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About This Activity

Activity Description and Learning Objectives

In this activity, experts in diabetes discuss the impact of clinical inertia, and how it may be addressed.

This activity has been jointly provided by Oakstone and touchIME ENDOCRINOLOGY.  Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

After watching this activity, participants should be better able to:

Target Audience

This activity has been designed to meet the educational needs of diabetologists, cardiologists and primary care physicians involved in the management of diabetes.

Disclosures – Faculty

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Prof. Davies discloses: Grants/research support from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, AstraZeneca and Janssen. Consultant/advisory boards for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier and Gilead Sciences Ltd. Speakers Bureau for Novo Nordisk, Sanofi-Aventis, Lilly, Merck, Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, NAPP, Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc.

Prof. Dagogo-Jack discloses: Grants/research support from AstraZeneca, Boehringer Ingelheim and Novo Nordisk. Consultant/advisory boards for Janssen, Sanofi, Merck, MSD and AstraZeneca. Stockholder in Aerami Therapeutics and Jana Care.

Prof. Del Prato discloses: Grants/research support from Merck & Co Inc, Novartis Pharmaceuticals Corporation, Boehringer Ingelheim and AstraZeneca. Consultant/advisory boards for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmithKline, Intarcia, Janssen Pharmaceuticals, Merck & Co Inc, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Laboratories Servier, Sanofi and Takeda Pharmaceuticals. Speakers Bureau for Boehringer Ingelheim, Novartis Pharmaceuticals Corporation and Takeda Pharmaceuticals.

Content Reviewer

Walter Murray Yarborough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™️. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. A score of 70% or higher is needed to obtain CME credit. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: January 31, 2020. Date credits expire: January 31, 2021.

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CME Post-test

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Q1. What is the objective of the decision cycle for establishing a management plan for patients with type 2 diabetes?

  1. A. Provide a document which patients can continually refer to regarding their care
  2. B. Ensure the same care plan is given to all patients
  3. C. Optimize quality of life and prevent complications
  4. D. Provide care at the lowest cost possible to conserve healthcare resources

Please try again

The goals of care in type 2 diabetes are to prevent complications and optimize quality of life.

Reference
Davies MJ, et al. Diabetes Care. 2018;41:2669–2701.

Q2. In type 2 diabetes, which of the following is the correct definition of clinical inertia?

  1. A. Failure to monitor patients every 3-6 months when on treatment
  2. B. Failure to promptly intensify therapeutic regimens when treatment goals are not met
  3. C. Patients who are non-adherent to their glucose-lowering medication
  4. D. Limited research into new treatments

Please try again

In type 2 diabetes, clinical inertia refers to failure to intensify therapy when treatment targets are not met.

Reference
Davies MJ, et al. Diabetes Care. 2018;41:2669–2701.

Q3. Which of the following approaches is most appropriate if a patient does not meet their blood glucose target?

  1. A. Intensify therapy when certain levels of hyperglycaemia are met
  2. B. Observe the patient’s progress over the next 6 months before altering treatment
  3. C. Refer to a specialist diabetes clinic for further assessment
  4. D. Intensify treatment early to meet treatment goals

Please try again

Delayed treatment intensification increases the risk of irreversible diabetes-related complications, including cardiovascular events.

References
Khunti K and Millar-Jones D. Prim Care Diabetes. 2017;11:3–12.
Paul SK, et al. Cardiovasc Diabetol. 2015;14:100.

Q4. Why is clinical inertia a particular concern in patients with existing cardiovascular disease?

  1. A. Clinical inertia increases the long-term risk of cardiovascular events
  2. B. Patients with cardiovascular disease are likely to be sedentary
  3. C. Patients on therapy for other comorbidities may have difficulty with polypharmacy
  4. D. Most diabetes therapies are contra-indicated in patients with cardiovascular disease

Please try again

Clinical inertia and poor glycaemic control have been associated with an increased risk of myocardial infarction, heart failure and stroke.

Reference
Paul SK, et al. Cardiovasc Diabetol. 2015;14:100.

Q5. Your patient has just been diagnosed with type 2 diabetes. They do not have established atherosclerotic cardiovascular disease, but their eGFR is 53 ml/min/1.73m2. Which of the following glucose-lowering regimens would you prescribe initially?

