In this episode of MD Newsline, Dr. Alyson K. Myers, endocrinologist and Associate Chair for Faculty Mentoring and Community Engagement at Montefiore in the Bronx, dives into one of the most pressing and underrecognized complications of diabetes: diabetic foot ulcers (DFUs) and the devastating risk of amputations. She discusses the intersection of clinical care, social determinants of health, and healthcare disparities, while also highlighting emerging technologies and multidisciplinary clinic models designed to reduce risks and improve patient outcomes. Drawing on her extensive experience in diabetes management and community engagement, Dr. Myers emphasizes both the urgent need for systemic change and the practical tools clinicians can use today to protect their patients.

Episode Highlights:

High Amputation Risk in Diabetic Foot Ulcers

Dr. Myers shares sobering statistics, noting that 44% of patients who present with a diabetic foot ulcer undergo an amputation within five years. This reality highlights the urgency of early screening, prevention, and intervention in diabetes care. She stresses that DFUs are not only medical complications but also markers of systemic inequity and missed opportunities for prevention.

The Role of Social Determinants of Health

Dr. Myers explores how socioeconomic status, racial disparities, and provider bias profoundly shape patient outcomes. In the Bronx and other underserved areas, patients often face delays in diagnosis, limited access to care, and inconsistent follow-up, all of which contribute to worse outcomes. She emphasizes the importance of addressing these systemic barriers alongside clinical treatment.

Innovative Technology for Prevention

Emerging tools, such as thermal-sensing mats and sensor-equipped socks, offer promising ways to identify foot ulcers before they progress. These devices can detect subtle temperature changes that indicate early tissue damage, allowing patients and providers to intervene earlier. Dr. Myers highlights the potential of technology to improve adherence and reduce disparities by making self-care more accessible.

Building Multidisciplinary DFU Clinics

Dr. Myers describes the creation of a multidisciplinary DFU clinic in the Bronx, modeled after programs at institutions like Stanford. By integrating endocrinology, podiatry, vascular surgery, infectious disease, and behavioral health, this model ensures that patients receive comprehensive, coordinated care. She explains how this approach can drastically reduce amputation rates and improve long-term patient outcomes.

Patient and Caregiver Education

Education remains a cornerstone of DFU prevention. Dr. Myers emphasizes strategies such as ensuring patients wear proper footwear, involving caregivers and family members in diabetes care, and simplifying self-care routines. She points out that community-based education and culturally sensitive approaches are essential for building trust and improving adherence.

Advocacy and Policy Change

Beyond clinical care, Dr. Myers stresses the importance of advocacy and systemic reform. She calls for insurance coverage expansion for proven therapies, including GLP-1 receptor agonists and PAD (peripheral arterial disease) screenings, which can significantly improve outcomes. Her message is clear: reducing disparities in diabetes care requires action at every level—from the exam room to healthcare policy.

Key Takeaway:

Diabetic foot ulcers are a leading cause of amputation, yet they remain preventable with the right tools and care models. Through early detection technologies, multidisciplinary clinics, culturally sensitive education, and equitable access to therapies, healthcare providers can dramatically improve patient outcomes and close persistent gaps in diabetes care.

Resources:

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Connect with Dr. Alyson K. Myers:LinkedIn

In this episode of MD Newsline, Dr. Rachael Sood, a diabetes nurse practitioner and certified diabetes care and education specialist from New Orleans, Louisiana, shares her insights from the 85th American Diabetes Association Scientific Sessions. As the founder of The Diabetes Collective, Dr. Sood discusses the evolution of diabetology—a specialized field focused solely on the identification, treatment, and management of diabetes across all patient populations.

Dr. Sood explores how personalized diagnostics, innovative technology, and education-driven care models are reshaping outcomes for patients with type 1, type 2, and prediabetes. She highlights the importance of accurate diagnosis, the role of genetic predisposition, and why clinicians must move beyond relying solely on hemoglobin A1C levels to ensure proper disease identification and management.

Episode Highlights:

Transforming the Diagnosis and Management of Diabetes

Dr. Sood explains the principles of diabetology and how it differs from traditional endocrinology. She emphasizes comprehensive assessment, including antibody screening, glucose monitoring, and the integration of genomic insights to accurately distinguish between type 1 and type 2 diabetes.

