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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Assessing New Options For The Treatment Of Diabetes: A Review For Practicing Clinicians


GOAL
To provide endocrinologists, diabetes experts, and cardiologists with the most up-to-date information on new therapies for type 2 diabetes.

TARGET AUDIENCE
This activity is designed for endocrinologists, diabetes experts, and cardiologists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Identify the mechanisms of action of the novel treatments for type 2 diabetes including incretin mimetics, peroxisome-proliferator activated receptors, and dipeptidyl peptidase inhibitors.
  • Understand the importance of new treatments for type 2 diabetes.
  • Describe the past, present, and future of diabetes care.
  • Identify the most important research presented at this year's American Diabetes Association Scientific Sessions.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: November 15, 2005.
Expiration date: November 15, 2007.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Merck & Co, Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

Christopher D. Saudek, MD
Hugh P. McCormick Family
Professor of Endocrinology
Director
Johns Hopkins Diabetes Center
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Saudek reports serving as a consultant to Novartis Pharmaceuticals Corporation.

PARTICIPATING FACULTY

Edward S. Horton, MD
Professor of Medicine
Harvard Medical School
Vice President
Joslin Diabetes Center
Boston, Massachusetts
Dr Horton reports serving as a consultant to Merck & Co, Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sankyo Pharma Inc, and Takeda Pharmaceutical North America.

Graham T. McMahon, MD, MMSc
Division of Endocrinology, Diabetes & Hypertension
Brigham & Women's Hospital
Boston, Massachusetts
Dr McMahon reports having no financial or advisory relationships with corporate organizations related to this activity.

Notice: The audience is advised that articles in this CME activity contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Horton—dipeptidyl peptidase inhibitors, inhaled insulin, insulin detemir, peroxisome-proliferator activated receptor agonists.

Dr McMahon—AVE010, CJC-1131, exubera, insulin detemir, liraglutide, LY548806, muraglitazar, ruboxistaurin, sitagliptin, sulodexide, vildagliptin.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Assessing New Options For The Treatment Of Diabetes: A Review For Practicing Clinicians
Christopher D. Saudek, MD*

This issue of Advanced Studies in Medicine features highlights from selected oral presentations and posters from the 65th Scientific Sessions meeting of the American Diabetes Association (ADA), held in San Diego, June 10-14, 2005.  It also includes a review article by Graham T. McMahon, MD, MMSc, and a clinician interview with Edward S. Horton, MD, regarding new developments in the treatment of type 2 diabetes. The prevalence of type 2 diabetes has increased dramatically over the past few decades. From these 3 expert and distinct views, the reader should get a good look at the truly exciting new developments occurring in diabetes and presented at the ADA Scientific Sessions. 

According to the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health, the current estimated total prevalence of diabetes (both type 1 and type 2) in the United States for people of all ages exceeds 18 million people, or 6.3% of the population. Thirteen million people have been diagnosed, and type 2 diabetes is believed to account for about 90% to 95% of all diagnosed cases. The incidence of type 2 diabetes has been rising steadily across all age groups, and the cost of treatment of diabetes (and its accompanying macro- and microvascular complications) is increasing rapidly as well.

Many oral drugs are available to today's clinicians for treatment of type 2 diabetes. The main classes include sulfonylureas and rapid-acting insulin secretagogues (agents that stimulate insulin secretion), the  biguanide metformin (which reduces hepatic glucose production), alpha-glucosidase inhibitors (which delay digestion and absorption of ingested carbohydrate), and thiazolidinediones (which improve insulin action). Then, when and if the patient needs insulin, a number of preparations are available. This array of options do have proven efficacy, with acceptable safety and tolerability profiles. They provide an adequate set of therapeutic tools to attain good glucose control.

Then why is it that a substantial number of patients with type 2 diabetes (more than half) do not achieve the recommended targets for glucose control?  Why, in fact, do less than 10% meet recommended levels of glucose, lipid, and blood pressure control? Clearly, we need to make treatments even more effective and easier on the patient. There is considerable research and development in progress now that could help clinicians treat people with type 2 diabetes in a more targeted and effective way. 

There is research into therapies with new mechanisms of action, including incretin-based therapies, dipeptidyl peptidase (DPP-IV) inhibitors, and peroxisome-proliferator activated receptors (PPARs), as well as novel insulin therapies. There are new approaches to the delivery of insulin. Some of these approaches have recently been approved by the US Food and Drug Administration (FDA), some are in the preapproval process, and some are in various phases of clinical trials. Studies are under way to better define which groups of patients respond best to which particular therapies.

A wealth of new information was presented at the ADA Scientific Sessions, presenting the latest that is available as well as a glimpse into the future of treating type 2 diabetes.

In this issue's clinician interview, Dr Horton gives us his overview as an experienced clinician and up-to-the-minute clinical investigator. He discusses in an informal but informed way the therapies for type 2 diabetes that have recently been approved by the FDA, as well as emerging therapies for the treatment of type 2 diabetes. He summarizes their mechanisms of action and how they differ from current gold standard treatments. He discusses whether certain agents, including both those that have been FDA approved and those still in clinical trials, appear to be more beneficial for particular subsets of people with type 2 diabetes. Dr Horton addresses the issues of weight gain and weight loss with the newer agents, and what cardiovascular repercussions are associated with these therapies. He also gives insight into the benefits of dual-acting PPAR agonists, which have become a topic of great interest because of their potential to lower glucose, improve lipids, and prevent cardiovascular disease.

Dr McMahon, in his more detailed and referenced article, examines the scientific findings behind the newest treatment options in type 2 diabetes. Again, he addresses both the drugs currently on the market and those in clinical trials. He describes the rising incidence of diabetes and reviews the different classes of drugs, including incretin mimetics, DPP-IV inhibitors, PPARs, and novel insulin therapies, exploring their specific mechanisms of action. Dr McMahon then goes into more detail on the efficacy, safety, and tolerability of the drugs that are found within each of these classes, offering the latest available data on each one.

The poster and oral presentations are selected for their particular relevance to the topics discussed by Drs Horton and McMahon. They show the data presented at the meeting, and cover a wide range of new and emerging treatment options for type 2 diabetes.  Included are abstracts that describe the efficacy and safety of pioglitazone and its effect on beta-cell function; the improvement in sustained glycemic control, cardiovascular risk factors, and weight loss observed with exenatide, an incretin mimetic; comparisons between DPP-IV inhibitors and exenatide on beta-cell injury; and the safety and efficacy of muraglitazar, a novel dual-agonist PPAR, as compared with a sulfonylurea.

We trust that you will be interested and even excited by the breadth of scientific research that is coming to the clinic for improving the management of type 2 diabetes.

*Hugh P. McCormick Family Professor of Endocrinology, Director, Johns Hopkins Diabetes Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Christopher D. Saudek, MD, Osler 576 Endocrinology, 600 N. Wolfe St, Baltimore, MD 21287. E-mail:
csaudek@jhu.edu.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.