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    Faculty & Disclosures
    Dr Joanna Van

    Diabetes Research Center, Tustin, CA, USA

    Dr Joanna Van is Principal Investigator at the Diabetes Research Center in Orange County, CA. She received her undergraduate degree from the University of California, San Diego, where she discovered a personal interest in research and diabetes medicine.read more

    Dr Van participated in numerous research publications while obtaining her medical degree from Western University of Health Sciences and Residency in Family Practice at Arrowhead Regional Medical Center. She has been a clinical research investigator for more than 11 years and has completed more than 130 clinical trials. She was voted as one of Orange County’s Physicians of Excellence by Orange Coast Magazine.

    Dr Van continues to be at the forefront of diabetes through her research, attendance, and presentations at various medical conferences. She admits that her job satisfaction comes primarily from her passion for her patients’ well-being and her personal commitment to providing quality medical research.

    Dr Joanna Van discloses: Grants/research support from Lilly, Eliem Therapeutics, Novo Nordisk, Pfizer, Sanofi and Lexicon

    Dr Vincent Woo

    University of Manitoba, Winnipeg, Manitoba, Canada

    Dr Vincent Woo obtained his medical degree from the University of Manitoba and his specialty training in Endocrinology and Metabolism at the University of British Columbia. He is currently a member of the Section of Endocrinology and Metabolism at the University of Manitoba.read more

    Dr Woo is actively involved with the Canadian Diabetes Association, where he is a past Chair of the Clinical and Scientific Section and served on the Board of Directors. He is a member of the Canadian Hypertension Guidelines and co-authored the Diabetes and Driving guidelines in Canada.

    Dr Woo chaired the 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, and was also on the Executive and Steering committees for the 2013 and 2018 Clinical Practice Guides, co-authoring many of the chapters. He was awarded the Gerald S. Wong Award in 2014 for dedication to diabetes service in Canada and the 2014 Best Banting award for dedicated service in diabetes for the Province of Manitoba. He has received teaching awards from the University of Manitoba Medical School.

    Dr Woo is a principal investigator at the Diabetes Research Group at the John Buhler Research Centre and is involved in a large number of important clinical trials. He has published over 100 articles and abstracts, and is a reviewer and Associate Editor for several journals, including Diabetes Care.

    He is actively involved in teaching and continuing medical education at all levels, from medical students, residents and fellows to family physicians and endocrinologists.

    Dr Vincent Woo discloses: Consulting and Speakers bureau fees from AstraZeneca, Boehringer Ingelheim, Lilly and Novo Nordisk.

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    What are the challenges of achieving glycemic control in patients with T2D, and how can they be overcome?
    How can individualized glycemic targets for patients with T2D be set and implemented in clinical practice?
    What treatment options are available to help safely achieve glycemic targets in patients with T2D?
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    touchIN CONVERSATION
    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Achieving individualized glycemic targets in patients with type 2 diabetes: What are the key considerations?

    Faculty Podcast Featured
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    • Select in the video player controls bar to choose subtitle language. Subtitles available in English, French, German, Italian, Mandarin, Portuguese, English, Spanish.
    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

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

    • Evaluate the unmet need regarding achieving glycemic control in patients with type 2 diabetes and the associated reasons
    • Decide how to apply individualized glycemic targets according to patient characteristics
    • Choose appropriate treatments with properties relevant to the individual patient to help achieve glycemic control
    Overview

    In this activity, experts in diabetes management respond to questions from the diabetes community on overcoming the challenges of achieving glycemic control, applying individualized targets in clinical practice, and the available treatment options for safely achieving glycemic targets in patients with type 2 diabetes.

    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 diabetologists, endocrinologists, diabetes nurses, and primary care physicians involved in the management of patients with type 2 diabetes.

    Disclosures

    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

    Dr Joanna Van discloses: Grants/research support fromLilly, Eliem Therapeutics, Novo Nordisk, Pfizer, Sanofi and Lexicon.

    Dr Vincent Woo discloses: Consulting and Speakers bureau fees from AstraZeneca, Boehringer Ingelheim, Lilly and Novo Nordisk.

    Content Reviewer

    Kaitlyn Rechenberg, PhD, MPH, APRN 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 1 AMA PRA Category 1 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 1 Category 1 credit 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.

    Nurses

    USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

    A maximum of 1 contact hour may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

    This activity is awarded .75 ANCC pharmacotherapeutic contact hour.

