The Evolving Role of the SGLT-2 Inhibitors in the T2DM Treatment Paradigm: A Roundtable Discussion

Diabetology
Curriculum:
The SGLT-2 Agents and Their Place in T2DM Treatment
Credits:
1 AMA PRA Category 1 Credit(s)™
Launch Date:
May 29, 2014
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Endocrinologists, Diabetologists, Nephrologists, Family Medicine and Internal Medicine Physicians, and allied healthcare professionals who treat patients with type 2 diabetes.

Relevant Terms:

Type 2 Diabetes, SGLT-2 Inhibitors

John Gerich, MD

John Gerich, MD
Director, Clinical Research Center
Professor Emeritus
University of Rochester School of Medicine and Dentistry
Rochester, NY

John Gerich, MD, is Director of the Clinical Research Center and Professor of Medicine and Physiology at the University of Rochester School of Medicine and Dentistry in Rochester, NY. Dr. Gerich has been involved in patient care, research, and education for over 40 years. In addition, he has participated in numerous clinical trials and mechanistic studies of new diabetes treatments. He has trained over 50 endocrine fellows and has over 500 scientific publications.

His major areas of research include hypoglycemia, glucagon physiology, pathogenesis of type 2 diabetes, regulation of hepatic and renal glucose production, and the mechanism and significance of postprandial hyperglycemia. Dr. Gerich has served on the Editorial Boards of various journals including the Journal of Clinical Investigation, the American Journal of Physiology, Diabetes, Diabetes Care, Postgraduate Medicine, Journal of Diabetes Complications, and the Journal of Clinical Endocrinology and Metabolism.  He is currently an associate editor of Diabetes Research and Clinical Practice.

Dr. Gerich is a member of the American Association of Physicians, the American Society for Clinical Investigation,  the American Physiological Society, the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and the International Diabetes Federation.  He has has been the recipient of numerous awards and honors, including the Lilly Award for Scientific Achievement from the American Diabetes Association, the Rumbach Award from the Juvenile Diabetes Association, and the Rolf Luft Medal (Karolinska institute).

Silvio Inzucchi, MD

Course Director
Silvio Inzucchi, MD
Professor of Medicine
Yale University School of Medicine
Section of Endocrinology
New Haven, CT

Silvio Inzucchi, MD, is Professor of Medicine at the Yale University School of Medicine in New Haven, where he also serves as Clinical Director of the Section of Endocrinology and Program Director of the Endocrinology and Metabolism Fellowship Program. He is also the Director of the Yale Diabetes Center at Yale-New Haven Hospital. He received his undergraduate degree from Fordham University in the Bronx and his MD from Harvard Medical School in Boston. He completed his residency in Internal Medicine and his post-doctoral Fellowship in Endocrinology and Metabolism at Yale-New Haven Hospital, in New Haven, CT.

Dr. Inzucchi has been an invited lecturer both nationally and internationally, on many topics pertaining to the clinical management of diabetes. He has authored or co-authored more than 300 manuscripts, chapters, and abstracts. His research has been published in leading peer-reviewed medical journals, including the New England Journal of Medicine and JAMA. His practical booklet The Yale Diabetes Center Diabetes Facts & Guidelines has an annual circulation in excess of 100,000 copies. A former member of the editorial board of Diabetes Care, Dr. Inzucchi is currently an Associate Editor of the Journal of Clinical Endocrinology and Metabolism.

In addition to his academic achievements, Dr. Inzucchi maintains a large clinical practice involving a wide spectrum of patients with endocrine diseases. His current research interests include diagnostic criteria for diabetes; the link between type 2 diabetes, insulin resistance, and cardiovascular complications; the evaluation of the asymptomatic diabetic patient for coronary artery disease; and the inpatient management of hyperglycemia.

Mark Molitch, MD

Mark E. Molitch, MD
Martha Leland Sherwin Professor of Endocrinology
Division of Endocrinology, Metabolism and Molecular Medicine
Northwestern University Feinberg School of Medicine
Chicago, IL

Mark E. Molitch, MD, is the Martha Leland Sherwin Professor of Endocrinology in the Division of Endocrinology, Metabolism and Molecular Medicine at Northwestern University Feinberg School of Medicine in Chicago, IL. He is active in clinical research in diabetes and other areas of endocrinology and has served as the Principal Investigator for the Northwestern center of the Diabetes Control and Complications Trial (DCCT); he was also Chair of the Complications Committee and a member of the Planning Committee for the DCCT. He is presentnly the Principal Investigator of the DCCT follow-up study “Epidemiology of Diabetes and Its Complications” (EDIC), is Principal Investigator of the Northwestern Center of the ongoing Diabetes Prevention Program Observational Study (DPPOS). and was Co-Principal Investigator of the recently completed Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study. 
 
