Continuous glucose monitors (CGM) used by people with 

 have been a focus of recent conversations both inside and outside the healthcare space. Superstar Nick Jonas has been raising awareness of this technology through his platforms and in new TV commercials, and companies like Apple are exploring glucose monitoring as an indicator for general health and wellness. All this attention has led to more people with diabetes becoming aware of this life-changing technology, and in turn, heading to their primary care provider to ask for a CGM.

With 34.2 million Americans living with diabetes, nearly every primary care provider is guiding treatment plans for people with type 1, type 2 and even pre-diabetes, but many healthcare providers are still not aware of CGM technology and how it can benefit patients. As healthcare providers, we work to keep pace with the latest treatments, technologies and tools available to be prepared to address patient questions and ultimately improve health outcomes. This is more important now than ever, as we’re starting to see a gap in healthcare provider knowledge and consumer awareness in an era where endless healthcare resources and information is at our patients’ fingertips.

While patients are doing their own research, they still expect us, as their healthcare provider, to be the experts on what tools and treatments we believe will best help them. A recent survey

 of people with insulin-treated diabetes found that patients believe it is the responsibility of their healthcare provider to bring new standards of care to their attention, like CGM systems.

CGM technology is widely considered the standard of care and clinically proven to improve outcomes for people with diabetes taking insulin. For those of us who may not be as familiar with the technology but want to inform future conversations with patients, here are 3 things you need to know about CGM systems:

How CGM systems differ from blood glucose monitoring: fingersticks

A CGM uses a small, wearable sensor and transmitter to measure and send real-time glucose values wirelessly to a smart device or receiver every five minutes. It eliminates the need for multiple daily fingersticks used in blood glucose monitoring (BGM).

A BGM shows glucose values at a single moment in time and patients may often miss or forget to take a reading, leaving many unknowns. A CGM connects the dots and provides a complete picture of glucose management, filling in the gaps for both patients and healthcare providers. The data gleaned from CGM technology show trends in glucose levels, the rate of change in readings and even alerts users of dangerously low or high glycemic levels. 

These data arm patients with real-time insights to inform short-term actions like taking medication or insulin, and long-term lifestyle adjustments as they can see how their body reacts to certain foods, physical activities or behaviors.

The benefits of CGM technology for people with type 1 and type 2 of all ages

The benefits of CGM systems for people of all ages have been clinically proven, from two years old to Medicare patients. The recent 

 study has shown the benefits of CGM technology for children ages 2-7 with type 1 diabetes in reducing hypoglycemia and parental burden and fear. The 

 study of adults ages 60 and older with type 1 diabetes found that CGM systems help to significantly lower A1C, reduce hypoglycemia and increase the amount of time a user spends in target glucose ranges. The technology is truly easy to use for all demographics.

We are also now seeing more evidence of the benefits of CGM for broader populations, including people with type 2 diabetes. Earlier this year the 

 study was the first of its kind to affirm that people with type 2 diabetes on basal insulin benefit from the use of CGM technology, with study participants showing significant increases in time in range and decreases in A1C. These outcomes occurred independent of direct provider interventions, so even getting a patient on the device to learn for themselves can be a win.

A CGM makes appointments more tailored and efficient

Not only does CGM technology give the power back to patients by arming them with information to make treatment decisions in real-time, it also provides healthcare providers with the insights and data needed to develop tailored medication and treatment regimens. The reports available to providers help make appointments with patients more efficient as you can quickly see potential issues, leaving more time to get to know the patient and discuss together ways to improve diabetes management and outcomes.

Diabetes patients are making healthcare treatment decisions nearly every minute of every day and are looking for new and better ways to ease the burden of managing their condition. Patients are asking, and it’s up to us as healthcare providers to educate and provide them with the best tools available to manage their diabetes.

 (Study of Improved Glucose Monitoring and Assessment) and 

 have great resources available to help you learn more about CGM technology and better understand how it can support your patients.

The demand for CGM technology will only continue to grow, and now is the time for healthcare providers to educate themselves on the proven benefits of the technology.

Aaron King, MD, is a family practitioner and diabetes specialist with Baptist Health System.

Authors and clinicians interested in being published on HCPLive can 

1. Dexcom, U.S. data on file, November 2020

3 Things Primary Care Providers Need to Know About Continuous Glucose Monitoring Technology

Aaron King, MD

Andrew Bomback, MD, MPH, is an assistant professor of medicine at Columbia University Medical Center.

 has been a disease without a targeted treatment, leaving patients and clinicians to deal with a devastating disease course with no clear standard of care.

