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Donna Pacheco

GLP‑1s and Racial/Ethnic Disparities: How Response and Access May Vary

Diverse patients and clinician reviewing glucose meter and GLP-1 injection therapy in a diabetes care setting

GLP-1 receptor agonists have transformed type 2 diabetes care, improving glycemic control, supporting weight loss, and reducing cardiovascular risk. However, disparities in GLP-1 use and access are becoming harder to ignore. Why do some patients gain access quickly while others face barriers at every step? Data suggest that prescribing patterns …

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GLP-1s and Reproductive Health: What to Know About Fertility, Pregnancy, and PCOS

Female physician reviewing chart with GLP-1 injection pen in foreground and silhouette of pregnant woman, representing GLP-1 reproductive health and pregnancy considerations

GLP-1 receptor agonists are transforming diabetes and obesity care. However, as more women of reproductive age use medications like semaglutide, liraglutide, and tirzepatide, questions about how GLP-1 therapies affect fertility and pregnancy are becoming increasingly common. Can patients conceive safely while taking these agents? Do they improve ovulation in women …

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Managing GLP-1 GI Side Effects Before Stopping Therapy

Physician discussing GLP-1 GI side effects and nausea management with a patient during a diabetes consultation

GLP-1 receptor agonists have transformed type 2 diabetes care. Yet for many patients, gastrointestinal side effects from GLP-1 therapy, such as nausea, vomiting, and constipation, can threaten long-term adherence. Have you ever had a patient achieve an impressive A1C reduction but consider stopping therapy because of persistent nausea? You are …

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Off-Ramp Planning for GLP-1s: When and How to Taper Without Losing Progress

Physician reviewing a gradual medication dose reduction chart with a patient during a consultation about GLP-1 tapering and metabolic health goals.

As more patients succeed on GLP-1 therapy, conversations about tapering these medications are becoming increasingly common in metabolic care. When patients reach meaningful goals in weight reduction, A1C improvement, or cardiometabolic risk, clinicians naturally begin asking what comes next. Is it safe to stop treatment? More importantly, can progress be …

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GLP-1s and Food Noise: Helping Patients Understand Hunger, Cravings, and Control

Woman calmly eating a healthy meal while unhealthy foods fade around her, illustrating reduced GLP-1 food noise and improved appetite control.

Patients taking GLP-1 receptor agonists often describe a surprising change: the “volume” of food thoughts seems to turn down. This experience, often described as a reduction in food noise with GLP-1 therapy, reflects measurable neuroendocrine shifts in appetite regulation and reward signaling. For clinicians, understanding and explaining this phenomenon is …

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GLP-1s in Young Adults: Rethinking Metabolic Risk and Early Intervention

Young adults consulting with a physician about GLP-1 therapy for obesity and early metabolic risk management

For years, GLP-1 receptor agonists have been associated with older adults who already have type 2 diabetes or established cardiovascular disease. However, metabolic dysfunction does not suddenly appear at age 60. In fact, obesity, insulin resistance, and prediabetes often begin decades earlier. That is why conversations around GLP-1 therapy in …

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Social Determinants First: Using CKM and SDOH to Sequence Diabetes Therapies in 2026

Clinician reviewing cardiovascular, kidney, and metabolic risk with social determinants to guide diabetes therapy decisions

A patient’s A1C can look acceptable on paper while everything else is quietly heading in the wrong direction. Cardiovascular risk is rising, kidney function is slipping, and the patient keeps missing follow-up visits because of cost, transportation, or work constraints. Most clinicians have seen this scenario play out, even when …

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Diabetes Care in the GLP-1 Era: Re-Designing Visits When One Drug Does So Much

Doctor reviewing diabetes metrics with patient during a GLP-1 era clinic visit using digital health tools

GLP-1 receptor agonists have changed diabetes care faster than almost any therapy in recent history. In many ways, one medication now touches glucose control, weight loss, cardiovascular risk, and even liver health. However, while outcomes have evolved, the typical clinic visit has stayed the same. As a result, clinicians often …

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GLP-1s and Serious Mental Illness: Tackling Antipsychotic-Associated Weight Gain

GLP-1 injection pen and metabolic monitoring tools illustrating treatment for antipsychotic-related weight gain

For many patients, antipsychotic medications are life-changing, even life-saving. Yet the same treatments that stabilize mood and thought can quietly drive weight gain, insulin resistance, and rising cardiometabolic risk. Over time, this unintended consequence places patients with serious mental illness at a much higher risk for obesity, type 2 diabetes, …

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