An active member of the American Diabetes Association, Dr. Molitch Chaired the Professional Practice Committee that wrote the 2002 ADA ”Standards of Medical Care for Patients with Diabetes Mellitus,” Chaired the working group that wrote the ADA Position Statement “Diabetic Nephropathy,” and also served as Chair of the ADA’s Provider Recognition Program. In addition, he is part of the working group that wrote the KDOQI Guideline for the treatment of diabetic kidney disease prepared by the National Kidney Foundation and its recent revision.
 
In addition to editing eight books and journal volumes, Dr. Molitch has authored or coauthored more than 400 original papers, review articles, book chapters, case reports and other publications. For many years, Dr. Molitch was an Associate Editor of the Year Book of Endocrinology and is a Coordinating Editor of the journal, “Pituitary.” He has just completed a 3-year term as Chair of the Clinical Endocrinology Update Program of the Endocrine Society and was President of the Pituitary Society, 2012-2013.

Elliot Sternthal, MD

CME Course Reviewer
Elliot Sternthal, MD
Director of Outpatient Diabetes Program
Boston Medical Center
Assistant Professor of Medicine
Boston University School of Medicine
Boston, MA

Clinical Service
In 2000 I was recruited to Boston Medical Center to direct both inpatient and outpatient diabetes care. I brought organizational and care coordination skills and diabetes care skills developed during 13 years in private practice and 6 years at the Joslin Diabetes Center. I recruited additional nurse practitioners to BMC and worked with certified diabetes educators to achieve and maintain American Diabetes Association recognition of our outpatient education program. I oversaw the expansion of the insulin pump program and use of continuous glucose sensors. In 2005, I petitioned for the establishment of a dedicated inpatient diabetes service. From 2008-2013, I have served as Director of Outpatient Diabetes Program at BMC where my goal was applying the chronic disease care model to diabetes.

Education
Since joining the faculty in the Section of Endocrinology, Diabetes and Nutrition I have had the opportunity to expand upon my passion for teaching. I have lectured to BUSM and BUSDM students on basic pathophysiology and pharmacology of diabetes in didactic lectures and to residents and fellows on more advanced topics in conferences. While I enjoy the challenge of providing concise, up-to-date lectures in an ever-changing area in this structured teaching setting, I particularly excel at teaching at bedside rounds or in case-based formats. I enjoy stimulating understanding of disease mechanisms by the use of the Socratic teaching method. While it is relatively easy for learners to provide "what and when" information, I emphasize the importance of teasing out answers to the "how and why" questions. I believe this approach allows a learner better reflection and lasting understanding, which are more likely to foster a behavioral change.

Continuing Medical Education
I am deeply committed to advancing CME in diabetes care to primary care providers in light of the burgeoning epidemics of diabetes and obesity in the US and the predicted shortage of clinical endocrinologists. Recently, I have helped develop "loosely structured" case-based programs that promote active participation by attendees and focus primarily on the process of arriving at a therapeutic decision rather than "right or wrong" answers. Continuing with innovation in teaching, I have collaborated with Dr. John Weicha of BUSM Family Medicine in developing web-based CME programs, and I used the virtual reality learning environment of Second Life to deliver a lecture to PCPs through the use of avatars. The majority of participants preferred it over a standard CME lecture.

I believe the pinnacle of my CME teaching was the realization of my long-time conceptualized Preceptorship in Type 2 Diabetes. With the logistic support of BUSM CME, this unique one-week immersion program highlighted the acquisition of practical knowledge, diagnostic and therapeutic skills and coordination of care. The hands-on contact with actual clinic patients taught that each patient's distinct clinical presentation required individualized care. Follow-up of program completers over the last two years have shown that they are more comfortable in proactively addressing therapeutic challenges by using newer agents and defining strategies of care.

