Adam Sturts, DO, is an internal medicine resident at Penn State Hershey Medical Center with an interest in cardiovascular health and endocrinology. Sturts is a graduate of the Rowan University School of Osteopathic Medicine and a type 1 diabetic.

Adam Sturts, DO

Anita Radhakrishnan, MD, is an advanced cardiac imaging specialist with AHN Cardiovascular Institute.

Community Echocardiogram Program Reveals Cardiac Risks, with Anita Radhakrishnan, MD

A community-based heart screening initiative in Western Pennsylvania is helping uncover significant rates of undiagnosed 

 in underserved groups, particularly African American women. The Every Heart Matters Initiative, backed by community grants, provides free screening echocardiograms to residents in low-income neighborhoods via churches, high-rises, and federally qualified health centers.

Among the first 200 participants, 67% were African American, 72% were women, and the average age was 61. One in four participants had abnormal findings, prompting referral to cardiology. Notably, 16% of African American women screened were found to have pulmonary hypertension (PH)—a rate far exceeding the 1–4% typically reported in the general population.

“Echocardiograms, which are just ultrasounds, are the workhorse of all cardiac testing as an extremely valuable test,” Anita Radhakrishnan, MD, a cardiologist at Allegheny Health Network Cardiovascular Institute, told HCPLive. “A lot of information can be obtained from an echocardiogram, and right now, electrocardiogram (EKGs) and biometric screenings are part of routine screenings accepted by the US Preventive Services Task Force (USPSTF), but echocardiograms are not.”

Many participants had symptoms or risk factors but never sought evaluation due to a lack of insurance, language barriers, or competing life priorities. The program was specifically targeted at people with no known SHD who either have symptoms, risk factors, or a long lapse in cardiac follow-up.

The program helped bridge that gap by offering not just testing, but follow-up communication, CD copies of echo images, and help with referrals, regardless of insurance status. All patients with abnormal results received a phone call, a written report, and a CD with imaging files they can share with any provider.

“We give them a full report, and I actually call every abnormal test result patient and explain the test result to them and explain why I feel they need to see a doctor, a cardiologist, and make sure they see their primary care physician,” Radhakrishnan told 

Beyond the clinical impact, the initiative is designed to be sustainable. Fellows perform the echocardiograms as part of their training, and the program is set to continue under the general cardiology fellowship. Radhakrishnan noted her hope that this model can scale nationally through cardiology training programs.

“All of our general fellows perform echoes as part of their training, and I think it’s a great way to get them involved in community work and serve underserved populations, with an opportunity to see how they can help them,” Radhakrishnan told 

. “Almost every city has anywhere from 5 to 10 programs that have trainees and cardiology fellows. I think this is the first, very easy step that we’re showing here in Pittsburgh, they could replicate across the country.”

Radhakrishnan reports no relevant disclosures.

Alnaimat S, Radhakrishnan AU. Every Heart Matters: A Local Initiative of Screening for Valvular Heart Disease in Western Pennsylvania. Presented at: American College of Cardiology (ACC.25) Annual Scientific Session. March 29 – 31, 2025. Chicago, Il.

Anita Radhakrishnan, MD, leads a community screening effort to detect early heart disease in underserved populations in Pittsburgh.

Anita Radhakrishnan, MD

For what it’s worth, I interview a lot of doctors. I’ve done a lot of panels. What struck me about you folks—the folks who deal with diabetics every day, or people with diabetes—I’m informed that diabetics is not the best term.

Not good—so, people with diabetes, people dealing with this disease. What I noticed is that you listen. Every 1 of you talks about listening to people. Doctors are bad at that, as a group, but not you. Did you select this because you like listening, or did you learn to listen because that’s what you do? I don’t know. It was just an observation. Call it a hunch. Look, we have come to the end of this discussion, but I don’t want to leave without giving each of you an opportunity to say something that you feel we may have omitted or something that you want to leave our audience with. Why don’t we go around, and each of you can take about 30 seconds and give us some final thoughts. Why don’t we start with you, Elaine?

