In part 2 of this episode of Crisis Point, 4 experts on pain and opioid misuse discuss continuing efforts to turn the tide.

Crisis Point: Turning the Tide in The Opioid Crisis

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

Addressing the Opioid Crisis: Efforts to Turn the Tide

This episode examines the growing and evolving opioid crisis, a public health emergency that has claimed more than half a million lives over the past 2 decades in the United States.

What began as a prescribing-driven epidemic has evolved into a more complex crisis fueled by the proliferation of illicit synthetic opioids, persistent gaps in access to treatment, and social determinants that drive vulnerability to substance use disorder.

In 2023, the overall rate of mortality from drug overdoses slightly fell for the first time since 2018.

 The decrease could be due to a number of factors, including new pharmaceutical options for treating opioid use disorder, a shift away from opioid prescribing regimens, regulatory and advocacy action, and even the COVID-19 pandemic. While the decrease is a positive sign for those working with OUD, overdose deaths related to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine remain at historic highs and the work is only beginning.

Be sure to check out part 1 of this episode, which into the complex challenges surrounding OUD, exploring how the opioid crisis has evolved and grown in recent years and how new pharmaceuticals and prescribing regimens may be helping to turn the tide.

In part 2, the conversation shifts to ongoing advocacy and regulatory action and significant progress in turning the tide in the opioid crisis so far.

Brief descriptions of the speakers featured in this project are provided below:

Angel Goenawan, MD, hospitalist at Bayhealth in Delaware

Bobby Mukkamala, MD president-elect of the American Medical Association (AMA) and chair of the AMA’s Substance Use and Pain Care Task Force

Michele J. Buonora, MD, MS, MSHS, assistant professor of medicine, Albert Einstein College of Medicine, Montefiore Einstein

Shoshana Herzig, MD, assistant professor of medicine, Harvard Medical School and Beth Israel Deaconess Medical Center

For more video content, visit our Crisis Point page to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

U.S. Overdose Deaths Decrease in 2023, First Time Since 2018. Webpage. CDC. May 15, 2024. 

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm

AMA Substance Use and Pain Care Task Force recommendations. Webpage. AMA. 2025. 

https://www.ama-assn.org/delivering-care/nation-s-overdose-epidemic/ama-substance-use-and-pain-care-task-force

HHS Announces Transformation to Make America Healthy Again. Webpage. HHS. March 27, 2025. 

https://www.hhs.gov/press-room/hhs-restructuring-doge.html

More than a dozen states, DC sue Trump administration over ‘dismantling’ of federal health agencies. Webpage. CNN. May 5, 2025. 

https://www.cnn.com/2025/05/05/health/states-sue-trump-administration-hhs-rfk

Angel Goenawan, MD

Closing Reflection: A Journey of Understanding and Resilience

Video content above is prompted by the following:

How do you think advancements in paroxysmal nocturnal hemoglobinuria care will impact the patient and caregiver experience in the future?

Are there any aspects of your care or communication with your health care team that you feel could be improved?

This program was made possible with support from Novartis Pharmaceuticals.

Panelists discuss how emerging treatments, digital health tools, and enhanced care coordination could streamline disease management and improve quality of life while identifying opportunities to strengthen provider communication and access to resources.

David Dingli, MD, PhD

Kitsios is an assistant professor of medicine in the division of pulmonary, allergy, critical care and sleep medicine at the University of Pittsburgh.

 remains a critical challenge in intensive care units (ICUs), affecting up to 50% of patients requiring invasive mechanical ventilation (IMV) and significantly increasing mortality rates, antibiotic use, and hospital stays.

 The COVID-19 pandemic has further underscored the urgency of understanding respiratory infections in critically ill patients, particularly as severe cases often necessitate prolonged IMV and are susceptible to developing VAP.