Caused by dysregulation of the alternative complement pathway, C3G often leads to progressive kidney failure, with many patients ultimately requiring transplantation—only to see the disease recur.

The US Food and Drug Administration approval of Novartis’ oral iptacopan (Fabhalta) for the treatment of adults with C3 glomerulopathy (C3G) marks a turning point in C3G care, offering the first FDA-approved drug for patients with the ultra-rare kidney disease.

The decision was based on data from the phase 3 APPEAR-C3G trial, where iptacopan met the primary endpoint of reducing 24-hour urine protein-to-creatinine ratio (UPCR) by 35.1% (95% CI, 13.8% to 51.1%; 

 = .0014), with sustained reductions at 12 months.

Additional analyses revealed use of iptacopan was associated with a higher proportion of patients meeting the composite renal endpoint—defined as a ≥50% UPCR reduction and ≤15% eGFR decline—occurring in 43.5% of iptacopan-treated patients versus 25.0% of those who switched from placebo at 6 months. A favorable effect on eGFR trajectory was also observed relative to historical trends.

Not only does this approval provide C3G patients with a treatment specifically designed to address the root cause of their disease, but it also opens the door for further advancements in complement-targeted therapies. With a new tool in their arsenal, clinicians can now offer patients a chance to slow or even stop disease progression—something that was once out of reach.

For additional insight into the significance of the approval and its impact on C3G care, the editorial team of 

 spoke with Gerald Appel, MD, a professor of clinical medicine, director of clinical nephrology, and director of the Glomerular Disease Center at Columbia University; Andrew Bomback, MD, an assistant professor of medicine at Columbia University Medical Center; and Jared Hassler, MD, a pathologist at the Temple University Hospital.

Expert Perspectives: Iptacopan FDA Approval for C3 Glomerulopathy

Relevant disclosures for Appel include Aurinia, Bristol Myers Squibb, Genentech, Genzyme-Sanofi, Eli Lilly, Merck, Pfizer, Mallinckrodt, Achillion, Alexion, Reata, Travere Therapeutics, GlaxoSmithKline, Vertex Therapeutics, Novartis, Apellis, Chinook, Arrowhead, Calliditas, and Vera. Relevant disclosures for Bomback include Amgen, Novartis, Kezar, Silence Therapeutics, Genentech, Visterra, Catalyst, Q32, and Apellis. Relevant disclosures for Hassler include Travere Therapeutics, Omeros, and Novartis.

Campbell P. FDA Approves Oral Iptacopan (Fabhalta) as First C3 Glomerulopathy Therapy. HCPLive. March 20, 2025. Accessed March 21, 2025. 

https://www.hcplive.com/view/fda-approves-oral-iptacopan-fabhalta-as-first-c3-glomerulopathy-therapy

A trio of nephrology experts discuss the significance of iptacopan’s FDA approval as the first treatment for C3G.

Andrew Bomback, MD, MPH

COVID-19 has obviously presented significant challenges in our clinical work, particularly in the evaluation, diagnosis, and treatment of patients with ADHD [attention-deficit/hyperactivity disorder] of all ages. What we’ve all done, of course, is acclimate to this, largely through the use of telemedicine, telepsychiatry for a lot of our patients. Although more recently, I’ve gone back to more of a hybrid model where I am seeing some patients live and some via telepsychiatry. 

There are significant challenges. Some of those challenges include the fact that it’s a little more difficult to do an evaluation and to collect all the nonverbal information that you might get from being in the room with a person. Part of the problem is you may be seeing only a portion of the patient’s body. You may not be seeing the lower half of the body if you’re on a virtual call. You might not see some of the fidgeting or hyperactivity, for instance.

Also, what I find is patients either do really well with virtual telepsychiatry or don’t. They have trouble focusing. They get distracted. It’s really important to try to individualize care for our patients. Some people try to do in-person meetings. Ideally, this may be helpful for the initial evaluation so we can collect as much information as possible. When you’re dealing with children, you’d like to have collateral information, so you’d like to have parents and caregivers involved. That can be a little harder too, although it can be done virtually.

As far as prescribing medications, that can present a challenge. Although now, states are going to e-prescribing. In Florida, we now have to e-prescribe all controlled substances. That makes it easier, not having to handwrite a prescription and somehow get it to the patient in a COVID-19 environment.

