Program Overview

Despite the availability of various therapeutic options for the management of type 2 diabetes, approximately two-thirds of patients do not reach the A1C target of less than 7%, set by the American Diabetes Association.

The natural history of type 2 diabetes is characterized by impaired postprandial insulin secretion and unopposed actions of glucagon that result from the progressive decline of islet cell function. Incretin-based therapies have been shown to preserve islet cell function and have emerged as an important option in the management of type 2 diabetes.

Incretins are intestinal hormones that stimulate insulin secretion from pancreatic Β-cells and inhibit glucagon secretion from pancreatic α-cells, both in a glucose-dependent manner. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide are the 2 principal incretin hormones, which are rapidly inactivated by the enzyme dipeptidyl peptidase-4 (DPP-4). Incretin-based therapies encompass various classes of agents: incretin enhancers (selective DPP-4 inhibitors), incretin mimetics (exenatide), and GLP-1 analogs (liraglutide) that are resistant to degradation by DPP-4. These agents promote glucose-dependent secretion of endogenous insulin to clinically improve glycemic control with a very low incidence of hypoglycemia. In clinical trials, incretin enhancers have shown weight-neutral effects. Incretin mimetics and incretin analogs, however, have demonstrated induction of weight loss through reductions in food intake as a result of inhibition of gastric emptying and induction of satiety. This effect may be of particular value in patients with type 2 diabetes as the majority of these patients are overweight or obese; even modest reductions in weight can improve glycemic control and attenuate cardiometabolic risk.

This activity will review the pathogenesis of type 2 diabetes, the mechanisms by which incretin hormones affect glucose homeostasis, and the role of incretin-based therapeutics in the management of type 2 diabetes.

Educational Objectives

After completing this activity, the participant should be better able to:

• Review the role of islet cell dysfunction in the onset and progression of type 2 diabetes

• Discuss the role of new incretin-based therapies in optimizing glycemic control

• Implement strategies to achieve glycemic goals recommended by current treatment guidelines

Target Audience

This activity has been designed to meet the educational needs of physicians and other healthcare professionals involved in the management of patients with type 2 diabetes.

Accreditation Statement

SciMed is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

SciMed designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosure

SciMed assesses conflicts of interest with its faculty and all individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are resolved by SciMed to ensure fair balance and scientific objectivity.

When asked to report any potential conflict(s) of interest, faculty reported the following:

Alan J. Garber, MD, PhD

Grants/Research Support: Bristol-Myers Squibb Company, Daiichi Sankyo, GlaxoSmithKline, Merck & Co., Inc., Novartis, Novo Nordisk, sanofi-aventis

Consultant: GlaxoSmithKline, Merck & Co., Inc., Novo Nordisk

Speakers Bureau: Bristol-Myers Squibb Company, GlaxoSmithKline, Merck & Co., Inc., Novo Nordisk

Jack L. Leahy, MD

Consultant: Merck & Co., Inc., sanofi-aventis

Speakers Bureau: Merck & Co., Inc., sanofi-aventis

Richard E. Pratley, MD

Grants/Research Support: Eli Lilly and Company, GlaxoSmithKline, Merck & Co., Inc., Novartis, sanofi-aventis, Takeda Pharmaceuticals

Consultant: GlaxoSmithKline, Novo Nordisk, Takeda Pharmaceuticals

Speakers Bureau: Merck & Co., Inc., Takeda Pharmaceuticals

Stock Shareholder: Novartis

All SciMed personnel involved in the development of content for this activity have no relevant conflicts to report.

The materials for this activity were peer reviewed by Ajaykumar D. Rao, MD, Tulane University Health Sciences Center. There were no relevant conflicts to report.

Activity Chairperson

Alan J. Garber, MD, PhD
Professor of Medicine, Biochemistry and Molecular Biology, and Molecular and Cellular Biology
Division of Diabetes, Endocrinology and Metabolism
Baylor College of Medicine
Houston, Texas

Faculty

Richard E. Pratley, MD
Professor of Medicine
Director, Diabetes and Metabolism Translational Medicine Unit
University of Vermont College of Medicine
Burlington, Vermont

Jack L. Leahy, MD
Professor of Medicine
Chief, Division of Endocrinology, Diabetes, and Metabolism
University of Vermont College of Medicine
Burlington, Vermont