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Managing FPG and PPG With Incretin-Based Therapies: A Therapeutic Double Play

INSTRUCTIONS

Click on the links below to view each section of the webcast for this activity. After viewing all 5 sections in their entirety, follow the link to take the posttest and evaluation.

After completing all 5 sections and the posttest and evaluation, a continuing education certificate will automatically be generated and should be printed or saved to your computer for your records.

Thank you for your participation.

Managing FPG and PPG With Incretin-Based Therapies: A Therapeutic Double Play

CME Webcast Information

A CME webcast is a recorded version of a live symposium. This CME webcast is based upon educational content presented in a live symposium held in Orlando, Florida on Wednesday, May 14, 2008.
Date of Original Release: May 14, 2008 (satellite symposium)
Release Date: October 31, 2008
Expiration Date: October 31, 2009
Estimated Time to Complete this Activity: 1.5 hours


Learning Format and Method of Participation

CME Webcast
To obtain CME credit, each participant should: 1) view the content presented; 2) complete and submit the CME demographic and evaluation form; 3) complete the post test questions and get a passing mark of 70% or higher; 4) print the online CME certificate; 5) Only those who get a score of 70% or higher will receive credit.
This activity should take approximately 1.5 hours to complete. The expiration date for this activity is May 31, 2009. No credit will be granted after this date.


Needs Assessment
In the area of clinical management of diabetes, an urgent and ongoing need for appropriate treatment remains. In order to effectively manage this widespread disease, clinical professionals need to fully understand diabetes and its treatment options. Because incretin-based therapies fill an important need by addressing both fasting plasma glucose (FPG) and postprandial plasma glucose (PPG), it is critical that healthcare providers (HCPs) understand these new treatments so that they may be able to incorporate them appropriately into their clinical practices.

Intended Audience
This activity is intended for endocrinologists, diabetologists, and other HCPs who treat patients with diabetes.

Learning Objectives
At the conclusion of this activity, participants should be able to:
• Compare and contrast the effects of FPG and PPG on overall glycemic control and diabetic complications
• Explain the concept of the incretin effect, and describe defects in incretin secretion and incretin action that occur in type 2 diabetes
• Describe the multiple metabolic defects that occur in type 2 diabetes
• Summarize the effects of GLP-1 and GLP-1 receptor agonists on metabolism
• Discuss the clinical efficacy and safety of incretin-based therapies for the treatment of type 2 diabetes, including contributions to FPG and PPG
• Describe how both the pathophysiologic processes in type 2 diabetes and indicators of glycemic control (A1C, FPG, and PPG) can be used to design a more effective treatment plan for patients with the disease

Accreditation and Credit Designation Statements
The American Association of Clinical Endocrinologists (AACE) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AACE designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Learner Bill of Rights
AACE recognizes that you are a life-long learner who has chosen to engage in continuing medical education to identify or fill a gap in knowledge, skill or performance. As part of AACE’s duty to you as a learner, you have the right to expect that your continuing medical education experience with AACE includes:
CONTENT that:
• Promotes improvements of quality in healthcare;
• Is valid, reliable, and accurate;
• Offers balanced presentations that are free of commercial bias for or against a product/service;
• Is vetted through a process that resolves any conflicts of interests of planners, teachers or authors;
• Is driven and based on learning needs, not commercial interests;
• Addresses the stated objectives or purpose; and
• Is evaluated for its effectiveness in meeting the identified educational need.
A LEARNING ENVIRONMENT that:
• Supports learners’ ability to meet their individual needs;
• Respects and attends to any special needs of the learners;
• Respects the diversity of groups of learners; and
• Is free of promotional, commercial and/or sales activities.
DISCLOSURE of:
• Relevant financial relationships planners, teachers and authors have with commercial interests related to the content of the activity; and
• Commercial support (funding or in-kind resources) of the activity.

Privacy and confidentiality policy
The American Association of Clinical Endocrinologists, Inc. (AACE) has created this privacy statement in order to demonstrate its firm commitment to privacy. The following discloses AACE's information gathering and dissemination practice for this Web site.
AACE monitors and retains information regarding the traffic on its Web site, including the links utilized by the site's users. Unless noted otherwise, however, and with the user's consent, no personally identifiable information is retained by AACE, although AACE cannot make any representation as to the practices of the organizations for which links are provided.

