CME Diabetes 2013-Toronto

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Novel Approaches to the Management of Type 2 Diabetes

From the William E. Matory, Sr and Jr. M.D. Memorial Symposium – Family Medicine Section held at the National Medical Association’s 2013 Scientific Assembly in Toronto, Ontario, Canada. This activity was supported in part by an educational grant from Novo Nordisk Pharmaceuticals.

Introduction

Diabetes is the seventh leading cause of death in the United States. Approximately 26 million people (8.3% of the population) in the United States have type 1 or type 2 diabetes. Only about one-half of these patients have been diagnosed. African Americans are two times more likely to have diabetes than whites. In fact, 12.6% of all African Americans (greater than 3 million) have diabetes. There are 800,000 new cases of diabetes per year, most of which is type 2. Type 2 diabetes currently accounts for over $245 billion in annual healthcare expenditure in the United States.

Educational Gap/Needs Assessment

There is a substantial amount of knowledge and research on effective treatment strategies to prevent and/or delay diabetes and its complications. In spite of this knowledge, a tremendous disparity exists between proven treatment regimens and the widespread use of these strategies. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists have provided medical guidelines for the intensive management of type 2 diabetes. However, even with these guidelines, data from the Centers for Disease Control and Prevention suggest that less than 5% of patients with diabetes receive care that conforms to current guidelines.

The majority of patients with diabetes receive their care from primary care physicians (PCPs). There have been a number of studies designed to improve the delivery of diabetes care at the level of the primary care provider. Several studies involving physician surveys, chart audits and reviews of administrative databases have shown that quality of diabetes care by PCPs is suboptimal. Lack of adherence to established clinical guidelines and failure to comply with quality measures is due to a number of factors, including physicians not remembering guideline recommendations, lack of time to carry out recommended procedures, lack of reimbursement, and lack of helpful technical and staff resources.

This program will review clinical study data on effective diabetes management using newer therapies for the management of patients with type 2 diabetes. The educational program will focus on novel therapies that have a lower propensity to cause weight gain, hypoglycemia and have been found to also be effective in patients with reduced creatinine clearance.

References/ Suggested Readings

  1. The Office of Minority Health Diabetes and African Americans page, U.S. Department of Health and Human Services Web site. Diabetes and African Americans.
  2. http://minorityhealth.hhs.gov/templates/content.aspx?ID=3017. Accessed November 6, 2011.
  3. Centers for Disease Control and Prevention Web site. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011.
  4. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed November 6, 2011.
  5. Kaiser Commission on Medicaid and the Uninsured Web page, The Henry J. Kaiser Family Foundation Web page. Health Insurance Coverage and Access to Care Among African Americans.
  6. http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13338. Accessed November 6, 2011.
  7. Spector RE. Cultural Diversity in Health and Illness. 5th ed. Upper Saddle River, NJ: Prentice Hall Health; 2000.
  8. Kaiser Commission on Medicaid and the Uninsured Web page, The Henry J. Kaiser Family Foundation Web page. Medicaid’s Role for Black Americans. http://www.kff.org/medicaid/upload/8188.pdf. Accessed November 6, 2011.
  9. Hausmann LR, Ren D, Sevick MA. Racial Differences in Diabetes‐Related Psychosocial Factors and Glycemic Control in Patients with Type 2 Diabetes. Patient Prefer Adherence. 2010; 4: 291–299. Available from: PubMed. Accessed November 6, 2011.
  10. Community Service Society Web page. African‐Americans More Likely to be Disenrolled from Medicaid.

Learning Objectives

Following completion of this session, participants should be able to: 1) apply a patient-centered approach to incorporate guideline recommendations for intensifying therapy to achieve glycemic control; 2) compare the safety and efficacy of diabetes therapies in patients with type 2 Diabetes; 3) identify the mechanism of action of incretin-mimetic agents and their potential for lowering fasting plasma glucose and postprandial glucose; and 4) discuss evidence-based combination pharmacotherapy in Type 2 diabetes.

Disclosures

The following speakers/planners have indicated relationships with commercial entities, not necessarily conflicting:

Kwabena Adubofour, M.D. Speakers Bureau:                            AstraZeneca Pharmaceutical Company
Ernest Asamoah, M.D. Speakers Bureau:                                   NovoNordisk, Takeda, Boehringer Ingelheim-Lilly
James Gavin III, M.D., PhD Consultant:                                        BristolMyersSquibb, AstraZenca, Sanofi, Amrin Pharmaceuticals, Reta Pharmaceuticals, LifeScan, Abbott Diabetes Care, Novo Nordisk

Acknowledgement of Commercial Support

This activity was supported in part by an educational grant from Novo Nordisk Pharmaceuticals.