Chatterji P, Joo H Lahiri K. Racial/ethnic- and education-related disparities in the control of risk factors for cardiovascular disease among individuals with diabetes. Diabetes Care. 2012;35:305-312.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434-444.
Del Prato S, Felton AM, Munro N, et al. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract. 2005;59:1345-1355.
Peyrot M, Rubin RR, Lauritzen T, et al. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care. 2005;28:2673-2679.
Elgrably F, Costagliola D, Chwalow AJ, Varenne P, Slama G, Tchobroutsky G. Initiation of insulin treatment after 70 years of age: patient status 2 years later. Diabet Med. 1991;8:773-777.
Wallace TM, Matthews DR. Poor glycaemic control in type 2 diabetes: a conspiracy of disease, suboptimal therapy, and attitude. QJM. 2000;93:369-374.
Kunt T, Snoek FJ. Barriers to insulin initiation and intensification and how to overcome them. Int J Clin Pract Suppl. 2009;(164):6-10.
Zoppini G, Verlato G, Bonora E, Muggeo M. Attending the diabetes center is associated with reduced cardiovascular mortality in type 2 diabetic patients: the Verona Diabetes Study. Diabetes Metab Res Rev. 1999;15:170-174.
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383-393.
Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes. Diabetes Care. 2013;36:3411-3417.
Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocr Pract. 2013;19:327-336.
Grant RW, Devita NG, Singer DE, Meigs JB. Polypharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care. 2003;26:1408-1412.
Spence MM, MaKarem AF, Reyes SL, et al. Evaluation of an outpatient pharmacy clinical services program on adherence and clinical outcomes among patients with diabetes and/or coronary artery disease. J Manag Care Spec Pharm. 2014;20:1036-1045.
Ascher-Svanum H, Lage MJ, Perez-Nieves M, et al. Early discontinuation and restart of insulin in the treatment of type 2 diabetes mellitus. Diabetes Ther. 2014; 5:225-242.
Grieve DJ, Cassidy RS, Green BD. Emerging cardiovascular actions of the incretin hormone glucagon-like peptide-1: potential therapeutic benefits beyond glycaemic control? BJP. 2009;157:1340-1351.
Zinman B, Wanner C, Lachin JM, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-2128.
Tang W, Zeve D, Seo J, Jo A-Y, Graff JM. Thiazolidinediones regulate adipose lineage dynamics. Cell Metab. 2011;14:116-122.
Vilsboll T, Christensen M, Junker AE, Knop FK, Gluud LL. Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ. 2012;344:d7771.
Safety Information: Invokana (canagliflozin). http://www.invokanahcp.com/safety-information/safety-and-tolerability-profile?sitelink=Safety%20Information&utm_source=bing&utm_medium=cpc&utm_campaign=SGLT2&utm_term=SGLT&utm_content=SGLT2|mkwid|arNHPAQ8_dc|pcrid|5878564940. Accessed January 11, 2016.
Haas B, Eckstein N, Pfeifer V, Mayer P, Hass MD. Efficacy, safety and regulatory status of SGLT2 inhibitors: focus on canagliflozin. Nutr Diabetes. 2014;4:e143.
Halimi S, Vergès B. Adverse effects and safety of SGLT-2 inhibitors. Diabetes Metab. 2014 Dec;40(6 Suppl 1):S28-S34.
Kaushal S, Singh H, Thangaraju P, Singh J. Canagliflozin: a novel SGLT2 inhibitor for type 2 diabetes mellitus N Am J Med Sci. 2014;6:107-113.
DiabetesInControl.com. Dr. Stanley Schwartz: thoughts on SGLT-2 inhibitors. May 14, 2014. http://www.diabetesincontrol.com/exclusive-interview-with-dr-stanley-schwartz-thoughts-on-sglt-2-inhibitors. Accessed January 11, 2016.
Pok EH, Lee WJ. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus. World J Gastroenterol. 2014;20:14315-14328.
Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia 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). Diabetologia. 2012;55:1577-1596.
Smith RJ, Nathan DM, Arslanian SA, Groop L, Rizza RA, Rotter JI. Individualizing therapies in type 2 diabetes mellitus based on patient characteristics: what we know and what we need to know. J Clin Endocrinol Metab. 2010;95:1566-1574.
Maric-Bilkan C. Obesity and diabetic kidney disease. Med Clin North Am. 2013;97:59-74.
Pfeffer MA, et al. The evaluation of lixisenatide in acute coronary syndrome – results of ELIXA. Presented at: American Diabetes Association 75th Scientific Sessions; June 5-9, 2015; Boston, Massachusetts. Session 3-CT-SY28.
Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract. 1995;41:169-175.
ACCORD Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-2559.
Brod M, Pohlman B, Wolden M, Christensen T. Non-severe nocturnal hypoglycemic events: experience and impacts on patient functioning and well-being. Qual Life Res. 2013;22:997-1004.
EMA. Xultophy. http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/002647/WC500170171.pdf. Accessed January 11, 2016.
Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384:2228-2234.
Rosenstock J, Fonseca VA, Gross JL, et al. Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro. Diabetes Care. 2014; 37:2317-2325.
Giorgino F, Benroubi M, Sun JH, Zimmermann AG, Pechtner V. Efficacy and safety of once-weekly dulaglutide versus insulin glargine in patients with type 2 diabetes on metformin and glimepiride (AWARD-2). Diabetes Care. 2015;38:2241-2249.
Blonde L, Jendle J, Gross J, et al. Once-weekly dulaglutide versus bedtime insulin glargine, both in combination with prandial insulin lispro, in patients with type 2 diabetes (AWARD-4): a randomised, open-label, phase 3, non-inferiority study. Lancet. 2015;385:2057-2066.
Weissman PN, Carr MC, Ye J, et al. HARMONY 4: randomised clinical trial comparing once-weekly albiglutide and insulin glargine in patients with type 2 diabetes inadequately controlled with metformin with or without sulfonylurea. Diabetologia. 2014;57:2475-2484.