In response to these challenges, I have launched the innovative Lung CovID-19 Interactions with Microbiota and Host (LUCID-IMHO) study. Funded by a $200,000 COVID-19 Respiratory Virus Research Award from the American Lung Association, this 2-year project aims to develop a novel, microbiome-based diagnostic framework for VAP in critically ill patients.

The LUCID-IMHO study leverages a high-dimensional, multi-omic dataset from 110 patients with severe respiratory failure requiring IMV. These patients underwent longitudinal sampling of the lower respiratory tract at 3 key intervals: baseline (0-2 days post-intubation), middle (days 3-7), and late (days 8-12). This comprehensive sampling strategy allows for detailed temporal analysis of microbial and host factors associated with VAP development.

A key innovation of the LUCID-IMHO study is its use of untargeted DNA metagenomics with rapid sequencing platforms, including the portable MiNION Mk1c sequencer by Oxford Nanopore Technologies. This approach enables systematic and comprehensive profiling of microbial communities, including bacteria, viruses, and fungi, without relying on traditional culture methods. Importantly, it allows for real-time data generation, potentially reducing the time from sample acquisition to diagnosis from days to hours.

Interim results of the LUCID-IMHO study, recently published in 

, provide significant insights into the microbiome dynamics of critically ill patients.

 The study conducted a longitudinal, multi-compartment assessment of host-microbiota interactions across 3 body sites—oral cavity, lungs, and gut—in 479 patients with acute respiratory failure receiving IMV. Findings were validated in 2 independent cohorts of critically ill COVID-19 patients.

Key findings from this interim analysis include:

Progressive dysbiosis in oral, lung, and gut microbiota of critically ill patients, characterized by reduced microbial diversity and alterations in composition over time.

The lung microbiome emerged as the strongest independent predictor of important clinical outcomes, outperforming oral and gut microbiota.

Specific clinical factors, including chronic obstructive pulmonary disease (COPD), immunosuppression, and antibiotic exposure, were associated with distinct dysbiotic patterns.

Anaerobe-targeting antibiotics were associated with anaerobic bacteria depletion in both respiratory and intestinal tracts, correlating with worse clinical outcomes.

The oral cavity was identified as the main source of microbial seeding in the lungs, with a small subset of patients (8.3%) showing enrichment for gut-origin bacteria associated with worse survival outcomes.

Dirichlet Multinomial Mixture (DMM) models stratified patients into distinct microbial clusters, revealing high-diversity clusters associated with better outcomes and low-diversity clusters linked to worsened clinical trajectories.

A Dysbiosis Index derived from these clusters successfully classified microbiota profiles in independent cohorts, including COVID-19 patients, demonstrating associations with inflammatory biomarkers and clinical outcomes.

These findings highlight the potential of microbiome analysis in critical care medicine, particularly for improving VAP diagnosis and management. The lung microbiome's strong predictive value for clinical outcomes, independent of traditional clinical predictors and host-response subphenotypes, suggests that integrating microbiome data into clinical decision-making could significantly enhance risk stratification and resource allocation in intensive care units.

Moreover, the study's insights into the effects of antibiotics on microbial communities underscore the importance of rational antibiotic use in critically ill patients. The observed associations between anaerobic bacteria depletion and worse clinical outcomes highlight potential unintended consequences of broad-spectrum antibiotic use and suggest avenues for more targeted therapeutic approaches.

The LUCID-IMHO study's approach aligns with recent advances in the field, such as the multi-institutional study published in 

 that defined clinically informative lung microbiome signatures associated with acute respiratory distress syndrome (ARDS) and hospital-acquired pneumonia (HAP).

 Together, these studies underscore the potential for microbiome-targeted therapies in critically ill patients.

As the LUCID-IMHO study progresses, its findings could lead to the development of a microbiome-based diagnostic framework for VAP, enabling more precise and timely interventions. This approach has the potential to revolutionize clinical practice by reducing unnecessary antibiotic use, improving patient outcomes, and alleviating the burden of antibiotic resistance in intensive care settings.

