Clinical Updates on Congenital and Acquired Lipodystrophy Translating Research Into Practice
Sponsored by
Developed by
This activity is supported by an educational grant from AstraZeneca. Held in conjunction with the 16th International Congress of Endocrinology held jointly with the Endocrine Society’s 96th Annual Meeting & Expo, ICE/ENDO 2014.
CME/MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
3
FACULTY Daniel Einhorn, MD, FACE, FACP Clinical Professor of Medicine University of California, San Diego Diabetes and Endocrine Associates Medical Director, Scripps Whittier Diabetes Institute La Jolla, California
Dr. Daniel Einhorn is the President of the American College of Endocrinology and the Past President of the American Association of Clinical Endocrinologists. He is the Medical Director of the Scripps Whittier Diabetes Institute, Clinical Professor of Medicine at the University of California, San Diego, President, Diabetes and Endocrine Associates, as well as a Fellow of the American College of Physicians and the American College of Endocrinology. Dr. Einhorn received his medical degree from Tufts University School of Medicine in Boston, Massachusetts. He completed his internship in medicine and fellowships in endocrinology and in diabetes and metabolism at Harvard Medical School and Beth Israel Deaconess Medical Center. The recipient of numerous awards from medical societies, industry, and community groups, Dr. Einhorn is a reviewer for many peer-reviewed journals and a national and international lecturer on diabetes, prediabetes, thyroid, sleep disorders, and clinical guidelines. He is the Editor of Clinics of North America for Type 2 Diabetes, Editor for Type 2 Diabetes: Interpreting Results in a Time of Pandemic for The Royal Society of Medicine Press, and an Associate Editor of the Journal of Diabetes.
For additional CME activities log on to
4
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 live activity 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.
LEARNING OBJECTIVES Upon completion of the proposed activity, learners will be better prepared to: • Describe the etiologic causes and pathophysiologic mechanisms of congenital and acquired lipodystrophies • Differentially diagnose various types of lipodystrophy based on the degree and pattern of adipose tissue loss, other clinical features, and appropriate laboratory testing • Discuss evidence supporting pharmacologic treatment of lipodystrophy and associated metabolic disorders • Tailor multimodal therapeutic regimens for lipodystrophy to address pathologic changes in fat distribution and associated metabolic disturbances
TARGET AUDIENCE This continuing medical education activity should be of substantial interest to endocrinologists and other health care providers involved in the diagnosis and management of the heterogeneous group of lipodystrophy syndromes.
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
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
5
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 supporter of this activity has no influence over the planning of this CME activity.
DISCLOSURE POLICY The faculty, committee members, and staff who are in position to control the content of this activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are related to the CME content. Financial 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 CME planners 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 of whether these financial relationships may have influenced 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 no relevant financial relationships: Daniel Einhorn, MD, FACE, FACP The following SPC member who reviewed content for this activity reported no relevant financial relationships: Jeffrey Boord, MD, MPH Endocrine Society and Integritas Communications staff associated with the development of content for this activity reported no relevant financial relationships.
For additional CME activities log on to
6
DISCLAIMER The information presented in this activity represents the opinion of the faculty and is not necessarily the official position of the Endocrine Society.
Use of professional judgment: The educational content in this activity relates to basic principles of diagnosis and therapy and does not substitute for individual patient assessment based on the health care provider’s examination of the patient and consideration of laboratory data and other factors unique to the patient. Standards in medicine change as new data become available.
Drugs and dosages: When prescribing medications, the physician is advised to check the product information sheet accompanying each drug to verify conditions of use and to identify any changes in drug dosage schedule or contraindications.
POLICY ON UNLABELED/OFF-LABEL USE The Endocrine Society has determined that disclosure of unlabeled/offlabel 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.
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
7
PRIVACY AND 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.
AMA PRA CATEGORY 1 CREDIT™ (CME) INFORMATION To receive a maximum of 0.5 AMA PRA Category 1 Credit™ participants must complete the activity evaluation form provided. To claim your CME credit, complete the evaluation form and return it to the staff member before you leave the activity. In exchange, you will receive a CME certificate. For questions about content or obtaining CME credit, please contact the Endocrine Society at education@endocrine.org.
