Cases in Practice: Incretin-Based Therapies for Common Patient Encounters

Robert R. Henry, MD
Professor of Medicine
University of California, San Diego
Chief, Section of Endocrinology & Metabolism
Director, Center for Metabolic Research
San Diego, California

Derek LeRoith, MD, PhD, FACP
Chief, Division of Endocrinology, Diabetes, and Bone Disease
Professor of Medicine
Mount Sinai School of Medicine
New York, New York

Jaime A. Davidson, MD, FACP, MACE
Clinical Professor of Internal Medicine
Division of Endocrinology
University of Texas Southwestern Medical School
President, WorldWIDE Diabetes
Dallas, Texas

Activity Overview
Type 2 diabetes is a progressive disease that often requires treatment intensification using several therapeutic agents. Incretin-based therapies, GLP-1 receptor agonists and DPP-4 inhibitors, address numerous pathophysiologic defects in type 2 diabetes with limited adverse effects. The availability of some incretin-based therapies in single-pill fixed-dose combinations (FDCs) may also be beneficial, as FDCs have been demonstrated to improve patient adherence and glycemic outcomes.

This activity is composed of 3 interactive case studies which explore options for the clinical use of incretin-based therapies in diverse clinical scenarios. Because each case study examines different aspects of diabetes care, completion of all 3 is expected to provide a broader perspective regarding the use of the 2 available classes of incretin-based therapies. In addition to providing information on the efficacy, safety, and tolerability of incretin-based therapies, the case studies address topics relevant to providing individualized care, such as considerations for diabetes management in the elderly and use of fixed-dose combinations.

Target Audience
This continuing medical education activity should be of substantial interest to endocrinologists and other healthcare professionals who treat patients with type 2 diabetes.

Learning Format
This online activity consists of 3 interactive case studies. After a brief review of the patient’s medical history and current laboratory data, the participant will be asked to select a strategy for intensifying glycemic control. The benefits and limitations of each approach will be described in detail. Each answer and its explanation must be viewed before proceeding to the next case. Participants may pause between cases to make it easier to accommodate their busy schedules.

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

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.

For Physicians: The Endocrine Society 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.

For Nurses: The Institute for Medical and Nursing Education (IMNE) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC’s) Committee on Accreditation.

IMNE designates this educational activity for 1.5 contact hours (0.15 CEUs). Accreditation by the ANCC’s Committee on Accreditation refers to recognition of educational activities and does not imply approval or endorsement of any product.

ANCC Accredited Providers have been approved by the National Certification Board for Diabetes Educators (NCBDE) as providers of continuing education (CE). Individuals seeking recertification from the NCBDE can use the CE contact hours received through participation in this activity.

Statement of Independence
As a provider of continuing medical education (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 (SPC). The commercial supporters of this activity have no influence over the selection of the faculty or specific presentations. 

The information presented in this activity represents the opinion of the faculty and is not necessarily the official position of The Endocrine Society.

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 (e.g., 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 Davidson has received fees from Abbott Laboratories; Animas Corporation; AstraZeneca Pharmaceuticals; Bristol-Myers Squibb & Company; CureDM, Inc; Eli Lilly and Company; Generex Biotechnology Corporation; GlaxoSmithKline; Johnson & Johnson (LifeScan, Inc); Merck Serono SA; Merck Sharpe & Dohme; Novo Nordisk Inc; Novartis Pharmaceuticals; Pfizer, Inc; Roche; sanofi-aventis; and Takeda Pharmaceuticals North America, Inc.

Dr Henry has received fees from Amylin Pharmaceuticals, Inc; AstraZeneca Pharmaceuticals; Bristol-Myers Squibb & Company; Dainippon Sumitomo Pharma Co, Ltd; GlaxoSmithKline; Eli Lilly and Company; Merck & Co, Inc; Novartis Pharmaceuticals; Novo Nordisk Inc; Pfizer, Inc; Roche; Daiichi-Sankyo Co Ltd; sanofi-aventis; Takeda Pharmaceuticals North America, Inc; and VeraLight, Inc. Dr Henry also holds stock in Amylin Pharmaceuticals, GlaxoSmithKline, Merck & Co, Inc, and Pfizer, Inc.

Dr LeRoith has received consulting fees from Merck & Co, Inc and Bristol-Myers Squibb & Company /AstraZeneca Pharmaceuticals, and speaker honoraria from Merck & Co, Inc, Novo Nordisk, Inc, and Takeda Pharmaceuticals North America, Inc.

The following SPC member who planned and/or reviewed content for this activity reported no relevant financial relationships: Enrico Cagliero, MD.

Endocrine Society staff associated with the development of this program reported no relevant financial relationships and/or conflicts of interest.

IMNE’s staff associated with the development of this program reported no relevant financial relationships and/or conflicts of interest.

Policy on Unlabeled/Off-Label Use
The Endocrine Society has deter mined that disclosure of unlabeled/off-label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation.

Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration (FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.

Privacy & Confidentiality Statement
The Endocrine Society will record learner’s personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties.

Acknowledgment of Commercial Support
This activity is supported by an educational grant from the Bristol-Myers Squibb and AstraZeneca Pharmaceuticals LP, Alliance Partners.

Method of Participation:
This enduring material is presented in electronic format.

To receive a maximum of 1.5 AMA PRA Category 1 Credits™ participants should:

Minimum System Requirements

The estimated time to complete all three cases of this activity, including review of material, is 1.5 hours.

Last Review Date: 10/2009
Activity Release Date: 10/2009
Activity Expiration Date: 10/2010