ADA 2026: Key Challenges in Optimizing Cardio-Renal Risk in Diabetes

Pharmacy Times interviews Tracey Taveira, Pharm.D., CDOE, CVDOE, on the key challenges she discovered in optimizing cardio-renal risk in diabetes that she presented in ADA 2026.

Taveira emphasized the value of multidisciplinary, team-based care in optimizing guideline-directed medical therapy for patients with diabetes and multiple cardiovascular risk factors. The presentation centered on a 58-year-old woman with type 2 diabetes, clinical obesity, stage 3A chronic kidney disease, and a recent myocardial infarction. According to Taveira, the complexity of patients with overlapping cardiometabolic conditions requires collaboration among multiple health care professionals, as no single clinician can effectively address every aspect of care. In this case, the cardiologist focused on secondary prevention and cardiac rehabilitation, the endocrinologist managed glycemic control, and the registered dietitian provided lifestyle and behavioral counseling. As a clinical pharmacist practitioner, Taveira’s role was to optimize medication therapy, address therapeutic inertia, improve adherence, and minimize adverse effects.

A major theme of the presentation was the pharmacist’s ability to bridge disciplines and identify opportunities for timely initiation and titration of evidence-based therapies. Taveira noted that obesity was the most challenging risk factor to optimize because it is a chronic, multifactorial disease influenced by biological, psychological, social, and environmental factors. Successful weight management requires a comprehensive approach that considers sleep, stress, nutrition, food access, transportation barriers, and competing life demands. Taveira stressed that obesity should be treated with the same seriousness and compassion as other chronic diseases rather than being reduced to simplistic advice such as “eat less and move more.”

Taveira also discussed a pharmacist-led shared medical appointment model developed to address common barriers to diabetes management. Supported by a Department of Veterans Affairs-funded randomized controlled trial involving more than 250 veterans with type 2 diabetes and cardiovascular risk factors, the intervention combined diabetes self-management education, behavioral support, and pharmacist-led medication optimization in group sessions. Although improvements in A1c, blood pressure, and LDL cholesterol were similar to usual care, participants in the shared medical appointment program experienced lower overall health care expenditures. Taveira concluded that pharmacists practicing within team-based care models can improve quality of care while reducing long-term health care costs.