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      Tuesday, May 30, 2023
      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
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      CME

      Real-Life Cases of Patients With Type 2 Diabetes and Chronic Kidney Disease: A Practice Challenge

      • Authors: Roberto Pecoits-Filho, MD, PhD
      • CME Released: 2/24/2023
      • Valid for credit through: 2/24/2024
      Start Activity

      • 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 activity is intended for primary care physicians (PCPs); nephrologists, diabetologists, and endocrinologists; and cardiologists.

      The goal of this activity is for learners to be better able to acknowledge serious health risks associated with chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and the availability of novel treatment options shown to reduce the risk of associated complications.

      Upon completion of this activity, participants will:

      • Have increased knowledge regarding the
        • Latest international society guideline recommendations for management of patients with CKD and T2D
        • Safety aspects of novel, selective nonsteroidal mineralocorticoid receptor antagonists (ns MRAs) for reducing the risk of CKD progression and cardiovascular (CV) risk reduction in patients with CKD
      • Have greater competence related to
        • Regular assessment of kidney function in patients with T2D
        • Practical use of novel mineralocorticoid receptor antagonists (MRAs) in appropriate patients with CKD and T2D

      Disclosures

      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.

      Faculty

      • Roberto Pecoits-Filho, MD, PhD

        Scientific Director
        Arbor Research Collaborative for Health
        Ann Arbor, Michigan

        Disclosures

        Roberto Pecoits-Filho, MD, PhD, has the following relevant financial relationships:
        Consultant or advisor for: Akebia Therapeutics; AstraZeneca; Bayer AG; Boehringer-Lilly; Fresenius Medical Care; Novo Nordisk
        Speaker or member of speakers bureau for: Akebia Therapeutics; AstraZeneca; Boehringer-Lilly; Fresenius Medical Care; Novo Nordisk
        Research funding from: AstraZeneca; Fresenius Medical Care

      Editor

      • Rita Moreira Da Silva, PhD, PharmD

        Medical Education Director, WebMD Global, LLC

        Disclosures

        Rita Moreira Da Silva, PhD, PharmD, has no relevant financial relationships.

      • Gina Montanero, PharmD

        Associate Medical Writer, Medscape, LLC

        Disclosures

        Gina Montanero, PharmD, has no relevant financial relationships.

      Compliance Reviewer

      • Yaisanet Oyola, MD

        Associate Director, Accreditation and Compliance, Medscape, LLC

        Disclosures

        Yaisanet Oyola, MD, has no relevant financial relationships.

      Peer Reviewer

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

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      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.

        Contact This Provider

      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 on applicability and acceptance of continuing education credit for this activity, 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 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.

      Follow these steps to earn CME/CE credit*:

      1. Read about the target audience, learning objectives, and author disclosures.
      2. Study the educational content online or print it out.
      3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the 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 from the CME/CE Tracker.

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      < CLINICAL ADVANCES IN Chronic Kidney Disease in Type 2 Diabetes
      From Medscape Education Family Medicine
      CME

      Real-Life Cases of Patients With Type 2 Diabetes and Chronic Kidney Disease: A Practice Challenge

      Authors: Roberto Pecoits-Filho, MD, PhDFaculty and Disclosures

      CME Released: 2/24/2023

      Valid for credit through: 2/24/2024

      processing....

