Understanding the Pathophysiology of the Aging Patient with Diabetes: Optimal Treatment through Incretin-based Therapies - Jun 6

Optimal Management of Aging patients with T2DM
1 ACPE 1 ANCC Contact Hours 1 AMA PRA Category 1 Credit(s)
Launch Date:
May 29, 2013
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Pharmacists, Primary Care Clinicians, Registered Nurses

Relevant Terms:

Diabetes, Geriatric Medicine, T2DM

Helena W. Rodbard, MD, FACP, MACE

Helena W. Rodbard, MD, FACP, MACE
Activity Cochair
Medical Director
Endocrine and Metabolic Consultants
Rockville, Maryland

Helena W. Rodbard, MD, FACP, MACE, is Past-President of the American College of Endocrinology (ACE) and Past-President of the American Association of Clinical Endocrinologists (AACE). She is Cochairperson of the committee that developed the 2009 AACE Diabetes Algorithms and previously served as the Chairperson of the task force that developed the AACE guidelines for the management of patients with diabetes. She also has served as the Chair of the Publications Committee for AACE.
Dr. Rodbard is a Master of the American College of Endocrinology (MACE) and a Fellow of the American College of Physicians (FACP). She completed fellowships at the National Institute of Child Health and Human Development (NICHD) and in the Diabetes Branch of the National Institute for Diabetes, Digestive and Kidney Diseases (NIDDK), and the National Institutes of Health (NIH). She has conducted research involving both basic and clinical aspects of diabetes and other endocrine disorders and currently leads an active program of clinical investigation.  
Dr. Rodbard has served on the faculties of Georgetown University Medical School and George Washington University Medical Center. She has served as a member of the board of the Juvenile Diabetes Research Foundation. Dr. Rodbard has lectured extensively regarding diabetes and other endocrine disorders, both nationally and internationally.
Dr. Rodbard is engaged in a very active, well established, and highly respected private practice of endocrinology with a focus on diabetes and metabolic disorders. She has been consistently listed in Best Doctors in America and Best Doctors in Washington, DC.

Anne Peters, MD, FACP, CDE

Anne Peters, MD, FACP, CDE
Activity Cochair
Director, Clinical Diabetes Program
Professor, Keck School of Medicine
University of Southern California
Beverly Hills, California

Anne L. Peters, MD, FACP, CDE, is currently a professor at the Keck School of Medicine at the University of Southern California (USC) and the Director of the USC Clinical Diabetes Program. She runs diabetes centers in Beverly Hills and in underserved East Los Angeles and works with the L.A. County Department of Health Services on a county-wide diabetes program.
Dr. Peters earned her undergraduate degree from Wesleyan University located in Middletown, Connecticut and her medical degree from the Pritzker School of Medicine at the University of Chicago. She performed her internal medicine residency at Stanford University Medical Center and fellowship in endocrinology at Cedars-Sinai Medical Center. She was in charge of the clinical diabetes programs at Cedars and then at the University of California, Los Angeles (UCLA) before moving to USC.
Dr. Peters has been a principal investigator on multiple clinical trials focusing on diabetes and diabetes prevention. She established the Community Diabetes Initiatives Research Center in collaboration with Children's Hospital Los Angeles with funding from the Keck Foundation, the Juvenile Diabetes Research Foundation (JDRF), American Diabetes Association (ADA), Rose Hills Foundation, California Nutrition Network, and the Helmsley Trust. Dr. Peters is a principal investigator for the National Institutes of Health (NIH) Look AHEAD Study and the UCLA/USC NIH P50 program project, "Family and Neighborhood Interventions to Reduce Heart Disease Risk in East L.A." 
She has been an invited speaker at many local, national, and international medical conferences. Dr. Peters has authored 3 books on diabetes and over 100 articles appearing in peer-reviewed medical journals including The Journal of the American Medical Association, Annals of Internal Medicine, Archives of Internal Medicine, Diabetes Care, and the American Journal of Medicine. She serves on the ABIM Endocrine Board and the Board of the ADA. Dr. Peters received the ADA Outstanding Physician Clinician Award in 2008 and the 2010 Bernardo Houssay Award from the National Minority Quality Forum for her work with the underserved. She is an author of the "ADA/European Association for the Study of Diabetes (EASD) Position Statement on the Management of Hyperglycemia in Type 2 Diabetes" and co-chair of the ADA Working Group on the Treatment of Type 1 Diabetes.