WebMD Global requires each individual who is in a position to control the content of one of its educational activities to disclose any relevant financial relationships occurring within the past 12 months that could create a conflict of interest.

Moderator(s)

Stefano Del Prato, MD

Professor of Endocrinology and Metabolism, University of Pisa, School of Medicine, Pisa, Italy

Disclosures

Disclosure: Stefano Del Prato, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; GI Dynamics; GlaxoSmithKline; Hanmi Pharmaceuticals; Intarcia Therapeutics, Inc.; Janssen Pharmaceuticals; Merck Sharp & Dohme Corp.; Novartis Pharmaceuticals Corporation; Novo Nordisk; Sanofi; Takeda Pharmaceuticals North America, Inc.
Served as a speaker or a member of a speakers bureau for: AstraZeneca; Eli Lilly and Company; GlaxoSmithKline; Janssen Pharmaceuticals; Merck Sharp & Dohme Corp.; Novartis Pharmaceuticals Corporation; Novo Nordisk; Sanofi; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Merck Sharp & Dohme Corp.; Novartis Pharmaceuticals Corporation; Novo Nordisk

Panelist(s)

Melanie Davies, MD

Professor of Diabetes Medicine and Honorary Consultant Physician, University of Leicester, Leicester, United Kingdom

Disclosures

Disclosure: Melanie Davies, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Pharmaceuticals; Lilly Deutschland GmbH; Merck Sharp & Dohme Corp.; Novo Nordisk; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Pharmaceuticals; Lilly Deutschland GmbH; Merck Sharp & Dohme Corp.; Mitsubishi Tanabe Pharma Corporation; Novo Nordisk; Sanofi; Takeda
Received grants for clinical research from: Lilly Deutschland GmbH; Novo Nordisk; Sanofi

Vivian Fonseca, MD

Professor of Medicine and Pharmacology, Tullis-Tulane Alumni Chair in Diabetes, Tulane University Health Sciences Center, New Orleans, Louisiana, United States

Disclosures

Disclosure: Vivian Fonseca, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; Janssen Pharmaceuticals; Novo Nordisk; Pamlab, L.L.C.; Sanofi; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Abbott Laboratories; Asahi Kasei Pharma; Eli Lilly and Company; Endo Barrier; Gilead Sciences, Inc.; Novo Nordisk

Tina Vilsboll, MD, DMSC

Professor of Endocrinology, University of Copenhagen; Head, Center of Diabetes Research, Gentofte Hospital, Copenhagen, Denmark

Disclosures

Disclosure: Tina Vilsboll, MD, DMSC, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Company; Eli Lilly and Company; Merck Sharp & Dohme Corp.; Novo Nordisk; Takeda Pharmaceuticals North America, Inc.
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; Merck Sharp & Dohme Corp.; Novo Nordisk; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Novo Nordisk

Editor(s)

Robert McCarthy, PhD

Scientific Director, WebMD Global, LLC

Disclosures

Disclosure: Robert McCarthy, PhD, has disclosed no relevant financial relationships.

Content Reviewer

Robert Morris, PharmD

Associate CME Clinical Director

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.

CPD

Starting and Staying on Once-Weekly Therapies for T2DM

Authors: Stefano Del Prato, MD; Vivian Fonseca, MD; Tina Vilsboll, MD, DMSC; Melanie Davies, MD
CPD Released: 1/26/2016
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 1/26/2017

Start Activity

Target Audience and Goal Statement

This educational activity is intended for an international audience of non-US healthcare professionals, specifically diabetologists, endocrinologists, primary care physicians, and nephrologists involved in the treatment of patients with type 2 diabetes mellitus (T2DM).

The goal of this activity is to review 3 cases of T2DM patients insufficiently controlled on oral medications, with a focus on the roles of both primary care physicians and specialist diabetologists/endocrinologists in optimizing therapies with weekly injectables.