 I’m just thinking back on the patients that I saw today. One of the biggest challenges of diabetes, and dealing with highs or lows, is that you could do everything perfectly Monday to Monday. With other things like saving money, or training for a marathon, you have something to build on. Maybe on the eighth day you can take a day off. That’s not the case with diabetes. You’ve got to start all over again that eighth day and do it all over again, and it may be the worst day of the eight. It’s such a marathon to run, and you don’t have an end line, or point, to look forward to. As a provider, you have to place yourself in that reality. You have to see through the patient’s eyes every day, and if you don’t do that, then you won’t understand their struggles and you miss the boat. That’s what I strive to do every day for them.

Wow, that was well said. Thank you. We really need to understand that, as Elaine has said, diabetes never gives the patient a break; it’s 24-7. Hypoglycemia is incredibly scary and really does limit so much of what the patient can and can’t do if we aren’t careful with educating our patients, assisting with quality of life, and making sure patients have a good understanding of their medications. We need to provide good education on prevention and treatment, and the use of continuous glucose monitoring [CGM] to try and help patients prevent hypoglycemia. We all need to take it seriously and make sure that we ask the right questions every time we touch the patient, so that hopefully we can have a better outcome for them.

I’m going to say something completely different, but I agree with what Elaine and Davida said. I want a system in which the pharmacist tells the patient and me every 2 years when their glucagon is going to expire, so I know to write a new prescription. Because what makes me crazy is when I’ve forgotten and the patient has forgotten to ask, and then they have a bad low and they don’t have their glucagon. Why can’t the pharmacists do this? I get bugged all the time about everything. Why can’t the pharmacist just say, “Patient X needs a prescription for glucagon”? That’s no skin off my back. They should probably just do it without a prescription. Why does this even have to require a prescription? That’s another issue. We need a system so patients and providers are reminded to do the refills. I don’t know why it doesn’t exist, so we need to create that solution.

Could that be built into the EMR [electronic medical record]?

When you click the prescription, it should pop up in 2 years.

 It should just say, “This is due.” Why not?

Jay Shubrook, DO, FACOFP, FAAFP, BC-ADM: 

Hypoglycemia is certainly something that’s very important to our patients, and most providers underestimate the frequency of it. Please ask your patient and the family at every visit about hypoglycemia. There’s no better time than today because we have plenty of tools to identify hypoglycemia, such as CGM, or continuous glucose sensors. We have ways that we can help patients have less hypoglycemia—particularly patients with type 2 diabetes—with novel therapies, and we have very effective treatments that can abort a hypoglycemic episode. Making sure you use the right treatment at the right time really is going to empower your patients not to be paralyzed by hypoglycemia but to be an informed and active crusader to prevent it and treat it earlier.

I want to thank all of you for being with us. This has been eye-opening for me because I don’t treat diabetes on a daily basis. I always thought, “It’s about sugar, for sure; usually it’s about hyperglycemia.” This hypoglycemic problem is real, significant, and tricky. These new therapies that I’ve learned about from you are strikingly interesting. Thank you all for being here.

I want to thank all of you at home for watching this 

. If you enjoyed the content, I want you to subscribe to our e-newsletter to receive upcoming Peer Exchanges and other great content right in your in-box.

Thought leaders in diabetes provide closing remarks about the importance of continuous awareness of glycemic control in patients as well as the need for effective communication between patients and providers. 

Final Thoughts: Awareness and Communication in Diabetes 

Elaine Apperson, MD, University of South Carolina School of Medicine  

Thoughts on the Current State of PBC Management

Video content above is prompted by the following:

Please share your concluding thoughts about management of PBC.

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by the progressive destruction of small and medium-sized bile ducts within the liver. This destruction is primarily mediated by autoreactive T lymphocytes targeting the epithelial cells of the bile ducts. The ensuing cholestasis leads to the accumulation of toxic bile acids, causing hepatocellular damage and inflammation. Over time, this chronic inflammatory process results in fibrosis and eventually cirrhosis. The pathophysiology of PBC is influenced by genetic predispositions and environmental factors, contributing to its complex etiology and progression.