Louis Kuritzky, MD

Louis Kuritzky, MD
Family Physician
Clinical Assistant Professor
Department of Community Health and Family Medicine
University of Florida
Gainesville, Florida

Dr. Kuritzky is a family physician and clinical assistant professor at the Department of Community Health and Family Medicine at University of Florida in Gainesville. He received his medical degree from the Medical College of Virginia in Richmond and completed his internship at Miami Valley Hospital in Dayton, Ohio.
Prior to joining the faculty at the University of Florida in 1983, Dr. Kuritzky was a member of the UCLA Family Medicine Clinical Faculty. His current professional society participation includes the American Society of Hypertension (ASH), the American Diabetes Association (ADA), and the American Association of Family Physicians (AAFP). In addition to being board-certified in family medicine by the American Board of Family Medicine, he has received certification as a specialist in hypertension by the ASH.
Dr. Kuritzky has given hundreds of presentations nationally and internationally at professional societies. He is on the editorial board of Internal Medicine Alert and the International Journal of Impotence Research. He has authored over 100 articles in journals including the New England Journal of Medicine, Journal of the American Medical Association, Comprehensive Therapy, Hospital Practice, and Patient Care.

Frank Lavernia, MD

Frank Lavernia, MD
Founder, North Broward Diabetes Center
Pompano Beach, Florida

Dr. Lavernia has been a practicing diabetologist in South Florida for over 30 years. He was the founder and director of the North Broward Diabetes Center in Pompano Beach, Florida. He lectures nationally on obesity, prediabetes, diabetes and their complications; he also speaks on lipid and hypertension disorders. He presents at Pri-Med, American College of Physicians, and NACE programs.

He has published multiple articles in a variety of national medical journals and online publications.  Dr. Lavernia has appeared on the Discovery Channel and on National Public Radio. He most recently completed various CME videos for the American Diabetes Association.

He is an adjunct faculty member of the National Diabetes Education Initiative, Vascular Biology Working Group, and for the Coalition for the Advancement of Cardiovascular Health. He is also a member of the American Diabetes Association and National Hispanic Medical Association.
1. Summarize the current understanding of the pathophysiology of T2DM especially as it relates to patients with longer durations of diabetes
2. Manage aging patients with diabetes effectively using therapies that address the underlying pathophysiological disturbances while minimizing adverse events
3. Prescribe optimal and convenient antidiabetic therapies that minimize the cardiovascular risk in their aging patients
4. Provide accurate and appropriate care and counsel for patients and their families as part of the treatment team

Estimated time to complete the program: 1 hour

5 min  Welcome and Overview
15 min  Case Presentation – Understanding T2DM Pathophysiology in the Aging: Duration of Disease
15 min  Case Presentation – Choosing Appropriate Therapy for Managing A1C in Aging Patients: Efficacy, Adverse Events, and Convenience
15 min  Case Presentation – Cardiovascular Risks in Aging Patients with Diabetes: Optimal Strategies to Minimize Risk
10 min  Question and Answer Session

Program Overview
Type 2 diabetes mellitus (T2DM) is an epidemic in the US and around the world. The 2011 Centers for Disease Control (CDC) report shows that 26.9% of individuals 65 years of age or older have diabetes. Additionally, 50% of adults 65 years of age or older were reported to have prediabetes, and in 2010, 390,000 new cases of diabetes were reported in this age group. Recent data show that the risk of coronary death and death from vascular causes in patients with diabetes was 2.31- and 2.32-fold higher than those without diabetes. Diabetes has been shown to decrease life expectancy by 6 years in individuals who are 50 years of age. Despite the availability of a wide variety of pharmaceuticals, T2DM in the aging remains a difficult condition to treat. A recent CDC analysis showed that between 2003 and 2006, ~32% of patients who were ≥65 years of age had an A1C level ≥7.0; ~11% had an A1C level ≥8%; and 4.1% had an A1C >9%. The complex nature of T2DM pathology and rapid emergence of new data, especially with respect to incretin-based therapies, makes it difficult for clinicians to stay abreast of the latest developments. Clearly, continuing education activities are needed to highlight the novel strategies that allow clinicians to not just control their aging  patients' glycemic profiles but also help minimize cardiovascular risks. Therefore, this activity will begin with an overview of the prevalence and morbidity associated with T2DM in aging patients and barriers such as fear of weight gain, fear of hypoglycemia, and ease and convenience of use of therapies that frequently hinder optimal management. Next, using the case of an aging patient, the faculty will review the current understanding of the pathophysiology of T2DM and highlight the mechanism of action of incretin-based therapies in this context. They will then highlight the role of a multifaceted approach for better glycemic control and for minimized cardiovascular risks consistent with guideline recommendations. Furthermore, they will discuss recent clinical trial data demonstrating the ease and convenience of use, safety and efficacy profiles of short- and long-acting incretin-based therapies in managing T2DM in aging patients. Finally, the expert faculty will drive home the key clinical takeaways and guideline recommendations that physicians can implement immediately into their clinical practices in order to improve care for their patients with T2DM.