Kitsios has received research funding from Karius, Inc., Pfizer, Inc., and Genentech, Inc.

Ranzani OT, Niederman MS, Torres A. Ventilator-associated pneumonia. 

. 2022;48(9):1222-1226. doi:10.1007/s00134-022-06773-3

Niederman MS. What COVID-19 Has Taught Us: Ventilator-associated Pneumonia Is Back! 

. 2022;206(2):132-134. doi:10.1164/rccm.202204-0799ED

Kitsios GD, Sayed K, Fitch A, et al. Longitudinal multicompartment characterization of host-microbiota interactions in patients with acute respiratory failure. 

. 2024;15(1):4708. doi:10.1038/s41467-024-48819-8

Montassier E, Kitsios GD, Radder JE, et al. Robust airway microbiome signatures in acute respiratory failure and hospital-acquired pneumonia. 

. 2023;29(11):2793-2804. doi:10.1038/s41591-023-02617-9

Interim results of the LUCID-IMHO study provide insights into the microbiome dynamics of critically ill patients with VAP.

Lung Microbiome Profiling: A Promising Approach to Enhance Diagnostic Precision for Ventilator-Associated Pneumonia

Georgios D. Kitsios, MD, PhD

The health risks associated with tobacco smoking are well known among consumers and healthcare professionals. Despite this knowledge, the success rate for 

 is low, in part because pharmacotherapy and counseling are under-utilized.

Data show that although 68% of smokers want to quit, only 6.8% utilize behavioral counseling, 29.0% utilize pharmacotherapy such as nicotine replacement therapy and/or non-nicotine prescription smoking cessation therapy (varenicline and bupropion SR), and only 4.7% used both.

One of the factors that might play a key role in this underutilization of proven cessation resources is the barrier to accessing a medical professional who can prescribe smoking cessation medications at the time when a patient decides to quit.

This barrier can be manifested in several ways including long waits for appointment times, distance needed to travel to access a provider, and limited availability of physician appointments outside of typical working hours. Additionally, many primary care physicians report insufficient time within the context of routine office appointments as a key barrier in being able to effectively address tobacco use with their patients.

To bridge this gap in care, in 2017 the US Centers for Medicare & Medicaid Services issued an informational bulletin encouraging states to “facilitate easier access to medically necessary and time-sensitive drugs for Medicaid beneficiaries,” including smoking cessation medications.

More than 90% of Americans live within five miles of a community retail pharmacy,

 and most are open evenings and weekends. Importantly, the ability to walk into a pharmacy without an appointment allows tobacco users to initiate action the moment they feel the desire to quit, a moment that might pass if they must wait for an appointment with a physician.

Currently, a dozen states in the US have statutes or legislation permitting pharmacists to prescribe some or all FDA-approved pharmacotherapy for tobacco cessation.

 These include New Mexico, where pharmacists have had prescriptive authority for this category of medications since 2004, Arizona, Arkansas, California, Colorado, Idaho, Indiana, Iowa, Maine, Missouri, Oregon, and West Virginia. Most of these states have minimum tobacco cessation education requirements for pharmacists who wish to prescribe, and the cessation protocols require (a) patient screening, (b) specific intervention components, and (c) documentation requirements, which collectively help to promote positive outcomes and enhance patient safety. It is notable that no negative reports related to pharmacist-prescribed cessation therapy have occurred in New Mexico across 15 years of protocol existence.

But how effective are pharmacists in helping patients quit? Several studies have shown that tobacco quit rates achieved when pharmacists prescribe cessation medications and provide counseling are similar to rates achieved by other healthcare professionals.

 Importantly, in a study based in New Mexico, more than one third of patients assisted were non‐white, and 53.4% did not have health insurance,4 suggesting that pharmacists are effective in reaching vulnerable and uninsured populations.

Given that only 7.4% of smokers are successful when quitting unassisted,1 pharmacists could play an important role in enhancing quit rates. Pharmacies may also provide more cost-effective access to smoking cessation therapy.