  1. A. Metformin plus basal insulin
  2. B. Metformin and lifestyle management only
  3. C. Metformin with lifestyle management, and consider an SGLT2 inhibitor from the start of therapy
  4. D. Metformin plus a sulphonylurea

Please try again

For appropriate high-risk individuals with established type 2 diabetes, a GLP-1 receptor agonist or SGLT2 inhibitor should be considered to reduce major adverse cardiovascular events, hospitalization due to heart failure, cardiovascular death, or chronic kidney disease progression independently of baseline or target HbA1c. For patients with established atherosclerotic cardiovascular disease, the level of evidence for major cardiovascular event benefit is greatest for GLP-1 receptor agonists. For patients with or without established atherosclerotic cardiovascular disease, but with heart failure with reduced ejection fraction or chronic kidney disease, the level of evidence for benefit is greatest for SGLT2 inhibitors.

Reference
Buse JB, et al. Diabetes Care. 2019 Dec 19. doi: 10.2337/dci19-0066 [Epub ahead of print].

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touchPANEL DISCUSSION

How can we effectively address clinical inertia to improve glycaemic control in patients with type 2 diabetes?

Introduction

Watch a panel of internationally renowned diabetes experts discuss the impact of clinical inertia in the treatment of type 2 diabetes, and how it can be addressed in clinical practice.

Professor Melanie Davies chairs a discussion with Professors Samuel Dagogo-Jack and Stefano Del Prato to review current knowledge of clinical inertia in type 2 diabetes, and how and why clinicians must tackle this important issue.

This activity is intended for diabetologists, cardiologists and primary care physicians who treat patients with type 2 diabetes.

This touchPANEL DISCUSSION was recorded in January 2020.

Learning Objectives

After watching this touchPANEL DISCUSSION, you should be better able to:

  • Define the potential impact of clinical inertia on your patients with type 2 diabetes
  • Identify the patient subgroups who will benefit most from early intensification of antihyperglycemic treatment
  • Describe which of your patients will benefit from early treatment intensification and how changes can be implemented into clinical practice

Clinical Spotlight

  • What is clinical inertia in type 2 diabetes and what is its impact on patients?
  • How can early treatment intensification improve glycaemic control?
  • Are there specific patient subgroups who could benefit from early antihyperglycaemic treatment intensification?

Clinical Spotlight

  • What is clinical inertia in type 2 diabetes and what is its impact on patients?
  • How can early treatment intensification improve glycaemic control?
  • Are there specific patient subgroups who could benefit from early antihyperglycaemic treatment intensification?
Download Slides

The Expert Panel

PROF. MELANIE DAVIES

PROF. SAMUEL DAGOGO-JACK

PROF. STEFANO
DEL PRATO

PROF. MELANIE DAVIES

Melanie Davies is Professor of Diabetes Medicine at the University of Leicester and an Honorary Consultant Diabetologist at the University Hospitals of Leicester NHS Trust, Leicester, UK. She is based in the Diabetes Research Centre, University of Leicester and is also the Co-Director of the Leicester Diabetes Centre.

Prof. Davies’ research interests include the causes, screening, prevention, self-management and treatment of type 2 diabetes mellitus. She is a National Institute for Health Research Senior Investigator Emeritus and Director of the NIHR Leicester Biomedical Research Centre. Prof. Davies is the Principal Investigator on a number of large global studies in the field of diabetes, obesity, physical activity, sedentary behaviour and cardiovascular disease, and has served as an expert for the National Institute for Health and Care Excellence (NICE) on a number of guideline groups. Prof. Davies was co-chair of EASD/ADA’s recent Consensus Report on T2DM Management. She was awarded the CBE (Commander of the Most Excellent Order of the British Empire) in the 2016 New Year’s Honour’s List for services to diabetes research and awarded Fellowship of the Academy of Medical Sciences in 2018.

Disclosures: Grants/research support from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, AstraZeneca and Janssen. Consultant/advisory boards for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier and Gilead Sciences Ltd. Speakers Bureau for Novo Nordisk, Sanofi-Aventis, Lilly, Merck, Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, NAPP, Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc.

