Moving Beyond “Treat-to-Failure” Strategies in T2DM: Evidence Along the Risk/Reward Path of Treatment Intensification
Among patients with type 2 diabetes mellitus (T2DM), those who consistently had an HbA1C level of 7% or higher and did not receive treatment intensification within 1 year experienced a _____ increased risk of cardiovascular events 5 years later compared with patients who consistently had an HbA1C level of less than 7% and received treatment intensification in the first year after diagnosis.(1,2)
Click the “Continue” button to learn more about how early treatment intensification, specifically with basal insulin, can help patients achieve glycemic control and simultaneously address multiple pathophysiologic defects associated with T2DM, potentially delaying disease progression.
- Paul SK, et al. Cardiovasc Diabetol. 2015;14:100.
- Khunti K, et al. Prim Care Diabetes. 2017;11:105-6.
Anne Peters, MD
Director, USC Clinical Diabetes Program
Professor of Clinical Medicine, Keck School of Medicine of USC
University of Southern California
Los Angeles, CA
Timothy S. Reid, MD
Mercy Diabetes Center
Amy Burdette, PhD
Manager, Educational Strategy & Content
Kathryn Schaefer, MSN, RN
Lead Nurse Planner
East Lansing, MI
Upon completion, participants should be able to:
- Describe the benefits of earlier treatment intensification with injectable combination therapies versus the traditional stepwise approach to T2DM management
This activity is intended for primary care physicians and endocrinologists.
Statement of Need
Currently, only 50% of the roughly 21 million patients with type 2 diabetes mellitus (T2DM) in the United States meet guideline-recommended hemoglobin A1C (HbA1C) targets. Unfortunately, numerous studies have shown that delays in treatment intensification for patients with T2DM occur frequently. Although the factors that contribute to delayed intensification of therapy are complex and multifactorial, one important issue is likely the reliance on a traditional stepwise progression through diabetes management. Another contributing factor is the discordance between clinicians and their patients with uncontrolled diabetes in their perceptions of diabetes control, with physicians reluctant to intensify therapy when there is a lack of patient agreement. The earlier use of injectable combination therapy, such as glucagon-like peptide-1 receptor agonists and insulin therapy, affords clinicians the ability to address multiple pathophysiologic defects associated with T2DM simultaneously and potentially delay or slow disease progression. The major barriers to the earlier use of combination therapy are related to concerns about patient adherence, cost, side effects, and patient disease acceptance.
Provided by Med-IQ.
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Med-IQ designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Instructions to Receive Credit
To receive credit, read the introductory CME material, listen to the audiocast, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.
Initial Release Date: December 19, 2018
Expiration Date: December 18, 2019
Estimated Time to Complete This Activity: 15 minutes
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.
Anne Peters, MD
Consulting fees/advisory boards: Abbott Laboratories, Becton, Dickinson and Company, Boehringer-Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Livongo Health, Merck & Co., Inc., Novo Nordisk, Optum, Inc., Sanofi-aventis U.S., Inc.
Fees received for promotional/non-CME activities (Speakers bureau): Novo Nordisk, Sanofi-aventis U.S., Inc.
Contracted research: AstraZeneca, Dexcom, Inc., MannKind Corporation
Ownership interest (stocks/stock options – excluding mutual funds): Mellitus Health, Inc., Omada Health, Inc., Stability Healthcare
Timothy S. Reid, MD
Consulting fees/advisory boards: AstraZeneca, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi-aventis U.S., Inc.
Fees received for promotional/non-CME activities: Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi-aventis U.S., Inc.
The peer reviewers and activity planners have no financial relationships to disclose.
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email email@example.com.
Operating system - Med-IQ supports the following operating systems:
- Microsoft Windows supported by Microsoft
- Mac OS supported by Apple
Browsers - Med-IQ supports the current version of each browser listed below, plus two prior versions:
Microsoft Internet Explorer
- Microsoft Edge
Operating system - Med-IQ supports the current operating system, plus two prior releases:
- Android (eg, Samsung Galaxy)
- Apple (eg, iPhone/iPad)
Browsers - Med-IQ supports the default browser for the applicable operating system release, plus two prior releases:
- Android (Chrome)
- Apple (Safari)
Applications & Software
PDF Viewer - Adobe Acrobat Reader or Adobe Reader
Adobe Flash Player - Med-IQ supports the current version, plus two prior versions
For technical assistance, please refer to our Support Manual.
Med-IQ fully complies with the legal requirements of the ADA and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact Med-IQ at 443 543 5200.
The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.
Privacy & Confidentiality
Acknowledgment of Commercial Support
This activity is supported by an educational grant from Sanofi US.
© 2018 Med-IQ, Inc.
Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.