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Diabetes, Cardiovascular Risk, Obesity CE/CME ACCREDITED Watch Time: 37 mins

touchMDT The future for glycemic control and weight loss in T2D and obesity: Incretin-based dual agonists and optimizing patient education

Watch specialists within an MDT plus a patient discuss incretin-based dual agonists and educational strategies for patients with T2D and obesity

 Overview & Learning Objectives

Patient with T2D and obesity
Endocrinologist (obesity) & Endocrinologist (diabetes)
Watch Video
Role of incretin hormones in health and in T2D Dr Fujioka, Prof. Wysham

Watch two endocrinologists who specialize in either obesity or diabetes, respectively, share their expert insights and the latest research on the role of the incretin hormones (GLP-1 and GIP) in healthy individuals and in those with T2D

Watch Video
Endocrinologist (diabetes), Endocrinologist (obesity) and Patient
Watch Video
GLP-1 RAs and dual agonists in T2D and obesity Prof. Wysham, Dr Fujioka, Ms Jones

Watch two endocrinologists specializing in diabetes or obesity, respectively, provide an overview of GLP-1 RA therapy in T2D and obesity and discuss the evidence for incretin-based dual agonists in development. Plus, see a patient’s personal account of achieving glycemic control and weight loss with GLP-1 RA therapy, and how any side effects were addressed.

Watch Video
Diabetes Care and Education Specialist, Endocrinologist (diabetes) & Patient
Watch Video
Early treatment intensification and education in T2D Ms Okemah, Prof. Wysham, Ms Jones

Watch a diabetes care and education specialist and an endocrinologist specializing in diabetes share their expert insights on how early treatment intensification, weight loss and patient education strategies in T2D and obesity may improve patient outcomes. Plus, see a patient’s personal account of starting treatment with a GLP-1 RA, managing side effects and their experience with diabetes education.

Watch Video
Endocrinologist (obesity) & Endocrinologist (diabetes)

Watch two endocrinologists who specialize in either obesity or diabetes, respectively, share their expert insights and the latest research on the role of the incretin hormones (GLP-1 and GIP) in healthy individuals and in those with T2D

Expert Spotlight
Dr Ken Fujioka
Nutrition and Metabolic Research Center, Scripps Clinic, San Diego, CA, USA
Prof. Carol Wysham
Rockwood Diabetes & Endocrinology Clinic, Spokane, WA, USA

Dr Ken Fujioka and Prof. Carol Wysham discuss the role of the incretin hormones in healthy individuals and in those with T2D and share insights from the latest research in this field

Listen on the Go

 Learn more Back to MDT Hub Time: 08:05
 
Endocrinologist (diabetes), Endocrinologist (obesity) and Patient

Watch two endocrinologists specializing in diabetes or obesity, respectively, provide an overview of GLP-1 RA therapy in T2D and obesity and discuss the evidence for incretin-based dual agonists in development. Plus, see a patient’s personal account of achieving glycemic control and weight loss with GLP-1 RA therapy, and how any side effects were addressed.
Expert Spotlight
Prof. Carol Wysham
Rockwood Diabetes & Endocrinology Clinic, Spokane, WA, USA
Dr Ken Fujioka
Nutrition and Metabolic Research Center, Scripps Clinic, San Diego, CA, USA
Patient: Ms Brittany Jones
Atlanta, GA, USA

Prof. Carol Wysham, Dr Ken Fujioka and Ms Brittany Jones discuss using GLP-1 RA therapy to treat T2D and obesity, including observations from a patient’s perspective, and consider the evidence for incretin-based dual agonists in development

Listen on the Go

 Learn more Back to MDT Hub Time: 12:58
 
Diabetes Care and Education Specialist, Endocrinologist (diabetes) & Patient

Watch a diabetes care and education specialist and an endocrinologist specializing in diabetes share their expert insights on how early treatment intensification, weight loss and patient education strategies in T2D and obesity may improve patient outcomes. Plus, see a patient’s personal account of starting treatment with a GLP-1 RA, managing side effects and their experience with diabetes education.
Expert Spotlight
Ms Jennifer Okemah
Salute Nutrition PLLC, Kirkland, WA, USA
Prof. Carol Wysham
Rockwood Diabetes & Endocrinology Clinic, Spokane, WA, USA
Patient: Ms Brittany Jones
Atlanta, GA, USA

Ms Jennifer Okemah, Prof. Carol Wysham and Ms Brittany Jones discuss the benefits of early treatment intensification with antihyperglycemic therapies and weight loss for patients with T2D and obesity, as well as the importance of effective patient education strategies. Ms Jones provides valuable insights from her personal experience of using GLP-1 RA therapy.

Listen on the Go

 Learn more Back to MDT Hub Time: 15:42
 
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Overview & Learning Objectives
Overview

In this activity, specialists in the multidisciplinary team (MDT) involved in caring for patients with type 2 diabetes (T2D) and obesity, plus a patient with both conditions, share their perspectives on incretin-based dual-agonist therapy, the benefits of early treatment intensification, weight loss, and patient education.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience 

This activity has been designed to meet the educational needs of endocrinologists involved in the management of patients with T2D and obesity.

