SARAH: Welcome back to the Southeast Ohio QI Hub video series and today we are joined by the one and only Dr.Amber Healey.

AMBER: Sarah, I don't know if the world could handle more me.

SARAH: They can today because we're doing updates on the standards of care 2026. Everyone's favorite video at the beginning of the year. Standards of care updates.

AMBER: Alright. 

SARAH: Alright. We have a lovely list of things to cover with you today. Really quick updates for you that Dr.Healy has suggest selected just for you. Just for you. Alright. Dr. Healy? I got a list here for us. So the first thing I have going on is you had said something about CGMs.So what are you gonna tell us about CGMs?

AMBER: They reemphasized uh, the importance of offering CGM at diagnosis to people of all ages. That are on insulin or other medications that cause hypoglycemia.

SARAH: Wow, that's great. So CGMs at diagnosis for basically anyone, especially on medications that cause hypoglycemia, is that what you said? Wonderful. That's fantastic. Alright, did we cover that?

AMBER: We did 

SARAH: Check, next D-S-M-E-S.

AMBER: They reemphasize the importance of lifestyle changes and D-S-M-E-S and offering that to your patients. And just to, as a reminder,
it should be offered at diagnosis when there's been a change in um, some status, like a new diagnosis, maybe a new complication and um, you know, any time yearly would be great or if other, if patients are interested in pursuing it. And I know that you wanted to make a plug for something to do with DSI

SARAH: I Did. Did you see that? 

AMBER: I did. I know I wanted to make sure you do that.

SARAH: I would like to take this opportunity to have everyone check out Diabetes and me a D-S-M-E-S Vs. Video series available online as a D-S-M-E-S video series. I mean it's the coolest. Okay. And I'm sure that there'll be a link that pops up.

AMBER: Well and Sarah where what, I know the link will pop up, but what website again?

SARAH: I believe you can find that on the SE Ohio SEO Qi hub. All right. Next. Which I think this is a super cool one, I have to say I enjoy this one there. I understand there is a, there's new information about fasting in here and especially religious versus non-religious fasting. So what can you tell me about that?

AMBER: So in the body of the guideline, they mentioned a little bit about intermittent fasting 'cause that's become a big thing. Yeah. So what's, what is intermittent fasting And that's usually when people will, you know, they only eat behind between certain hours of the day. So like some patients will do the 12 and 12 and it's, they kind of set their hours. Other patients will do the 16 and eight. They only eat for eight between certain hours for eight hours outta the day. So they talk about that a little bit. And Then they also mention religious fasts because we have patients out there that for religious reasons they might, you know, like Ramadan for example, they will fast throughout the day and only eat at night. So they have a risk table that they added. Table 5.3.

SARAH: Okay. 5.3. Okay. 

AMBER: And they have um, a calculator where you can look at the risks of, you know, around your patient and fasting to observe their religion. I thought that was a really nice ad.

SARAH: It's a very nice ad. That's very cool.

AMBER: And then if they also included another table 5.4. Where they talk about the different medications. Um, and then the risk for hypoglycemia with those medications when somebody's fasting and then how to time them. To when they're eating their food. So I think that's really great information because you know, patients do come in and ask these questions. And Wanna be ready to support them.

SARAH: That's amazing. So tables 5.3 and 5.4 around fasting. I think that's fantastic. Those are great. Um, I appreciate that a lot actually. Alright, so the next thing on our list blood pressure changes. 

AMBER: Yeah. So in the cardiovascular section, which is section 10. Um, they always talk about the four pillars of preventing cardiovascular issues and that's blood sugar, blood pressure, lipids, and I believe smoking or dietary things is the fourth pillar. But I, you know, and but the blood pressure, uh, target changed again. So this blood pressure target since I have been practicing, I've seen 125. 
And someone with kidney, like a systolic blood pressure and somebody with kidney issues. I've seen 130 with other risk factors. They've gone back to 130.I'm sorry 120. It's a lot to keep track.

SARAH: It's a lot of numbers. It's a lot of numbers.

AMBER: They've swung as loose as 140.

SARAH: That's what I remember as 140.

AMBER: They're back to recommending a systolic blood pressure target of 120 in patients that are at high risk for cardiovascular issues and or have with kidney issues. So that includes a lot of our patients with diabetes 'cause they're at higher risk. So that was based off of some larger trials that they cite in the. In the body of the recommendations. So our goal is to get blood pressure, systolic blood pressures back down to 120 in our patients.

SARAH: Alright. Alright. That's good to know actually, it's a good one too. Um, speaking somewhat of medications as well. We also wanted to include something on therapeutic inertia.