The panel of experts offers expert insights and concluding thoughts on the management of primary biliary cholangitis (PBC), emphasizing the importance of personalized treatment strategies, monitoring, and the evolving role of new therapies in improving patient outcomes.

Ira Jacobson, MD

Key Takeaways for Improving CKD Diagnosis and Treatment in Patients With Type 2 Diabetes

In closing, what are the key takeaways for improving CKD diagnosis and treatment in patients with type 2 diabetes?

Now that we have many options in CKD, how should we think about sequencing these products in different patient types, for instance, to address CV and renal risk, in patients with earlier, less advanced disease as well those with later, advanced stages?

Chronic kidney disease (CKD) in Type 2 Diabetes patients necessitates early detection to prevent progression and associated complications. Identifying at-risk patients involves considering factors such as hypertension, family history of kidney disease, and elevated blood glucose levels. Screening tests include estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Early detection is crucial as it allows timely intervention, potentially slowing disease progression and reducing cardiovascular risks. CKD is a significant risk factor for heart failure, making early detection vital for comprehensive cardiovascular risk management.

Panelists discuss the key takeaways for improving chronic kidney disease (CKD) diagnosis and treatment in patients with type 2 diabetes, emphasizing how to effectively sequence treatment options based on patient types to address cardiovascular and renal risks in both early and advanced stages of the disease.

Mark A. Meeker, DO, FACP, CPE 

Scientific Affairs, Innovation, and New Technology

Parvez Mantry, MD, discusses the burden of HCV and challenges to diagnosis and therapy. He also explores general awareness regarding HCV and opportunities for screening.

HCV: A Population Health Perspective

Parvez Mantry, MD

Assistant Director of Interventional Psychiatry

Ryan J. Wakim, MD, DFAPA, explores the causes and diagnostic criteria for treatment resistant depression. He also discusses the importance of comprehensive assessment and personalized approaches to care.

The Burden of Treatment Resistant Depression

Paul Ruberg, PA-C

A panel of ophthalmologists discuss how retinal disease management has evolved in the past decade and continues to change.

Generational Trends and Innovations in Retinal Disease Care

1:00 Evolving trends
5:50 Key Advances
8:20 Targeting Ang/Tie pathway
13:12 Role of steroids
15:00 Biosimilars
18:44 Therapies in the pipeline

A panel of ophthalmologists discuss how retinal disease management has evolved in the past decade and continues to change with advancements in diagnostics and therapies.

Generational Trends and Innovations in Retinal Disease Treatment

Peter Kaiser, MD

One of the issues has been that there does appear to be a therapeutic ceiling with all our agents. We’re seeing about 40% to 60% clinical remissions along those lines, depending on where these drugs are positioned. Both of us have been very aggressive about trying to get these drugs earlier in the course to prevent complications. If you look in the clinical trials with ustekinumab or vedolizumab, the average duration of Crohn disease is 10 years. Patients with 10 years of disease are already developing the problems that we’re trying to prevent. One of the things that I would like to focus on in the future is earlier intervention with these highly effective therapies that we’ve been discussing. What other unmet needs do you see in the pediatric and adult populations for IBD [inflammatory bowel disease]?

 I also have a very keen interest in preconception and fertility in the management of women’s reproductive health, which does tie in to everything we’re talking about. The message to all our female patients is that it’s all about safety and being able to have your disease under control. It is paramount that having anti-inflammatories onboard is what is most important. We know the risk benefit profiles associated with therapies and how to use these therapies in pregnancy, particularly the biologics. We need to be focused on teaching the right thing to our physician partners and patients, that it’s all about controlled inflammation. 

