How diabetes care is evolving

Dr. John Wig: Chuck, can you ground us on the scope of the problem with diabetes and speak to the different types and the patient populations and size that up for us?

Charles Henderson: Diabetes has become the fastest growing chronic disease in the world, not just the United States. In the U.S., over 40 million people have diabetes. And to drill down a little bit more, that means every 21 seconds someone in the United States is diagnosed with diabetes.

There are 3 common types of diabetes. There's type 1 diabetes, type 2 diabetes and gestational diabetes.

Type 1 diabetes is an autoimmune disease where your immune system mistakenly destroys the beta cells in the pancreas that make the insulin your body needs. So you need to take insulin to live.

With type 2 diabetes, your body doesn’t make enough insulin or doesn’t use the insulin it does make well. Type 2 diabetes is the most common type of diabetes.

Gestational diabetes occurs during pregnancy. Blood glucose levels may or may not return to normal after giving birth. Even if they do return to normal, the individual has a higher risk for developing type 2 diabetes later in life and needs to be tested on a regular basis.

In addition to these 3 types of diabetes, there's also a condition, pre-diabetes, where blood glucose levels are high, but not high enough to be diagnosed with diabetes. Pre-diabetes can lead to type 2 diabetes and its many serious complications, including heart disease, stroke and even preventable amputations. Importantly, it’s possible for people with pre-diabetes to prevent or delay type 2 diabetes.

Another startling stat is that in addition to the 40 plus million Americans living with diabetes, there are also 115 million Americans living with pre-diabetes. That’s why the importance of our mission has never been more urgent than right now.

John: I'm glad you brought up prediabetes, Chuck. I was just reading one source saying the pre-diabetic population will be close to a billion patients globally by 2045. Hopefully, with some of the newer therapies, maybe that gets indented a little bit.

Let's talk about guidelines. Every year the ADA releases a standard of care in diabetes. I know you recently released your guidelines for 2026. Beyond putting it out as a publication or putting it online, how are you thinking about getting that message out from your organization?

Charles: Just to level set, I think our standards of care in diabetes and our recently released obesity standards of care are best in class. One of the 4 pillars of the ADA is education. We want to provide trusted diabetes education and prevention management — both for people affected by diabetes and obesity, as well as the healthcare professionals who care for them. We recently hired a chief health quality officer about a year ago to lead our primary care quality initiative and our health access group.

Type 2 diabetes prevention and lifestyle change programs

Charles: I also want to zoom out a little bit and talk about some of the programs that we have. We offer type 2 diabetes prevention and lifestyle change programs. Children with diabetes are a big issue in this country. Our ADA camp provides a summer camp experience in a medically safe environment. We have healthcare professionals who volunteer to stay overnight with these kids. We also have a few day camps.

What's neat about our camps is that these kids meet others like them and learn about managing their diabetes. Some campers even learn to change their continuous glucose monitors (CGM) or insulin pump sites on their own at camp. So it's about helping them take ownership of what they're dealing with.

Charles: Fast forwarding to talking about AI, I would say AI just allows us to move at a faster pace and allows us to scale. You’ll see some announcements come out in the next couple of weeks about us teaming up with some AI companies. So we continue to look to work with other organizations to ensure that our up-to-date information on care and research in diabetes and obesity is provided to healthcare professionals and individuals in a very timely manner.

John: Love your focus on technology and where the puck is moving. In addition to the host of medications that are emerging, whether it's the GLP-1s or the long-acting basal insulin product that was just approved or new beta cell therapies. There are also some great opportunities in things like wearables.

Beyond making sure that people have access to these therapies and technologies, you're also thinking about innovation and investing in key companies. So, what are the goals here and how are you thinking about that?

Charles: One of the things that I'm trying to push at ADA is innovation. I'm trying to push speed. We need to be able to take calculated risks and really look at some of the positive, disruptive healthcare companies out there in the market. And I always say that this is the greatest time to be alive on Earth, when you think about all the novel therapies, the new data, the new technologies that are now available in the diabetes and obesity space.

You touched on GLP-1s. Now that they’re also approved to treat overweight and obesity, they’re all the rage in the public conversation right now. But GLP-1s have been approved for treatment of type 2 diabetes in the United States for over 20 years.

