weight loss in diabetes treatment changed?

I believe it has changed in many ways; addressing obesity is now a central therapeutic goal.

5.

Why is weight loss important?

Because it has been shown to improve glycemic control and prevent metabolic or organ-related complications.

6. What is new in blood glucose monitoring?

Continuous glucose monitoring—taking readings approximately every five minutes, totaling around 288 times a day using new systems known as CGMs—improves glycemic control and prevents major fluctuations and hypoglycemic episodes.

These systems consist of a monitoring sensor that samples interstitial fluid and uses specialized software to translate it into a blood glucose reading.

At the same time, using separate software, the attending physician can monitor the glucose levels recorded by the CGM on their computer, enabling direct collaboration with the patient.

These readings are recorded in real time. I believe that artificial intelligence plays a significant role by continuously improving these monitoring systems. I believe it is the diabetologist’s responsibility to leverage the capabilities of these systems, after analyzing them and informing the patient about the benefits they offer regarding the avoidance of hypoglycemia and the improvement of glycemic control.

7. What are the most important new classes of medications?

Over the last decade, we have added highly safe medications to our therapeutic arsenal—such as SGLT2 inhibitors and GLP-1 agonists—which provide cardiac and renal protection.

8. Does insulin remain important, or have new therapies replaced it?

Insulin was discovered in 1921 and made available to patients with diabetes in 1922.

We have now surpassed a century of its use in treating patients with diabetes.

When categorizing patients into the two main groups—type 1 and type 2 diabetes—we see that type 1 patients are treated exclusively with insulin.

Gestational diabetes is also treated solely with insulin.

Surgical patients with diabetes are managed with insulin during the pre-operative, intra-operative, and post-operative periods. Furthermore, when a diabetic patient develops a severe infection, it is treated with insulin for the duration of the infection; insulin is also used in other serious health conditions (such as heart attack, ketoacidosis, etc.).

Therefore, insulin was and remains a fundamental therapeutic tool in the management of the diabetic patient.