Target Audience
This activity has been designed to meet the educational needs of primary care clinicians, registered nurses, pharmacists, and other healthcare professionals involved in the care of patients with type 2 diabetes mellitus.

Physician Continuing Medical Education
Accreditation Statement
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 Postgraduate Institute for Medicine and ACCELMED. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
The Postgraduate Institute for Medicine designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Continuing Education

Accreditation Statement
Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Credit Designation
Postgraduate Institute for Medicine designates this continuing education activity for 1.0 contact hour(s) (0.1  CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number – 0809-9999-13-283-L01-P)

Type of Activity

Hardware / Software Requirements
To view this educational activity you will need 
a personal computer or smartphone with internet access and one of the following web browsers:
Flash Player 8.0 or later (http://www.adobe.com/go/getflash) (Flash Player 10 or later recommended), and one of the following browsers:
Windows: Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Firefox 1.1+, Safari 1.0+, Google Chrome, or Opera
Linux: Firefox 1.1+
Broadband connection with 500+ Kbps
Policy on Privacy and Confidentiality
Please see final activity for the policy on privacy and confidentiality that relates to this internet activity.  
Upon receipt of the completed activity evaluation form, transcript information will be available at www.mycpemonitor.net within 4 weeks.
Nursing Continuing Education
Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Credit Designation
This educational activity for 1.0 contact hours is provided by Postgraduate Institute for Medicine.
California Board of Registered Nursing
Provider approved by the California Board of Registered Nursing, Provider Number 13485, for 1.0  contact hours.
Fee Information
There is no fee for this educational activity.

A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you upon completion of the program.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
The faculty reported the following financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity:

Louis Kuritzky, MD
Consultant Fees: Boehringer-Ingelheim GmbH; Daiichi Sankyo, CO., LTD.; Janssen Global Services, LLC; Johnson & Johnson; Lilly USA, LLC; Novartis International AG; Novo Nordisk A/S; Ortho-McNeil; sanofi-aventis; Takeda Pharmaceuticals Company Limited
Grant Reviewer: Pfizer Inc.

Frank Lavernia, MD
Speakers' Bureaus: Janssen Global Services, LLC; Novo Nordisk A/S

Anne Peters, MD, FACP, CDE
Consultant Fees: Abbott Diabetes Care; Amylin Pharmaceuticals, Inc./Lilly USA, LLC; Becton, Dickinson and Company; F. Hoffman-La Roche Ltd.; Janssen Pharmaceuticals, Inc.; Medtronic, Inc.; Takeda Pharmaceutical Company Limited; sanofi-aventis, U.S. LLC
Speakers' Bureaus: Amylin Pharmaceuticals, Inc./Lilly USA, LLC; Novo Nordisk A/S

Helena W. Rodbard, MD, FACP, MACE
Consultant Fees: Amylin Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Lilly USA, LLC; Novo Nordisk A/S
Consultant Fees Spouse: Amylin Pharmaceuticals, Inc.; Halozyme Therapeutics; Merck & Co., Inc.
Speakers' Bureaus: Amylin Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Lilly USA, LLC; Merck & Co., Inc.; Novo Nordisk A/S
Contracted Research: Amylin Pharmaceuticals, Inc.; Biodel Inc.; Merck & Co., Inc.; Novo Nordisk A/S; sanofi-aventis, U.S. LLC

The planners and managers reported the following financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity:

The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CCMEP, Jan Schultz, RN, MSN, CCMEP, and Patricia Staples, MSN, NP-C, CCRN, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
The following ACCELMED planner and manager, Jason LeDune, MS, hereby states that he or his spouse/life partner has no relationships with commercial interests. 
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners.  Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.


This activity is supported by an independent medical education grant from the Bristol-Myers Squibb and AstraZeneca Pharmaceuticals LP, Alliance Partners.