I've got to give a shout out to the Obesity Association, a division of the ADA. In January, they published a section on pharmacologic treatment of obesity in adults as a part of our standards of care in overweight and obesity. This chapter details the growing evidence supporting the use of GLP-1s and other weight loss therapies to achieve weight loss goals in people living with obesity.

While there's a lot of buzz about GLP-1s, this chapter is super important because it discusses how to individualize therapy because there are options beyond GLP-1s that may be appropriate for some individuals. I'm not a clinician, but we know that the management of type 2 diabetes, the management of overweight and obesity should be individualized. Things are changing rapidly and there's not a single approach that works for everyone.

The sheer volume of research in this space is creating a lot of momentum globally. Just today, there was a big announcement about the approval of an oral GLP-1 for weight loss. There's even interest in studying whether the benefits of GLP-1s and SGLT2 inhibitors observed in type 2 diabetes really hold true for people with type 1 diabetes. And so this is a super, super active area of study. But when I think of breakthroughs, particularly for type 1 diabetes, there are advances in beta cell therapy with efforts to replace or regenerate the pancreatic beta cells responsible for insulin production. This is a great step toward a potential cure for type 1 diabetes.

Back to the larger question about diabetes technology, it's getting better every hour, every second. A great example of these tech advancements that are super, super exciting is in the artificial pancreas area. They combine a CGM, an insulin pump and a control algorithm. We mentioned AI earlier in the conversation and device makers are starting to leverage it to take the burden away from the patient.

So we’re getting more real-world data about the benefits of broadening technology use for people living with type 2 diabetes. Going back to the ADA standards of care in diabetes, we now recommend the use of diabetes technology, such as CGMs, as early as diagnosis for people with type 2 diabetes.

I get excited about this stuff, but I also want to stress health access because these advancements are only good if people have access to them.

John: Thanks, there's a whole lot to unpack there. Access is a major focus for us as well, and we always try to advocate for the best prices for patients. As you mentioned, these are game-changing medications, and folks should have the opportunity to take them.

So we touched on a lot of different things today, but I wanted to take it back to where we started, which is from a patient perspective. You’re out there every day. Your team is out there every day. The first question is, what are you hearing from people with diabetes? Is what we're talking about really what folks are talking about? And the second part of the question is what's the one action you'd wish every listener would take after this conversation, whether they have diabetes or not?

Charles: I do hear from patients all the time. Some of the diabetes technologies we just mentioned, like continuous glucose monitors and automated insulin delivery systems, are driving meaningful change for people with diabetes. Now, people don't have to prick their fingers to measure their blood glucose anymore or draw up a syringe to deliver insulin. These transformational tools are making huge impacts, not just in clinical outcomes, but on quality of life and just overall satisfaction.

And then for the second part of your question about takeaways from this discussion, I would just say “go to the doctor.” Get a primary care physician. And then secondly, be honest with your doctor. When I was younger, there were some things that I was concerned about, but I didn't mention because I didn’t know what was going to come out of the doctor's mouth. So be honest and establish that relationship.

Also, understand your numbers. Get your glucose checked. Get your A1C checked— even If you're healthy or think you're healthy because you're exercising. We’re predisposed to different things in life, whether it be from environmental factors, from genetics or from family history. So I would encourage everybody to get tested and understand your numbers.

John: Yeah, even as a physician, I’m probably guilty of not being honest and going to the doctor as much as I probably should. But that really is critical.

Quickly back to the CGM example: It's amazing, at least in my experience, what happens with patient behavior when someone sees a number in real time. It's one thing to take medication but not know what's happening. I have countless examples of people that have changed their behaviors based on CGM data. It’s such an important tool on so many levels.

Before you go, the ADA scientific sessions are just few months away and are always great. Can we talk a little bit about what can be expected from the conference this year?

Charles: Our ADA Scientific Sessions event is in a different city every year. This is our Super Bowl of diabetes. This year it will be held from June 5th through the 8th in New Orleans. This is the premier diabetes conference in the world. We have experts come together to share the latest breakthroughs in diabetes research, prevention and care. I'm super, super excited for the event.

Before we close, I would also encourage people to visit diabetes.org and obesityassociation.org for diabetes and obesity resources to help them and or their loved ones thrive. And for healthcare professionals, please visit professional.diabetes.org.