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Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-1589.
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Roumie CL, Hung AM, Greevy RA, et al. Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2012;157:601-610.
Monami M, Genovese S, Mannucci E. Cardiovascular safety of sulfonylureas: a meta-analysis of randomized clinical trials. Diabetes Obes Metab. 2013;15:938-953.
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Marx N, Rosenstock J, Kahn SE, et al. Design and baseline characteristics of the CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes (CAROLINA^®). Diab Vasc Dis Res. 2015;12:164-174.
Dormandy JA, Charbonnel B, Eckland DJ, et al; PROactive Investigators. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005;366:1279-1289.
Erdmann E, Dormandy JA, Charbonnel B, et al. The effect of pioglitazone on recurrent myocardial infarction in 2,445 patients with type 2 diabetes and previous myocardial infarction: results from the PROactive (PROactive 05) Study. J Am Coll Cardiol. 2007;49:1772-1780.
Wilcox R, Bousser MG, Betteridge DJ, et al; PROactive Investigators. Effects of pioglitazone in patients with type 2 diabetes with or without previous stroke: results from PROactive (PROspective pioglitAzone Clinical Trial In macroVascular Events 04). Stroke. 2007;38:865-873.
Home PD, Pocock SJ, Beck-Nielsen H, et al; RECORD Study Team. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet. 2009;373:2125-2135.
Bach RG, Brooks MM, Lombardero M, et al; BARI 2D Investigators. Rosiglitazone and outcomes for patients with diabetes mellitus and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Circulation. 2013;128:785-794.
Kernan WN, Viscoli CM, Furie KL, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374:1321-1331.
Chiasson JL, Josse RG, Gomis R, et al; STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003;290:486-494.
ORIGIN Trial Investigators, Gerstein HC, Bosch J, et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012;367:319-328.
Drucker DJ. Dipeptidyl peptidase-4 inhibition and the treatment of type 2 diabetes: preclinical biology and mechanisms of action. Diabetes Care. 2007;30:1335-1343.
Scirica BM, Bhatt DL, Braunwald E, et al; SAVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369:1317-1326.
White WB, Cannon CP, Heller SR, et al; EXAMINE Investigators. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369:1327-1335.
Bethel MA, Green JB, Milton J, et al; TECOS Executive Committee. Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Obes Metab. 2015;17:395-402.
Green JB, Bethel MA, Armstrong PW, et al; TECOS Study Group. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373:232-242.
Scirica BM, Braunwald E, Raz I, et al; SAVOR-TIMI 53 Steering Committee and Investigators. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation. 2014;130:1579-1588.
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Moderator

Carol H. Wysham, MD

Clinical Associate Professor of Medicine, University of Washington, Spokane, Washington

Disclosures

Disclosure: Carol H. Wysham, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Lilly; Janssen Pharmaceuticals, Inc.; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Lilly; Janssen Pharmaceuticals, Inc.; Novo Nordisk; Sanofi

Dr Wysham does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Wysham does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelists

John E. Anderson, MD

Internist, The Frist Clinic, Nashville, Tennessee

Disclosures

Disclosure: John E. Anderson, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Global Services LLC; Lilly; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Global Services LLC; Lilly; Pamlab, L.L.C.; Sanofi

Dr Anderson does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Anderson does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Lawrence Blonde, MD

Director, Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diabetes and Metabolism, Associate Internal Medicine Residency Program Director, New Orleans, Louisiana

Disclosures

Disclosure: Lawrence Blonde, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; GlaxoSmithKline; Intarcia Therapeutics, Inc.; Janssen Pharmaceuticals, Inc.; Merck & Co., Inc.; Novo Nordisk; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Janssen Pharmaceuticals, Inc.; Merck & Co.; Novo Nordisk, Sanofi (Click here to enter...)
Received grants for clinical research from: AstraZeneca Pharmaceuticals LP; Janssen Pharmaceuticals, Inc.; Lexicon Pharmaceuticals, Inc.; Novo Nordisk; Merck & Co.; Sanofi

Dr Blonde does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Blonde does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Serge Jabbour, MD

Professor of Medicine; Director, Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Disclosures

Disclosure: Serge A. Jabbour, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly

Dr Jabbour does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Jabbour does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Scientific Director

Anne G. Le, PharmD, RPh

Senior Scientific Director, Medscape, LLC

Disclosures

Disclosure: Anne G. Le, PharmD, RPh, has disclosed no relevant financial relationships.