I am continuing my diabetes CME activities through academic outreach programs delivered on site to primary care providers and through the development of  enduring educational materials (recently highlighting diabetes complications)  as well as web-based programs.
1. Describe the potential benefits of targeting the kidney in T2DM management
2. Review the most recent data on the clinical advantages and disadvantages of the SGLT2 inhibitor drug class
3. Implement individualized T2DM treatment strategies that incorporate the concept of personalized medicine

Program Description
Despite increased awareness, evolving knowledge, and therapeutic advances, many patients with type 2 diabetes mellitus (T2DM) fail to meet evidence-based treatment goals. As understandings of the disease have increased, so has the development of newer medications with unique mechanisms of action. With the recent approval of the first agent in the sodium glucose cotransporter 2 (SGLT-2) drug class and others in clinical trials, clinicians need to be aware of the role this novel drug class will play in diabetes management.
 
Part of the Diabetes Learning Center designed to improve T2DM clinical practice, this roundtable discussion convenes 3 renowned diabetes experts to explore the latest data on the potential benefits and risks of the SGLT-2 inhibitor drug class, and how these agents can best be used to treat T2DM. The faculty will share their unique perspectives on the concept of personalized diabetes medicine, and will discuss how they currently treat their own patients.

Accreditor Disclosure of Conflicts of Interest Policy
Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve any apparent conflicts of interest. In addition, faculty members are asked to disclose when any unapproved use of pharmaceuticals and devices is being discussed. 

FACULTY DISCLOSURES

Silvio Inzucchi, MD (CHAIR), is a consultant to Boehringer-Ingelheim, Bristol-Myers Squibb, Janssen, and Merck. He is also a speaker for Merck.

Mark E. Molitch, MD,
receives grant/research support from Novartis and Novo Nordisk.  He is also a consultant to Bristol-Myers Squibb/AstraZeneca, Eli Lilly, Janssen Therapeutics, Novartis, and Novo Nordisk.

John Gerich, MD, is a consultant to Boehringer-Ingelheim/Lilly, Bristol-Myers Squibb/AstraZeneca, Janssen Therapeutics, and MannKind. He is on the speakers' bureaus of Boehringer-Ingelhiem/Lilly, Bristol-Myers Squibb, Janssen Therapeutics, MannKind, and Merck.

Elliot Sternthal, MD, CME reviewer for Boston University School of Medicine, has no relevant financial relationships or conflicts of interest.

*Unlabeled/investigational uses of commercial products is discussed in this activity: Safety/efficacy data for the investigational agent empagliflozin will be presented.

STAFF DISCLOSURES
Susan Basilico and Krista Sierra of Haymarket Medical Education, have nothing to disclose with regard to commercial interest. 
Michael Burk, Program Manager of Boston University School of Medicine, has no relevant financial relationships or conflicts of interest.

ACCREDITATION STATEMENT
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 sponsorship of Boston University School of Medicine (BUSM) and Haymarket Medical Education. Boston University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement(s):
Boston University School of Medicine designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Certificates:  MD/Physician and NON-MD
 
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
 
Boston University School of Medicine Disclaimer
THESE MATERIALS AND ALL OTHER MATERIALS PROVIDED IN CONJUNCTION WITH CONTINUING MEDICAL EDUCATION ACTIVITIES ARE INTENDED SOLELY FOR PURPOSES OF SUPPLEMENTING CONTINUING MEDICAL EDUCATION PROGRAMS FOR QUALIFIED HEALTH CARE PROFESSIONALS.  ANYONE USING THE MATERIALS ASSUMES FULL RESPONSIBILITY AND ALL RISK FOR THEIR APPROPRIATE USE.  TRUSTEES OF BOSTON UNIVERSITY MAKES NO WARRANTIES OR REPRESENTATIONS WHATSOEVER REGARDING THE ACCURACY, COMPLETENESS, CURRENTNESS, NONINFRINGEMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OF THE MATERIALS.  IN NO EVENT WILL TRUSTEES OF BOSTON UNIVERSITY BE LIABLE TO ANYONE FOR ANY DECISION MADE OR ACTION TAKEN IN RELIANCE ON THE MATERIALS.  IN NO EVENT SHOULD THE INFORMATION IN THE MATERIALS BE USED AS A SUBSTITUTE FOR PROFESSIONAL CARE.

This program is sponsored by Boston University School of Medicine.



 
Supported by an educational grant from Janssen Therapeutics.


 
Produced by Haymarket Medical Education.




INSTRUCTIONS
To obtain credit, a score of 65% or better is required. This CME/CE is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the posttest survey, and have received your digital copy of your credit certificate. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.

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