A
Comprehensive Review of Incretin Therapies for Type 2 Diabetes
Faculty
Jeffrey
S. Freeman, DO, FACOI
Professor of Internal Medicine
Chairman, Division of Endocrinology and Metabolism
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvania
Biography
Jeffrey S. Freeman, DO, FACOI, is Professor of Internal Medicine and
Chairman of the Division of Endocrinology and Metabolism at the Philadelphia
College of Osteopathic Medicine (PCOM) in Philadelphia, Pennsylvania.
Dr. Freeman earned his medical degree at the College of Osteopathic
Medicine and Surgery, Des Moines, Iowa. He is a Fellow of the American
College of Osteopathic Internists and the American College of Physicians
and is a member of the Philadelphia Endocrinology Society and the American
Diabetes Association. He is a founding board member of the Northeast
Lipid Association (NELA), a former program director of the Endocrinology
Division of the American College of Osteopathic Internists, past president
of the American Diabetes Association's Pennsylvania Affiliate, and past
president-elect of the American Diabetes Association, Mid-Atlantic Region.
Dr. Freeman
has been Chairman of the Division of Metabolic Diseases of the Pennsylvania
Osteopathic Medical Association for over 15 years and has served as
an Assistant Editor of Diabetes Forecast. He has been an investigator
in trials of pramlintide, PPAR dual agonists, DPP-IV inhibitors, and
glucose sensing. He has published over 20 papers, most recently a review
of C-reactive protein; a paper identifying glucose excursions with glucose
sensing with pramlintide use is in press.
Dr. Freeman
is in solo and group clinical practices in Philadelphia and the surrounding
area.
Frank
Svec, MD, PhD
Chief, Section of Endocrinology
Professor of Medicine
School of Medicine at New Orleans
LSU Health Sciences Center
New Orleans, Louisiana
Biography
Frank Svec, MD, PhD, graduated in 1974 from Case Western Reserve's MD-PhD
program with a PhD in biochemistry. After completing a residency in
internal medicine at the Cleveland Metropolitan Hospital, an affiliate
of Case, he undertook a fellowship in endocrinology at Vanderbilt University,
where he worked with Robert Harrison, MD, and Grant Liddle, MD, on characterizing
the glucocorticoid receptor of pituitary cells.
In 1979, Dr. Svec began his career in the Department of Medicine, Section
of Endocrinology, at Louisiana State University in New Orleans. He rose
to the position of professor of medicine and chief of the section. In
1993 he completed a sabbatical year in the prestigious endocrine section
of St Bartholomew's Hospital in London, England. In addition to his
clinical responsibilities, he has continued an active research career
in the areas of obesity, appetite control, and insulin resistance. His
current research interest is the effect of periodontitis and premature
birth. He has nearly 100 peer-reviewed publications and a similar number
of abstracts and has served as reviewer for numerous endocrine journals.
Over the years he has received numerous teaching awards.
Release
Date: February 6, 2008
Expiration
Date: August 6, 2009
Target
Audience:
This activity is targeted to primary care physicians, pharmacists, nurses,
and other healthcare professionals with an interest in the treatment
of diabetes.
Activity
Purpose
The purpose of this activity is to review the physiologic actions of
the incretin hormones and discuss the use of incretin-related therapies
in maintaining glycemic control in patients with type 2 diabetes.
Statement
of Need/Activity Overview/Goal
Type 2 diabetes is a progressive disease that may remain asymptomatic
for years. The underlying pathophysiology is hyperglycemia due to deterioration
in pancreatic beta-cell function and insulin resistance. Landmark trials
such as the United Kingdom Prospective Diabetes Study and the Diabetes
Control and Complications Trial underscore the importance of maintaining
good glycemic control to reduce micro- and macrovascular complications
and mortality. In the early stages of the disease, diet and exercise
can be used to control hyperglycemia. However, owing to the progressive
deterioration in beta-cell function, most patients eventually require
pharmacologic intervention. Combination therapy with oral antidiabetic
agents such as metformin, sulfonylureas, or thiazolidiones is often
used first, although its efficacy deteriorates over time owing to progressive
loss of beta-cell function. Exogenous insulin may eventually be needed
to maintain good glycemic control.
Research
into the pathophysiology of diabetes has elucidated novel targets for
treating type 2 diabetes, including the incretin glucagon-like peptide-1
(GLP-1). This endogenous peptide hormone is rapidly released from the
gastrointestinal tract in response to a meal and stimulates glucose-dependent
insulin secretion, suppresses glucagon secretion, slows gastric emptying,
and reduces food intake. Data from animal studies also suggest that
GLP-1 may preserve beta-cell function. Patients with type 2 diabetes
have decreased production of GLP-1 compared with healthy controls, implicating
GLP-1 in the pathophysiology of diabetes. Exenatide, a GLP-1 receptor
agonist, was the first approved agent in the new therapeutic class of
incretin mimetics. Clinical studies have demonstrated that exenatide,
when used in conjunction with oral antidiabetic agents, results in sustained
glycemic control and reduced body weight.
