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The next frontier in managing obesity with or without T2D: The role of novel combinations

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Tutorial

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Poll

What is your approach to managing GI side effects for patients taking a GLP-1RA?

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Counsel patients on diet
   
Reduce GLP-1RA dose for a few weeks
   
Discontinue GLP-1RA therapy
   
Counsel patients on diet and reduce dose
   

Tutorial

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Poll

How much weight loss do your patients with obesity typically achieve with a GLP-1RA?

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About 10%
   
About 15%
   
About 20%
   
More than 20%
   

Tutorial

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Poll

Which feature of GLP-1–combination therapies for obesity is most interesting to you?

Submit your answer to see the results

Potential for increased weight loss
   
Potential for reduced dose of GLP-1RA
   
Potential for improved tolerability
   
Potential for reduced risk of obesity complications
   
 
Expert Interviews
Obesity, Diabetes CE/CME accredited

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Three experts answer questions on a specific theme offering practical insights drawn from daily practice. Close

The next frontier in managing obesity with or without T2D: The role of novel combinations

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Dr Sue D Pedersen is a specialist in endocrinology and metabolism, a certified American Board of Obesity Medicine (ABOM) diplomate, and a clinical lecturer at the University of Calgary, Canada. Her clinical endocrinology practice is at the C-ENDO Diabetes & Endocrinology Clinic in Calgary. read more

Dr Pedersen is heavily involved in obesity and type 2 diabetes research. She is principal investigator, national lead investigator, and/or global panel member for several studies of obesity and diabetes pharmacotherapy, and has authored dozens of peer-reviewed publications.

Dr Pedersen is the lead author on the Pharmacotherapy chapter of the 2020 and 2022 Canadian Obesity Clinical Practice Guidelines, which is formally endorsed by The Obesity Society (TOS), Obesity Medicine Association (OMA), European Association for the Study of Obesity (EASO), and many other obesity organizations. She is also a member of the Expert Committee for the Diabetes Canada guidelines as a co-author of the Weight Management chapter. She has a public information website for healthcare providers and patients about obesity and diabetes with over 3.2 million hits to date (www.drsue.ca), and a podcast (www.dishingthescience.com).

Dr Susan Pedersen discloses: Independent contractor relationship from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, Eisai, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Advisory board or panel from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Consultant fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Grants/research support from AstraZeneca, Lilly, Novo Nordisk, Pfizer, Prometic and Sanofi. Speaker’s Bureau fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly and Novo Nordisk.

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Learning Objectives

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

  • Explain the rationale for combination GLP-1-based therapies, including the role of amylin analogues in the management of obesity with or without type 2 diabetes
  • Review the latest clinical evidence on efficacy of novel combination therapies for individuals with obesity with or without type 2 diabetes
  • Analyse the latest data on the safety of novel combination therapies for individuals with obesity with or without type 2 diabetes
Overview

In this activity, watch three experts discuss the rationale behind glucagon-like peptide-1 (GLP-1)-based combination therapies and review the latest clinical evidence for these novel combinations. The expert faculty will provide their insights on what these combination treatments may mean for the future management of obesity with or without type 2 diabetes (T2D). read more

This activity is jointly provided by USF Health and touchIME.
touchIME is an EBAC® accredited provider.

Target Audience

Endocrinologists, diabetologists and cardiologists involved in the future management of obesity with or without type 2 diabetes.

USF Accreditation

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Susan Pedersen discloses: Independent contractor relationship from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, Eisai, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Advisory board or panel fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Consultant fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Grants/research support from AstraZeneca, Lilly, Novo Nordisk, Pfizer, Prometic and Sanofi. Speaker’s Bureau fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly and Novo Nordisk.

Dr Donna Ryan discloses: Advisory board or panel fees from Altimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Biohaven, Calibrate, Carmot/Roche, CINRx, Currax, Epitomee, Fractyl, Gila, Lilly, Nestle, Novo Nordisk, Pfizer, Regeneron, Structure Therapeutics and Wondr Health, Zealand. Consultant fees from eMedd and Scientific Intake (Relationship Terminated). Speaker’s Bureau fees from Lilly and Novo Nordisk. Stock/shareholder (self-managed) fees from Calibrate, Epitomee; Roman, Scientific Intake and Xeno Bioscience (Relationships Terminated).

