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A Case in Point: The Appropriate Use of a Glucagon-Like Peptide-1 Receptor Agonist in Patients With Uncontrolled Diabetes in Primary Care

  • Authors: Eduard Montanya, MD, PhD
  • CME Released: 11/11/2022
  • Valid for credit through: 11/11/2023
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This educational activity is intended for an international audience of non-US and non-UK primary care physicians, cardiologists, and other HCPs involved in the management of patients with T2D.

The goal of this activity is for learners to improve their ability to manage patients with T2D using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and other cardiorenal protective agents.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Broad clinical benefits of oral and injectable GLP-1 RAs
  • Have greater competence related to the
    • Practical aspects of initiating oral or injectable GLP-1 RAs safely and effectively in primary care


Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Eduard Montanya, MD, PhD

    Professor of Medicine
    University of Barcelona
    Barcelona, Spain


    Eduard Montanya, MD, PhD, has the following relevant financial relationships:
    Consultant or advisor for: Novo Nordisk; Roche; Sanofi
    Speaker or member of speakers bureau for: Merck Sharp & Dohme; Novo Nordisk; Sanofi
    Research funding from: Menarini


  • Grace O'Malley, BSc, PhD

    Associate Medical Education Director, WebMD Global, LLC


    Grace O'Malley, BSc, PhD, has no relevant financial relationships.

  • Gina Montanero, PharmD

    Associate Medical Writer, Medscape, LLC


    Gina Montanero, PharmD, has no relevant financial relationships.

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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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 in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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A Case in Point: The Appropriate Use of a Glucagon-Like Peptide-1 Receptor Agonist in Patients With Uncontrolled Diabetes in Primary Care

Authors: Eduard Montanya, MD, PhDFaculty and Disclosures

CME Released: 11/11/2022

Valid for credit through: 11/11/2023


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Leo is a 48-year-old barkeeper. After being diagnosed with diabetes 4 years ago, he is concerned about his health. He comes to the primary care office today for his annual checkup and to review his recent laboratory results. He tells you that he cut back to only smoking cigarettes in the mornings and on nights that he works, and he only has a drink or 2 after work on the weekends. Because he works nights and odd hours at the bar, he eats most of his meals on the go, and he asks for advice on losing some weight. 

Leo's medical history and the results of his physical exam and laboratory tests are shown in Table 1. He does not have overt cardiovascular disease (CVD). You note that his blood pressure (BP) is 145/94 mm Hg despite adherence to an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker. His glycated hemoglobin (HbA1c) is 7.4% on metformin.


Table 1. Leo's Medical Record

History Findings
Medical T2D × 4 years, hypertension × 10 years, dyslipidemia × 8 years, and obesity
Current medications Metformin 1000 mg twice daily, lisinopril 20 mg/d, metoprolol 100 mg twice daily, simvastatin 20 mg/d
Social/Occupational Barkeeper, single; divorced, lives with dog; smoker × 30 years, recreational drinker; has 2 adult sons. Sedentary lifestyle. High-fat diet; poor intake of fruit, vegetables, and whole grains
Physical Exam Findings
Vital signs  BP: 145/94 mm Hg Heart rate: 78 bpm
Body measurements Weight 96 kg, waist circumference 112 cm, BMI 35.5 kg/m2; class 2 obesity 
Extremities No edema
Neck No distended neck veins
Lungs No rales
Abdomen Soft, nontender
CBC Results
Metabolic Panel Results
FPG 122 mg/dL
HbA1c 7.4%
Lipid panel LDL 75 mg/dL, HDL 35 mg/dL, TG 170 mg/dL
eGFR 91 mL/min/m2
UACR 9 mg/g
BMI, body mass index; CBC, complete blood count; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TG, triglyceride; UACR, urine albumin-to-creatinine ratio
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