Physician burn-out, which is being at least partially driven by increased workloads, is a serious and growing challenge for the healthcare community.

 Collaboration between physicians and pharmacists with respect to prescribing smoking cessation therapy, could achieve two beneficial goals of reducing demands on physicians’ time while increasing access to therapy that can help those motivated to quit smoking succeed in this difficult endeavor.

Physicians could benefit themselves and their patients by learning about options in their states to collaborate with pharmacists in the area of smoking cessation therapy and sharing appropriate information with patients regarding the role that pharmacists can play in helping them reach their quitting goals.

New digital solutions will also enable patients and providers to find a pharmacist who can prescribe smoking cessation therapy. Work is currently ongoing to launch a website that can help patients find a pharmacy near them that prescribes smoking cessation therapy, similar to the birthcontrolpharmacies.com project that has helped connect women with pharmacists who can prescribe birth control.

Although 2021 has already started, it’s not too late to resolve to quit smoking. Physicians and patients alike should know that, in some states, the local pharmacist can be a valuable and accessible resource for achieving this important but challenging goal.

Physicians in states that don’t yet permit pharmacists to prescribe smoking cessation therapy are encouraged to consider recommending this approach to their state health officials and legislators. Quitting smoking is difficult, and those who seek to do so deserve as much support as the healthcare community and our elected leaders can provide.

Karen Hudmon, DrPH, is a Professor of Pharmacy Practice at Purdue University.

Katy Ellis Hilts, PhD, is a Postdoctoral Fellow at the Indiana University School of Nursing.

Clinicians interested in responding to this piece or submitting to HCPLive can reach the editorial team here.

 Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults - United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017;65(52):1457e1464.

 American Lung Association. Indiana’s standing order for tobacco cessation: A case study. Available at: 

https://www.lung.org/getmedia/a673abfe-eb7e-4801-a374-01724df6ca6c/standing-order-indiana-case-study-final.pdf

 National Alliance of State Pharmacy Associations. Pharmacist prescribing: Smoking cessation aids. Available at: 

https://naspa.us/resource/tobacco-cessation/

 Adams AJ and Hudmon KS. Pharmacist prescriptive authority for smoking cessation medications in the United States. J Am Pharm Assoc. 2018;58(3):253-257. doi: 10.1016/j.japh.2017.12.015

 Csikar JI, Douglas GV, Pavitt S, Hulme C. The cost-effectiveness of smoking cessation services provided by general dental practice, general medical practice, pharmacy and NHS Stop Smoking Services in the North of England. Community Dent Oral Epidemiol. 2016;44:119e127

 Scheepers R, Silkens M, van den Berg J, Lombarts K. Associations between job demands, job resources and patient-related burnout among physicians: results from a multicentre observational study. BMJ Open. 2020;10(9):e038466. Published 2020 Sep 24. doi:10.1136/bmjopen-2020-038466

More than two-thirds of smokers want to quit, but lack proper resources. A prescribing professional could help make up that difference.

The Important, Evolving Role of Pharmacists in Helping Patients Quit Smoking

Karen Hudmon, DrPH & Katy Ellis Hilts, PhD

Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

Fatty liver disease is a growing public health crisis — yet it often remains undetected until catastrophic events force a diagnosis. Jerry Rosenberg’s story is a powerful reminder of this reality and offers key takeaways for physicians working at the intersection of primary care, hepatology, critical care, and transplant medicine.

Without traditional risk factors or a known diagnosis, Rosenberg went from a healthy, active lifestyle to a coma and liver failure within days — his first real sign that something was wrong.

A Silent Disease with Deadly Consequences

Before his health crisis, Rosenberg was thriving. He co-owned a nightclub, exercised regularly, maintained a healthy weight, and traveled extensively. Despite his active lifestyle and lack of alcohol consumption, he unknowingly had advanced fatty liver disease.