      References

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      2. Jager KJ, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96:1048-1050.
      3. de Boer IH, et al. Diabetes Management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022;45:3075-3090.
      4. Briasoulis A, et al. Chronic kidney disease as a coronary artery disease risk equivalent. Curr Cardiol Rep. 2013;15:340.
      5. Davies MJ, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45:2753-2786.
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      7. Cosentino F, et al; ESC Scientific Document Group. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41:255-323.
      8. Shlipak MG, et al; Conference Participants. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021;99:34-47.
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      17. Marso SP, et al; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311-322.
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      21. Zinman B, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-2128.
      22. McGuire DK, et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: a meta-analysis. JAMA Cardiol. 2021;6:148-158.
      23. Zelniker TA, et al. Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation. 2019;139:2022-2031.
      24. Bellastella G, et al. Glucagon-like peptide-1 receptor agonists and prevention of stroke systematic review of cardiovascular outcome trials with meta-analysis. Stroke. 2020;51:666-669.
      25. Kristensen SL, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019;7:776-785.
      26. Sattar N, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol. 2021;9:640-641.
      27. Giugliano D, et al. GLP-1 receptor agonists and cardiorenal outcomes in type 2 diabetes: an updated meta-analysis of eight CVOTs. Cardiovasc Diabetol. 2021;20:189.
      28. gov. A research study to see how semaglutide works compared to placebo in people with type 2 diabetes and chronic kidney disease (FLOW). Accessed January 9, 2023. https://clinicaltrials.gov/ct2/show/NCT03819153
      29. EMPA-KIDNEY Collaborative Group, Herrington WG, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388:117-127.
      30. Heerspink HJL, et al. Dapagliflozin in patients with chronic kidney disease. New Engl J Med. 2020;383:1436-1446.
      31. Perkovic V, et al; CREDENCE Trial Investigators. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295-2306.
      32. Staplin N, et al. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet. 2022;400:1788-1801.
      33. Heidenreich PA, et al. 2022 ACC/AHA/HFSA guideline for the management of heart failure. J Card Fail. 2022;28:e1-e167.
      34. Agarwal R, et al; FIDELIO-DKD and FIGARO-DKD Investigators. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J. 2022;43:474-484.
      35. Ito S, et al. Esaxerenone (CS-3150) in patients with type 2 diabetes and microalbuminuria (ESAX-DN): phase 3 randomized controlled clinical trial. Clin J Am Soc Nephrol. 2020 Dec 7;15:1715-1727.
      36. Finerenone [prescribing information]. Approved 2021.
      37. Bakris GL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. New Engl J Med. 2020;383:2219-2229.
      38. Pitt B, et al. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. New Engl J Med. 2021;385:2252-2263.
      39. Diaz Acevedo J, et al. Abstract 10533: cardiorenal effects of SGLT2 inhibitors and finerenone in type 2 diabetes and chronic kidney disease. Single, dual or triple therapy? A network meta-analysis. Circulation. 2022;146:A10533
      40. Rossing P, et al. Finerenone in patients with chronic kidney disease and type 2 diabetes by sodium-glucose cotransporter 2 inhibitor treatment: the FIDELITY analysis. Diabetes Care. 2022;45:2991-2998.
      41. American Diabetes Association. 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of care in diabetes--2023. Diabetes Care. 2022;46:S128-S139.
      42. Wharton S, et al. Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice. Postgrad Med. 2022;134:14-19.
      43. Trujillo JM, et al. GLP-1 receptor agonists: an updated review of head-to-head clinical studies. Ther Adv Endocrinol Metab. 2021;12:204201882199732.
      44. Frías JP, et al. Efficacy and safety of dulaglutide 3.0 mg and 4.5 mg versus dulaglutide 1.5 mg in metformin-treated patients with type 2 diabetes in a randomized controlled trial (AWARD-11). Diabetes Care. 2021;44:765-773.
      45. Frías JP, et al. Efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial. Lancet Diabetes Endocrinol. 2021;9:563-574.
      46. Liraglutide [prescribing information]. Approved 2010. Revised 2020.
      47. Semaglutide injection [prescribing information]. Approved 2017. Revised 2021.
      48. Janež A, et al. SGLT2 inhibitors and the clinical implications of associated weight loss in type 2 diabetes: a narrative review. Diabetes Ther. 2021;12:2249-2261.
      49. Lee PC, et al. Weight loss associated with sodium-glucose cotransporter-2 inhibition: a review of evidence and underlying mechanisms. Obes Rev. 2018;19:1630-1641.
      50. Frías JP, et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. New Engl J Med. 2021;385:503-515.
      51. gov. A study of tirzepatide (LY3298176) compared with dulaglutide on major cardiovascular events in participants with type 2 diabetes (SURPASS-CVOT). Accessed September 13, 2022. https://clinicaltrials.gov/ct2/show/NCT04255433
      52. American Diabetes Association. 10. Cardiovascular disease and risk management: standards of care in diabetes--2023. Diabetes Care. 2022;46:S158-S190.
      53. Stenvinkel P, et al. Chronic inflammation in chronic kidney disease progression: role of Nrf2. Kidney Int Rep. 2021;6:1775-1787.
      54. Bakris GL, et al; Mineralocorticoid Receptor Antagonist Tolerability Study-Diabetic Nephropathy (ARTS-DN) Study Group. Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. JAMA. 2015;314(9):884-94.
      55. Epstein M, et al. Aldosterone, mineralocorticoid receptor activation, and CKD: a review of evolving treatment paradigms. Am J Kidney Dis. 2022;80:658-666.
      56. Agarwal R, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021 Jan 7;42:152-161.
      57. Pitt B, et al. Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J. 2013;34:2453-2463.
      58. Agarwal R, et al. A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease. Clinical Kidney Journal. 2023;16:293-302.
      59. Filippatos G, et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J. 2016;37:2105-2114.
      « Return to: Real-Life Cases of Patients With Type 2 Diabetes and Chronic Kidney Disease: A Practice Challenge
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