    Date of original release: 01 October 2021. Date credits expire: 01 October 2022.

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

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    This Activity Is Funded By:

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

    The information provided by this CE 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 CE 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: 01 October 2021. Date credits expire: 01 October 2023.

    This content is intended for healthcare professionals outside of the UK

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    touchIN CONVERSATION
    Achieving individualized glycemic targets in patients with type 2 diabetes: What are the key considerations?
    1 CE/CME credit
    Question 1/4
    Which of the following are considered to contribute to clinical inertia, and represent barriers to achieving glycemic targets?

    Clinical and therapeutic inertia in the treatment of type 2 diabetes result from healthcare practitioner-, patient-, and healthcare system-based factors, and represents a serious barrier to optimal treatment escalation, and therefore, glycemic control.
    The development of new therapeutic agents has presented physicians and patients with a wider choice of options for adapting treatment to individual requirements.
    Patients are more likely to accept and adhere to treatment if they perceive it is contributing to a positive outcome and addressing a need. Therefore, a proactive rather than reactive approach is important in managing patients with diabetes.
    Readily accessible information is needed on available medications, particularly new agents, with a focus on safety, side effects, efficacy, effectiveness, ease of prescription, purchase, administration, and storage.

    Reference
    Okemah J, et al. Adv Ther. 2018;35:1735–45.

    Question 2/4
    Which glycemic target would you consider setting for a patient who is over 75 years of age; has had type 2 diabetes for over 20 years; and has cognitive impairment, ASCVD and CKD?

    ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease.

    According to the recent American Diabetes Association guidelines, older adults (>65 years) who are otherwise healthy with few coexisting chronic illnesses and intact cognitive function and functional status should have lower glycemic goals, such as A1c <7.5%. Those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals, such as A1c <8.0–8.5%.
    Tight glycemic control in older adults with multiple medical conditions is considered overtreatment and is associated with an increased risk of hypoglycemia. Unfortunately, overtreatment is common in clinical practice.

    A1c, glycated hemoglobin.

    Reference
    American Diabetes Association. Diabetes Care. 2021;44(Suppl. 1):S73–84.

    Question 3/4
    Your patient is a 48-year-old woman with HFrEF with an LVEF of 35%. She was recently diagnosed with type 2 diabetes, and prescribed metformin in the first line. She has been identified as having an increased risk of hypoglycemia, and a target of A1c <7.5% was set. After 3 months, her A1c is 8.0%. Which of the following recommended treatment classes would you use as an add-on to metformin?

    A1c, glycated hemoglobin; DPP-4i, dipeptidyl peptidase 4 inhibitor; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; SGLT2i, sodium–glucose co-transporter 2 inhibitor; TZD, thiazolidinedione.

    Among patients with type 2 diabetes who have heart failure, an SGLT2i is recommended as part of the glucose-lowering regimen, independent of A1c and in consideration of patient–specific factors.

    A1c, glycated hemoglobin; SGLT2i, sodium–glucose co-transporter 2 inhibitor.

    Reference
    American Diabetes Association. Diabetes Care. 2021;44(Suppl. 1):S111–24.

    Question 4/4
    Your patient is a 60-year-old man with a BMI of 30.5 kg/m2 and coronary artery disease. His A1c at diagnosis was 10.3%. After 3 months, his A1c is still high, at 9.1%. Considering his high BMI and elevated ASCVD risk, what available treatment class would you consider first to help achieve this target?

    A1c, glycated haemoglobin; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CVD, cardiovascular disease; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium–glucose co-transporter 2 inhibitor; SU, sulfonylurea; TZD, thiazolidinedione.

    The American Diabetes Association guidelines recommend treatment with an SGLT2i or a GLP-1 RA if there is a compelling need to minimize weight gain or promote weight loss. As the patient has coronary artery disease and is ≥55 years old, there is an indicator of ASCVD risk. In such cases, a GLP-1 RA or SGLT2i with proven CVD benefit is recommended.

    A1c, glycated hemoglobin; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; GLP-1 RA, glucagon-like peptide-1 receptor agonist; SGLT2i, sodium–glucose co-transporter 2 inhibitor.

    Reference
    American Diabetes Association. Diabetes Care. 2021;44(Suppl. 1):S111–24.

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    This Activity Is Funded By:

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

    The information provided by this CE 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 CE 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: 01 October 2021. Date credits expire: 01 October 2023.

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