CME/CE: Updating Comprehensive Type 2 Diabetes Management

CME/CE: Updating Comprehensive Type 2 Diabetes Management
Author Information (click to view)

Alan J. Garber, MD, PhD, FACE

Medicine, Biochemistry, and Molecular & Cellular BiologyDiabetes
Endocrinology and Metabolism
Baylor College of Medicine

Alan J. Garber, MD, PhD, FACE, has indicated to Physician’s Weekly that he has been a consultant for Novo Nordisk and Intarcia.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Review the latest update to the American Association of Clinical Endocrinologists and the American College of Endocrinology’s comprehensive type 2 diabetes management algorithm.

Method of Participation(click to view)

Release Date: 4/28/17
Expiration Date: 4/28/2018

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at akhcme.com/akhcme/lessons/59.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Alan J. Garber, MD, PhD, FACE
Discloses the following financial relationships with pharmaceutical or medical product manufacturers:
Consultant: Intarcia Therapeutics, Inc; Novo Nordisk, Inc.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.

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Alan J. Garber, MD, PhD, FACE (click to view)

Alan J. Garber, MD, PhD, FACE

Medicine, Biochemistry, and Molecular & Cellular BiologyDiabetes
Endocrinology and Metabolism
Baylor College of Medicine

Alan J. Garber, MD, PhD, FACE, has indicated to Physician’s Weekly that he has been a consultant for Novo Nordisk and Intarcia.

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The American Association of Clinical Endocrinologists has updated its algorithm for the comprehensive management of type 2 diabetes. The algorithm emphasizes obesity as a risk factor for diabetes and its complications. It also stresses titrating medications appropriately and reinforcing the need to lose weight loss and use lifestyle therapies.
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The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) recently published an update to their comprehensive type 2 diabetes management algorithm. “The update provides clinicians with a practical guide that considers the whole patient, their spectrum of cardiovascular risks and complications, and evidence-based approaches to treatment,” explains Alan J. Garber, MD, PhD, FACE, who was the AACE/ACE Task Force chair for the updated algorithm. “It’s designed to serve as a practical and easy-to-use decision-making tool for patients’ medical management.”

The AACE/ACE algorithm, which was published in Endocrine Practice, has been updated to reflect the role of newer therapies, management approaches, and important clinical data. It includes an updated section on lifestyle therapy and discusses all classes of obesity as well as anti-hyperglycemic, lipid-lowering, and antihypertensive medications that have most recently been approved by the FDA. The document also details specific lipid targets for patients with type 2 diabetes based on their unique characteristics (Table). The recommendations for blood pressure and lipid control are critical as these have been identified as the two most important risk factors for cardiovascular disease (CVD).

 

An Emphasis on Obesity

It is important to note that the updated algorithm emphasizes obesity as one of the underlying risk factors for type 2 diabetes and its microvascular complications. Placing a great emphasis on obesity and its role in the development and management of type 2 diabetes may guide physicians in providing tailored care to optimize patient outcomes. The update also includes important information on necessary weight loss therapies as well as details regarding the evaluation and treatment of cardiovascular risks.

The AACE/ACE Task Force notes that the updated algorithm reiterates the organizations’ recently published position that obesity is fundamentally a chronic, complications-centric disease that is progressive and requires patients to have a long-term commitment to weight loss and to maintain use of important lifestyle therapies. Specifically, weight loss therapy should consist of a lifestyle prescription that incorporates a reduced-calorie healthy meal plan in addition to prescriptions for physical activity and behavioral interventions. According to the AACE/ACE Task Force, clinicians should consider using FDA-approved weight loss medications for obesity if they are needed to achieve the degree of weight loss required to reach therapeutic goals.

 

Stratifying CVD Risk

According to Dr. Garber, the AACE/ACE algorithm also focuses on stratifying CVD risk factors and treatment recommendations based on each patient’s risk profile. “The document provides clinicians with a detailed assessment of all FDA-approved anti-diabetic medications and their impact on congestive heart failure and artherosclerotic CVD,” he says. “This update is thoroughly constructed to address specific problems in diabetes care in a concise, practical, and actionable manner in order to help healthcare providers develop effective patient care plans.”

 

Follow Guiding Principles

The AACE/ACE algorithm is organized into discrete sections that address various aspects that are critical to improving the management of type 2 diabetes. It is recommended that all clinicians follow the founding principles of the algorithm. This includes guidance on using lifestyle therapies and insulin as well as recommendations for treating obesity, prediabetes, hypertension, and dyslipidemia.

According to the AACE/ACE document, lifestyle therapy—which includes medically-supervised weight loss—is key to managing type 2 diabetes. Weight loss should be considered a lifelong goal, and behavioral interventions and weight loss medications should be used as required to achieve chronic therapeutic goals. Glycemic control targets include fasting and postprandial glucoses.

 

Treatment Considerations

When choosing therapies, clinicians are recommended to use initial A1C levels as a guide. “Treatments must be individualized on the basis of patient characteristics, the impact of net cost to patients, formulary restrictions, and personal preferences,” Dr. Garber says. “The algorithm is also flexible with regard to applicability because guidance is offered based on each patient’s unique characteristics and needs.”

Clinicians are urged to titrate all diabetes medications appropriately and in a timely manner when managing this patient group in order to optimize outcomes. Doses of medications may vary depending on the drug being used. As such, physicians will likely need to adjust doses, regardless the medication class.

AACE/ACE also emphasizes that minimizing risks of hypoglycemia and weight gain should be top priorities. The document notes that initial acquisition cost of medications is only a part of the total care for patients. Clinicians should regularly monitoring requirements, risk of hypoglycemia, weight gain, and safety.

Recommendations are also provided for using combination therapy, which is usually required and should involve agents with complementary actions. To comprehensively manage patients, efforts should include lipid and blood pressure therapies and treatments for related comorbidities. Therapies should be evaluated frequently—about every 3 months—until patients are stable before seeing them less often. Importantly, doctors are urged to make therapeutic regimens as simple as possible to optimize adherence.

Readings & Resources (click to view)

Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm – 2017 executive summary. Endocrine Pract. 2017 Jan 17 [Epub ahead of print]. Available at: https://www.aace.com/publications/algorithm and at: http://journals.aace.com/doi/abs/10.4158/EP161682.CS.

Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology: clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocr Pract. 2015;21:1-87.

Mechanick JI, Garber AJ, Handelsman Y, Garvey WT. American Association of Clinical Endocrinologists’ position statement on obesity and obesity medicine. Endocrine Pract. 2012;18:642-648.

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