DISCLOSURE INFORMATION

Declaration of Disclosure and Conflicts of Interest
It is the policy of AACE to ensure balance, independence, objectivity and scientific rigor in all of its CME activities. Presentation content may include discussions of an unlabeled or an investigational use of a product. AACE requires that participating faculty disclose to the audience any product(s) and its use(s) discussed in the educational activity that are unapproved/unlabeled for the use by the FDA or still considered investigational in nature.
Everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. “Relevant financial relationships” are financial relationships in any amount occurring within the past 12 months that create a conflict of interest. AACE requires speakers, faculty, CME Committee and other individuals who are in a position to control the content of this educational 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 evaluated by AACE for fair balance, scientific objectivity of studies mentioned in the presentation and educational materials used as basis for content, and appropriateness of patient care recommendations.
The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial influence.

CME Accreditation Committee Disclosures

Dr. David M. Cook reports that he has received speaker honoraria from Eli Lilly and Company, Genentech, Inc., Novartis AG, and Tercica. Dr. Cook has no identified conflicts of interest.

Dr. Dace L. Trence reports that she has received speaker honoraria from Pfizer Inc., and is a stock shareholder of Medtronic, Inc. and sanofi-aventis U.S. LLC.  Dr. Trence has no identified conflicts of interest.

Dr. Surendra K. Varma reports that he does not have any relevant financial relationships with any commercial interests.  Dr. Varma has no identified conflicts of interest.

Dr. Sydney A. Westphal reports that she has received speaker honoraria from Merck & Co., Inc. and Novartis AG, and is a stock shareholder of Eli Lilly and Company and Merck & Co., Inc.  Dr. Westphal has no identified conflicts of interest.

Faculty Disclosures

Etie Moghissi, MD, FACP, FACE, reports that she has received speaker honoraria from Amylin Pharmaceuticals, Eli Lilly and Company, Merck & Co., Inc. and Novo Nordisk, Inc. She also reports that her presentation will not include discussion of any investigational or unlabeled use of a product. Dr Moghissi has no identified conflicts of interest.

David D’Alessio, MD, reports that he has received consultant honoraria from Genaera Corporation Inc, MannKind Corporation, Merck & Co., Inc. and Novo Nordisk, Inc., and research grant support from Amylin Pharmaceuticals, Eli Lilly and Company, and Novartis AG. He also reports that his presentation will include discussion of liraglutide, vildagliptin, and exenatide LAR, which are used for the treatment of type 2 diabetes. Dr D’Alessio has no identified conflicts of interest.

Vivian Fonseca, MD, FRCP, FACE, reports that he has received speaker honoraria from Eli Lilly and Company, GlaxoSmithKline, Novartis AG, sanofi-aventis U.S., Pfizer Inc., and Takeda Pharmaceuticals North America, Inc. He also reports that he has received speaker’s bureau and advisory panel honoraria from Eli Lilly and Company, Novo Nordisk Inc., MannKind Corporation, and sanofiaventis U.S. Dr Fonseca reports that he has received consultant
honoraria from Eli Lilly and Company, GlaxoSmithKline, MannKind Corporation, Novartis AG, Novo Nordisk Inc., Pfizer Inc., sanofi-aventis U.S., and Takeda Pharmaceuticals North America, Inc., and research grant support from AstraZeneca, Daiichi-Sankyo, Eli Lilly and Company, GlaxoSmithKline, MannKind Corporation, Novartis AG, Novo Nordisk Inc., Pfizer Inc., sanofi-aventis U.S., and Takeda Pharmaceuticals North America, Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use of a product. Dr Fonseca has no identified conflicts of interest.

Harold Lebovitz, MD, FACE, reports that he has received advisory board honoraria from Amylin Pharmaceuticals and LifeScan and is a stockholder of Amylin Pharmaceuticals and Merck & Co., Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use of a product. Dr Lebovitz has no identified conflicts of interest.

