Weighing Treatment Options in COPD and Diabetes

Target Audience

This program is intended for primary care providers (PCPs) and other clinicians involved in managing patients with chronic obstructive pulmonary disease.

Statement of Need/Program Overview or Program Description

Characterized by pulmonary airflow obstruction that is not completely reversible, COPD is a treatable group of clinical respiratory entities that includes emphysema, chronic bronchitis, and combinations of these disorders.¹ Although COPD is a common disease, it remains undiagnosed or misdiagnosed in millions of Americans^2,3 Type 2 diabetes mellitus (T2DM) frequently occurs alongside COPD and can lengthen a hospital stay for a patient suffering an acute exacerbation of COPD.^4,5 Fortunately, there are multiple options to control T2DM, some of which can also reduce COPD mortality rates, particularly among patients with COPD exacerbations.⁶ Patients with comorbid COPD and T2DM have certain treatment considerations, namely, the detrimental effects of oral corticosteroids on glycemic control.⁷ Clinicians must also be aware of the possible link between high-dose inhaled corticosteroids and risk of new or worsening T2DM, though the benefits typically outweigh the risks._⁸ This Whole Patient activity focusing on COPD and T2DM features a primary care physician and a pulmonologist discussing patient management, including diagnosis, therapeutic escalation, when primary care should refer to specialists, and how to support a multidisciplinary care team.

References

1. GOLD. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: Updated 2021 (http://goldcopd.org). Vancouver, Washington: Global Initiative for Chronic Obstructive Lung Disease (GOLD);2021.
2. Kosacz NM, Punturieri A, Croxton TL, et al. Chronic Obstructive Pulmonary Disease Among Adults—United States, 2011. Atlanta, GA: Office of Surveillance, Epidemiology, and Laboratory Services;2012.
3. Wise RA, Tashkin DP. Preventing chronic obstructive pulmonary disease: what is known and what needs to be done to make a difference to the patient? Am J Med. 2007;120(8 Suppl 1):S14-22.
4. George C, Ducatman AM, Conway BN. Increased risk of respiratory diseases in adults with type 1 and type 2 diabetes. Diabetes Res Clin Pract. 2018;142:46-55./li>
5. Terzano C, Colamesta V, Unim B, et al. Chronic obstructive pulmonary disease (COPD) exacerbation: impact of comorbidities on length and costs during hospitalization. Eur Rev Med Pharmacol Sci. 2017;21(16):3680-3689.
6. Yen FS, Chen W, Wei JC, Hsu CC, Hwu CM. Effects of metformin use on total mortality in patients with type 2 diabetes and chronic obstructive pulmonary disease: a matched-subject design. PLoS One. 2018;13(10):e0204859.
7. Aldibbiat AM, Al-Sharefi A. Do benefits outweigh risks for corticosteroid therapy in acute exacerbation of chronic obstructive pulmonary disease in people with diabetes mellitus? Int J Chron Obstruct Pulmon Dis. 2020;15:567-574.
8. Price DB, Russell R, Mares R, et al. Metabolic effects associated with ICS in patients with COPD and comorbid type 2 diabetes: a historical matched cohort study. PLoS One. 2016;11(9):e0162903.

Educational Objectives

Upon completion of this activity, participants will be better able to do the following:

• Describe recently published clinical trial data for maintenance therapy in COPD and updates to evidence-based guidelines
• Individualize management plans for patients with COPD to reflect new evidence, guidelines, symptom severity, exacerbation risk, and chronic comorbid conditions

Faculty

Fernando J. Martinez, MD, MS
Chief, Pulmonary and Critical Care Medicine
Bruce Webster Professor of Medicine
Joan and Sanford I. Weill Department of Medicine
Weill Cornell Medical College
New York - Presbyterian Hospital/Weill Cornell
Medical Center
New York, New York

Charles P. Vega, MD, FAAFP
Health Sciences Clinical Professor
University of California (UC) Irvine Department of Family Medicine
Associate Dean for Diversity and Inclusion
UC Irvine School of Medicine
Executive Director, UC Irvine Program in Medical Education for the Latino Community
Irvine, California

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.

Physician Credit Designation

Global Education Group designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

 This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integritas Communications. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 0.5 contact hour(s) (which includes 0.1 hour(s) of pharmacology).

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.

Term of Offering

This activity was released on September 28, 2021 and is valid for one year. Requests for credit must be made no later than September 28, 2022.

Global Contact Information

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

Fee Information& Refund/Cancellation Policy

There is no fee for this educational activity.

System Requirements

PC
1.4 GHz Intel Pentium 4 or faster processor (or equivalent)
Windows 10, 8.1 (32-bit/64-bit), Windows 7 (32-bit/64-bit)
512 MB of RAM (1 GB recommended)
Microsoft Internet Explorer 11 or later, Windows Edge browser, Mozilla Firefox, and Google Chrome
For HTML Client – Google Chrome (v70.0 & above), Mozilla Firefox (v65.0 & above), and Edge (v42.0 & above)

MAC
1.83 GHz Intel Core Duo or faster processor
512 MB of RAM (1 GB recommended)
MAC OS X 10.12, 10.13 and 10.14
Mozilla Firefox, Apple Safari, Google Chrome
For HTML Client – Google Chrome (v70.0 & above), Apple Safari (v12.0 & above), and Mozilla Firefox (v65.0 & above)

Disclosure of Conflicts of Interest

Global Education Group (Global) adheres to the policies and guidelines, including the Standards for Integrity and Independence in Accredited CE, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All persons in a position to control the content of an accredited continuing education program provided by Global are required to disclose all financial relationships with any ineligible company within the past 24 months to Global. All financial relationships reported are identified as relevant and mitigated by Global in accordance with the Standards for Integrity and Independence in Accredited CE in advance of delivery of the activity to learners. The content of this activity was vetted by Global to assure objectivity and that the activity is free of commercial bias.

All relevant financial relationships have been mitigated.

The faculty have the following relevant financial relationships with ineligible companies:

Fernando J. Martinez, MD, MS: Consultant: AbbVie Inc., AstraZeneca plc, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol Myers Squibb, CSL Behring, DevPro Biopharma LLC, GlaxoSmithKline plc, IQVIA Inc., Novartis International AG, Polarean Imaging plc, Pulmonx Corporation, Raziel Therapeutics, sanofi-aventis U.S. LLC/Regeneron Pharmaceuticals, Inc., Shionogi Inc., Teva Pharmaceutical Industries Ltd., United Therapeutics Corporation, Varacyte, Inc., Verona Pharma Contracted Research: Afferent Pharmaceuticals/Merck & Co., Inc., Bayer AG, Biogen Inc., CHIESI USA, Inc., GlaxoSmithKline plc, Respivant Sciences, Roche Holding AG Other (Data and Safety Monitoring Board (DSMB_, Event Adjudication): GlaxoSmithKline plc, Medtronic plc

Charles P. Vega, MD, FAAFP: Consultant: GlaxoSmithKline plc

The planners and managers have the following relevant financial relationships with ineligible companies:

Kristin Delisi, NP: Nothing to disclose
Lindsay Borvansky: Nothing to disclose
Andrea Funk: Nothing to disclose
Ashley Cann: Nothing to disclose
Liddy Knight: Nothing to disclose
Kim Rodriguez: Nothing to disclose
Celeste Collazo, MD: Nothing to disclose
Gena Dolson: 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. 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.