Type 2 Diabetes in Practice. An Expert Commentary with Farhad Zangeneh, MD, FACP, FACE A Clinical Context Report

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1 Type 2 Diabetes in Practice An Expert Commentary with Farhad Zangeneh, MD, FACP, FACE A Clinical Context Report

2 Clinical Context: Type 2 Diabetes in Practice Expert Commentary Jointly Sponsored by: and

3 Clinical Context: Type 2 Diabetes in Practice Expert Commentary This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc., which was made possible, in part, through a collaboration with Eli Lilly and Company.

4 Type 2 Diabetes in Practice Clinical Context Series The goal of this series is to provide up-todate information and multiple perspectives on the pathogenesis, patient identification, symptoms, risk factors, and current and emerging treatments and best practices in the management of type 2 diabetes.

5 Type 2 Diabetes in Practice Clinical Context Series Target Audience Endocrinologists, cardiologists, diabetes educators, primary care physicians, nurses, nurse practitioners, physician assistants, pharmacists, and other healthcare professionals involved in the care of patients with type 2 diabetes.

6 Activity Learning Objective Upon successful completion of this educational program, participants should be able to: l Review the relevance and significance of the activity in the broader context of clinical care.

7 CME Information: Physicians l Statement of Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Projects In Knowledge and MedPage Today. Projects In Knowledge is accredited by the ACCME to provide continuing medical education for physicians.

8 CME Information l Credit Designation Projects In Knowledge designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

9 CME Information: Physicians l Credit for Family Physicians MedPage Today "News-Based CME" has been reviewed and is acceptable for up to 2098 Elective credits by the American Academy of Family Physicians. AAFP accreditation begins January 1, Term of approval is for one year from this date. Each article is approved for 0.5 Elective credits. Credit may be claimed for one year from the date of each article.

10 CE Information: Nurses l Statement of Accreditation Projects In Knowledge, Inc. (PIK) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. Projects In Knowledge is also an approved provider by the California Board of Registered Nursing, Provider Number CEP This activity is approved for 0.50 nursing contact hours. There is no fee for this activity. DISCLAIMER: Accreditation refers to educational content only and does not imply ANCC, CBRN, or PIK endorsement of any commercial product or service.

11 CE Information: Pharmacists l Projects In Knowledge is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program has been planned and implemented in accordance with the ACPE Criteria for Quality and Interpretive Guidelines. This activity is worth up to 0.5 contact hours (0.05 CEUs). The ACPE Universal Activity Number assigned to this knowledge-type activity is H04-P.

12 Discussant Farhad Zangeneh, MD, FACP, FACE AACE Board of Directors, Member Consultant in Endocrinology/Medical Director Endocrine, Diabetes & Osteoporosis Clinic (EDOC) Sterling, Virginia

13 Disclosure Information Farhad Zangeneh, MD, has disclosed the following relevant financial relationships: Salary/Honoraria: Boehringer Ingelheim, Diachi Sankyo, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Novo Nordisk, sanofiaventis, Santarus, and Takeda

14 Disclosure Information Dori F. Zaleznik, MD, Associate Clinical Professor of Medicine, Harvard Medical School, Boston; Chris Kaiser; and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. The staffs of Projects In Knowledge and MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

15 Diabetes Drugs That Can Cause Hypoglycemia Insulin Sulfonylurea (glimepiride) Diabetes Drugs That Are Euglycemic Biguanide (metformin) GLP 1 inhibitors (exenatide, liraglutide) DPP 4 inhibitors (sitagliptin linagliptin) Alpha-glucosidase inhibitors (arcabose, precose) Thiazolidinediones (pioglitazone) Dopamine 2-agonists (cycloset) Selective Bile Acid Squestrants (colesevelam)

16 Signs of Hypoglycemia: <70 mg/dl Confusion Visual disturbances Nervousness or anxiety Heart palpitations Shakiness Sweating Hunger

17 Managing Diabetes Is Multidisciplinary Endocrinologists Primary care physicians Cardiologists Nephrologists Pharmacists Nurses

18 Even Patients Not Aware of Hypoglycemia They accept daily lows They have snack plans for these lows They don t report these to doctors If they did, treatment plan can be modified

19 Summary: At the end of this activity, participants will be able to: Recognize certain drugs put diabetics at a higher risk of hypoglycemia Identify drugs that will help maintain euglycemia Determine the signs and symptoms of hypoglycemia Develop ways to work across specialties to manage diabetes Discuss ways to better educate patients about avoiding hypoglycemia