Challenging The Pathophysiology of T2DM: The Role of Basal Insulin Therapy

An abundance of glucose-lowering agents are available for treating type 2 diabetes mellitus (T2DM). Because T2DM is a progressive disease, many individuals with T2DM eventually need insulin.^1-6 As pancreatic β-cell function declines, insulin therapy becomes increasingly necessary.^2,7,8 In the United Kingdom Prospective Diabetes Study, more than half of adults with newly diagnosed T2DM on monotherapy required additional therapy within 3 years, and 75% by 9 years.⁹ In the Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial, 11.4% of adults in the standard-care arm of the trial (no insulin use at baseline) were treated with insulin within 7 years.10 Providing exogenous insulin can be thought of as hormone replacement therapy that addresses several core pathophysiological deficits associated with T2DM: it corrects the relative insulin deficiency seen in T2DM; lowers blood glucose, glucagon, and free fatty acid levels; and reverses glucotoxicity and lipotoxicity.^1,4 Because many patients will eventually need insulin therapy, every health care professional (HCP) who manages patients with T2DM should know how to use this indispensable medication effectively and safely.

Current treatment algorithms from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) include basal insulin as a treatment option throughout the progression of T2DM.^5,6 Indeed, insulin therapy is recommended in symptomatic patients with newly diagnosed T2DM and/or those with elevated glycated hemoglobin (A1C; ie, A1C ≥10% per ADA or >9% per AACE/ACE).^5,6 Patients who start insulin earlier in the disease process and at lower levels of A1C have a better glycemic response and likelihood of achieving glycemic goals.¹¹ Given that many patients with T2DM may eventually need insulin therapy,⁹ it should be presented during the course of patient education as a reasonable therapeutic option, not as a threat or punishment^.5,12

Going Flat Out for Glycemic Control: The Role of New Basal Insulins in Patient-Centered T2DM Management

This activity is intended for NPs, PAs, and other health care professionals (HCPs) with a particular interest in the clinical diagnosis and treatment of common metabolic and endocrine diseases, especially those who provide care for or manage adult patients with T2DM.

Start CME/CE Activity

Supported by an educational grant from:

Sanofi US

Activity Information

Activity Release Date: December 1, 2018
Expiration Date: November 30, 2019

PLEASE NOTE:

There are pre-assessment questions associated with the content of this program that should be accessed at www.caringfordiabetes.com/CRinsulin prior to participating in this activity.

This activity is provided by the Institute for Medical and Nursing Education, Inc.

ACTIVITY OVERVIEW

Current type 2 diabetes mellitus (T2DM) guidelines emphasize individualizing care and prioritizing treatment regimens that minimize hypoglycemia and weight gain. Several new insulins have recently been approved, some of which are available in concentrations not previously available in the United States. Among these are next generation longer-acting (ultralong-acting) basal insulin analogues, which are associated with a lower risk of hypoglycemia than previous long- acting basal insulin analogues. With the availability of new basal insulins, there is a need to educate nurse practitioners (NPs) and physician assistants (PAs) about initiating, titrating, and individualizing insulin therapy.

This activity will review current evidence and best practices for individualizing and intensifying antihyperglycemic therapy using current basal insulin options to achieve patient-centered goals in individuals with T2DM. Additionally, participants in this activity will learn about the rationale for and role of different basal insulins for the treatment of patients with T2DM. To enhance the written information, embedded QR codes will feature video clips of patient cases and audio clips of faculty discussion, offering realistic insight regarding the personal and professional experiences of participants and expert opinions of program faculty in providing optimal diabetes care in patients with T2DM.

LEARNING OBJECTIVES

Explain the role and appropriate use of next-generation longer-acting (ultralong-acting) basal insulins for addressing the underlying pathophysiology of T2DM
Compare next-generation longer-acting (ultralong-acting) and other basal insulins regarding therapeutic characteristics, including pharmacokinetic/pharmacodynamic profiles, efficacy, safety, and dosing
Develop patient-centered treatment regimens that include next-generation longer-acting (ultralong-acting) insulins to minimize barriers to successful use of basal insulin therapy

CME AND CE ACCREDITATION AND CREDIT DESIGNATION STATEMENTS

For Physicians

The Institute for Medical and Nursing Education, Inc. (IMNE), is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

IMNE designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits^™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For Physician AssistantsThe American Academy of Physician Assistants (AAPA) has determined that AMA PRA Category 1 Credit(s)™ is acceptable to meet AAPA CME requirements for PAs.