PROF. SAMUEL DAGOGO-JACK

Samuel Dagogo-Jack, MD, is Professor of Medicine and Chief of the Division of Endocrinology, Diabetes and Metabolism at the University of Tennessee Health Science Center (UTHSC), Memphis, TN, USA. He is Board-certified in Endocrinology, Diabetes and Metabolism, sees patients with diabetes and endocrine disorders and supervises the training of medical residents and endocrinology clinical fellows. Prof. Dagogo-Jack holds the A.C. Mullins Endowed Professorial Chair in Translational Research at UTHSC, his current research focus being the interaction of genetic and environmental factors in the prediction and prevention of prediabetes, diabetes and its complications. He is Principal Investigator of three NIH-funded studies: the Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC); the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS); and the Pathobiology and Reversibility of Prediabetes in a Biracial Cohort Study (PROP-ABC). He is a Past President of the American Diabetes Association and a recipient of the Banting Medal for Leadership from the ADA and the Distinction in Endocrinology Award from the American College of Endocrinology.

Disclosures: Grants/research support from AstraZeneca, Boehringer Ingelheim and Novo Nordisk. Consultancy/advisory boards for AstraZeneca, Janssen, Merck, MSD and Sanofi. Stockholder in Aerami Therapeutics and Jana Care.

PROF. STEFANO DEL PRATO

Stefano Del Prato, MD, is Professor of Endocrinology and Metabolism at the School of Medicine, University of Pisa, and Chief of the Section of Diabetes, University Hospital of Pisa, Italy. His main research interests have always been the physiopathology and therapy of type 2 diabetes and insulin resistance. He is a member of many societies and associations including the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA), and acts as referee for numerous journals, serving on the editorial boards of major scientific journals in the field of diabetes and metabolism. Prof. Del Prato is past Vice-President of the EASD, past President and Honorary President of the Italian Society of Diabetology, and the current President of the EASD. He also served as Chairman of the Scientific Committee of the World Diabetes Congress in Dubai, UAE, in 2011. He has been awarded several honours including the Prize of the Italian Society of Diabetology for outstanding scientific activity and the Honorary Professorship at the Universidad Peruana Cayetano Heredya in Lima.

Disclosures: Grants/research support from Merck & Co Inc, Novartis Pharmaceuticals Corporation, Boehringer Ingelheim and AstraZeneca. Consultant/advisory boards for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmithKline, Intarcia, Janssen Pharmaceuticals, Merck & Co Inc, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Laboratories Servier, Sanofi and Takeda Pharmaceuticals. Speakers Bureau for Boehringer Ingelheim, Novartis Pharmaceuticals Corporation and Takeda Pharmaceuticals.

About This Activity

Activity Description and Learning Objectives

In this activity, experts in diabetes discuss the impact of clinical inertia, and how it may be addressed.

This activity has been jointly provided by Oakstone and touchIME ENDOCRINOLOGY.  Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

After watching this activity, participants should be better able to:

  • Define the potential impact of clinical inertia on their patients with type 2 diabetes
  • Identify the patient subgroups who will benefit most from early intensification of antihyperglycaemic treatment
  • Describe which of their patients will benefit from early treatment intensification and how changes can be implemented into clinical practice

Target Audience

This activity has been designed to meet the educational needs of diabetologists, cardiologists and primary care physicians involved in the management of diabetes.

Disclosures – Faculty

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Prof. Davies discloses: Grants/research support from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, AstraZeneca and Janssen. Consultant/advisory boards for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier and Gilead Sciences Ltd. Speakers Bureau for Novo Nordisk, Sanofi-Aventis, Lilly, Merck, Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, NAPP, Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc.

Prof. Dagogo-Jack discloses: Grants/research support from AstraZeneca, Boehringer Ingelheim and Novo Nordisk. Consultant/advisory boards for Janssen, Sanofi, Merck, MSD and AstraZeneca. Stockholder in Aerami Therapeutics and Jana Care.

Prof. Del Prato discloses: Grants/research support from Merck & Co Inc, Novartis Pharmaceuticals Corporation, Boehringer Ingelheim and AstraZeneca. Consultant/advisory boards for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmithKline, Intarcia, Janssen Pharmaceuticals, Merck & Co Inc, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Laboratories Servier, Sanofi and Takeda Pharmaceuticals. Speakers Bureau for Boehringer Ingelheim, Novartis Pharmaceuticals Corporation and Takeda Pharmaceuticals.

Content Reviewer

Walter Murray Yarborough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™️. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. A score of 70% or higher is needed to obtain CME credit. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: January 31, 2020. Date credits expire: January 31, 2021.