Assimilating the Evidence in T2DM

Faculty

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

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

Marc S. Sabatine, MD, MPH
Chairman, TIMI Study Group
Director, Brigham Research Institute
Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine
Brigham and Women's Hospital
Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Kumar Sharma, MD
Chief, Division of Nephrology
Vice Chair for Research, Department of Medicine
Medical Arts & Research Center – MARC
UT Health San Antonio
San Antonio, Texas

Target Audience

The educational design of this activity addresses the needs of endocrinologists and other diabetes specialists.

Statement of Need

Diabetes disorders afflict more than 34 million Americans, while another 88 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. The American Diabetes Association and American Association of Clinical Endocrinologists recommend assessing patients for CVD, HF, or CKD comorbidities independent of their glycated hemoglobin (HbA1c) and incorporating sodium-glucose cotransporter-2 (SGLT2) inhibitors (and other antihyperglycemic classes, such as glucagon-like peptide-1 receptor agonists), into treatment regimens for T2DM in patients with these comorbidities.^3,4 Specific CKD and HF trials have increased support for the expanded role of SGLT2 inhibitors beyond T2DM, requiring further education on their appropriate use and prescribing considerations.^5,6 The established relationships among T2DM, CVD, HF, and CKD necessitate individualized treatment to avoid or mitigate hyperglycemia and these common comorbidities. This Case-in-Point™ activity will address these topics to ensure attendees understand the pathophysiologic link between T2DM and common comorbidities, the role of SGLT2 inhibitors in managing these common comorbidities, and their application in clinical practice.

References

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report. 2020; https://www.cdc.gov/diabetes/data/statistics/statistics-report.html. Accessed March 17, 2020.
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. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2020 executive summary. Endocr Pract. 2020;26(1):107-139.
4. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2020. Diabetes Care. 2020;43(suppl 1):S98-S110.
5. Mahaffey KW, Jardine MJ, Bompoint S, et al. Canagliflozin and cardiovascular and renal outcomes in type 2 diabetes mellitus and chronic kidney disease in primary and secondary cardiovascular prevention groups. Circulation. 2019;140(9):739-750.
6. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995-2008.

Educational Objectives

Upon completion of this activity, participants will be able to:

• Explain the pathophysiologic relationships between T2DM and cardiovascular disease, heart failure, and chronic kidney disease, including implications for treatment
• Compare the designs and results of large-scale renal and cardiovascular outcomes trials with SGLT2 inhibitors for T2DM
• Describe multidimensional efficacy and safety profiles and prescribing considerations for SGLT2 inhibitors in patients with T2DM
• Incorporate common comorbidities (eg, CVD, HF, and CKD) into treatment planning for patients with T2DM

Physician Accreditation Statement

The Postgraduate Institute for Medicine (PIM) designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Integritas Communications. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Disclosure of Conflicts of Interest

PIM requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by PIM 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 activity:

Daniel Einhorn, MD, FACE, FACP: Consulting: AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen Therapeutics, Novo Nordisk A/S; Research Support: AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S, Teva Pharmaceutical Industries Ltd.; Speakers Bureaus: AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen Therapeutics, Novo Nordisk A/S, sanofi-aventis U.S. LLC.

Serge A. Jabbour, MD, FACP, FACE: Consultant/Independent Contractor: AstraZeneca, Eli Lilly and Company, Janssen Pharmaceuticals, Inc.

Marc S. Sabatine, MD, MPH: Consulting: Amgen Inc., Anthos Therapeutics, Inc., AstraZeneca, Bristol-Myers Squibb Company, DalCor Pharmaceuticals, Dr. Reddy’s Laboratories Inc., Intarcia Therapeutics, Inc., Merck & Co., Inc.

Kumar Sharma, MD: Data & Safety Monitoring Boards: Cara Therapeutics, sanofi-aventis U.S. LLC; Research support : Boehringer Ingelheim.

The PIM planners and managers have nothing to disclose. The Integritas Communications planners and managers, Gena Dolson and Jim Kappler, PhD, have 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 US Food and Drug Administration. PIM 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.