arrow Log In to View Account     |      
HOME
Johns Hopkins Medicine
Hopkins Logo


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


Confronting the Epidemic: Strategies for Improved Glycemic Control in the Type 2 Diabetic Patient


GOAL
The goal of this activity is to provide physicians with current information regarding effective therapy for type 2 diabetes.

TARGET AUDIENCE
This activity is designed for endocrinologists and primary care physicians.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Describe methods to reduce microvascular and macrovascular complications of type 2 diabetes mellitus.
  • Identify the importance of tight glycemic control in type 2 diabetic patients.
  • Define mechanisms to mimic normal exogenous insulin patterns in diabetic patients using insulin alone or in combination with oral therapy.

ACCREDITATION STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 hours in Category 1 credit toward the American Medical Association's Physicians' Recognition Award. Each physician should claim only those hours of credit that he/she actually spends on this educational activity. Credits are available until the expiration date of December 31, 2004.

This continuing medical education activity was produced under the supervision of Christopher D. Saudek, MD, Professor of Medicine, and Simeon Margolis, MD, PhD, Professor of Medicine, Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.

This program is supported by an unrestricted educational grant from Aventis Pharmaceuticals Inc.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. 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. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000

FACULTY ADVISORS

    Simeon Margolis, MD, PhD
    Professor of Medicine
    Division of Endocrinology and Metabolism
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Margolis reports having no financial or advisory relationships with corporate organizations related to this activity.

    Chistopher D. Saudek, MD
    Professor of Medicine
    Division of Endocrinology and Metabolism
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Saudek reports serving as a consultant to Aventis Pharmaceuticals Inc.

PARTICIPATING FACULTY

    Martin J. Abrahamson, MD
    Assistant Professor of Medicine
    Harvard Medical School
    Chief, Adult Diabetes
    Joslin Diabetes Center
    Boston, Massachusetts
    • Dr Abrahamson reports serving on the speakers' bureau for and receiving honoraria from Aventis Pharmaceuticals Inc, Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline, Novo Nordisk, Novartis Pharmaceuticals Corporation, and Pfizer Inc.

    Alan C. Moses, MD
    Professor of Medicine
    Harvard Medical School
    Senior Vice President and Chief Medical Officer
    Joslin Diabetes Center
    Boston, Massachusetts
    • Dr Moses reports receiving grants and/or research support from Novo Nordisk and Pfizer Inc; and serving as a consultant to GlaxoSmithKline, Interleukin Genetics, NeuroMetrix, Inc, and TheraSense.

    David M. Nathan, MD
    Professor of Medicine
    Harvard Medical School
    Diabetes Unit
    Massachusetts General Hospital
    Boston, Massachusetts
    • Dr Nathan reports being coinventor of metformin for prevention of type 2 diabetes.

    Bernard Zinman, MDCM
    Director, Leadership Sinai Centre for Diabetes
    Sam and Judy Pencer Family Chair in Diabetes
    Professor of Medicine
    Mount Sinai Hospital
    Toronto, Ontario, Canada
    • Dr Zinman reports receiving grants and/or research support from, serving as a consultant to, and receiving honoraria from Eli Lilly and Company and Pfizer.

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.

Off Label Product Discussion
Faculty have disclosed that their articles have referenced the following off-label/unapproved uses of drugs or products:

Product
Dr Nathan discusses the use of metformin for prevention of type 2 diabetes.

Confronting the Epidemic: Strategies for Improved Glycemic Control in the Type 2 Diabetic Patient
Christopher D. Saudek, MD*; Simeon Margolis, MD, PhD*

Diabetes is becoming increasingly prevalent because of increased obesity in the United States. Nearly one third of the estimated 17 million cases of diabetes remain undiagnosed. Type 2 diabetes is the leading cause of end-stage renal disease, lower extremity amputations, and new cases of blindness among adults ages 20 to 74 years. Other complications include a 2-fold to 4-fold increased risk of myocardial infarction and stroke. Glycemic control is essential for reducing the occurrence of clinical complications in diabetic patients. Because many factors contribute to the pathogenesis of diabetes, physicians face the dilemma of determining which treatment regimen to use in certain clinical settings.

Many advances have occurred in the management of type 2 diabetes and in our understanding of the pathogenesis of the disease; however, we are not where we should be. This issue of Advanced Studies in Medicine, based on presentations from the 84th Annual Meeting of the Endocrine Society held in San Francisco, California, June 19-22, 2002, examines the problems surrounding the management of diabetes with oral therapy and the impact of postprandial glucose control. The authors offer approaches to creating physiologic insulin replacement regimens.

Drs Alan C. Moses, Martin J. Abrahamson, and Bernard Zinman examine the challenges clinicians face regarding the control of diabetes; combination versus monotherapy; the importance of achieving target hemoglobin A1c levels; the impact of postprandial glucose control; and approaches and advances in insulin therapy and insulin replacement regimens.

Dr Moses reviews the progress we have made regarding diabetes therapy and drug development. Although we are beginning to learn more about the pathogenesis of the disease, the medical community faces many challenges in diagnosing and managing diabetes. Dr Moses urges endocrinologists to change the paradigm regarding diabetes therapy; they must spread the word about the importance of intensive diabetes therapy and using both oral and insulin therapy to improve glycemic control.

Dr Abrahamson offers insight into the pathophysiologic abnormalities that lead to hyperglycemia and examines postprandial hyperglycemia as an independent risk factor for mortality, including cardiovascular mortality. He addresses the relationship between glycemic control and the complications of diabetes and offers pharmacotherapeutic approaches with oral agents.

Dr Zinman focuses primarily on insulin treatment. Physiologic insulin treatment remains the gold standard in diabetes care. The challenge lies in providing 24-hour replacement of basal insulin that will adjust to the needs of individuals for meal and postmeal insulin requirements; educating patients about the progressive nature of diabetes and the high likelihood of the need for insulin replacement; and explaining new delivery systems and the importance of maintaining near-normal glycemic levels.

An additional article from Dr David M. Nathan cites the statistics identifying diabetes as an epidemic in the United States and links the rising prevalence to a corresponding increased prevalence of obesity. He also discusses the importance of maintaining glycemic control in diabetic patients, but emphasizes that preventing the disease is essential to controlling the epidemic and its complications. He asks how to best apply our resources to accomplish this monumental task. Dr Nathan also points out that the Diabetes Prevention Program showed how a combination of caloric restriction and increased exercise resulted in significant weight loss and a remarkable reduction in the development of diabetes in high-risk individuals.

All of the above articles focus on a similar message: diagnoses must be made sooner, treatment must be more aggressive, and simultaneous treatment with multiple agents, rather than sequential use of drugs, offers greater glycemic control.

*Professor of Medicine, Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.





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.