AMBER: Yeah. They reiterated the importance of preventing therapeutic inertia. Okay. And for those that might not remember what that means, it's basically where we get really comfortable with how we're managing a patient and they may not be doing as well hitting targets with, um, their glucose. Uh, but we don't change anything. So, um, it's important to remember to escalate therapies as appropriate in a patient, um, if they're not making their goals. And so that, you know, that was a reemphasis in the guideline this year.

SARAH: Okay. That's kind of cool. And going more along, medications, kind of steering in that same direction. Um,something about focusing on medications that are beneficial. So What did they tell us about that?

AMBER: So they're still still really important. Uh, I think they, that heart failure had a bigger emphasis this time. But, um, medications that are beneficial not just to glucose, but the comorbid conditions that we see with diabetes coronary the cardiovascular disease. Heart failure. Chronic kidney disease and the meds that help with that. So traditionally we've put a big emphasis on the GLP-1 class. 

SARAH: Yeah. 

AMBER: The, uh,

SARAH: SGLT Twos. 

AMBER: The SGLT twos. Yep. And then like the, the twin Cretin GLP-1 GIP medication that exists. So those are all important. So if you can get multiple benefits from one medication, it is really important to reemphasize the use of those in the appropriate patients.

SARAH: That's cool. Okay. Awesome. And last but certainly not least, 'cause it's kind of a cool topic. We're gonna talk about MASLD. So talk to me a little, what do we wanna share from the guidelines and, and,and share your thoughts on MASLD.

AMBAER: So a couple years ago, um, if you weren't aware, NASH and NAFL previously known as like non-alcoholic fatty liver. They Changed the name, the nomenclature on it because they thought it was confusing and maybe a little, you know, negative with the, some of the words that they use. So now it's known as metabolic dysfunction associated steatotic liver disease.

SARAH: Okay. You did good. That was good. I'm glad you said it.

AMBER: Or um, you know, MASOL and then there's also MASH. Metabolic dysfunction associated steatohepatitis.

SARAH: Okay. All right. MASH. Okay.

AMBER: And so they've renamed things. They also have uh, a, they've screening guidelines. 'cause last year was a big year for guidelines actually. Uh, there were this co publication between ACE and ADA and the one of the uh, GI organizations around because we know that people with diabetes and obesity are at higher risk for having this MASLD. Um, and so with this they have recommended starting screening with what they call the FIB four.

SARAH: The FIB four. Okay.

AMBER: And so this is a calculation. Okay. And the calculation is based on age, uh, liver enzymes, the AST and the ALT. And then platelet level. So it's a good re good time to bring back your CBC if you weren't doing it already in people with diabetes.


SARAH: That's actually really cool. Alright.

AMBER: And so based on that calculation, you can stratify somebody's risk for whether, how likely they are to have fibrosis in the liver because we don't know why some people progress and become more fibrotic and why other people don't. So it's important to, to keep an eye on this. So if that fib four is higher than 1.3 Then they recommend follow up imaging usually with like an ultrasound, it's got elastography potential on it so they can figure out how, you know, fibrotic the liver is. And um, that helps guide therapy and uh, if you need to refer to A hepatologist or a GI specialist, uh, for additional medication because again, those medications, like the GLP ones Right. And um, the GLP GIP Um, are really helpful in helping improve liver Fibrosis. And they've also got a specific med called Resmetirom. And that really can only be written right now by people in the gi in the GI hepatology field.

SARAH: Okay. So in the guidelines there were a couple tables, a couple figures that we wanted to mention. Also Because I think that will help even summarize what we have just talked about.

AMBER: Absolutely. 

SARAH: So there's figure 4.2, right. Which is relevant to the screening.

AMBER: Screening. Yep. 

SARAH: Okay. Anything else you wanted to say about that one? No, I mean it helps guide like which direction to go. It's a decision tree, so it's really awesome. It's nice. And then, um, figure

SARAH: Second One, 

AMBER: figure 4.3 talks more about the treatment, like emphasis on lifestyle, emphasis on weight loss, emphasis on optimizing diabetes control and cardiovascular risk. Which were other parts of the updates we talked about earlier. And then the pharmacology.


SARAH: That's cool. Medications appropriate for help with treatment. That's cool. That's awesome. This was great. Thanks Dr. Healy.


AMBER: You're welcome.

SARAH: It's always a pleasure. Thank you for joining us for some updates to the 2026 standards of care. Uh, hopefully that was a nice summary for you of some of the things they covered. And, um, I'm sure we'll be back with another video from the southeast Ohio QI hub.