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Clinical Issues in Type 2 Diabetes Consensus and Controversies Around Intensifying Noninsulin Therapy

John E. Anderson, MD; Alan J. Garber, MD, PhD, FACE; Julio Rosenstock, MD

 

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

This activity is supported by an educational grant from AstraZeneca

Faculty

John E. Anderson, MD
Internist
Past President, The Frist Clinic
Nashville, Tennessee

Alan J. Garber, MD, PhD, FACE
Professor
Medicine, Biochemistry, and Molecular and Cellular Biology
Diabetes, Endocrinology and Metabolismw
Baylor College of Medicine
Houston, Texas

Julio Rosenstock, MD
Director, Dallas Diabetes and Endocrine Center
Clinical Professor of Medicine
University of Texas Southwestern Medical Center
Dallas, Texas

Target Audience

The educational design of this activity addresses the needs of endocrinologists, internists, and other practitioners involved in the diagnosis and treatment of type 2 diabetes mellitus (T2DM).

Statement of Need/Program Overview

Over the last decade, increased understanding of the pathophysiology of type 2 diabetes mellitus (T2DM) has aided the development of new and expanding classes of antihyperglycemic medications.1,2 For example, particularly promising results have been observed with agonists of glucagon-like peptide-1 (GLP-1) receptors, and inhibitors of either dipeptidyl peptidase 4 (DPP4) or sodium-glucose cotransporter 2 (SGLT2).3-6 The threshold challenge for clinicians who manage individuals with T2DM is how to best combine these agents in multimodal treatment regimens to address patients’ numerous medical, psychosocial, and educational needs. Indeed, achieving patient-centered targets for blood glucose and other clinical parameters with appropriately aggressive therapy is critical to optimize T2DM outcomes.1,7 National society guidelines stress the need for individualized care and proactive clinician and patient engagement to overcome clinical inertia, while balancing intensification of therapy against treatment-related risks, especially hypoglycemia.1,7,8 Yet debate around the practical implications of large-scale studies confound day-to-day decision-making by endocrinologists and other diabetes-focused clinicians, elevating the importance of clinical experience in managing diverse patient populations. Further complicating these issues, the evidence base is constantly evolving, and the volume of published information about T2DM can obscure the most clinically relevant data for health care practitioners. This Clinical Issues™ program will provide particpants with expert interpretations of recent clinically relevant trial data and actionable recommendations around the use of combinations of noninsulin antihyperglycemic agents in the management of T2DM.

References

  1. American Diabetes Association. Standards of medical care in diabetes--2016. Diabetes Care. 2015;39(suppl 1):S1-S112.
  2. 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.
  3. Mogensen UM, et al. Cardiovascular safety of combination therapies with incretin-based drugs and metformin compared with a combination of metformin and sulphonylurea in type 2 diabetes mellitus—a retrospective nationwide study. Diabetes Obes Metab. 2014;16(10):1001-1008.
  4. 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.
  5. Wu JH, et al. Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular events, death, and major safety outcomes in adults with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2016 [Epub ahead of print].
  6. Liu XY, et al. Efficacy and safety of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes: a meta-analysis of randomized controlled trials for 1 to 2 years. J Diabetes Complications. 2015;29(8):1295-1303.
  7. 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—2016 Executive Summary. Endocr Pract. 2016;22(1):84-113.
  8. Seaquist ER, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. J Clin Endocrinol Metab. 2013;98(5):1845-1859.

Educational Objectives

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

  • Identify patient-specific treatment goals in T2DM that reflect disease severity, comorbidities, therapeutic risks, and psychosocial status
  • Discuss the profiles, evidence for clinical benefits, and associated warnings for noninsulin antihyperglycemic medications
  • Intensify multidrug noninsulin regimens for various patient types to optimize glycemic control and improve other clinical parameters
  • Utilize motivational interviewing techniques to engage patients in their antidiabetes management plans, facilitate lifestyle changes, and improve 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. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. 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
inquire@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

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 E. Anderson, MD Consultant – Abbott Diabetes Care, Inc., AstraZeneca plc, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., sanofi-aventis U.S. LLC.Honoraria – Abbott Diabetes Care, Inc., AstraZeneca plc, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., sanofi-aventis U.S. LLC. Speakers Bureaus – Abbott Diabetes Care, Inc., AstraZeneca plc, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., sanofi-aventis U.S. LLC.

Alan J. Garber, MD, PhD Consultant – Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S

Julio Rosenstock, MD Consultant –AstraZeneca plc, Boehringer Ingelheim GmbH, Daiichi Sankyo Company, Limited, GlaxoSmithKline, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., F. Hoffmann-La Roche Ltd, sanofi-aventis U.S. LLC.,Takeda Pharmaceutical Company LimitedGrant/Research Support – AstraZeneca plc, Boehringer Ingelheim GmbH, Bristol-Myers Squibb, Daiichi Sankyo Company, Limited, Eli Lilly and Company, GlaxoSmithKline, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., F. Hoffmann-La Roche Ltd, sanofi-aventis U.S. LLC., Takeda Pharmaceutical Company LimitedHonoraria – AstraZeneca plc, Boehringer Ingelheim GmbH, Daiichi Sankyo Company, Limited, GlaxoSmithKline, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., F. Hoffmann-La Roche Ltd, sanofi-aventis U.S. LLC., Takeda Pharmaceutical Company Limited.

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:

Amanda Glazar, PhD      Nothing to disclose
Andrea Funk      Nothing to disclose
Laura Gilsdorf      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 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 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, possible contraindications, dangers of use, review of applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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expiration 01/30/2018

type Webcast