“I had just received a clean bill of health from my doctor,” Rosenberg said. “I didn’t drink. Liver disease wasn’t something I was ever told to worry about.”

The turning point came while on vacation, after a suspected case of food poisoning. Within days, Rosenberg collapsed and entered hepatic coma. Local doctors in Bermuda offered little hope of survival. Only after multiple international care coordination efforts was he airlifted to Florida, and later accepted into Mayo Clinic’s transplant program.

Delayed Diagnosis and Missed Screening Opportunities

Rosenberg’s experience reflects a broader pattern seen across healthcare settings. Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), now affect 

Multiple studies show that NAFLD often goes undetected in primary care, even when patients have risk factors like obesity, diabetes, or metabolic syndrome. However, Rosenberg didn’t fit even those profiles — further underscoring the need for more nuanced risk assessment and screening tools beyond conventional assumptions.

Critical Care, Transplant Readiness, and Multidisciplinary Coordination

Rosenberg’s journey also highlights challenges in transplant triage, especially for patients presenting with acute liver failure without a clear etiology.

With few hospitals willing to accept him, Rosenberg’s case required rapid, cross-border coordination between emergency medical teams, hepatologists, transplant centers, and intensive care specialists.

Post-transplant, his rehabilitation was extensive. Prolonged ICU stays led to muscle atrophy, requiring inpatient rehab and nursing home care to regain basic mobility.

“Learning to walk again was one of the hardest parts,” Rosenberg recalled. “My brother, who was also my caregiver, pushed me every day.”

Despite his medical history, Rosenberg frequently encountered stigma—both in the hospital and in his community.

“There was an automatic assumption that my liver failure was alcohol-related,” he said. “That stigma was hurtful and it’s still something I speak out about.”

For clinicians, this highlights an important care gap: Addressing biases and misconceptions when communicating with patients about liver disease. Not all patients with liver failure have a history of alcohol misuse. This is especially true as NAFLD/NASH continues to rise as a leading cause of transplantation.

Advocacy, Education, and the Physician’s Role

Today, Rosenberg is a vocal advocate with the 

. He speaks at medical schools, health fairs, and policy events to raise awareness about fatty liver disease and the need for increased organ donation.

Screen proactively, even in patients without obvious risk factors.

Educate without bias, avoiding stigma-laden assumptions.

Encourage patients to understand their liver health, especially those with metabolic risk factors.

“I want doctors to know that their words matter,” Rosenberg said. “You could catch this early for someone else.”

NAFLD/NASH can progress silently — even in lean, low-risk individuals.

Acute liver failure without prior warning signs presents unique diagnostic and triage challenges.

Multidisciplinary coordination is essential for successful transplant outcomes.

Stigma remains a significant barrier in liver disease care—clinician communication can help address this.

Early screening and patient education can prevent late-stage crises.

As Rosenberg’s story makes clear, liver disease is not always visible — but its consequences can be life-altering.

Fatty liver disease, particularly nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), is a significant public health issue often undiagnosed until severe complications arise. Jerry Rosenberg's case exemplifies the silent progression of this disease, even in individuals without traditional risk factors. His experience underscores the necessity for improved screening, multidisciplinary care coordination, and addressing stigma in liver disease management. Physicians are encouraged to proactively screen, educate without bias, and advocate for increased awareness and organ donation to mitigate late-stage liver disease crises.

A patient’s near-fatal journey from undiagnosed fatty liver disease to liver transplant highlights the urgent need for better screening and stigma-free communication.

From Asymptomatic to Acute Liver Failure: A Wake-Up Call for NAFLD Screening

Lana Pine

Laura Ross, PA-C, CLS, AACC, is a physician assistant and clinical lipid specialist in cardiology at the Park Nicollet Heart and Vascular Center in St. Louis Park, MN. She is a member of ACC's Interventional Leadership Council and the Prevention Work Group, and she is president of the Academy of Physician Associates in Cardiology.

