Clinical Issues in Type 2 Diabetes

Faculty

Lawrence Blonde, MD, FACP, FACE
Director, Ochsner Diabetes Clinical Research Unit
Frank Riddick Diabetes Institute
Department of Endocrinology
Ochsner Medical Center
New Orleans, Louisiana

Jaime A. Davidson, MD, FACP, MACE
Clinical Professor of Medicine
Touchstone Diabetes Center
University of Texas, Southwestern Medical Center
Dallas, Texas

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

Target Audience

The educational design of this activity addresses the needs of endocrinologists and other health care providers involved in the treatment of patients with type 2 diabetes.

Educational Objectives

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

1. Describe the relative benefits and risks of GLP-1 receptor agonists versus other oral and injectable antidiabetes medications
2. Select among available short- and long-acting GLP-1 receptor agonists when intensifying T2DM therapy for various patient types
3. Tailor combination regimens that include GLP-1 receptor agonists and other antihyperglycemic agents based on disease severity, comorbidities, and risks of hypoglycemia
4. Engage in open dialogues with patients about the clinical profiles of GLP-1 receptor agonists and treatment adherence

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.^1-3 Agonists of glucagon-like peptide-1 (GLP-1) receptors, for example, take advantage of incretin hormone signaling to induce glucose-independent insulin release from pancreatic β cells, reduce hepatic glucose production, slow gastric emptying, and increase satiety.^1,3,4 The potential benefits and risks of GLP-1 receptor agonists for various patient types or complicating comorbidities are the subjects of much ongoing clinical research.^5-10 Indeed, education on how to achieve individualized glycemic targets and appropriately use these medications is of great practical interest to endocrinologists and other health care providers. This Clinical Issues™ program will provide participants with scientifically rigorous, clinically accurate, and highly applicable recommendations for the roles of GLP-1 receptor agonists in multimodal T2DM management. 

References

1. American Diabetes Association. Standards of medical care in diabetes--2015. Diabetes Care. 2015;36(suppl 1):S1-S94.
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. Freeman JS. Role of the incretin pathway in the pathogenesis of type 2 diabetes mellitus. Cleve Clin J Med. 2009;76(suppl 5):S12-S19.
4. Inzucchi SE, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364-1379.
5. Wang B, et al. Blood pressure-lowering effects of GLP-1 receptor agonists exenatide and liraglutide: a meta-analysis of clinical trials. Diabetes Obes Metab. 2013;15(8):737-749.
6. Monami M, et al. Effects of glucagon-like peptide-1 receptor agonists on cardiovascular risk: a meta-analysis of randomized clinical trials. Diabetes Obes Metab. 2014;16(1)38-47.
7.  Shao N, et al. Benefits of exenatide on obesity and non-alcoholic fatty liver disease with elevated liver enzymes in patients with type 2 diabetes. Diabetes Metab Res Rev. 2014;30(6):521-529.
8.  Schwartz S, DeFronzo RA. Is incretin-based therapy ready for the care of hospitalized patients with type 2 diabetes?: The time has come for GLP-1 receptor agonists! Diabetes Care. 2013;36(7):2107-2111.
9. Elkind-Hirsch K, et al. Comparison of single and combined treatment with exenatide and metformin on menstrual cyclicity in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(7):2670-2678.
10. Seufert J, Gallwitz B. The extra-pancreatic effects of GLP-1 receptor agonists: a focus on the cardiovascular, gastrointestinal, and central nervous systems. Diabetes Obes Metab. 2014;16(8):673-688.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the preactivity questionnaire, view the activity, and complete the posttest and evaluation form.

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Clinical and Patient Educators Association (CPEA) and Integritas Communications. CPEA is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Clinical and Patient Educators Association 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.

CPEA Contact Information

For information about the accreditation of this program, please contact CPEA at 303-953-4580
or inquire@cpea-assn.org.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Clinical and Patient Educators Association (CPEA) 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 CPEA 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:

Lawrence Blonde, MD, FACP, FACE: Grant Research Support to Dr. Blonde’s institution from Eli Lilly and Company, Novo Nordisk, and sanofi-aventis U.S. LLC. Speakers Bureau for AstraZeneca, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, and sanofi-aventis U.S. LLC. Consultant to AstraZeneca, GlaxoSmithKline, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Quest Diagnostics Inc., and sanofi-aventis U.S. LLC. 

Jaime A. Davidson, MD, FACP, MACE: Consultant to and Advisory Board Member for Amgen Inc., Aspire Bariatrics, AstraZeneca, Boehringer Ingelheim GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Johnson & Johnson, Lifescan, Inc., Merck & Co., Inc., Novo Nordisk, Roche Diagnostics, and sanofi-aventis U.S. LLC. Speakers Bureau for Janssen Pharmaceuticals, Inc., Novo Nordisk, and Takeda Pharmaceuticals Limited. 

Daniel Einhorn, MD, FACP, FACE: Consultant to and Grant Research Support from AstraZeneca, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, sanofi-aventis U.S. LLC, and Takeda Pharmaceuticals Limited. Speakers Bureau for Janssen Pharmaceuticals, Inc.

The 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 has nothing to dislcose
Andrea Funk has nothing to disclose
Jim Kappler, PhD has 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. Clinical and Patient Educators Association (CPEA) 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.