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

Prof. Carol Wysham discloses: Grants/Research support from Abbott (relationship terminated), Allergan, Corcept, Eli Lilly, Mylan (relationship terminated), Novo Nordisk, Regeneron and Vanda.

Dr Ken Fujioka discloses: Consultancy fees from Amgen, Boehringer Ingelheim, Gelesis, Janssen Global Services, Nalpropion Pharmaceuticals, Novo Nordisk, Phenomix, Rhythm Pharmaceuticals, Sunovion and Takeda. Speaker’s Bureau fees from Nalpropion Pharmaceuticals, Novo Nordisk, Rhythm Pharmaceuticals and Takeda.

Ms Jennifer Okemah discloses: Advisory board fees from Medtronic. Consultancy fees from Dexcom, Insulet, Medtronic and Tandem. Speaker’s Bureau fees from BigFoot Biomedical. Stock/Shareholder (self-managed) in Insulet and Tandem.

Ms Brittany Jones has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Christy Thai, PharmD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Sola Neunie has 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 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

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: 28 March 2022. Date credits expire: 28 March 2023.

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

Learning Objectives

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

  • Recognize the effect of incretin hormones and glucagon on metabolism in wellness and in T2D
  • Evaluate the rationale and latest evidence for incretin-based dual-agonist therapies in patients with T2D and obesity
  • Apply early treatment intensification, weight loss and patient education strategies in patients with T2D and obesity
Faculty & Disclosures
Prof. Carol Wysham

Rockwood Diabetes & Endocrinology Clinic, Spokane, WA, USA

Prof. Carol Wysham is a clinical professor of medicine at the University of Washington School of Medicine and a clinical endocrinologist at MultiCare/Rockwood Clinic in Spokane, Washington. read more

Prof. Wysham earned her medical degree at the University of Iowa College of Medicine in Iowa City. She completed an internship and residency in internal medicine at Oregon Health Sciences University in Portland and a fellowship in endocrinology and metabolism at the University of Iowa Hospitals and Clinics in Iowa City. She is certified by the American Board of Internal Medicine with subspecialty certification in endocrinology and metabolism.

Prof. Wysham is a member of the American Diabetes Association and the Endocrine Society. She has served as member and chair of the American Diabetes Association Clinical Practice Committee, member, co-chair and chair of the Annual Meeting Steering Committee of the Endocrine Society and is current president of the Endocrine Society. She has more than 30 years of experience in clinical research and has written numerous articles for scientific journals including JAMA, Diabetes Care and The Lancet.
Prof. Carol Wysham discloses: Grants/Research support from Abbott (relationship terminated), Allergan, Corcept, Eli Lilly, Mylan (relationship terminated), Novo Nordisk, Regeneron and Vanda.
Dr Ken Fujioka

Nutrition and Metabolic Research Center, Scripps Clinic, San Diego, CA, USA

Dr Ken Fujioka is currently Director of the Nutrition and Metabolic Research Center and Obesity Telemedicine at Scripps Clinic in the Department of Diabetes and Endocrinology. read more

He is certified in obesity medicine by the American Board of Obesity Medicine and is currently President-elect of the National Board of Physician Nutrition Specialists. Dr Fujioka has authored over 100 papers in peer-reviewed journals on weight management and related comorbid disease. He has participated as a principal investigator on over 100 clinical trials and as sub-principal investigator on numerous National Institutes of Health grants. He has authored a comprehensive standard of care for the Medical Board of California (1997) on obesity treatment and lectured extensively nationwide on obesity treatments.

Dr Fujioka currently splits his time evenly between clinical research and clinical practice.

Dr Ken Fujioka discloses: Consultancy fees from Amgen, Boehringer Ingelheim, Gelesis, Janssen Global Services, Nalpropion Pharmaceuticals, Novo Nordisk, Phenomix, Rhythm Pharmaceuticals, Sunovion and Takeda. Speaker’s Bureau fees from Nalpropion Pharmaceuticals, Novo Nordisk, Rhythm Pharmaceuticals and Takeda.
Ms Jennifer Okemah

Salute Nutrition PLLC, Kirkland, WA, USA

Ms Jennifer Okemah has been a registered dietitian/nutritionist since 2005 and a certified diabetes care and education specialist (CDCES) since 2007. She has an additional certification as a sports specialist in dietetics as well as being board certified in advanced diabetes management. read more

Ms Okemah has a unique specialist knowledge of all technology products approved for diabetes care by the Food and Drug Administration. She loves data! She is a leader in her field in patient care, mentoring, serving as a preceptor, speaking, creating webinars and writing for nutrition and diabetes blogs. She has also authored several scientific publications on type 2 diabetes management. But what she loves most is taking complex information and making it usable, to help people in reaching the health goals they set for themselves.