The other thing I find is that sometimes children do a little better in this virtual environment, but many with ADHD struggle more. There’s a lot more stress and difficulty in school. Obviously, there’s more isolation, so fewer social relationships, fewer extracurricular activities, and maybe less access to exercise, which has been shown to be very beneficial for ADHD. These are some of the challenges that we’re trying to negotiate in the era of COVID-19.

Tele-prescribing of stimulants presents some unique challenges in the era of COVID-19. Part of the challenge is making sure you can e-prescribe appropriately. Most of us have figured out how to do that. Also, you want to make sure the pharmacy is available and shows up on your e-prescribing software. It is required, when we prescribe stimulants, that we monitor certain things. This can be more challenging in this environment, particularly when assessing vital signs, height, and weight. Blood pressure, heart rate, height, and weight can be a challenge in the virtual environment. This is when I may sometimes have the patient come to the office, just for the vital signs and height and weight checks. Or the patient can get 1 of the home monitoring devices, which you can get at many pharmacies. These devices can monitor blood pressure and heart rate. Your patients can check those periodically and report the results to you. Or you can certainly have them email that to you or communicate electronically.

As far as monitoring for abuse and possibility of diversion, this is something we also need to keep our eyes on. We can do this in various ways, including by checking prescribing databases, which can certainly be done online.

As far as monitoring for other issues and problems, such as the emergence of psychotic or manic symptoms or the possibility of vasoconstriction or cardiovascular issues, this is where taking a very careful history and evaluation and trying to look at the patient and evaluate them as best you can on camera really seems to help.

It’s important to understand that when evaluating and treating ADHD, comorbidity is the rule. Three-quarters of patients with ADHD will have a least 1 other comorbid condition. This is important because sometimes our core treatments for ADHD can help alleviate these other conditions. For instance, secondary anxiety or secondary depression. Sometimes, however, we do have to institute specific treatment in addition to the ADHD treatment to address a comorbid condition.

Rakesh Jain, MD, MPH: When parents and their children first come to see me for an evaluation for ADHD, there’s often a lot of confusion. We have a lot of myths in our heads. “Is this bad parenting?” “Was this just because one of us got divorced?” Is it because I had too many Diet Cokes when I was pregnant?” 

My first job is to offer parents and children a combination of sympathy and encouragement. I offer sympathy for the suffering they have gone through and encouragement that, if we do the right thing, we can make a pretty significant difference in all the challenges your child is having and you’re having as parents and caregivers. I have found that injection of enthusiasm, support, and knowledge to be as useful as anything I do.

The second step is really a pretty quick but accurate increase in knowledge base about the disease. Most people are quite surprised to know that it is a neurobiologically active condition. It is an inherited condition. It is a brain-based condition. Even though behavior is what they might see, the child is not being a “bad” child. 

Finally, we need to give an explanation of why interventions work or why a combination of nonpharmacological and pharmacological interventions is best explained in the context of neurobiology. 

When I offer that whole package of information, from sympathy to increasing their enthusiasm and encouragement to disease-state knowledge and then finally medication and nonmedication knowledge, you can see the parents and the child breathe a sigh of relief. “I’ve got a direction. There’s something I can do. I feel empowered.” That is precious. As a clinician, once I see that, I know I have established a solid therapeutic relationship that will lead to good outcomes.

Optimizing care and managing challenges for patients with ADHD during the COVID-19 pandemic and advice for clinicians educating patients and families on disease management. 

Optimizing Care for ADHD During COVID-19 

Andrew J. Cutler, MD, SUNY Upstate Medical University

Despite being the most common primary glomerulonephritis worldwide, 

 and end-stage kidney disease. Despite advances in understanding its pathophysiology, treatment options have historically been limited to supportive care, including renin-angiotensin system inhibitors, blood pressure control, and corticosteroids for high-risk patients.

Recently, a growing understanding of the immunopathogenesis of IgAN has led to the emergence of novel therapeutic strategies, including the inhibition of A proliferation-inducing ligand (APRIL), a key driver of IgA production. By reducing pathogenic IgA1 production at its source, APRIL inhibition has the potential to alter the course of the disease. Accordingly, several anti-APRIL drug candidates, including sibeprenlimab, atacicept, telitacicept, and zigakibart, are in clinical development for IgAN.

For more on APRIL inhibition and the current IgAN treatment landscape, the editorial team of 

 spoke with Edgar Lerma, MD, a clinical associate professor of medicine in the section of nephrology at the University of Illinois at Chicago.