Editor

Eleanor Swift Yasgur, MA, LSW

Teaneck, NJ

Disclosures

Disclosure: Eleanor Swift Yasgur, MA, LSW, has disclosed no relevant financial relationships.

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Robert Morris, PharmD

Associate CME Clinical Director, Medscape, LLC

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

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This activity has been peer reviewed and the reviewer has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Novo Nordisk; Sanofi
Served as a speaker or a member of a speakers bureau for: Merck; Novo Nordisk; Sanofi

CME

Cardiovascular Outcomes With Antihyperglycemic Therapy: Past, Present, and Future Impact on Practice

Authors: Carol H. Wysham, MD; John E. Anderson, MD; Lawrence Blonde, MD; Serge A. Jabbour, MD
CME Released: 6/23/2016
THIS ACTIVITY HAS EXPIRED
Valid for credit through: 6/23/2017

Start Activity

Target Audience and Goal Statement

This activity is intended for diabetologists & endocrinologists, primary care physicians, and cardiologists.

The goal of this activity is to provide participants with an understanding of the importance of improving cardiovascular (CV) outcomes in diabetes management, and how recently reported CV outcomes data related to type 2 diabetes (T2D) therapies impact current and future clinical practice.

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

Identify the link between diabetes, CVD, and risk
Recognize the rationale for CV outcomes trials in patients with T2D
Compare CV outcomes clinical data among older and modern classes of antihyperglycemic agents
Assess effect of CV outcomes data on modern T2D practice

Disclosures

Moderator

Carol H. Wysham, MD

Clinical Associate Professor of Medicine, University of Washington, Spokane, Washington

Disclosures

Disclosure: Carol H. Wysham, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Lilly; Janssen Pharmaceuticals, Inc.; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Lilly; Janssen Pharmaceuticals, Inc.; Novo Nordisk; Sanofi

Dr Wysham does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Wysham does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelists

John E. Anderson, MD

Internist, The Frist Clinic, Nashville, Tennessee

Disclosures

Disclosure: John E. Anderson, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Global Services LLC; Lilly; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Global Services LLC; Lilly; Pamlab, L.L.C.; Sanofi

Dr Anderson does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Anderson does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Lawrence Blonde, MD

Director, Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diabetes and Metabolism, Associate Internal Medicine Residency Program Director, New Orleans, Louisiana

Disclosures

Disclosure: Lawrence Blonde, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; GlaxoSmithKline; Intarcia Therapeutics, Inc.; Janssen Pharmaceuticals, Inc.; Merck & Co., Inc.; Novo Nordisk; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Janssen Pharmaceuticals, Inc.; Merck & Co.; Novo Nordisk, Sanofi (Click here to enter...)
Received grants for clinical research from: AstraZeneca Pharmaceuticals LP; Janssen Pharmaceuticals, Inc.; Lexicon Pharmaceuticals, Inc.; Novo Nordisk; Merck & Co.; Sanofi

Dr Blonde does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Blonde does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Serge Jabbour, MD

Professor of Medicine; Director, Division of Endocrinology, Diabetes & Metabolic Diseases, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Disclosures

Disclosure: Serge A. Jabbour, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly

Dr Jabbour does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Jabbour does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Scientific Director

Anne G. Le, PharmD, RPh

Senior Scientific Director, Medscape, LLC

Disclosures

Disclosure: Anne G. Le, PharmD, RPh, has disclosed no relevant financial relationships.

Editor

Eleanor Swift Yasgur, MA, LSW

Teaneck, NJ

Disclosures

Disclosure: Eleanor Swift Yasgur, MA, LSW, has disclosed no relevant financial relationships.