Chronic pelvic inflammation can never end well. That is something I’m vocal about within my preconception clinic, and I counsel women appropriately. But it does have to do with some of these small molecules. We’ll add a layer of complexity when we are looking at bringing these therapies to the clinic. With some therapies, such as the small molecules, we don’t have a lot of real-world experience on the impact in the first trimester because they cross the placenta. That is the question that we need to get more data on. For example, with ozanimod, it will be in the label to stop 3 months before conception. With JAKs you need to stop it. It does add a layer of complexity—we’ve become ob-gyns in terms of figuring out how to use these therapies. An unmet need is also understanding the safety of these therapies in women of reproductive age.

 Did that also apply to pediatric patients? Are there other unmet needs besides improving the efficacy and maintaining a good safety profile in kids?

Marla Dubinsky, MD: It’s a similar concept once you get beyond the VEO [very early onset] IBD. We have the same principles. Similar to what you talked about, whether those extraintestinal manifestations were activity linked or not, the same applies to growth. For all our therapies, just because you heal the intestine, does not equate to growth improvement. We don’t know. We need more data. Does gut-specific therapy have the same impact as systemic therapies? These are things that we need to see from our clinical trials.

There are a couple of unmet needs that you made me think about. I do believe, as I noted before, the future is combination therapy. It could be diet plus biologic. It could be small molecule plus biologic. It could be fecal restorative therapy. It doesn’t matter. The concept of combination means that 1 therapy alone is not going to be the answer. I was addressing your plateau. This is the way I’m thinking about it. Also, sequence will be a hugely important topic to address, meaning understanding the sequence over the long lifetime of a patient who has an evolving immune system based on the therapies we’re using.

I have to plug something that both you and I believe strongly. The plateau may also be the fact that we are not addressing the emotional or behavioral well-being of our patients in clinical trials or the real world, so we can understand how social determinants of behavior, mental health, and comorbidities impact outcomes. We may see a different percentage of remission at week 52. That is an important unmet need that we need to focus on.

I want to amplify your recognition of the social determinants. Certainly in 2021, we’ve seen social determinants of COVID-19 infections and increasingly recognize the disparities of health care in treating chronic illnesses such as ulcerative colitis, Crohn disease, inflammatory bowel disease. We really need to address these disparities and try to improve, whether it’s with psychology, social workers, diet, and education. All these combinations—as your group and our group have shown—really impact patients. They keep them out of the emergency department. Keep them out of the hospital. We need our systems to help us address these disparities. As practitioners, it’s challenging for us and our staff to address this full spectrum of the patients’ needs, from diet to psychological or behavioral support. Economically, 1 of the biggest issues we all have is access to these highly effective therapies. We’re dealing with different insurance programs that may not allow us to use these drugs in the most effective manner that we think we could.

Thank you for watching this HCPLive® Peers & Perspectives®. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peers & Perspectives® and other great content right in your in-box. Thank you.

Current treatment limitations in inflammatory bowel disease and the rationale for earlier initiation and use of newer therapies to manage pediatric and adult patients.

Addressing Current Treatment Gaps in Pediatric and Adult IBD 

Stephen B. Hanauer, MD, Northwestern University Feinberg School of Medicine

 Does anything else catch your eyes, Ed or Jessica?

 I’m most excited for, at the current moment, the selective JAKs to be coming down the line, especially for Crohn disease. That’s really what I have my eye on, in addition to, as Bill just mentioned, the IL-23 inhibitors. Those are the things that are coming the soonest, and I’m excited to have more hopefully safe and efficacious options when treating Crohn disease. Those are what I have my eye on, in addition to, of course, my personal biases: the microbiome therapeutics, of which there are several under investigation. We did see some intriguing initial data from Seres Therapeutics in 1 of their agents in the treatment of ulcerative colitis, although these are still very early days. We also know there are several companies working on FMT [fecal microbiota transplantation]–like products, but really more selective microbiome therapeutics. I’m very excited for those. The positioning of microbiome therapeutics earlier or in combination with other advanced therapies is really exciting.

 Ed, do you have any final words on therapies?