: Can you provide an overview of the current treatment landscape for IgA nephropathy and what unmet needs exist for patients?

: One of the things that's interesting [about IgAN] is that this is considered a rare kidney disease, but it is the most common primary glomerulonephritis worldwide. In fact, there's an annual global incidence of 2.5 cases per 100,000 persons.

The disease manifests in several ways. Patients can present with asymptomatic hematuria, which means blood in the urine, or proteinuria, and that is protein in the urine, or they can present with advanced stages of kidney disease.

If you think about it, any patient who is diagnosed with what is called a rare kidney disease, it's a little bit disconcerting, right? So there's uncertainty about it, and this obviously impacts the patient's physical, mental, and emotional health. A lot of patients become anxious, and this can affect their daily activities, as well as even their daily work lives.

One of the things that's important about IgA nephropathy is that when patients are diagnosed, usually they are between 20 and 40 years of age. That's a very young population, right? So if these patients are 20 to 40 years of age, if you think about them and you think they eventually progress to kidney failure or what we call end-stage kidney disease, that means requirement of dialysis or kidney transplantation, this happens in their lifetimes.

So if they get to that point of reaching kidney failure, it's really a lifestyle change. They have to adjust to this new condition in their lives and it affects not only their personal lives, but also the lives of their families and their relatives.

: What challenges exist for developing effective pharmacologic therapies for IgA nephropathy?

: Let me put this in perspective. For many years, for many decades, whenever we diagnosed a patient with IgA nephropathy, and by the way, the only way to diagnose a patient with IgAN is through a kidney biopsy. Whenever a patient is diagnosed with IgAN, we explain to them that this is how the disease happens, this is what to expect, and so on and so forth.

For many years, the only thing we had to offer patients was treatment and medications to manage their symptoms and maybe slow down the progression of the kidney disease.

For blood pressure control, we use certain antihypertensive agents called renin-angiotensin system blockers. And of course, along with that, it's lifestyle – dietary salt restriction, aerobic exercise on most days, weight loss if necessary, cessation of smoking, so on and so forth.

And then the only other treatment that we offer is, whenever they don't respond to the ones I mentioned earlier, the next step would be to consider immunosuppressive therapies.However, the therapies that we had available back then had significant side effects and long-term toxicity.

So when you mention novel agents, over the past few years, we have had a deluge of novel therapeutic agents for IgAN. We now have a better understanding of the pathophysiology of how it can develop, and by understanding this mechanism, several phase 2 and phase 3 clinical trials have been published and have influenced the way we manage the disease. There are now different options for treatment that target the different pathophysiologic steps that lead to eventual kidney failure.

: There has recently been an increased focus on targeting APRIL. Can you tell me a little bit about that?

: So when we say APRIL, it stands for A proliferation-inducing ligand. This is actually a cytokine in the tumor necrosis factor family, and APRIL is integral to the development and progression of IgAN.

When we say cytokine, it is a substance secreted by certain cells of the immune system, and these cytokines have an effect on the other cells.

APRIL actually promotes the survival and the class switch, switching up B cells to produce IgA, particularly what we call the pathogenic galactose deficient IgA1. The abbreviation is Gd-IgA1, which actually forms immune complexes in the kidneys.

So these complexes are deposited in the glomeruli, which later on triggers inflammation, and as you trigger this inflammation, it leads to kidney damage. One way of thinking about this is you think of APRIL as a toggle within the immune system. So if you think of an electrical grid, APRIL powers specific circuits, and when you activate it, you turn it on, it helps promote the production of these pathogenic Gd-IgA1 and immune complexes formation and this leads to kidney damage and injury.

If you target APRIL, you turn it off, it is like pushing the toggle, turning it off and then this reduces the production of those harmful molecules that I mentioned. If you reduce the production of those molecules, then you prevent that damage and the injury that follows.

So, targeting APRIL represents a potential therapeutic strategy that disrupts this pathogenic sequence. If you inhibit APRIL, you can decrease the production of those harmful molecules, those Gd-IgA1, and eventual immune complex formation deposition into the kidneys, which eventually leads to end-stage kidney disease and the need for dialysis or transplantation.

: There are some promising agents in clinical development progressing through phase 2 and phase 3 trials. Is there anything that you think holds the most therapeutic potential for improving IgAN care?