The APAC Recap: Cardiomyopathy at CAPP Live 2024 with Greg Duck, PA-C

, host Laura Ross, PA-C, clinical lipid specialist and president of the Academy of Physician Associates in Cardiology (APAC), interviewed Greg Duck, PA-C, co-chair of APAC’s heart failure committee and director of internal medicine and a cardiology PA at Acclaim Physician Group. Duck shared insights from his CAPP 2024 presentation on 

, a condition he frequently encounters in his practice with underserved populations.

Duck emphasized the importance of understanding the patient’s drug use patterns to tailor medical management and ensure effective treatment. He highlighted the need for careful use of beta blockers in patients actively using methamphetamines to avoid adverse events and promote adherence to therapy. Additionally, Duck shared key clinical pearls, such as medications like wellbutrin and mexiletine causing false-positive methamphetamine urine screens, underscoring the importance of avoiding stigma and mislabeling patients.

The conversation also touched on gaps in guidelines specific to methamphetamine-related heart failure, with Duck recommending adherence to established heart failure with reduced ejection fraction (HFrEF) protocols and regular follow-ups to optimize care. He advocated for transparency in monitoring strategies, such as routine urine drug screens, to build trust with this vulnerable population. Duck concluded with a discussion of the Heart Failure Society of America (HFSA) heart failure certification, encouraging advanced practice providers to pursue this credential to enhance patient care and professional expertise.

All episodes of The APAC Recap will be available on HCPLive.com and our 

Laura Ross, PA-C, interviewed Greg Duck, PA-C, on methamphetamine-induced cardiomyopathy, focusing on its management in underserved populations. Duck stressed understanding drug use patterns for effective treatment and highlighted the cautious use of beta blockers in active methamphetamine users. He noted medications like wellbutrin and mexiletine can cause false-positive urine screens, emphasizing the need to avoid stigma. Duck recommended following HFrEF protocols and regular follow-ups, advocating for transparency in monitoring. He encouraged pursuing HFSA heart failure certification to enhance care and expertise.

Greg Duck, PA-C shared insights from his CAPP 2024 presentation on tailoring medical management and effective treatment of methamphetamine-induced cardiomyopathy.

Laura Ross, PA-C

Diabetes Dialogue: Technology, Therapeutics, and Real-World Perspectives!

Diabetes Dialogue: Upcoming Research on Type 1 Diabetes in Pregnancy with Carol Levy, MD

In this episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, sit down with Carol Levy, MD, director of the Mount Sinai Diabetes Center and 

 Clinical Research, to discuss the upcoming T1D Pregnancy and Me – or PRAM T1D – clinical study.

Levy explains that the motivation for the study arose from ongoing clinical uncertainty regarding optimal Continuous Glucose Monitor (CGM)-derived metrics during pregnancy, despite data from previous studies such as CONCEPTT that support CGM use. She underscores the limitations of existing guidelines, which were based primarily on fingerstick glucose targets, and notes that while targets like >70% time in range (TIR 63–140 mg/dL) are widely cited, there is insufficient evidence around how factors such as mean glucose, glycemic variability, and fasting values impact maternal and neonatal outcomes.

The study is designed to enroll at least 500 pregnant individuals with type 1 diabetes during their first trimester, with a goal of completing recruitment in under two years. Participants will be followed throughout pregnancy, and the study will collect both glycemic and pregnancy-related data through CGM and AID system uploads as well as patient-reported outcomes. Importantly, the study is intentionally designed to reflect real-world management—recruiting not only from major academic centers but also through self-enrollment from individuals across the U.S., including those receiving care in community settings. This decentralized model allows for broad inclusion across diverse geographies and practice types, helping address the gap in understanding how diabetes in pregnancy is managed outside tertiary care environments.