 Some of the etrolizumab UC [ulcerative colitis] results were clearly mixed and somewhat disappointing, but don’t forget, we still have a Crohn [disease] trial out there. At some point, we’re going to have some anti-integrin data, and more on Crohn, so there may be something. There are a few other molecules in that realm, so who knows what will happen?

 In that same vein, there’s an orally systemically bioavailable alpha(4) beta(7) [LPAM] inhibitor that’s a small molecule. Think of it as oral vatelizumab. That’s in phase 1 testing. Then there’s another that’s a short peptide that gets down into the more distal gut, and you can think of it as inside out instead of outside in. We always knew that vatelizumab didn’t work solely the way it was proposed because, at doses and drug concentrations that are one-tenth of what’s required for clinical efficacy, you can completely saturate the alpha(4) beta(7) receptors on the appropriate lymphocytes in the periphery. If the entire mechanism of action of vatelizumab is blocking lymphocyte trafficking from the periphery to the gut, then that should be sufficient for efficacy, and it’s not. It makes you think that there’s some other mechanism beyond that, possibly with an antibody in the tissue affecting cell-cell interactions of cells that have already trafficked. With this inside-out peptide, you can see efficacy, and they saw it in a pilot study in the clinic, as well as in animal models, at concentrations where you got some into the blood but only to the point that it was 60% saturating the receptor in the periphery. You wouldn’t expect that to work, yet it did. Anyway, I’m with that. We’re going to see an evolution in anti-integrins and maybe oral therapies. Wouldn’t that be cool?

 That’s a lot to unpack and look forward to. With that, I want to thank everyone for the rich and informative discussion. Before we conclude, I’d like to get some final thoughts from each of you about what you’d like to say to our clinical colleagues. What should they be striving for in treatment and looking for the future? Jessica, why don’t we start with you?

 As we’re evolving in this space, it can potentially feel a bit overwhelming. There are almost too many potential choices coming down the line, so what I would tell my colleagues is to assess your patients. Look for prognostic factors to help you make those treatment decisions, pick targets that you’re going to follow, and do that systematically with your patients every time. It’s going to be different for every patient, but really that’s a way to keep things straight and organized. Stay attuned to the data and all these exciting developments coming down the pipeline. Remember, you can always lean on some of your colleagues at IBD [irritable bowel disease] centers if you’re unsure about therapies or want assistance. For example, I’m always happy to have discussions with my colleagues about which agent we should be choosing, why, or if they’re uncomfortable with potential therapeutic options, because until you have a lot of hands-on experience with some of these drugs, it takes a bit to get comfortable with them. That would be some of my advice to anybody out there treating IBD, but it’s starting to feel a bit overwhelming by all these new advances coming down.

 I’m going to a total side thing. We’re seeing patients with complicated diseases. One of our jobs is to stay rational but also project confidence and hope. Sometimes, we see these patients who have lost hope. Usually, for almost every patient, there’s something you can do to improve their quality of life. Just keep that in mind.

 We’re at the end of the beginning of the revolution of IBD therapy. Buckle up—a lot of new stuff will come, but we have an amazing repertoire of therapies that we can use today. Be students of the field and the craft, and learn to use those therapies and, as Ed said, improve the lives of your patients.

 I always say to the fellows here [Cumming School of Medicine at the University of Calgary], “We need to demand more.” We need to demand more of ourselves to help the patients, demand more of science to push things forward to improve the lives of the patients and to pay attention to those little things that we’ve all talked about tonight. Ed summed it up nicely, that even if you’re on your fourth biologic or advanced therapy, there’s something you can do for that patient that will make tomorrow better for them. Always look at what you can do for that individual patient. With that, to all of you, this was just fantastic stuff. I hope the audience enjoyed it.

 If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming 

 and other great content right in your in-box. I’m sure you’ll see the folks in front of you on future programs. Thank you very much.

Jessica Allegretti, MD, MPH, and Edward Loftus Jr., MD, review emerging agents in the later phases for the management of IBD.

Authors