: Right now we are actually looking at the guidelines for sort of directing how these agents will be used in the future, so it's exciting for us as nephrologists because now we have so many options. Before, we only had symptom management and blood pressure control.

For more information about IgAN and the role of APRIL, there's actually a website, 

, that has a lot of new insights and news about IgAN.

Editors’ note: Lerma has relevant disclosures with Travere Therapeutics, Akebia/Otsuka, Astra Zeneca, Bayer, Glaxo Smith Kline, Otsuka, Vifor, and Bayer.

Mathur M, Chan TM, Oh KH, et al. A PRoliferation-Inducing Ligand (APRIL) in the Pathogenesis of Immunoglobulin A Nephropathy: A Review of the Evidence. 

IgA nephropathy (IgAN) is a prevalent primary glomerulonephritis and a significant cause of chronic and end-stage kidney disease. Traditional treatments have been limited to supportive care, but recent insights into IgAN's immunopathogenesis have led to novel therapies targeting APRIL, a cytokine involved in IgA production. Inhibiting APRIL could alter disease progression by reducing pathogenic IgA1 production. Several anti-APRIL drugs, such as sibeprenlimab and atacicept, are in clinical trials, offering hope for improved management of IgAN and addressing unmet therapeutic needs.

Lerma discusses the current treatment landscape for IgA nephropathy and what role APRIL inhibition may play in treating IgAN.

The Therapeutic Potential of APRIL Inhibition in IgAN, with Edgar Lerma, MD

Edgar Lerma, MD

Final Insights

Video content above is prompted by the following:

Are there any final insights you’d like to share regarding LDL-C and Lp(a) screening and management of high-risk cardiovascular patients?

Pediatric lipid screening is crucial for early detection and management of dyslipidemia, which can prevent cardiovascular diseases later in life. Current guidelines recommend universal lipid screening for children between ages 9-11 and 17-21, with selective screening for those with risk factors. However, implementation remains inconsistent due to barriers such as lack of awareness and time constraints in clinical practice. To improve uptake, strategies include integrating screening into routine pediatric visits, utilizing electronic health records for reminders, and educating healthcare providers and families about the importance and benefits of early lipid screening.

Panelists discuss how effective cardiovascular risk management requires comprehensive screening for both LDL-C and Lp(a), along with aggressive treatment strategies for high-risk patients.

Erin D. Michos, MD, MHS

Numerous advanced therapies have been introduced in recent years for the management of 

, and it has been suggested that these novel therapies are contributing to a decreased need for colectomy among this patient population.

 However, many individuals with UC still do not respond to medical management and require surgical intervention, most commonly in the form of a colectomy followed by the creation of an ileal pouch-anal anastomosis (IPAA) to restore intestinal continuity and prevent the need for an ileostomy.

 In this approach, surgeons may elect to perform a stapled anastomosis without mucosectomy, which leaves a rectal remnant (cuff) and has been shown to improve functional outcomes.

Although most patients with an IPAA report positive pouch health, inflammation of the pouch (pouchitis) and rectal cuff (cuffitis) are common and present with symptoms of increased frequency of bowel movements, urgency, and rectal bleeding.

 In addition to these symptoms, rectal cuff inflammation has been shown to increase the risk of pouch failure (pouch explant, pouch re-do, or diversion ileostomy), but it remains unknown by which specific mechanisms and clinical sequelae that this condition may be associated with poor long-term pouch outcomes.

To address this gap in knowledge, Powers et al. conducted a retrospective cohort study of adult patients with 

 who underwent IPAA between January 2010 and December 2021. These patients were divided into cohorts based on whether they had demonstrated inflammation of the rectal cuff on one or more endoscopic evaluations (pouchoscopies) at any time following surgical completion. Outcomes of this study included the development of fistulas and strictures of the ileal pouch while excluding anastomotic and peri-anal disease. These diagnoses were recorded through review of imaging, endoscopic, and clinical visit data from electronic health records.

In total, this study identified 402 patients who met inclusion and exclusion criteria, with 182 (45%) patients in the endoscopic cuff inflammation cohort and 220 (55%) patients in the control cohort. Most patients included in this study were male (56.7%) and had been diagnosed with UC (93.8%). The overall median follow-up time was 3.2 (Interquartile range [IQR], 1.4-5.2) years after surgical completion, with the cuff inflammation cohort demonstrating a slightly longer follow-up (4.0 years; IQR, 2.3-6.2) compared to the control group (2.6 years; IQR, 1.2-4.5).