Commercial Support Acknowledgment
The content contained herein was derived from a regional meeting series originally supported by an educational grant from Novo Nordisk Inc.

Faculty Profiles
Etie Moghissi, MD, FACP, FACE
Associate Clinical Professor of Medicine
University of California, Los Angeles
Los Angeles, CA
Dr Moghissi is a native of Shiraz, Iran. She attended Pahlavi University School of Medicine in Shiraz where she also completed an internship and two years of residency in internal medicine. She then came to the United States for further training in internal medicine at St. Luke’s-Roosevelt Hospital, Columbia University in New York City and a fellowship in endocrinology at the University of Southern California in Los Angeles. She is currently in private practice in Marina Del Rey, California and is an Associate Clinical Professor in Medicine at UCLA.
Dr Moghissi has served on the Board of Directors of AACE for the past seven years and currently serves as a trustee of the American College of Endocrinology. She has been involved in numerous AACE committees and task forces, and is currently serving as the Co-Chair of the AACE-Inpatient Diabetes Task Force. She was the Co-Chair of the AACE Inpatient Diabetes Consensus Conference and Position Statement (2004) and AACE/American Diabetes Association (ADA) Inpatient Diabetes “Call to Action” Consensus Conference and Position Statement (2006). Her efforts have been instrumental in driving a major improvement in the care of hospitalized patients with diabetes. She is actively involved in professional medical education both nationally and internationally.

Harold Lebovitz, MD, FACE
Professor of Medicine
Division of Endocrinology and Metabolism/Diabetes
SUNY Health Science Center
Brooklyn, NY
Harold Lebovitz, MD, FACE, is Professor of Medicine in the Division of Endocrinology and Metabolism/Diabetes at The State University of New York (SUNY) Health Science Center in Brooklyn. He received his BS summa cum laude in mathematics in 1952 and his MD with numerous honors in 1956 from the University of Pittsburgh. After completing an internship at Mount Sinai Hospital in New York and a medical residency at the University of Pittsburgh Health Center, Dr Lebovitz completed a 3-year fellowship in endocrinology at Duke University.
Dr Lebovitz then was appointed to the faculty of medicine at Duke University in 1962 and rose through the ranks to Professor of Medicine and Associate Professor of Physiology by 1971. He was Director of the Division of Endocrinology at Duke University from 1964 through 1982. In 1982, Dr Lebovitz moved to SUNY Health Science Center as Professor of Medicine, Chief of the Section of Endocrinology and Diabetes, and Director of the NIH-sponsored Clinical Research Center. He remained as Chief of the Section of Endocrinology and Diabetes until the end of 1998. Dr Lebovitz spent 18 months in the Department of Biochemistry at Duke (1963-1965) and 1 year in the Department of Cell Biology at Baylor (1975-1976) as Visiting Professor.
Dr Lebovitz is an internationally recognized authority in the field of diabetes. He and his colleagues have contributed to the understanding of the pathogenesis of type 2 diabetes, particularly as it relates to ethnic and racial differences, to mechanisms of action and clinical utility of therapeutic agents used in the treatment of type 2 diabetes, and to the effects of body composition on insulin resistance and its associated abnormalities. Dr Lebovitz has published approximately 210 peer-reviewed publications and 90 chapters or books. He has served or currently serves on numerous review and advisory committees of the ADA, NIH, and the Veterans Administration. Dr Lebovitz also currently serves on several editorial boards of peer-reviewed journals.
Dr Lebovitz’s contributions have been recognized by many organizations, and he has been the recipient of many awards, including the Albert E. Renold Medal of the ADA in 1994, the Charles H. Best Distinguished Service Award of the ADA in 2001, the Samuel Moses Oration Award of the Research Society for the Study of Diabetes in India in 1993, the Servier Medal of the Philippine Diabetes Association in 1999, and the Distinction in Clinical Endocrinology Award of the American College of Endocrinology in 2003.

