iProfessor Workbook

Setting Glycemic Targets in Type 2 Diabetes Updates to National Clinical Practice Guidelines

Jointly sponsored by Educational Review Systems, Inc., and Integritas Communications

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

Setting Glycemic Targets in Type 2 Diabetes Updates to National Clinical Practice Guidelines

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FACULTY Zachary T. Bloomgarden, MD Prerecorded Editor-in-Chief, Journal of Diabetes Clinical Professor Division of Endocrinology & Metabolism Department of Medicine Icahn School of Medicine at Mount Sinai New York, New York

Dr. Bloomgarden has an international reputation for writing and lecturing on diabetes, has authored some 500 publications in this field, and is Editorin-Chief of the Journal of Diabetes. A past member of the Board of the American Association of Clinical Endocrinologists, he has been principal investigator in numerous studies. Dr. Bloomgarden has been listed for many years in the Castle Connolly Guide, Top Doctors: New York Metro Area. In 2012, Dr. Bloomgarden was awarded the title of Master of the American College of Endocrinology.

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INTENDED AUDIENCE This activity is intended for primary care providers, nurse practitioners, physician assistants, and other health care providers involved in the diagnosis and ongoing management of T2DM. There are no prerequisites for this educational activity.

EDUCATIONAL OBJECTIVES At the conclusion of this educational activity, participants should be better prepared to: • Discuss the multisystem consequences of T2DM and the rationale for appropriate screening, early diagnosis, and prompt treatment • Establish individualized treatment goals for T2DM that reflect full patient-specific biopsychosocial profiles and guide the intensification of antihyperglycemic therapy

NEEDS ASSESSMENT AND LEARNER’S GAP Diabetes is a constellation of diseases characterized by high blood glucose levels. The disorders afflict an estimated 25.6 million adult Americans 20 years or older, with type 2 diabetes mellitus (T2DM) constituting approximately 95% of all diagnosed cases.1-3 Alarmingly, an estimated 27% of people with diabetes have not received a diagnosis, and among adults with diagnosed diabetes, 16% are not taking medications for treatment.2 If not treated promptly and aggressively, T2DM can lead to both microvasculopathies (nephropathy, retinopathy, and neuropathy) and macrovasculopathies (coronary, cerebral, and peripheral vascular disease), highlighting the need for early, intensive treatment.4,5 Because primary care providers (PCPs) are involved across the spectrum of chronic diseases, they are critical to providing and coordinating patient care as well as identifying and surmounting barriers to achieving success. Indeed, PCPs are often the first to see patients with diabetes and are uniquely positioned to screen for this complex disease and its myriad complications, set the initial goals of

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therapy, and identify patients who require more aggressive treatment soon after diagnosis. Fully realizing these roles is difficult within the demands of a busy practice. This Interactive Professor™ program will provide attendees with practical recommendations on setting glycemic targets and tailoring patient-centered therapy for individuals with T2DM.

REFERENCES 1. Dabelea D, Bell RA, D’Agostino RB Jr, et al. Incidence of diabetes in youth in the United States.

JAMA. 2007;297(24):2716-2724.

2. Centers for Disease Control and Prevention, US Department of Health and Human Services.

National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA: Centers for Disease Control and Prevention; 2011.

3. Centers for Disease Control and Prevention, US Department of Health and Human Services.

Diabetes Report Card 2012. Atlanta, GA: Centers for Disease Control and Prevention; 2012.

4. Creager MA, Lüscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation.

2003;108(12):1527-1532.

5. Inzucchi SE, Bergenstal RM, Buse JB, 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.

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 sponsorship of Educational Review Systems, Inc., and Integritas Communications.

CREDIT DESIGNATION This program has been reviewed and is acceptable for up to 0.25 Prescribed credit hours by the American Academy of Family Physicians. AAFP Prescribed credit is accepted by the AMA as

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equivalent to AMA PRA Category 1 Credit™ for the American Medical Association (AMA) Physician’s Recognition Award (PRA). When applying for the AMA PRA, Prescribed hours earned must be reported as Prescribed hours, not as Category 1. (This statement applies to all Physicians, not just Family Physicians.)

CONFLICT OF INTEREST STATEMENT The Conflict of Interest Disclosure Policy of Educational Review Systems, Inc., requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to his/her contribution to the activity will not be permitted to present.

Educational Review Systems, Inc., also requires that faculty participating in any CME activity and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.

FACULTY AND PLANNING COMMITTEE DISCLOSURES Zachary T. Bloomgarden, MD AstraZeneca plc/Bristol-Myers Squibb Co. (Consultant); Baxter International, Inc. (Stock Holder); Boehringer Ingelheim (Consultant, Speaker); CVS Caremark Corporation (Stock Holder); Dainippon Sumitomo Pharma Co., Ltd. (Consultant); Forest Laboratories, Inc. (Consultant); Johnson & Johnson (Consultant); Medtronic, Inc. (Consultant); Merck & Co., Inc. (Consultant, Speaker); Novartis International AG (Consultant, Stock Holder); Novo Nordisk (Speaker); Roche Holding AG (Stock Holder); Santarus, Inc. (Speaker); St. Jude Medical, Inc. (Stock Holder) Jim Kappler, PhD, of Integritas Communications, has no relevant financial relationships to disclose.

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SUGGESTED READING American Diabetes Association: Standards of Medical Care in Diabetes—2012.

American Diabetes Association. Diabetes Care.

2012;35(suppl 1):S11-S63.

Adiposity, age, and family history as a simplified prediction of future diabetes mellitus from the SHIELD study.

Bays H, Fox KM, and Grandy S. Obesity.

2011;19(suppl 1):S223.

Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus.

Defronzo RA. Diabetes. 2009;58(4):773-795.

American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan.

Handelsman Y, Mechanick JI, Blonde L, et al.

Endocr Pract. 2011;17(suppl 2):1-53.

10-year follow-up of intensive glucose control in type 2 diabetes.

Holman RR, Paul SK, Bethel MA, et al. N Engl J Med. 2008;359(15):1577-1589.

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).

Inzucchi SE, Bergenstal RM, Buse JB, et al.

Diabetes Care. 2012;35(6):1364-1379.

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Drug-induced hypoglycaemia in type 2 diabetes.

Inkster B, Zammitt NN, Frier BM. Expert Opin Drug Saf. 2012;11(4):597-614.

Diabetes management in the kidney patient.

Garg R, Williams ME. Med Clin North Am. 2013;97(1):135-156.

Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial.

Wing RR. Arch Intern Med. 2010;170(17):1566-1575.

Setting Glycemic Targets in Type 2 Diabetes Updates to National Clinical Practice Guidelines

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