In total, 41 patients developed non-anastomotic strictures and 25 patients developed fistulas during the follow-up period. On univariable analysis, the development of non-anastomotic strictures and fistulas were both more frequent in the cohort with cuff inflammation (

 = .032, respectively). Multivariable logistic regression models were fit to assess this relationship while controlling for potential confounders including pan-colitis disease distribution, duration of disease before colectomy, and history of extraintestinal (skin, eye, and joint) manifestations of IBD.

Controlling for these potential confounders, the endoscopic cuff inflammation cohort again demonstrated significantly higher odds of non-anastomotic strictures compared to individuals without cuff inflammation (Adjusted odds ratio [aOR], 3.47; 95% CI, 1.71 - 7.52; 

 <.001). For the development of fistulas, individuals with cuff inflammation had odds 2.57 times those of the cohort without cuff inflammation (aOR, 2.57; 95% CI, 1.11-6.47; 

 = .034). Additionally, a prior history of extraintestinal manifestations was significantly associated with fistula development (aOR, 2.82; 95% CI, 1.21-7.09; 

From these results, this study suggests that endoscopic inflammation of the rectal cuff is associated with structural pathologies of the pouch, which may contribute to a higher risk of pouch failure. Patients undergoing pouchoscopy who are found to have cuff inflammation should therefore be monitored and treated for these specific structural conditions to limit the risk of long-term complications. Furthermore, this study suggests that extraintestinal manifestations may also predict structural pouch disease and should thus be considered when evaluating a patient’s risk for future pouch health.

Future directions from this study include performing time-to-event analyses given the varying follow-up times and considering whether more distal disease (anastomotic strictures, perianal fistulas) demonstrates the same trends noted in this study.

Ghoz H, Kesler A, Hoogenboom SA, et al. Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control? 

. 2020;24(2):270-277. doi:10.1007/S11605-019-04474-9

Garcia-Planella E, Mañosa M, van Domselaar M, et al. Long-term outcome of ulcerative colitis in patients who achieve clinical remission with a first course of corticosteroids. 

. 2012;44(3):206-210. doi:10.1016/J.DLD.2011.10.004

Ng KS, Gonsalves SJ, Sagar PM. Ileal-anal pouches: A review of its history, indications, and complications. 

. 2019;25(31):4320. doi:10.3748/WJG.V25.I31.4320

Chambers WM, Mortensen NJMC. Should ileal pouch-anal anastomosis include mucosectomy? 

. 2007;9(5):384-392. doi:10.1111/J.1463-1318.2007.01211.X

Zezos P, Saibil F. Inflammatory pouch disease: The spectrum of pouchitis. 

WJG. 2015;21(29):8739. doi:10.3748/WJG.V21.I29.8739

Kayal M, Plietz M, Rizvi A, et al. Inflammatory Pouch Conditions Are Common After Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients. 

. 2020;26(7):1079-1086. doi:10.1093/IBD/IZZ227

Findings suggest cuffitis after ileal pouch-anal anastomosis is linked to long-term complications including strictures and fistulas, potentially contributing to a greater risk of pouch failure.

Cuff Inflammation Following Pouch Creation and Future Stricture, Fistula Development

Joseph Carter Powers

Michelle Rodrigues, MBBS, is a dermatologist in Australia.

Michelle Rodrigues, MBBS

 I’ve enjoyed the opportunity to talk with you because I’ve learned a ton. Your experience and acknowledge is outstanding. To wrap this up, what would be your take-home messages for health care providers treating opioid-induced constipation?

 One would be to open the conversation if you see it on their list. I find that being a PCP [primary care physician] these days is the hardest job. The patients are living longer and in and out of the hospital. With the amount of record review, interaction with the charts, and certain care measures, this may be 10th on the list. They may be doing well from a pain relief perspective. We ask that question, but it’s hard when they have a million other medical problems. But it’s a simple question.

Patients oftentimes don’t want to bring it up or talk about it. It’s embarrassing. But it can affect their quality of life. We’re happy to help. I’m happy to see patients and have the longer discussion with them, especially if we can initiate the appropriate-line therapies to start. It’s important to open that conversation and ask them the simple question: “I see you’re on opiates. How are your bowel habits?” If there’s an issue, then start to get them on the right track to treatment, because it’s very efficacious and safe, as we talked about. They don’t have to bear this burden. We can help fix it for them.