Prof. Carel le Roux discloses: Grant/research support from:  Anabio and Irish Research Council, Health Research Board, Science Foundation Ireland. Advisory board/consulting fees from Altimmune, Amgen, Arrowhead, AstraZeneca, Boehringer Ingelheim, Eli Lilly,  GI Dynamics, Gila Pharmaceuticals, Herbalife, Irish Life Health, Irish Society for Nutrition and Metabolism, Johnson & Johnson, Keyron, Novo Nordisk and Roche. Speaker’s bureau fees from Boehringer Ingelheim, Currax Pharmaceuticals, Eli Lilly, Herbalife, Johnson & Johnson, Novo Nordisk and Rhythm Pharmaceuticals. Other financial or non-financial interests fees from Beyond BMI, Co-owner Obesity Clinics and My Best Weight.

Content Reviewer

Angela Massey Hill, PharmD, CPh, RPh, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributors

Annette Wiggins and Joanne Morton have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 27 February 2025. Date credits expire: 27 February 2028.

If you have any questions regarding credit, please contact cpdsupport@usf.edu

EBAC® Accreditation

touchIME is an EBAC® accredited provider since 2023.

This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 45 minutes of effective education time.

The Accreditation Council for Continuing Medical Education (ACCME®), and the Royal College of Physicians and Surgeons of Canada hold an agreement on mutual recognition on substantive equivalency of accreditation systems with EBAC®.

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals and the American Medical Association (AMA), physicians may convert EBAC® CE credits to AMA PRA Category 1 CreditsTM. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other healthcare professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

Faculty Disclosure Statement / Conflict of Interest Policy

In compliance with EBAC® guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities.

Faculty

Dr Susan Pedersen discloses: Independent contractor relationship from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, Eisai, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Advisory board or panel fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Consultant fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly, Novo Nordisk and Pfizer. Grants/research support from AstraZeneca, Lilly, Novo Nordisk, Pfizer, Prometic and Sanofi. Speaker’s Bureau fees from Abbott, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, GlaxoSmithKline, Lilly and Novo Nordisk.

Dr Donna Ryan discloses: Advisory board or panel fees from Altimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Biohaven, Calibrate, Carmot/Roche, CINRx, Currax, Epitomee, Fractyl, Gila, Lilly, Nestle, Novo Nordisk, Pfizer, Regeneron, Structure Therapeutics and Wondr Health, Zealand. Consultant fees from eMedd and Scientific Intake (Relationship Terminated). Speaker’s Bureau fees from Lilly and Novo Nordisk. Stock/shareholder (self-managed) fees from Calibrate, Epitomee; Roman, Scientific Intake and Xeno Bioscience (Relationships Terminated).

Prof. Carel le Roux discloses: Grant/research support from:  Anabio and Irish Research Council, Health Research Board, Science Foundation Ireland. Advisory board/consulting fees from Altimmune, Amgen, Arrowhead, AstraZeneca, Boehringer Ingelheim, Eli Lilly,  GI Dynamics, Gila Pharmaceuticals, Herbalife, Irish Life Health, Irish Society for Nutrition and Metabolism, Johnson & Johnson, Keyron, Novo Nordisk and Roche. Speaker’s bureau fees from Boehringer Ingelheim, Currax Pharmaceuticals, Eli Lilly, Herbalife, Johnson & Johnson, Novo Nordisk and Rhythm Pharmaceuticals. Other financial or non-financial interests fees from Beyond BMI, Co-owner Obesity Clinics and My Best Weight.

Requirements for Successful Completion

Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

Date of original release: 27 February 2025. Date credits expire: 27 February 2027.

Time to Complete: 45 minutes

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org 

 

 

Topics covered in this activity

Obesity / Diabetes
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The next frontier in managing obesity with or without T2D: The role of novel combinations
0.75 CE/CME credit

Question 1/5
What is the rationale for combining a GLP-1RA with an amylin analogue for management of obesity with or without type 2 diabetes?

GLP-1, glucagon-like peptide-1; RA, receptor agonist.

Combination strategies that target multiple hormonal pathways could lead to better efficacy for managing obesity with or without type 2 diabetes.1 In particular, combining amylin analogues and a GLP-1RA may induce a synergistic weight loss effect.2

There is the potential of increased therapeutic efficacy by opposing multiple compensatory mechanisms in our natural human biology that defend against weight loss.1 There is also the potential to use lower doses of each treatment in the combination, which may reduce the risk of adverse events.1

Abbreviation

GLP-1RA, glucagon-like peptide-1 receptor agonist.