For Nurse Practitioners and Nurses

IMNE is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC’s) Commission on Accreditation.

This educational program provides 1.5 contact hours of continuing education credit.

IMNE has determined the 1.25 hours of this program will satisfy ANCC’s pharmacotherapeutics contact hour requirement for ANCC certified Clinical Nurse Specialists and Nurse Practitioners. The CEU certificate will reflect this credit.

For Certified Diabetes Educators

ANCC-accredited providers have been approved by the National Certification Board for Diabetes Educators (NCBDE) as providers of continuing education (CE). Individuals seek-ing recertification from the NCBDE can use the CE contact hours received through their participation in this activity.

METHOD OF PARTICIPATION

To receive a maximum of 1.5 AMA PRA Category 1 Credits^™ or ANCC continuing nursing education credit, participants should:

Complete the preassessment questions at www.caringfordiabetes.com/CRinsulin
Read the entire activity
Complete the activity posttest and evaluation at http://www.cvent.com/d/pbqrw7/7E
A CME/CE certificate will be emailed or mailed to you upon achieving a score of 80%.

CME/CE CREDIT QUESTIONS

For questions about the content or obtaining CME/CE credit, please contact IMNE:

Steve Weinman RN, CHCP
Email: steve.weinman@imne.com
Phone: 1-609-936-7015
Activity Release Date: December 1, 2018
Expiration Date: November 30, 2019

DISCLOSURES

It is the policy of IMNE to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All individuals involved in planning (eg, faculty, CME/CE provider staff, and educational partner staff) are expected to disclose any significant financial relationships with commercial interests over the past 12 months. It is also required that faculty identify and reference off-label product or investigational uses of pharmaceutical agents and medical devices.

Resolutions of conflict of interest have been made in the form of external peer review.

The following disclosures have been made:

Faculty
Vanita Aroda, MD
Consultant: Novo Nordisk; Sanofi
Research Grants: AstraZeneca/Bristol-Myers Squibb; Calibra; Eisai; Janssen; Novo Nordisk; Sanofi; Theracos

Davida Kruger, MSN, APN-BC, BC-ADM
Advisory Board: Abbott; Dexcom; Eli Lilly; Intarcia; Janssen; Novo Nordisk; Sanofi
Speakers’ Bureau: Abbott; AstraZeneca; Boehringer Ingelheim; Dexcom; Eli Lilly; Insulet; Janssen; Novo Nordisk; Valeritas
Research Grants: AstraZeneca; Dexcom; Eli Lilly; The Leona M. and Harry B. Helmsley Charitable Trust; Lexicon; Novo Nordisk
Stock: Dexcom

IMNE Staff

All staff of IMNE in a position to influence content have filed statements of disclosure with the continuing education provider. Any conflicts of interest were identified and resolved prior to their involvement in planning this activity. These disclosures are available for review by contacting Steve Weinman at 1-609-936-7015 or steve.weinman@imne.com.

Amy Carbonara
Vice President
Ms. Carbonara has nothing to disclose.

Margery Tamas, HBSE, MPH
Editorial Manager
Ms. Tamas has nothing to disclose.

Steve Weinman, RN, CHCP
Director of Accreditation
Mr. Weinman has nothing to disclose.

External CME/CE Reviewers
Martin Quan, MD
Dr. Quan has nothing to disclose.

Darilyn Paul, APRN
Ms. Paul has nothing to disclose.

DISCLAIMER

This activity is designed for HCPs for educational purposes. Information and opinions offered by the faculty/presenters represent their own viewpoints. Conclusions drawn by the participants should be derived from careful consideration of all available scientific information. While IMNE makes every effort to have accurate information presented, no warranty, expressed or implied, is offered. The participant should use his/her clinical judgment, knowledge, experience, and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.

COMMERCIAL SUPPORT ACKNOWLEDGMENT

This activity is supported by an educational grant from Sanofi US.

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