 Yes, the conversation or even the prompt to have that conversation is important. We transitioned to electronic intake forms, and we have smart responses, where if somebody is taking opioids, it starts to ask about all the things related to opioids, including feeling sleepy, being able to function at work, and driving. Constipation came up there, and we were surprised by the number of people who were responding to this. We had never thought to have that discussion. With the time that you have to be able to discuss this, it might be very low on the list. But if you’re able to screen and have the conversation based on that response, it cuts out a lot of time, and thankfully we have some great options to choose from that will make the conversation go quickly and smoothly.

 Excellent. Thank you once again for participating in 

Expert Perspectives in the Management of Opioid-Induced Constipation

A panel of experts discuss their key takeaways and the future of treating opioid-induced constipation. 

Future Directions in the Treatment of Opioid-Induced Constipation

Neel Mehta, MD

 There are several important things that we usually advise gastroenterologists to do when treating patients with ulcerative colitis [UC]. We have several options to treat moderate to severe ulcerative colitis. But it’s also important to mention that we need to approach treatment in a better fashion with the drugs we already have. For example, we know that we should aim to treat earlier, with more efficacious therapies, and not wait until someone has a complication to introduce a biologic or a new-generation small molecule. For example, a patient on mesalamine who’s symptomatic and requires multiple courses of steroids should likely be started on another drug. Another important piece of advice is to remember that we’ll have newer therapies in the future. It’s important to discuss these other options with the patient, because it’s a combined or shared decision with the patient about the best option for them. Some patients may be uncomfortable getting injections or infusions, and they’d prefer an oral therapy. Also, some patients may feel uncomfortable with the potential adverse events.

 The advice I would give a gastroenterologist is not to be afraid of our new-generation therapies—to treat our patients with ulcerative colitis—when it’s clear that mesalamine isn’t controlling their symptoms. Also, be aware of patients who are steroid dependent. Too often you see a patient who can’t get below 15 mg of prednisone. They come in, their faces are round, they’ve gained weight, and they have horrible acne. There’s damage that has been done that’s undoable. Patients scare themselves by reading things on the internet. When they approach the doctor and say, “I’d rather be on steroids because I know the risks of steroids,” as gastroenterologists, we need to speak with confidence that steroids are the “bad guys” and other medications that we’ve been talking about are safer than steroids, both short term and long term. Therefore, we need to speak with confidence and not wait years for these people to be melted away by steroids before we do something about it.

 The treatment of UC is a dialogue between you and the patients. The best advice I could give is that you need to sit down with the patient early on in their disease and define targets and goals so the patient is onboard with treatment of the disease. Once you define the targets, you treat to the target and reassess. OK isn’t good enough. You need to get these patients into remission. Once in remission, it’s important to consistently monitor these patients, whether it’s fecal calprotectin, periodic endoscopy, or whatever you and the patient agree on. It’s important to continually monitor these patients to keep them in remission and to keep the inflammatory burden down to improve their symptoms, their quality of life, and hopefully to decrease the risk of complications progressing. It’s a matter of persistence and using the right medication at the right time.

It’s also important to not undertreat patients. There’s a trend among a lot of folks to start patients on mesalamine so they get a little better, but that’s good enough. Until you’ve assessed their inflammation, endoscopy, and histology, you need to consider moving forward if you’re not meeting the targets that you set.

 In general, how we approach the treatment of ulcerative colitis has dramatically changed. We should not classify patients as mild to moderate or moderate to severe. Many patients, now classified as mild to moderate, need newer therapies, or as gastroenterologists, we should approach these patients differently. It’s important to mention that there are several new drugs coming in the next year or 2, and it’s important to be updated on the benefits and risks of each drug.

 As far as I’m concerned, the way the future is looking for people with IBD [inflammatory bowel disease] is using most of the medications we have in rational combinations. These combinations of medications will complement one another. Obviously, the reason it’s a bit pie-in-the-sky is because of finances. Because we use biosimilars and, presumably, some of the medications we have in clinical trials, the only way we’re going to have a higher response rate and remission rate, especially in the more difficult patients, will be by using combination therapies.

 Thank you for allowing me to participate. It was a pleasure to be at DDW [Digestive Disease Week] this year. It was very exciting. Every year, as we go to these conferences, the information gets better and better.

We’re constantly learning about new mechanisms, how to properly use these medications—in the right patients—and how to assess patients and get them a better quality of life and long-term remission. It’s a very exciting time to be practicing medicine.