Vivian Fonseca, MD, FRCP, FACE
Professor of Medicine
Tullis-Tulane Alumni Chair in Diabetes
Chief, Section of Endocrinology
Tulane University Medical Center
New Orleans, LA
Vivian Fonseca, MD, FRCP, FACE, is Professor of Medicine, the Tullis-Tulane Alumni Chair in Diabetes, and Chief of the Section of Endocrinology at Tulane University Medical Center in New Orleans, Louisiana. Dr Fonseca received his MD in 1978 from Bombay University, Bombay, India. He is a fellow of the American Association of Clinical Endocrinologists, the Royal College of Physicians (London), and the American College of Physicians.
Dr Fonseca serves on numerous professional committees, including the clinical practice committee (current chairman) of the ADA and the joint ADA/American College of Cardiology “Make the Link” Program. He has been editor-in-chief of Diabetes Care since 2007, having formerly been associate editor. Until 2006, Dr Fonseca was editor-in-chief of the Journal of the Metabolic Syndrome and Related Disorders. He also served on the editorial board of the Journal of Clinical Endocrinology and Metabolism (2003-2006). Dr Fonseca is an ad hoc reviewer for several other journals, including New England Journal of Medicine, JAMA, Diabetes, Diabetic Medicine, Kidney International, The American Journal of Clinical Nutrition, British Medical Journal, and Metabolism. He has also published over 200 papers, review articles, and book chapters, and is the editor of the textbook Clinical Diabetes: Translating Research into Practice.
Dr Fonseca’s current research interests include the prevention and treatment of diabetic complications and risk factor reduction in cardiovascular disease. He has a research program evaluating homocysteine and inflammation as risk factors for heart disease in diabetes. Dr Fonseca is also an investigator in the National Institutes of Health (NIH)-funded Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and serves on the glycemia control committee. He is a co-investigator on the NIH TINSAL–2D study and serves on the steering and ancillary studies committees. Dr Fonseca is funded by the ADA to study the impact of hurricane Katrina on diabetes and comorbidities.

David D’Allesio, MD
Professor of Medicine
Director, Division of Endocrinology, Diabetes and Metabolism
University of Cincinnati School of Medicine
Chief, Endocrinology and Diabetes Clinic

VA Medical Center
Cincinnati, OH
David D’Alessio, MD, is Professor of Medicine and Director of the Division of Endocrinology, Diabetes and Metabolism at the University of Cincinnati School of Medicine. He is a staff physician at the Cincinnati VA Medical Center, attending physician at the University of Cincinnati Hospital, and Chief of the Endocrinology and Diabetes Clinic at the Cincinnati VA Medical Center.
Dr D’Alessio received his MD from the University of Wisconsin in Madison. His primary research interests are in the regulation of glucose tolerance and abnormalities that lead to glucose tolerance in type 2 diabetes. Work in Dr D’Alessio’s lab focuses on the interplay between circulating glucose, gastrointestinal (GI) hormones, and neural signals to control insulin secretion. He is actively involved in research examining the regulation of glucose tolerance by GLP-1 in nondiabetic and diabetic persons; the ability of GI hormones to mediate food intake and energy balance in response to diets of differing macronutrient content; and the mechanisms by which GLP-1 suppresses food intake.
Throughout his career, Dr D’Alessio has been the recipient of many honors, including the Howard Hughes Medical Institute Research Resources Program Award, the ADA Clinical Research Award, and the Paul Beeson Award for Clinical Teaching. Additionally, he has authored over 60 peer-reviewed scientific publications and serves as a scientific reviewer for numerous journals in the areas of endocrinology, gastroenterology, and pediatrics.

Copyright statement:
Copyright 2008, AACE. All rights reserved. No part of this publication may be reproduced or transmitted in any other form or by any other means, electronic or mechanical, without first obtaining written permission from AACE.

Novo Nordisk IncThis activity is supported by an educational grant from Novo Nordisk Inc
American Association of Clinical EndocrinologistsThis activity is sponsored by the American Association of Clinical Endocrinologists
International Medical PressProgram management services provided by International Medical Press

Provider Contact Information: 
For questions regarding this CME activity, please contact:
AACE c/o Lauren Hogan
Phone: (904) 353-7878
Email:  lhogan@aace.com

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