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Clinical Updates in Type 2 Diabetes An Evolving Role for Combinations of Injectable Antihyperglycemic Therapies

John L. Leahy, MD; Javier Morales, MD, FACP, FACE

 

This activity is jointly provided by Global Education Group and Integritas Communications.

 

This activity is supported by an educational grant from Novo Nordisk Inc.

Faculty

John L. Leahy, MD
Professor, Department of Medicine
Co-Director, Division of Endocrinology, Diabetes and Metabolism
University of Vermont Larner College of Medicine
Colchester, Vermont

Javier Morales, MD, FACP, FACE
Associate Clinical Professor of Medicine
Donald and Barbara Zucker School of Medicine at Hofstra Northwell
Hempstead, New York
Vice President
Advanced Internal Medicine Group, PC
East Hills, New York

Target Audience

The educational design of this activity addresses the needs of primary care providers and other clinicians involved in the ongoing management of patients with type 2 diabetes mellitus (T2DM).

Statement of Need/Program Overview

Despite recent signs of success in slowing the United States’ epidemic of type 2 diabetes mellitus (T2DM), many patients are not consistently meeting recommended targets for blood glucose levels.1,2 Poorly controlled T2DM continues to place tremendous burdens on affected individuals, their families, and health care systems.3-5 Over the two last decades, a better pathophysiologic understanding of the disease has spurred the development of new and expanding classes of antihyperglycemic medications.6-8 These include new long-acting basal insulin analogs with reduced hypoglycemia risks and several pleiotropic agonists of glucagon-like peptide-1 (GLP-1) receptors.9,10 These advances have naturally led to studies evaluating outcomes when T2DM is treated with multidrug regimens comprising agents from both injectable medication classes.11 In fact, two fixed-dose combination formulations are now available in the United States.12-14 With overall goals of improving glycemic control and reducing long-term risks among the diverse patient populations, this multimedia eHealth Source™ activity focuses on the mechanistic rationale, the clinical trial data for efficacy and safety, and the practical considerations for combining basal insulin analogs and GLP-1 receptor agonists to better manage T2DM antihyperglycemic medication classes.

References

  1. Gregg EW. The changing tides of the type 2 diabetes epidemic—smooth sailing or troubled waters ahead? Kelly West Award Lecture 2016. Diabetes Care. 2017;40(10):1289-1297.
  2. Carls G, et al. Achievement of glycated hemoglobin goals in the US remains unchanged through 2014. Diabetes Ther. 2017;8(4):863-873.
  3. Liu J, et al. The burden of severe hypoglycemia in type 2 diabetes. Curr Med Res Opin. 2017:1-19.
  4. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008;26(2):77-82.
  5. Chawla A, et al. Microvascular and macrovascular complications in diabetes mellitus: distinct or continuum? Indian J Endocrinol Metab. 2016;20(4):546-551.
  6. American Diabetes Association. Standards of Medical Care in Diabetes—2017. Diabetes Care. 2017;40(suppl 1):S1-S135.
  7. Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795.
  8. Garber AJ, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm—2017 Executive Summary. Endocr Pract. 2017;23(2):207-238.
  9. Ratner RE, et al. Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase 3 trials. Diabetes Obes Metab. 2013;15(2):175-184.
  10. Trujillo JM, et al. GLP-1 receptor agonists: a review of head-to-head clinical studies. Ther Adv Endocrinol Metab. 2015;6(1):19-28.
  11. Eng C, et al. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384(9961):2228-2234.
  12. Valentine V, et al. Rationale for, initiation and titration of the basal insulin/GLP-1RA fixed-ratio combination products, IDegLira and IGlarLixi, for the management of type 2 diabetes. Diabetes Ther. 2017;8(4):739-752.
  13. Linjawi S, et al. The efficacy of IDegLira (Insulin Degludec/Liraglutide Combination) in adults with type 2 diabetes inadequately controlled with a GLP-1 receptor agonist and oral therapy: DUAL III randomized clinical trial. Diabetes Ther. 2017;8(1):101-114.
  14. Rosenstock J, et al. Benefits of LixiLan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus insulin glargine and lixisenatide monocomponents in type 2 diabetes inadequately controlled on oral agents: The LixiLan-O randomized trial. Diabetes Care. 2016;39(11):2026-2035.

Educational Objectives

After completing this activity, the participant will be better able to: 

  • Describe the clinical rationale for combining insulin and incretin-based agents in the treatment of patients with T2DM
  • Discuss the clinical profiles and prescribing considerations for combinations of injectable antihyperglycemic agents in the management of T2DM
  • Intensify antihyperglycemic regimens with injectable combination medications based on progress toward individualized glycemic targets, risks of hypoglycemia, and other patient-specific parameters
  • Educate patients with T2DM to motivate lifestyle modifications, reduce hypoglycemia risks, and enhance treatment adherence

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation

Global Education Group designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 70% or better on the posttest and complete the program evaluation

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.

*Required to view printable (PDF) version of the lesson.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: 

John L. Leahy, MD Honoraria: Merck & Co., Inc.; sanofi-aventis U.S. LLC.; Novo Nordisk Inc.; Janssen Pharmaceuticals, Inc. 

Javier Morales, MD, FACP, FACE Consultant/Independent Contractor: Novo Nordisk Inc.; Eli Lilly and Company; Janssen Pharmaceuticals, Inc.; Abbott Laboratories; Honoraria: Novo Nordisk Inc.; Eli Lilly and Company; Abbott Laboratories; Speakers Bureau: Novo Nordisk Inc.; Eli Lilly and Company; Janssen Pharmaceuticals, Inc.; Abbott Laboratories.

The following planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Ashley Marostica, RN, MSN  Nothing to disclose
Andrea Funk  Nothing to disclose
Jim Kappler, PhD  Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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credit amount 1.50

credit type CME

release 10/25/2017

expiration 10/25/2018

type eHealthSource