Advice for community physicians and gastroenterologists to help manage patients with ulcerative colitis. 

Tips to Optimize Care for Patients With Ulcerative Colitis 

Timothy Ritter, MD, GI Alliance 

Victoria Barbosa, MD, MPH, is an associate professor for the University of Chicago Section of Dermatology.

Skin of Color Savvy: The Art and Science of Treating Patients of Color

SOCS Clinical Episode 3

, Victoria Barbosa, MD, MPH, MBA, associate professor of dermatology at the University of Chicago and president of the Skin of Color Society (SOCS), is joined by Janiene Luke, MD, clinical professor of dermatology at Loma Linda University. Together, they engage in a comprehensive discussion on hair care myths, patient habits, and the management of 

The conversation begins with a deep dive into common misconceptions about alopecia, highlighting how the term is often misunderstood by patients. Luke explains that alopecia is a broad term encompassing various forms of hair loss, each requiring distinct diagnostic and treatment approaches. They discuss the challenges of educating patients who self-diagnose and stress the importance of accurate clinical evaluation. Barbosa shares that many patients assume alopecia refers to a specific condition rather than a general term for hair loss, making clear communication critical.

The discussion then shifts to protective styling, an area where many patients unknowingly engage in damaging practices. Barbosa and Luke highlight how tight hairstyles, prolonged wear, and excessive tension can lead to conditions such as traction alopecia. They emphasize patient education on safer styling techniques and discuss the difficulty of balancing these conversations within the time constraints of clinical practice. Barbosa describes her structured approach, breaking hair loss visits into multiple sessions to ensure comprehensive evaluation, while Luke shares strategies for handling these time-consuming discussions in a busy clinic setting.

Both experts outline their structured approaches to diagnosing and managing hair loss. Luke shares insights into her clinic’s thorough patient evaluation, which includes taking detailed histories, utilizing dermoscopy, and selectively performing biopsies. They stress the importance of cultural humility and patient-centered care, particularly in addressing the emotional distress often associated with hair loss. Barbosa underscores the need for dermatologists to physically examine the scalp, noting that some patients report prior experiences where their hair loss was assessed from a distance.

The conversation also covers specific types of alopecia commonly seen in patients with skin of color, including central centrifugal cicatricial alopecia (CCCA), frontal fibrosing alopecia (FFA), and lichen planopilaris (LPP). They discuss how these conditions are often misdiagnosed as traction alopecia, underscoring the need for careful clinical examination, including checking for eyebrow loss and facial pigmentation. Luke shares how dermoscopy-guided biopsies have improved diagnostic accuracy in her practice.

In terms of treatment, they discuss the role of topical and oral therapies, including corticosteroids, doxycycline, minoxidil, and platelet-rich plasma (PRP). Luke shares her experience incorporating metformin into CCCA treatment and expresses excitement about ongoing research into JAK inhibitors. They also touch on hair transplant options for patients with traction alopecia, emphasizing the importance of selecting surgeons experienced with curly and textured hair. Barbosa details how she offers patients a choice between topical and oral minoxidil, framing treatment as a collaborative process to maintain patient autonomy and adherence.

The episode concludes with a discussion on best practices in hair care, product recommendations, and the importance of partnering with knowledgeable hairstylists to support patients. Barbosa and Luke emphasize that dermatologists can enhance patient outcomes by either learning about Black hair care or establishing connections with local hairstylists specializing in textured hair. They stress the importance of recommending water-based moisturizing products, sulfate-free shampoos, and proper conditioning practices to help patients maintain healthy hair.

This episode delivers expert perspectives on diagnosing and managing hair loss in patients with skin of color, combining scientific insights with practical clinical strategies to improve patient outcomes. By fostering culturally intelligent and responsive conversations, personalizing treatment approaches, and staying informed on the latest research, dermatologists can better serve their diverse patient populations.

Barbosa has the following disclosures: Pfizer, Eli Lilly, L'Oréal, Vichy, and Beiersdorf. Luke's disclosures include Eli Lilly, Sanofi/Regeneron, and Arcutis.

This summary was formulated with the assistance of artificial intelligence.

Hosted by Skin of Color Society and produced by HCPLive, 

 delves into the latest research, clinical insights, and culturally competent care practices in dermatology with leading experts. Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.

In this episode, Victoria Barbosa, MD, MPH, MBA, and Janiene Luke, MD, highlight insights and misconceptions about alopecia.