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

Identify barriers to optimal care for patients with T2DM including practical issues and patient- and physician-related factors
Appraise treatment algorithms and the rationale for once-weekly therapies vs shorter-acting (once-daily) agents, with a focus on identifying the most suitable patient types for longer-acting agents
Interpret the benefits/limitations of once-weekly treatment strategies, including emerging strategies with insulin combinations, and the results of relevant clinical trials

Disclosures

Moderator(s)

Stefano Del Prato, MD

Professor of Endocrinology and Metabolism, University of Pisa, School of Medicine, Pisa, Italy

Disclosures

Disclosure: Stefano Del Prato, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; GI Dynamics; GlaxoSmithKline; Hanmi Pharmaceuticals; Intarcia Therapeutics, Inc.; Janssen Pharmaceuticals; Merck Sharp & Dohme Corp.; Novartis Pharmaceuticals Corporation; Novo Nordisk; Sanofi; Takeda Pharmaceuticals North America, Inc.
Served as a speaker or a member of a speakers bureau for: AstraZeneca; Eli Lilly and Company; GlaxoSmithKline; Janssen Pharmaceuticals; Merck Sharp & Dohme Corp.; Novartis Pharmaceuticals Corporation; Novo Nordisk; Sanofi; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Merck Sharp & Dohme Corp.; Novartis Pharmaceuticals Corporation; Novo Nordisk

Panelist(s)

Melanie Davies, MD

Professor of Diabetes Medicine and Honorary Consultant Physician, University of Leicester, Leicester, United Kingdom

Disclosures

Disclosure: Melanie Davies, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Pharmaceuticals; Lilly Deutschland GmbH; Merck Sharp & Dohme Corp.; Novo Nordisk; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Pharmaceuticals; Lilly Deutschland GmbH; Merck Sharp & Dohme Corp.; Mitsubishi Tanabe Pharma Corporation; Novo Nordisk; Sanofi; Takeda
Received grants for clinical research from: Lilly Deutschland GmbH; Novo Nordisk; Sanofi

Vivian Fonseca, MD

Professor of Medicine and Pharmacology, Tullis-Tulane Alumni Chair in Diabetes, Tulane University Health Sciences Center, New Orleans, Louisiana, United States

Disclosures

Disclosure: Vivian Fonseca, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Eli Lilly and Company; Janssen Pharmaceuticals; Novo Nordisk; Pamlab, L.L.C.; Sanofi; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Abbott Laboratories; Asahi Kasei Pharma; Eli Lilly and Company; Endo Barrier; Gilead Sciences, Inc.; Novo Nordisk

Tina Vilsboll, MD, DMSC

Professor of Endocrinology, University of Copenhagen; Head, Center of Diabetes Research, Gentofte Hospital, Copenhagen, Denmark

Disclosures

Disclosure: Tina Vilsboll, MD, DMSC, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; AstraZeneca Pharmaceuticals LP; Bristol-Myers Squibb Company; Eli Lilly and Company; Merck Sharp & Dohme Corp.; Novo Nordisk; Takeda Pharmaceuticals North America, Inc.
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; Merck Sharp & Dohme Corp.; Novo Nordisk; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Novo Nordisk

Editor(s)

Robert McCarthy, PhD

Scientific Director, WebMD Global, LLC

Disclosures

Disclosure: Robert McCarthy, PhD, has disclosed no relevant financial relationships.

Content Reviewer

Robert Morris, PharmD

Associate CME Clinical Director

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

The Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the United Kingdom (FPM) has reviewed and approved the content of this educational activity and allocated it 0.50 continuing professional development credits (CPD).

Contact WebMD Global

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information about your eligibility to claim credit, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent participating in the activity. To successfully earn credit, participants must complete the activity online during the credit eligibility period that is noted on the title page.

Follow these steps to claim a credit certificate for completing this activity:

Read the information provided on the title page regarding the target audience, learning objectives, and author disclosures, read and study the activity content and then complete the post-test questions. If you earn a passing score on the post-test and we have determined based on your registration profile that you may be eligible to claim CPD credit for completing this activity, we will issue you a CPD credit certificate.
Once your CPD credit certificate has been issued, you may view and print the certificate from your CME/CE Tracker. CPD credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of the Medscape Education homepage.

We encourage you to complete an Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

From Medscape Education

CPD

Starting and Staying on Once-Weekly Therapies for T2DM

Authors: Stefano Del Prato, MD; Vivian Fonseca, MD; Tina Vilsboll, MD, DMSC; Melanie Davies, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CPD Released: 1/26/2016

Valid for credit through: 1/26/2017

processing....

This feature requires the newest version of Flash. You can download it here.

CPD Information Download Slides

Print
Like Tweet

Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of WebMD Global, LLC or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the European Medicines Agency for use in Europe and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Moderator(s)

Stefano Del Prato, MD

Panelist(s)

Melanie Davies, MD

Vivian Fonseca, MD

Tina Vilsboll, MD, DMSC

Editor(s)

Robert McCarthy, PhD

Content Reviewer

Robert Morris, PharmD

CPD

Starting and Staying on Once-Weekly Therapies for T2DM

Target Audience and Goal Statement

Disclosures

Moderator(s)

Stefano Del Prato, MD

Panelist(s)

Melanie Davies, MD

Vivian Fonseca, MD

Tina Vilsboll, MD, DMSC

Editor(s)

Robert McCarthy, PhD

Content Reviewer

Robert Morris, PharmD

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Starting and Staying on Once-Weekly Therapies for T2DM