A key strength of the study lies in its technology-agnostic design. All CGM and insulin delivery devices are eligible, and the study aims to capture how current technologies—many of which are used off-label in pregnancy—are being applied in practice. By not restricting enrollment based on device type, the research team will be able to analyze patterns of use, self-management strategies, and variations in outcomes across platforms, laying the groundwork for future clinical guidance and product development.

Dr. Levy highlights that the study is also collecting data on quality of life, treatment satisfaction, and hypoglycemia-related fear, noting the real psychological burden that accompanies tight glucose management in pregnancy. These insights are expected to be critical in informing both clinician counseling and future research on patient-centered care. The data will be curated in partnership with the JAEB Center for Health Research, which will also provide statistical support for future analyses. The research team intends for the final dataset to become a resource for the broader clinical and scientific community.

Though the study’s current focus is on singleton pregnancies in individuals using any type of diabetes technology, Dr. Levy notes that the team has plans to adapt the protocol to account for emerging devices and future research questions, including expanded enrollment if supported by additional funding. She emphasizes the importance of generating robust, generalizable data to guide both clinical practice and the development of pregnancy-specific diabetes technologies—a long-neglected area in industry research.

The conversation concludes with a shared sense of urgency and optimism. As CGM and AID use continues to rise among individuals with type 1 diabetes, the need for pregnancy-specific data, tools, and targets becomes increasingly critical. Dr. Levy calls on endocrinologists, obstetricians, and maternal-fetal medicine specialists alike to engage with the study and help bridge the current evidence gaps. With enrollment already well underway, this initiative has the potential to transform care for pregnant individuals with type 1 diabetes by informing not only best practices but also product innovation and policy.

Relevant disclosures for Levy include Sequel, Eli Lilly and Company, Tandem Diabetes, and Dexcom. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

Isaacs, Bellini, and Levy discuss a currently recruiting trial investigating Continuous Glucose Monitor metrics in pregnant individuals with type 1 diabetes.

Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES

Sidney Braman, MD, Icahn School of Medicine 

 For take-home messages, the first and foremost is that people with sickle cell disease want to live normal, active lives. They don’t want to spend their time in the hospital. If you’re seeing them in front of you, there’s a reason, and there are always strategies to try to improve the overall quality of life for people with sickle cell disease. We should provide them with all of the opportunities available to try to make their lives better. There has been a lot of structural racism that has affected how patients with sickle cell disease are treated, both in the emergency department and in lots of places. We have to overcome that structural racism and make sure our patients have every opportunity to live a long healthy life.

 It is so important for hematologists and primary care providers who take care of patients with sickle cell disease to first, establish the trust. Many of our patients suffer from what they perceive to be bias against them when they come in for crisis. Please take the time to listen to them and to get to know them because once you can establish that trust, we can really improve the lives of our patients with sickle cell. Second, sickle cell disease-modifying therapies are needed. We can no longer think that sickle cell pain is simply, “Am I in a painful event, or am I not in a painful event?” Please understand the importance that the organ complications over time are the life-limiting complications of sickle cell. Getting patients to accept sickle cell disease-modifying therapies from an early stage of life is vital.

Third, understand the impact of sickle cell on quality of life. Please pay attention to schoolwork, how sickle cell affects their relationships, how it can affect them holding a job, and view our patients in the whole because sickle cell impacts every aspect of their lives. In several cases, we’re the only providers they have to turn to for addressing this multi-socioeconomic impact of sickle cell. Please look out for the entire patient, not just the sickle cell pain event.

 It’s important that we take a life span perspective when we treat people with sickle cell disease. Many of the complications that we see in adulthood start in pediatrics, but don’t necessarily cause problems for children. But that doesn’t mean that they aren’t important. I’ll take the kidney as an example. We start seeing a lot of microscopic proteinuria, the microalbuminuria in children with sickle cell disease as adolescents. It can be almost a third of adolescents who have sickle cell anemia who develop microalbuminuria, but they don’t have renal insufficiency as children. Many of them still have hyperfiltration, where their creatinine levels are lower than normal. As those patients move into their 20s and 30s, we see the development of chronic renal disease, and with that, worsening anemia and disease progression in other ways. It’s important that we intervene when people with sickle cell disease are children because that’s where these end-organ complications start.