CME Reviewer

Robert Morris, PharmD

Associate CME Clinical Director, Medscape, LLC

Disclosures

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

Peer Reviewer

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From Medscape Education Diabetes & Endocrinology

CME

Cardiovascular Outcomes With Antihyperglycemic Therapy: Past, Present, and Future Impact on Practice

Authors: Carol H. Wysham, MD; John E. Anderson, MD; Lawrence Blonde, MD; Serge A. Jabbour, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED

CME Released: 6/23/2016

Valid for credit through: 6/23/2017

processing....

Abbreviations

ACS = acute coronary syndrome
AGE = advanced glycation end products
AGI = a-glucosidase inhibitor
ALT = alanine aminotransferase
BP = blood pressure
BID = twice daily
BMI = body mass index
CABG = coronary artery bypass graft
CAC = coronary artery calcium
CAD = coronary artery disease
CHD = coronary heart disease
CHF = congestive heart failure
CKD = chronic kidney disease
CRP = C-reactive protein
CV = cardiovascular
CVA = cerebrovascular accident
CVD = cardiovascular disease
CVOT = cardiovascular outcome trial
DPP-4 = dipeptidyl-peptidase-4
DPP-4-I = dipeptidyl-peptidase-4 inhibitor
EFS = event-free survival
eGFR = estimated glomerular filtration rate
Empa = empagliflozin
FDA = Food and Drug Administration
FPG = fasting plasma glucose
GLP-1 = glucagon-like peptide-1
HbA_1c = glycated hemoglobin
HDL = high-density lipoprotein
HDL-C = high-density lipoprotein cholesterol
HF = heart failure
HHF = hospitalizations for heart failure
HR = hazard ratio
HTN = hypertension
Hypo = hypoglycemic events by time spent
IL = interleukin
ITT = intention-to-treat
LDL = low-density lipoprotein
LDL-C = low-density lipoprotein cholesterol
LS = least square
MACE = major adverse cardiovascular event
MedDRA = Medical Dictionary for Regulatory Activities
MESI = medical events of special interest
MH-OR = Mantel-Haenszel odds ratio
MI = myocardial infarction
NPH = neutral protamine Hagedorn
NS = not significant
NT-proBNP = N-terminal pro-B-type natriuretic peptide
OAD = oral antidiabetic
OASIS = Organization to Assess Strategies for Ischemic Syndromes
PAD = peripheral artery disease
PAI-1 = plasminogen activator inhibitor-1
PCI = percutaneous coronary intervention
Pio = pioglitazone
PP = postprandial
QW = once weekly
RA = receptor agonist
revasc = revascularization
RR = relative risk
RRR = relative risk reduction
SAA = serum amyloid A
SBP = systolic blood pressure
SGLT1 = sodium-glucose cotransporter 1
SGLT2 = sodium-glucose cotransporter 2
SMBG = self-monitoring of blood glucose
Std = standard
SU = sulfonylurea
T1D = type 1 diabetes
T2D = type 2 diabetes
TC = total cholesterol
TF = tissue factor
TG = triglycerides
tPA = tissue plasminogen activator
TSH = thyroid-stimulating hormone
TZD = thiazolidinedione
UA = unstable angina
UACR = urine albumin-to-creatinine ratio

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References

Faculty and Disclosures

Moderator

Carol H. Wysham, MD

Panelists

John E. Anderson, MD

Lawrence Blonde, MD

Serge Jabbour, MD

Scientific Director

Anne G. Le, PharmD, RPh

Editor

Eleanor Swift Yasgur, MA, LSW

CME Reviewer

Robert Morris, PharmD

Peer Reviewer

CME

Cardiovascular Outcomes With Antihyperglycemic Therapy: Past, Present, and Future Impact on Practice

Target Audience and Goal Statement

Disclosures

Moderator

Carol H. Wysham, MD

Panelists

John E. Anderson, MD

Lawrence Blonde, MD

Serge Jabbour, MD

Scientific Director

Anne G. Le, PharmD, RPh

Editor

Eleanor Swift Yasgur, MA, LSW

CME Reviewer

Robert Morris, PharmD

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Cardiovascular Outcomes With Antihyperglycemic Therapy: Past, Present, and Future Impact on Practice

Abbreviations