Technology as a Game-Changer in Diabetes Care

Dr. Sood shares how continuous glucose monitors (CGMs) and insulin pumps have revolutionized real-time patient engagement. These smart biosensors empower patients to understand how lifestyle, stress, and nutrition directly affect glucose levels, fostering self-awareness and adherence to treatment plans.

Overcoming Clinical Inertia and Patient Barriers

She highlights the need to address clinical inertia, encouraging clinicians to adapt treatment plans as patients' needs evolve. Dr. Sood underscores the importance of patient education, empathy, and collaboration with family and community networks to improve adherence and reduce care fatigue.

Breakthroughs in Treatment and Research

Reporting from the ADA conference, Dr. Sood discusses the promising results of Vertex Pharmaceuticals' islet cell therapy, which shows evidence of restoring natural insulin production in type 1 diabetes. She also explains the role of TZLD (teplizumab) in delaying the onset of type 1 diabetes, potentially changing the disease trajectory for high-risk patients.

Next-Generation Therapies and GLP-1 Innovation

Dr. Sood breaks down the expanding role of GLP-1 receptor agonists—from glucose regulation to benefits in cardiovascular health, weight management, and chronic kidney disease. She reveals data on the new CagreSema combination therapy, which combines semaglutide with an amylin analog, showing over 20% weight reduction and improved metabolic outcomes.

Insurance and Access Challenges

Dr. Sood addresses the ongoing struggle of insurance coverage, prior authorizations, and high costs for new medications, offering practical advice for clinicians and patients to navigate access through manufacturer programs and cash-based options.

Key Takeaway:

Dr. Sood emphasizes that diabetes care is entering a transformative era—one defined by early detection, patient empowerment, and precision medicine. With new therapies, technologies, and care models emerging rapidly, collaboration among clinicians, patients, and innovators will be essential to achieving long-term success in diabetes prevention and management.

Link & Resources:

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Connect with Dr. Rachael Sood: Here

In this episode of MD Newsline, Dr. Sarimar Agosto Salgado, Oncologic Endocrinologist at Moffitt Cancer Center, shares insights from a panel discussion at the AACE 2025 conference on the complexities of advanced thyroid cancer. She explores case-based approaches to recurrent, radioactive iodine-refractory disease and introduces the evolving strategy of re-differentiation therapy—a promising method for resensitizing tumors to radioactive iodine.

Dr. Salgado also highlights real-world challenges including diagnostic errors, late referrals, and the need for greater access to multidisciplinary care.

Episode Highlights:

Understanding Radioactive Iodine-Refractory Disease

Dr. Salgado explains that a subset of thyroid cancer patients no longer respond to radioactive iodine due to disease progression. For these patients, careful monitoring, local therapies like SBRT, or systemic treatments become necessary depending on the tumor's growth and location.

Re-differentiation Therapy Explained

She introduces re-differentiation—a technique using short-term targeted therapy (e.g., BRAF inhibitors) to restore the tumor's ability to uptake radioactive iodine. This allows for additional rounds of treatment and may delay or reduce the need for long-term systemic therapy.

The Role of Real-World Data and Registries

Because prospective clinical trials remain limited, Dr. Salgado advocates for collecting data through real-world registries and academic collaborations. These efforts may help define optimal timing, predictive markers, and response indicators for re-differentiation therapy.

Challenges in Diagnosis and Timely Referral

Dr. Salgado reflects on misdiagnosed cases, including rare thyroid variants confused with neuroendocrine tumors. She emphasizes the importance of early referral to expert centers before treatment limits available options.

Access and Equity in Advanced Thyroid Cancer

Many patients lack access to high-volume thyroid teams, leading to missed opportunities. Dr. Salgado urges clinicians to prioritize expert pathology review, molecular testing, and full-neck imaging to avoid delays in diagnosis and care.

Key Takeaway:

Advanced thyroid cancer is complex and often underestimated. Early referral, precision strategies like re-differentiation, and equitable access to expert teams are critical to improving outcomes and expanding hope for patients with this challenging disease.

Resources & Links:

Website: MD Newsline

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Connect with Dr. Sarimar Agosto Salgado: Here