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Endocrinology and Diabetes CME Monograph - On the Brink of Change: Evolving Treatment Paradigms and GLP-1 Receptor Agonists

Content for this activity is based on the live symposium, "On the Brink of Change: Evolving Treatment Paradigms and GLP-1 Receptor Agonists," which was presented as a satellite symposium at ENDO 2010 on Sunday, June 21, 2010 in San Diego, California. This monograph and the live symposium were sponsored by the Endocrine Society (ENDO), developed by the Institute for Medical and Nursing Education (IMNE), and supported by an educational grant from Novo Nordisk Inc.

Overview
Scientific advances and improved clinical understanding of the characteristics of type 2 diabetes (T2D) patients, combined with the availability of more therapeutic agents and treatment paradigms, have culminated in the call for individualized approaches to managing T2D. Recent treatment paradigms, including consensus statements by the American Diabetes Association and European Association for the Study of Diabetes and by the American Association of Clinical Endocrinologists and the American College of Endocrinology, have evolved to incorporate newer agents, including GLP-1 RAs, to better address the multiple aspects of T2D pathophysiology.

Although treatment paradigms provide guidance, healthcare providers need to be prepared to draw on their clinical expertise to appropriately select GLP-1 R As for individual patients based on comparative efficacy, tolerability, and safety. Clinicians need to be aware of the potential treatment impact of GLP-1 RAs at various disease stages, on multiple therapeutic goals, on quality of life, and on adherence to therapy. Additionally, knowledge of current applications under investigation for GLP-1 R As may enhance clinicians' understanding of the characteristics of this class of agents.

Target Audience
This continuing medical education (CME) activity should be of substantial interest to endocrinologists and other healthcare providers who treat patients with diabetes.

Learning Objectives
Upon completion of this educational activity, learners will be able to

  • Compare the safety, efficacy, and tolerability of first- and second-generation GLP-1 receptor agonists (GLP-1 RAs).
  • Assess the role of GLP-1 RAs in emerging treatment paradigms with regard to management of diabetes pathophysiology, consideration of nonglycemic effects, cardiovascular safety, and hypoglycemia.
  • Explain the role of GLP-1 RAs in treating patients at different stages in the progression of type 2 diabetes (T2D).
  • Describe the appropriate use of GLP-1 RAs in the context of comorbidities common among patients with T2D.
  • Discuss preclinical and clinical evidence regarding advances in the understanding of effects of GLP-1 and GLP-1 RAs that may have bearing beyond glycemic control in T2D (eg, effects on weight, the cardiovascular [CV] system, ß cells, the liver, acute metabolic regulation).

Accreditation Statement
The Endocrine Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Endocrine Society has achieved Accreditation with Commendation.

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

Method of Participation
This enduring material is presented as a print supplement to Endocrine News. To receive a maximum of 1.5 AMA PRA Category 1 Credit(s) participants should:

  • Read the activity in its entirety
  • Take the activity posttest
  • Complete the activity evaluation and return it by fax or mail

The estimated time to complete this activity, including review of material, is 1.5 hours. For questions about content or obtaining CME credit, please contact The Endocrine Society at: education@endo-society.org.

Last Review Date: August 17, 2010
Activity Release/Expiration Date:
September 2010 - September 2011

Statement of Independence
As a provider of CME accredited by the Accreditation Council for Continuing Medical Education, The Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous. The scientific content of this activity was developed under the supervision of The Endocrine Society's Special Programs Committee. The commercial supporters of this activity have no influence over the selection of the faculty or specific presentations.

Disclosure Policy
The faculty, committee members, and staff involved in planning this CME activity are required to disclose to learners any relevant financial relationship(s) that have occurred within the last 12 months with any commercial interest(s) whose products or services are discussed in the CME content. Such relationships are defined by remuneration in any amount from the commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (eg, stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers' bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent faculty with relevant financial relationships from planning or delivery of content, but rather to provide learners with information that allows them to make their own judgments. It remains for learners to determine whether financial interests or relationships may influence the educational activity with regard to exposition or conclusion. The Endocrine Society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.

The following faculty reported relevant financial relationships:
Dr Robert Henry reports he is a consultant for Amylin Pharmaceuticals, Inc; AstraZeneca; Bristol-Myers Squibb; Eli Lilly and Company; GlaxoSmithKline; Merck & Co., Inc.; Novo Nordisk Inc.; and F. Hoffmann-La Roche Ltd. He receives grant/research support from Amylin Pharmaceuticals, Inc.; AstraZeneca; and Bristol-Myers Squibb. He also has pension stock in Amylin Pharmaceuticals, Inc.

Dr Lawrence Blonde reports that he has received grant/research support from Amylin Pharmaceuticals, Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; MannKind Corporation; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Novo Nordisk Inc.; Pfizer, Inc.; Roche Pharmaceuticals; and sanofi-aventis. He has also received honoraria from Amylin Pharmaceuticals, Inc.; AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Daiichi Sankyo Co, Ltd.; Eli Lilly and Company; GlaxoSmithKline; Haloyzyme Therapeutics; LifeScan, Inc.; MannKind Corporation; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Novo Nordisk Inc.; Pfizer, Inc.; Roche Pharmaceuticals; sanofi-aventis; and VeroScience.

Dr Alan Garber reports that he has received honoraria as a consultant from GlaxoSmithKline; Novo Nordisk Inc.; Merck & Co., Inc.; and Roche Pharmaceuticals. He also received grant/research support from Bristol-Myers Squibb; Daiichi Sankyo Company, Ltd.; GlaxoSmithKline; Metabasis Therapeutics; Novo Nordisk Inc.; Merck & Co., Inc.; Roche Pharmaceuticals; and sanofi-aventis. Additionally, he has received honoraria for speakers' bureau participation from Daiichi Sankyo Company, Ltd.; GlaxoSmithKline; Novo Nordisk Inc.; and Merck & Co., Inc.

Dr Derek LeRoith reports that he participates in an advisory board for Bristol-Myers Squibb; AstraZeneca; sanofi-aventis; and Merck & Co., Inc. He receives grant/research support from sanofi-aventis.

Kimberly McFarland, PhD is a senior medical writer with the IMNE, a medical education company that receives educational grants from several commercial interests. She reports no relevant financial relationships and/or conflicts of interest.

The following committee members who planned and/or reviewed content for this activity reported relevant financial relationships:
Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.

Institute for Medical and Nursing Education staff associated with the development of content for this activity reported no relevant financial relationships.

Commercial Support Acknowledgement
This activity is supported by an educational grant from Novo Nordisk Inc.


Sponsored by The Endocrine Society


Developed by the Institute for Medical and Nursing Education, Inc


This activity is supported by an educational grant from Novo Nordisk, Inc.

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