Ms Jennifer Okemah discloses: Advisory board fees from Medtronic. Consultancy fees from Dexcom, Insulet, Medtronic and Tandem. Speaker’s Bureau fees from BigFoot Biomedical. Stock/Shareholder (self-managed) in Insulet and Tandem.
Ms Brittany Jones

Atlanta, GA, USA

Ms Brittany Jones, a mother of two from Atlanta, GA, USA, is an office manager in a busy chiropractic office. She developed gestational diabetes several years ago while pregnant with her second child. At that time, Ms Jones, who has been overweight since childhood, was unaware of the implications of her diagnosis, noting that “You would have thought that after that I would have mentally accepted the fact that uncontrolled diabetes is dangerous. But I kept going with old habits of poor dieting and lack of exercise.”

Two years ago, Ms Jones’s body mass index and HbA1c reached such high levels that she began to actively learn how to manage her diabetes and weight. She now focuses daily on implementing lifestyle changes and medication adherence to enhance her quality of life and that of her family.

Ms Jones’s desire and mission is to share her story with others, including on her social media channel (Brie&Babies on YouTube). Of her journey with managing type 2 diabetes and obesity she says, “It’s not easy, but with me incorporating healthier meal choices, adding 30 minutes of daily exercise, and taking my medication, I’ve managed to lose 40 pounds and lower my HbA1c. It’s a slow process, but it’s well worth it”.

Ms Brittany Jones has no interests/relationships or affiliations to disclose in relation to this activity.
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This Activity Is Funded By:

This activity is funded by an independent medical education grant from Eli Lilly.
This medical education is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 28 March 2022. Date credits expire: 28 March 2023.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/4
Which statement best summarizes the action of the endogenous incretin hormones after food intake in healthy individuals?
 Correct

The endogenous incretin hormones, GLP-1 and GIP, are secreted from the gut upon nutrient stimulation and potentiate insulin secretion, which is essential for the regulation of postprandial metabolism. Insulin reduces blood glucose levels by promoting glucose uptake by cells. Furthermore, GLP-1 has an inhibitory effect on glucagon secretion, as well as delaying gastric emptying and promoting satiety.

Abbreviations
GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide-1.

Reference
Boer GA, Holst JJ. Biology (Basel). 2020;9:473.

Question 2/4
Incretin-based dual GIP and GLP-1 receptor agonists may offer an additional treatment option for patients with type 2 diabetes and obesity in the future. Based on the results of the SURPASS clinical trial program, if approved, how would you communicate to your patients on the potential benefits of these agents after 9–12 months of treatment?

GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide-1; HbA1c, glycated hemoglobin.
 Correct

The SURPASS clinical trials investigated the efficacy and safety of tirzepatide, a dual GIP and GLP-1 receptor agonist, in adults with type 2 diabetes and a BMI ≥25 kg/m2 who were inadequately controlled by antihyperglycemic medication.1–4 Across SURPASS-2, -3, -4 and -5, over a 40- or 52-week period, tirzepatide reduced HbA1c levels by 1.9–2.6 percentage points, depending on the dose, while weight loss from baseline was 11.3–13.9% with the highest dose (15 mg).1–4

Abbreviations
BMI, body mass index; GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide-1; HbA1c, glycated hemoglobin.

References

  1. Frías JP, et al. N Engl J Med. 2021;385:503–15.
  2. Ludvik B, et al. Lancet. 2021;398:583–98.
  3. Del Prato S, et al. Lancet. 2021;398:1811–24.
  4. Dahl D, et al. Diabetes. 2021;70(Suppl_1):80-LB.
Question 3/4
Cotadutide, a dual GLP-1 and glucagon receptor agonist, has been investigated in a phase IIb study in patients with type 2 diabetes and overweight inadequately controlled by metformin. Which statement best describes the % change in body weight with cotadutide versus placebo at 14 weeks?

GLP-1, glucagon-like peptide-1.
 Correct

A phase IIb study of cotadutide, a dual GLP-1 and glucagon receptor agonist, enrolled adults with a BMI ≥25 kg/m2 and type 2 diabetes inadequately controlled with metformin. Patients were randomized to cotadutide (100, 200 or 300 μg), placebo or open-label liraglutide.
The coprimary endpoints were met: from baseline to week 14, percentage-point change in HbA1c level was -1.1 to -1.3 with cotadutide versus -0.23 with placebo, and % change in body weight was -3.0 to -5.0 versus -0.7, respectively (all p<0.001).

Abbreviations
BMI, body mass index; GLP-1, glucagon-like peptide-1; HbA1c, glycated hemoglobin.

Reference
Nahra R, et al. Diabetes Care. 2021;44:1433–42.

Question 4/4
Your 48-year-old female patient with type 2 diabetes is showing signs of non-adherence to her medication and tells you that she finds her injection device difficult to use. What steps would you take to address this?
 Correct

Diabetes self-management education and support enables people with diabetes to make informed decisions and to assume responsibility for day-to-day diabetes management. Education should be individualized and available on an ongoing basis and at critical junctures, including at diagnosis, annually, when complications arise and during transitions in life and care.

Reference
Davies MJ, et al. Diabetologia. 2018;61:2461–98.

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