Although
the majority of diabetes care is provided in the primary care setting,
data indicate that approximately 50% of patients with type 2 diabetes
do not achieve established targets of glycemic control despite receiving
treatment for hyperglycemia. As such, it is important for healthcare
providers who care for patients with type 2 diabetes, including primary
care physicians, nurse practitioners, and certified diabetes educators,
to understand which patients are candidates for exenatide and how this
incretin mimetic fits into current treatment guidelines.
Learning
Objectives
On completion of this activity, participants should be able to:
- Identify
clinician and patient barriers to achieving glycemic targets in patients
with type 2 diabetes
- Recognize
the role of the incretin hormones, including GLP-1, gastric inhibitory
polypeptide, and dipeptidyl peptidase IV, in the pathophysiology of
type 2 diabetes
- Interpret
the efficacy, safety, and tolerability data of available and emerging
incretin therapies
- Integrate
incretin-related therapies into treatment paradigms for type 2 diabetes
AOA
Accreditation Statement
The American Osteopathic Association's Council on CME approved this
program for 1 hour of AOA Category 1-B credit. Available for 18 months
beginning February 6, 2008.
Instructions
To receive 1 hour of AOA-approved Category 1-B credit you must:
- Complete
the activity online
- Successfully
complete the online quiz scoring 6 out of 8 correct answers or higher
- You
will have three opportunities to successfully complete the quiz
Your statement
of credit will be issued immediately upon successful completion of the
quiz, and your AOA CME record will be updated within 24 hours.
Term of Offering
This activity has a release date of February 6, 2008 and is valid for
18 months. Requests for credit must be received no later than September
5, 2009. This CME activity was planned and produced in accordance with
AOA CME Guidelines and the ACCME Essential Areas and Policies. Please
refer to the posttest at the end of this activity for further instruction
regarding credit.
A review
committee has agreed that this material can be completed in 1 Hour.
This estimated study time in turn has determined the credit hours being
offered.
CME
Accreditation Statement
Discovery Institute of Medical Education (DIME) is accredited by the
Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians.
CME
Designation Statement
DIME designates this educational activity for a maximum of 1.25 AMA
PRA Category 1 Credit™. Physicians should only claim credit
commensurate with the extent of their participation in the activity.
Continuing
Nursing Education
DIME
is an approved provider of continuing nursing education by the Illinois
Nurses Association, an accredited approver by the American Nurses Credentialing
Center's Commission on Accreditation.
This activity
is eligible for up to 1.2 nursing contact hours.
Continuing
Pharmacy Education Statement
DIME is accredited by the Accreditation Council for Pharmacy Education
as a provider of continuing pharmacy education. This program has been
assigned the ACPE Universal Program Number 246-999-08-002-H01-P and
has been approved for 1.25 contact hour [0.125 CEUs] of continuing education
credit.
All participants are required to complete an evaluation form. Certificates
will be automatically generated upon completion of the evaluation. There
is no fee for participating in the activity or for the generation of
the certificate. Initial release date: February 6, 2008.
Faculty
Information
Faculty
Disclosures
Current guidelines state that participants in CME/CE activities should
be made aware of any affiliation or financial interest that may affect
those involved with content development or presentation. Those persons
have completed a Statement of Disclosure, and their names and relevant
information will appear in the course materials. This information is
used to: (1) determine whether a conflict exists, (2) resolve the conflict
by initiating a content validation process, and (3) advise learners
of this information. Information unavailable at the time of printing
will be made available for review before the presentation.
This CME/CE
activity may include discussions regarding the use of medications that
may be outside the approved labeling for these products. Physicians
should consult the current prescribing information for these products.
DIME requires the speaker to disclose that the product is not labeled
for the use under discussion. Compliance is documentation that demonstrates
the provider has a practice in place to make this requirement known
to the faculty.
Jeffrey
S. Freeman, DO, FACOI
Sources of Funding for Research: None
Consulting Agreements: Reliant Pharmaceuticals, Inc.; Takeda
Pharmaceuticals
Financial Interests/Stock Ownership: None
Speakers' Bureau/Honorarium Agreements: GlaxoSmithKline; Novo
Nordisk A/S
Frank
Svec, MD, PhD
Sources of Funding for Research: None
Consulting Agreements: None
Financial Interests/Stock Ownership: None
Speakers' Bureau/Honorarium Agreements: None
Discussion
of Off-Label, Investigational, or Experimental Drug Use: vildagliptin
Fee
There is no fee for participating in the activity or for the generation
of the certificate or statement of credit.
Funding
Statement
This
activity is funded through an educational grant from Amylin Pharmaceuticals,
Inc., and Eli Lilly and Company. The content was developed independently
by the contributing faculty. All materials are included with permission.
The opinions expressed are those of the faculty and are not to be construed
as those of the publisher or grantor.
In accordance
with DIME policies regarding financial and off-label disclosure, the
audience is advised that one or more presentations in this continuing
medical education (CME) activity may contain references to off-label
or unapproved uses of drugs or devices. Participants should note that
the use of these agents outside currently approved labeling is considered
experimental and are advised to consult prescribing information for
these products. This CME activity was planned and produced in accordance
with AOA CME Guidelines and ACCME Essential Areas and Policies.
Sponsored
by the American Osteopathic Academy of Medical Informatics and DIME
www.DIMedEd.org
©2007 DIME