References

  1. Coutinho W, Halpern B. Diabetol Metab Syndr. 2024;16:6.
  2. Melson E, et al. Int J Obes (Lond). 2024; doi.org/10.1038/s41366-024-01473-y. Online ahead of print.
Question 2/5
Which GLP-1RA is being investigated in phase II trials in combination with eloralintide?

GLP-1RA, glucagon-like peptide-1 receptor agonist.

The combination of eloralintide and tirzepatide is being investigated in a phase II clinical trial in patients aged 18–75 with type 2 diabetes and a BMI ≥27.0 kg/m2 (NCT06603571). The comparator arms are eloralintide alone, tirzepatide alone and placebo.

Abbreviation

BMI, body mass index.

Reference

Clinicaltrials.gov. NCT06603571. Available at https://clinicaltrials.gov/study/NCT06603571 (accessed 24 January 2025).

Question 3/5
Which of the following best describes the findings of a phase II clinical trial of co-administered semaglutide plus cagrilintide (CagriSema) vs semaglutide or cagrilintide alone?

HbA1c, glycated haemoglobin.

The phase II clinical trial examined the effects of co-administered semaglutide and cagrilintide (CagriSema; n=31), semaglutide (n=31) and cagrilintide (n=30). This trial found that the change in HbA1c from baseline to week 32 was significantly greater with CagriSema vs cagrilintide (p<0.001), with a greater proportion of patients receiving CagriSema achieving their target HbA1c (<7.0% and ≤6.5%) compared with cagrilintide and semaglutide. Patients receiving CagriSema achieved a mean change in body weight of –15.6%, this was –5.1% and –8.1% in patients receiving semaglutide and cagrilintide respectively.

Abbreviation

HbA1c, glycated haemoglobin.

Reference

Frias JP, et al. Lancet. 2023;402:720–30.

Question 4/5
Your patient is a 56-year-old woman with obesity, type 2 diabetes and hypertension. After 1 year on tirzepatide and calorie-restricted diet, she achieved 5% weight loss. She would like to achieve at least 10% weight loss to reduce her risk of obesity-related complications. What would you recommend next for this patient?

GLP-1RA, glucagon-like peptide-1 receptor agonist.

As Dr Donna Ryan explains, not all individuals will achieve desired weight loss with currently available anti-obesity medications. “We know as we add targets we get increased weight loss. If we could add another target to our treatment, we would likely see more weight loss.”1 Ongoing phase III studies, such as the REIMAGINE and REDEFINE series of trials, are investigating the use of co-administered semaglutide and cagrilinitide (CagriSema) in various patient populations, including those with type 2 diabetes (e.g. REDEFINE 2; NCT05394519) and patients with established cardiovascular disease with or without type 2 diabetes (REDEFINE 3; NCT05669755).2

References

  1. TouchIME interview with Dr Donna Ryan; 29 January, 2025.
  2. Clinicaltrials.gov. Available at https://clinicaltrials.gov/ (accessed 10 January 2025).
Question 5/5
Your patient is a 38-year-old man with obesity, sleep apnoea and prediabetes. After thorough discussion, he initiates therapy with a GLP-1RA. He returns after 4 weeks on the lowest dose complaining of severe nausea, and reports episodes of vomiting and diarrhoea. He wants to discontinue therapy. What do you recommend for this patient?

GLP-1RA, glucagon-like peptide-1 receptor agonist.

Prof. le Roux explains, “The most common side effects that we see [with GLP-1RA therapy] are GI based. We also see that these are mostly mild and moderate and related to the dose escalation. So we can manage that very carefully… What we would like is for our patients to adhere to these medications because then they’re going to have the most benefit. But what we do see is that if we’re not careful enough, many patients discontinue the treatment2 and that’s why it’s so important to understand the safety and allow us to manage it much better.”1

Abbreviations

GLP-1RA, glucagon-like peptide-1 receptor agonist; GI, gastrointestinal.

References

  1. TouchIME interview with Prof. Carel le Roux; 29 January, 2025.
  2. Rodriguez PJ et al. JAMA Network Open. 2025;8:e2457349.
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