Activity Description
This video features Steven Edelman, MD and Jeremy Pettus, MD discussing management strategies for glycemic control, including initiation and titration of basal and prandial insulin as well as GLP-1 receptor agonists. Learn about the most up to date clinical information on GLP-1 receptor agonists and the newer basal insulins, and advantages and limitations of prescribing a GLP-1 receptor agonist versus a basal insulin in patients with type two diabetes on oral medications only. The course will also discuss new basal insulin/GLP-1 RA fixed dose combinations recently approved by the FDA, and the most appropriate therapy using basal insulin and or GLP-1 RA in different patient scenarios commonly seen in clinical practice.

Target Audience
This course is designed for diabetes healthcare providers including endocrinologists, primary care physicians, nurse practitioners, physician assistants, nurses, certified diabetes educators, pharmacists, and other healthcare providers wanting to expand their knowledge of diabetes management.

Method of Participation
This web-based program is comprised of a video discussion between two faculty members and takes approximately 1.5 hours to complete. It is available free of charge. Participants should take the pre-activity survey, watch the video, take a post-test and submit and evaluation to receive a certificate available for download.

Educational Objectives

Following completion of this educational activity, learners should be able to:

1. Outline the most up to date clinical information on GLP-1 receptor agonists and the newer basal insulins

2. Describe the advantages and limitations of prescribing a GLP-1 receptor agonist versus a basal insulin in patients with type two diabetes on oral medications only.

3. Discuss the clinically relevant information on the new basal insulin/GLP-1 RA fixed dose combinations recently approved by the FDA.

4. Describe the most appropriate therapy using basal insulin and or GLP-1 RA in different patient scenarios commonly seen in clinical practice.

Statement of Need
The number of available treatments options for individuals with type 2 diabetes has significantly increased since metformin was introduced to the US market in 1995. Currently, there are nine different classes of oral medications in addition to injectable agents including the older and newer insulin receptor agonists. 

With such a wide array of treatment options available it is important to note that a common clinical practice for the majority of health care providers, including endocrinologists, is to wait until a patient fails on oral agents before considering injectable agents as part of their therapeutic treatment regimen. In addition, prescribing information has shown that HCPs rarely start two different diabetes medications at the same time. With the continuous advent of new treatment options, health care providers need to be educated on not only the importance of considering implementing an injectable therapy earlier in a patient’s treatment regimen but most importantly, to also know which option, GLP-1 or basal, including new recently approved formulations that have fixed ratios of a basal insulin and a GLP-1RA (insulin degludec/liraglutide 100/3.6 and insulin glargine/lixixenatide 100/33).

Accreditation
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 the University of California, San Diego School of Medicine and Taking Control of Your Diabetes (TCOYD). The University of California, San Diego School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. 

Credit Designation
AMA: The University of California, San Diego School of Medicine designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.50 hours of Category 1 credit for completing this program. 

Nurses: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credits™ issued by organizations accredited by the ACCME. For the purpose of relicensure, the California Board of Registered Nursing accepts AMA PRA Category 1 Credit™ (report up to 1.50 hours of credit and list "CME Category 1" as the provider number).

Pharmacists: The California Board of Pharmacy accepts as continuing education for pharmacists coursework which meets the standard of relevance to pharmacy practice and is accepted as continuing education by the Medical Board of California.

Certified Diabetes Educators: To satisfy the requirement for renewal of certification by continuing education for the National Certification Board for Diabetes Educators (NCBDE), continuing education activities must be diabetes related and approved for a provider on the NCBDE list of approved providers (www.ncbde.org). NCBDE does not approve continuing education. The University of California, San Diego is accredited by the ACCME, which is on the NCBDE list of approved providers.

Release Date: August 28, 2018
Expiration Date: August 27, 2021


Faculty

Steven V. Edelman, MD
Clinical Professor of Medicine
Division of Endrocrinology
University of California, San Diego 
School of Medicine
Founder and Director
Taking Control of Your Diabetes
San Diego, California

Jeremy Pettus, MD
Assistant Professor of Medicine
Division of Endocrinology
University of California, San Diego 
School of Medicine
Director, Type 1 Track
Taking Control of Your Diabetes

Balance and Objectivity of Content
It is the policy of the University of California, San Diego School of Medicine to ensure balance, independence, objectivity and scientific rigor. All persons involved in the selection, development and presentation of content are required to disclose any real or apparent conflicts of interest. All conflicts of interest will be resolved prior to an educational activity being delivered to learners through one of the following mechanisms 1) altering the financial relationship with the commercial interest, 2) altering the individual's control over CME content about the products or services of the commercial interest, and/or 3) validating the activity content through independent peer review. All persons are also required to disclose any discussions of off label/unapproved uses of drugs or devices. Persons who refuse or fail to disclose are disqualified from participating in the CME activity. Participants will be asked to evaluate whether the speaker's outside interests reflect a possible bias in the planning or presentation of the activity. This information is used to plan future activities.

Disclosure

Steven V. Edelman, MD has disclosed the following financial relationships relevant to this activity: 
Board Member: Senseonics; Medical Advisory Board: AstraZeneca, Dexcom, Johnson & Johnson, Lilly USA, LLC, MannKind Corporation, Merck, Novo Nordisk, sanofi-aventis U.S. Inc.; Speaker’s Bureau: AstraZeneca, Dexcom, Johnson & Johnson, Lilly USA, LLC, MannKind Corporation, Merck, Novo Nordisk, sanofi-aventis U.S. Inc.

Jeremy Pettus, MD has disclosed the following financial relationships relevant to this activity: 
Consultant: MannKind Corporation, Novo Nordisk, sanofi-aventis U.S Inc.

The CME staff, meeting planners, editorial staff, planning committee, peer reviewer, and CME committee reviewers do not have any relevant financial relationships to disclose.

Off-label Disclosure: These educational activities may contain discussion of unlabeled and/or investigational uses of agents that are not approved by the FDA. Please consult the prescribing information for each product.

The views and opinions expressed in these activities are those of the faculty and do not necessarily reflect the views of the University of California, San Diego.

Cultural Competency
This activity is in compliance with California Assembly Bill 1195 which requires CME courses with patient care components to include curriculum in the subjects of cultural and linguistic competencies. Cultural competency is defined as a set of integrated attitudes, knowledge, and skills that enables health care professionals or organizations to care effectively for patients from diverse cultures, groups, and communities. Linguistic competency is defined as the ability of a physician or surgeon to provide patients who do not speak English or who have limited ability to speak English, direct communication in the patient's primary language. Cultural and Linguistic Competency was incorporated into the planning of this activity. Additional resources on cultural and linguistic competency and information about AB1195 can be found on the UC San Diego CME website at http://cme.ucsd.edu 

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