Sophie M. Lanzkron, MD, MHS; Jeffrey D. Lebensburger; and John J. Strouse, MD, PhD, share key takeaways and closing thoughts for the management of sickle cell disease.

Advice for Sickle Cell Disease Management

Sophie M. Lanzkron, MD, MHS

The Psychological Impacts of Myopia Diagnosis and Treatment, with Thuy-Lan Nguyen, OD

2025 American Optometric Association Conference

 in Minneapolis, MN, Thuy-Lan Nguyen, OD, assistant professor at Nova Southeastern University, presented her lecture on the psychological impacts of 

Myopia has long been a central focus of a significant amount of research. However, there is little in the literature discussing its psychological impact on both patients and their families. Previous studies have investigated the mental health of parents of children with myopia, finding a direct correlation between the diagnosis and increased anxiety and depressive symptoms.

Additionally, studies investigating the psychological impact on adolescents diagnosed with myopia have indicated a high prevalence of anxiety and various mood disorders compared to those without myopia. One particular study, conducted in Israel, found a nearly twofold increase in odds of anxiety as a result of the diagnosis.

Nguyen discussed the limited awareness that the psychological side of myopia treatment receives in the optometry field. She commented on the communication strategies that she recommends for helping children and families understand and commit to long-term therapy.

“A lot of parents, even if they accept the idea that their child might need to wear glasses, may not be aware of the new research and the new technology that we have that can help to slow the changes or the progression of myopia,” Nguyen told 

. “It’s mostly a conversation with parents to get them to understand there are things that we can do, that times have changed.”

Nguyen also pointed out the potentially prohibitive barrier of cost, noting that many approach myopia control as a one-time investment in a pair of glasses rather than a significant commitment to long-term therapy.

“We can easily write that prescription and your child can go ahead and get glasses, keep it simple,” Nguyen said. “But the long term consequences of not doing something may be greater than the initial investment, and it’s really just a matter of educating patients, having the empathy to understand it’s a lot for them to process, both mentally and emotionally, but also financially.”

Nguyen also discussed potential future treatments, from spectacles and contacts to actual medications and surgeries.

“A lot of the research comes from overseas and eventually we’ll have it here in the states, treatments other than just glasses, contacts, and medications,” Nguyen said. “Red light therapy is being studied overseas, as well as other noninvasive surgeries that can help to slow the progression of myopia. There’s a lot of potential out there – only time will tell.”

Ultimately, Nguyen encouraged clinicians to consider the stresses and psychological burdens that children and families may experience after a myopia diagnosis. She suggested that, while simple prescriptions can be effective, clinicians should keep in mind that treatment must often be tailored to the patient.

“We can all write the prescriptions – we do it every day and we do it multiple times a day,” Nguyen said. “Just know that kids are stressed, and sometimes being told that they are nearsighted can certainly add to that stress, and we should be aware of that and understand that. Sometimes you have to cater your treatment to the individual. Not every myope is the same.”

1: Nguyen T. The Psychology and Science of Myopia Control. Presented at the 2025 American Optometric Association Conference in Minneapolis, MN, June 25-28, 2025.

2: Guo LY, Sun H, Hu M, Jiang YH, Luo ZH. Mental health status of parents of young patients with high myopia. J Int Med Res. 2020;48(1):300060519873474. doi:10.1177/0300060519873474

3: Nitzan I, Shmueli O, Safir M. Association of myopia with anxiety and mood disorders in adolescents. Eye. 2024;38(15):3016-3018. doi:10.1038/s41433-024-03170-6

Nguyen spoke to the importance of being aware of heightened stress, anxiety, and depression due to myopia’s long-term treatment requirements.

Authors