For additional CME activities log on to
8
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
9
10
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
11
12
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
13
14
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
15
16
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
17
18
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
19
20
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
21
22
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
23
24
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
25
26
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
27
28
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
For additional CME activities log on to
29
30
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
31
GUIDELINES The Clinical Approach to the Detection of Lipodystrophy—A Consensus Statement From the American Association of Clinical Endocrinologists A consensus statement from the American Academy of Clinical Endocrinologists about the classification, detection, and diagnosis of various types of lipodystrophy. The expert task force of clinical practitioners and leaders in lipodystrophy research aims to increase awareness of these underdiagnosed disorders and provide a framework for future diagnostic criteria. Handelsman Y, et al. Endocr Pract. 2013;19(1):107-116. LINK: https://www.aace.com/files/lipodstrophy-cs.pdf
American Diabetes Association’s Standards of Medical Care in Diabetes—2014 The American Diabetes Association’s Standards of Care provide clinicians, patients, researchers, payers, and other interested individuals with the components of good diabetes management, general treatment goals, and tools to evaluate the quality of care. Importantly, these recommendations should be adjusted based on individual preferences, comorbidities, and other patient-related factors. American Diabetes Association. Diabetes Care. 2014;37(suppl 1):S14-S80. LINK: http://care.diabetesjournals.org/content/37/ Supplement_1/S14.full.pdf
American Association of Clinical Endocrinologists’ Comprehensive Diabetes Management Algorithm 2013 This algorithm from the AACE outlines a complicationscentric approach to diabetes care and recommendations on evidence-based treatment approaches. The document contains sections on managing obesity, prediabetes, hyperglycemia, hypertension, and hyperlipidemia, as well as other risk-reduction strategies. Garber AJ, et al. Endocr Pract. 2013;19(2):327-336. LINK: https://www.aace.com/files/aace_algorithm.pdf
For additional CME activities log on to
32
TOOLS Lipodystrophy Resource Center at The Endocrine Society The Endocrine Society has created a variety of educational materials covering the pathophysiology, clinical presentations, and treatment of lipodystrophies. Particular emphasis is placed on the connections between generalized or partial adipose tissue loss and their often severe metabolic complications, including severe insulin resistance, type 2 diabetes, and hypertriglyceridemia. LINK: http://www.endocrine.org/education-and-practicemanagement/continuing-medical-education/lipids-and-obesity/ lipodystrophy-resource-room-slide-series
My Lipodystrophy Web Site This Web site contains information and resources for patients with lipodystrophy and their families. In addition to helping people better communicate with healthcare providers, the Web site also provides access to communities of people living with lipodystrophy. LINK: http://mylipodystrophy.com
SUGGESTED READING Ectopic lipid storage and insulin resistance: a harmful relationship. BorĂŠn J, et al. J Intern Med. 2013;274(1):25-40. LINK: http://onlinelibrary.wiley.com/doi/10.1111/joim.12071/pdf
Clinical classification and treatment of congenital and acquired lipodystrophy. Chan JL, Oral EA. Endocr Pract. 2010;16(2):310-323. LINK: http://www.ncbi.nlm.nih.gov/pubmed/20061300
Clinical effects of long-term metreleptin treatment in patients with lipodystrophy. Chan JL, et al. Endocr Pract. 2011;17(6):922-932. LINK: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498767/pdf/nihms410897.pdf
Clinical Updates on Congenital and Acquired Lipodystrophy
Translating Research Into Practice
33
Lipodystrophy: pathophysiology and advances in treatment. Fiorenza CG, et al. Nat Rev Endocrinol. 2011;7(3):137-150. LINK: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150735/pdf/nihms313106.pdf
Lipodystrophies: genetic and acquired body fat disorders. Garg A. J Clin Endocrinol Metab. 2011;96(11):3313-3325. LINK: http://press.endocrine.org/doi/pdf/10.1210/jc.2011-1159
Lipodystrophy: metabolic insights from a rare disorder. Huang-Doran I, et al. J Endocrinol. 2010;207(3):245-255. LINK: http://joe.endocrinology-journals.org/content/207/3/245.full.pdf
Leptin and the central nervous system control of glucose metabolism. Morton GJ, Schwartz MW. Physiol Rev. 2011;91(2):389-411. LINK: http://physrev.physiology.org/content/91/2/389.full-text.pdf+html
Exploring the pathophysiology behind the more common genetic and acquired lipodystrophies. Nolis T. J Hum Genet. 2014;59(1):16-23. LINK: http://www.nature.com/jhg/journal/v59/n1/pdf/jhg2013107a.pdf
Rationale for leptin-replacement therapy for severe lipodystrophy. Oral EA, Chan JL. Endocr Pract. 2010;16(2):324-333. LINK: http://aace.metapress.com/content/e2n14628x168001n/
How to diagnose a lipodystrophy syndrome. Vantyghem MC, et al. Ann Endocrinol (Paris). 2012;73(3):170-189. LINK: http://www.ncbi.nlm.nih.gov/pubmed/22748602
For additional CME activities log on to
34
Please visit the CLINICAL RESOURCE CENTER for additional information and resources
EXCHANGECME.com/iPLIPO
Copyright Š 2014 Educational Review Systems, Inc., and Integritas Communications. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.