Multidimensional Issues in Type 2 Diabetes Debates and Discussions Around Cardiovascular and Renal Outcomes

Daniel Einhorn, MD, FACE, FACP; Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE; Serge Jabbour, MD, FACP, FACE

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

This activity is supported by an independent educational grant from AstraZeneca.


Daniel Einhorn, MD, FACE, FACP
Clinical Professor of Medicine
University of California, San Diego
Medical Director, Scripps Whittier Institute for Diabetes
President, Diabetes and Endocrine Associates
La Jolla, California

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE
Medical Director and Principal Investigator
Metabolic Institute of America
Tarzana California

Serge Jabbour, MD, FACP, FACE
Professor of Medicine
Director, Division of Endocrinology
Diabetes and Metabolic Diseases
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, Pennsylvania

Target Audience

The educational design of this activity addresses the needs of cardiology, endocrinology, and diabetology clinicians involved in the treatment of patients with type 2 diabetes.

Program Overview

Diabetes disorders afflict more than 30 million Americans, while another 84 million adult Americans have prediabetes.1 Multisystem consequences of type 2 diabetes mellitus (T2DM) include cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). The pathophysiologic mechanisms underlying T2DM, CVD, HF, and CKD share common characteristics: metabolic changes, a proinflammatory state, and oxidative stress.2 It is critical for providers to be aware of the heightened risk for poor outcomes in their patients with T2DM. Following several cardiovascular outcomes clinical trials with sodium-glucose cotransporter-2 (SGLT2) inhibitors, the American Diabetes Association recommends incorporating these agents (and other antihyperglycemic classes, such as glucagon-like peptide-1 receptor agonists), into treatment regimens for T2DM, particularly when CVD risks are elevated.The effects of SGLT2 inhibitors on renal glucose reabsorption, along with their ability to lower body weight, cardiac afterload, and blood pressure, translate to a reduction in renal and cardiac adverse events frequently associated with T2DM.4 The established relationships among T2DM, CVD, HF, and CKD necessitate individualized treatment to avoid or mitigate hyperglycemia and these common comorbidities. This Clinical Issues™ program will address these topics to ensure attendees understand normal glucose homeostasis, the role of maladaptive reabsorption in T2DM, and the benefits SGLT2 inhibitors may have on common comorbidities associated with T2DM as well as their application in clinical practice.


  1. Centers for Disease Control and Prevention. National diabetes statistics report. 2017; Accessed November 15, 2018.
  2. Kovacic JC, Castellano JM, Farkouh ME, Fuster V. The relationships between cardiovascular disease and diabetes: focus on pathogenesis. Endocrinol Metab Clin North Am. 2014;43(1):41-57.
  3. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701.
  4. Toth-Manikowski S, Atta MG. Diabetic kidney disease: pathophysiology and therapeutic targets. J Diabetes Res. 2015;2015:697010.

Educational Objectives

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

  1. Describe the reciprocal pathophysiologic relationships between T2DM and CVD, HF, and CKD, including treatment implications
  2. Compare the designs and results of large-scale cardiovascular outcomes trials with SGLT2 inhibitors for T2DM
  3. Discuss the mechanistic profiles, evidence for clinical benefits, and safety concerns associated with SGLT2 inhibitors as treatment options for patients with T2DM
  4. Intensify treatment regimens for patients with T2DM based on glycemic targets, cardiovascular and renal risks, recent guideline recommendations, and other clinical parameters

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 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 designates this enduring activity for a maximum of 1.0 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

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the posttest and program evaluation. Your post-test will automatically be graded. If you successfully complete the posttest (score of 80% or higher), your statement of participation will be made available immediately. Click on the View Statement of Participation link and print the statement for your records. If you receive a score lower than 80%, you will receive a message notifying you that you did not pass the posttest. You will have 2 opportunities to pass the posttest.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global requires instructors, planners, managers and other individuals and their spouse/life partner 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 spouse/life partner have with commercial interests related to the content of this CME activity:

Daniel Einhorn, MD, FACE, FACP

Consultant/Independent Contractor: Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen Therapeutics, Novo Nordisk A/S, sanofi-aventis U.S. LLC;
Grant/Research Support: Mylan N.V., Dexcom, Eli Lilly and Company; Speaker’s Bureau: Abbott, Boehringer Ingelheim, Eli Lilly and Company, Janssen Therapeutics, Novo Nordisk A/S, sanofi-aventis U.S. LLC; Stock Shareholder: Halozyme, Inc.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE 

Consultant/Independent Contractor: Aegerion, Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Gilead Sciences, Inc., Intarcia, Eli Lilly, Janssen Therapeutics, Merck, Merck-Pfizer, Novo-Nordisk, Regeneron, Sanofi, Target; Grant/Research Support: Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Gan & Lee, Hamni, Janssen Therapeutics, Lexicon, Merck, Mylan, Novo Nordisk, Sanofi; Speaker’s Bureau: Aegerion, Amarin, Amgen, AstraZeneca, BI-Lilly, Janssen Therapeutics, Merck, Novo-Nordisk, Sanofi, Regeneron

Serge A. Jabbour, MD, FACP, FACE

Consultant/Independent Contractor: AstraZeneca; Speaker’s Bureau: Janssen Therapeutics

The following planners and managers reported that neither they nor their spouses/life partners have financial relationships or relationships to products or devices with commercial interests related to the content of this CME activity:

Lindsay Borvansky, Andrea Funk, Liddy Knight, Ashley Cann, Gena Dolson, Celeste Collazo, Jim Kappler, PhD

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 and Integritas 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.


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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expiration 05/31/2020