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Initiating and intensifying therapy in type 2 diabetes: Managing the progressive nature of the disease
Go to supplement >>FREE 2.0 CME Credits Release Date: October 1, 2008
Expiration Date: October 1, 2009 Learning Objectives • Summarize current recommendations for screening patients for type 2 diabetes mellitus (T2DM).
• Explain the progressive nature of T2DM and how this characteristic demands progressive therapeutic intervention to reach and maintain treatment goals.
• Describe recent treatment algorithms for adding, changing, or adjusting the dosage of medications in patients whose glycemic control is suboptimal on their current treatment regimens.
• List the dosing ranges for initiating insulin in the treatment of patients with T2DM.
• Discuss the pros and cons of incretin-based therapies and where they fit into the existing treatment paradigm for T2DM.
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Faculty Disclosures
Dr Brunton is on the advisory boards for Amylin, Novo Nordisk, Inc. and Pfizer.
Dr Tenzer-Iglesias is on the CME speakers’ bureau and/or has received honorarium from Abbott Laboratories and Boehringer-Ingelheim.
Dr Unger receives royalties from Lippincott and Elsevier; is on the advisory boards for Amylin, Eli Lilly, Nektar Pharmaceuticals, Novo Nordisk Inc., Pfizer and sanofi-aventis; is on the speakers’ bureau for Amylin, Eli Lilly, Novo Nordisk Inc., Pfizer and sanofi-aventis; receives contracted research from Amylin and has ownership interest in Amylin. |
Sponsor Disclosure Statement The content collaborators at the Primary Care Education Consortium report that there are no existing financial relationships to disclose. Statement of Support This program is sponsored by the Primary Care Education Consortium and is supported by an educational grant from Novo Nordisk Inc. Medium: CME print publication Accreditation Statement This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the Primary Care Education Consortium. The Primary Care Education Consortium designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This activity has been reviewed and is acceptable for up to 2 Prescribed credits by the American Academy of Family Physicians. Of these credits, 1 conforms to the AAFP criteria for evidence-based CME clinical content. CME credit has been increased to reflect 2 for 1 credit for only the EB CME portion. AAFP accreditation begins 10/1/08. The term of approval is for one year from this date, with option for yearly renewal. When reporting AAFP credit, report total Prescribed and Elective credit for this activity. It is not necessary to label credit as evidence-based for reporting purposes.
The EB CME credit awarded for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since clinical research is ongoing, AAFP recommends that learners verify sources and review these and other recommendations prior to implementation into practice. Release Date: October 1, 2008
Expiration Date: October 1, 2009 Method of Physician Participation After reading the supplement in its entirety, go to: www.pceconsortium.org/YBTJsupp and complete the online evaluation. Upon completing the evaluation you will be prompted to print your certificate of completion. Clinical Practice Recommendations for AAFP EB CME Designation Practice Recommendation: The ADA recommends continuing timely augmentation of therapy with additional agents (including early initiation of insulin therapy) as a means of achieving and maintaining recommended levels of glycemic control (ie, A1C <7% for most patients). Evidence-Based Source: National Guideline Clearinghouse Website of Supporting Evidence: http://care.diabetesjournals.org/cgi/content/full/31/Supplement_1/S12 Strength of Evidence: Consensus treatment recommendation Practice Recommendation: Monitoring of glycemic status is considered a cornerstone of diabetes care and affects how physicians and patients adjust medical therapy as well as behavioral therapy (e.g., diet and exercise). HbA1c is the preferred standard for measuring glycemic control over the previous 2-3 months. Evidence-Based Source: Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Website of Supporting Evidence: http://www.ahrq.gov/clinic/epcsums/glycasum.pdf Strength of Evidence: Consistent, good-quality patient-oriented evidence Practice Recommendation: Incretin therapy offers an alternative option to currently available hypoglycemic agents for nonpregnant adults with type 2 diabetes, with modest efficacy and a favorable weight-change profile. Evidence-Based Source: Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: systematic review and meta-analysis. JAMA. 2007 Jul 11;298(2):194-206. Website of Supporting Evidence: http://jama.ama-assn.org/cgi/content/full/298/2/194
Strength of Evidence: Consistent, good-quality patient-oriented evidence 
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