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Integrating GLP-1 RAs into T2D management: A unified approach, from PCP to patient

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touchMDT Integrating GLP-1 RAs into T2D management: A unified approach, from PCP to patient

Watch specialists within an MDT, plus a patient, discuss the role of GLP-1 RAs in the management of T2D.

 Overview & Learning Objectives

Patient with type 2 diabetes
Primary Care Physician & Endocrinologist
Watch Video
GLP-1 RAs: How do they work? Dr K Fernando, Prof. Dr M Nauck

Watch a primary care physician and an endocrinologist share their expert insights on the mechanism of action of GLP-1 RAs, the efficacy of available GLP-1 RAs and their applicability in clinical practice, and investigational dual-agonist therapies

Watch Video
Primary Care Physician & Nurse Specialist & Patient Advocate
Watch Video
Managing the side effects of GLP-1 RAs Dr K Fernando, Dr Ş Özcan, Ms KA Hardy

Watch a primary care physician and a diabetes nurse specialist review the safety of GLP-1 RAs, and how to educate patients on managing the side effects of these agents. Plus, see a patient advocate recount first-hand experiences of patients with T2D currently taking a GLP-1 RA therapy.

Watch Video
Endocrinologist & Primary Care Physician & Patient Advocate
Watch Video
GLP-1 RAs in the T2D treatment pathway Prof. Dr M Nauck, Dr K Fernando, Ms KA Hardy

Watch an endocrinologist and a primary care physician explore the role of GLP-1 RAs in the T2D management pathway and the real-world factors affecting selection of a GLP-1 RA. Plus, see a patient advocate share first-hand experiences of how GLP-1 RA therapy can help patients to achieve their glycaemic and weight-loss goals

Watch Video
Primary Care Physician & Endocrinologist

Watch a primary care physician and an endocrinologist share their expert insights on the mechanism of action of GLP-1 RAs, the efficacy of available GLP-1 RAs and their applicability in clinical practice, and investigational dual-agonist therapies
Expert Spotlight
Dr Kevin Fernando
North Berwick Health Centre, North Berwick, Scotland, UK
Prof. Dr med. Michael Nauck
St Josef-Hospital (Ruhr-University Bochum), Bochum, Germany

Dr Kevin Fernando and Prof. Dr med. Michael Nauck review the rationale for using GLP-1 as a therapeutic target in T2D and provide an overview of available and pipeline GLP-1 RA-based therapies.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:20
 
Primary Care Physician & Nurse Specialist & Patient Advocate

Watch a primary care physician and a diabetes nurse specialist review the safety of GLP-1 RAs, and how to educate patients on managing the side effects of these agents. Plus, see a patient advocate recount first-hand experiences of patients with T2D currently taking a GLP-1 RA therapy.
Expert Spotlight
Dr Kevin Fernando
North Berwick Health Centre, North Berwick, Scotland, UK
Prof. Dr Şeyda Özcan
Atlas University, Istanbul, Turkey
Ms Kelly Ann Hardy
Margate, UK

Dr Kevin Fernando and Prof. Dr Şeyda Özcan review the safety of GLP-1 RAs and the role of patient education in managing the side effects of these agents. Plus, patient advocate Kelly Ann Hardy shares patient experiences of using GLP-1 RAs

Listen on the Go

 Learn more Back to MDT Hub Time: 14:24
 
Endocrinologist & Primary Care Physician & Patient Advocate

Watch an endocrinologist and a primary care physician explore the role of GLP-1 RAs in the T2D management pathway and the real-world factors affecting selection of a GLP-1 RA. Plus, see a patient advocate share first-hand experiences of how GLP-1 RA therapy can help patients to achieve their glycaemic and weight-loss goals
Expert Spotlight
Prof. Dr med. Michael Nauck
St Josef-Hospital (Ruhr-University Bochum), Bochum, Germany
Dr Kevin Fernando
North Berwick Health Centre, North Berwick, Scotland, UK
Ms Kelly Ann Hardy
Margate, UK

Prof. Dr med. Michael Nauck and Dr Kevin Fernando explore the role of GLP-1 RAs in the T2D management pathway and the real-world factors affecting selection of a GLP-1 RA. Plus, patient advocate Kelly Ann Hardy shares patient experiences of how GLP-1 RA therapy has influenced their glycaemic and weight-loss goals

Listen on the Go

 Learn more Back to MDT Hub Time: 12:09
 
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Learning Objectives & Overview
Overview

In this activity, specialists in the MDT involved in caring for patients with T2D, plus a patient, share their perspectives on GLP-1 RA therapies, including data supporting their use, managing side effects, and their role in the T2D management pathway.

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 primary care practitioners and endocrinologists involved in the care of patients with type 2 diabetes.

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

Dr Kevin Fernando discloses: Advisory board or panel fees from Lilly and Roche. Speakers bureau fees from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Lilly, Merck Sharp & Dohme, Mundipharma International, Napp and Novo Nordisk.

Prof. Dr med. Michael Nauck discloses: Advisory board or panel fees from AstraZeneca, Berlin-Chemie, Genentech, GlaxoSmithKline, Sun Pharma and Takeda (all relationships terminated). Consultant fees from Regor Pharmaceuticals. Other fees from Altimmune (Drug Monitoring and Safety Board).

Prof. Dr Şeyda Özcan has no financial interests/relationships or affiliations in relation to this activity.

Ms Kelly Ann Hardy has no financial interests/relationships or affiliations in relation to this activity.

Content reviewer

Christy M Thai, PharmD, BCPS 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 1.0 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 1.0 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: 14 April 2022. Date credits expire: 14 April 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:

  • Evaluate the data supporting the use of GLP-1 RAs for treatment of T2D and apply them to practical considerations associated with GLP-1 RA use
  • Manage potential side effects of GLP-1 RAs, including GI symptoms, and discuss self-management with patients
  • Recognize the role of GLP-1 RAs in the T2D management pathway and apply this knowledge to clinical practice
Faculty & Disclosures
Dr Kevin Fernando

North Berwick Health Centre, North Berwick, Scotland, UK

Dr Kevin Fernando is a part-time GP Partner and GP Educational Supervisor working at the coalface in North Berwick Health Centre, Scotland, UK. read more

Dr Fernando is Scottish lead of the Primary Care Diabetes Society, Royal College of General Practitioners (RCGP) Clinical Advisor for Diabetes, and Multimorbidity and Education Director for GPnotebook Education.

He graduated from the University of Edinburgh in 2000 and holds both MRCGP and MRCP (UK) qualifications. He holds a Master’s degree in diabetes, which he passed with distinction.

Dr Fernando has been elected to the Fellowship of the RCGP, the Royal College of Physicians of Edinburgh and also the Academy of Medical Educators for his work in diabetes and medical education.

Dr Kevin Fernando discloses: Advisory board or panel fees from Lilly and Roche. Speakers bureau fees from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Lilly, Merck Sharp & Dohme, Mundipharma International, Napp and Novo Nordisk.
Prof. Dr med. Michael Nauck

St Josef-Hospital (Ruhr-University Bochum), Bochum, Germany

Prof. Dr med. Michael Nauck is Professor of Diabetology and Head of Clinical Research at the Diabetes Division of St. Josef-Hospital (Ruhr-University Bochum) in Bochum, Germany. He teaches at Georg-August University, Göttingen, and Ruhr-University, Bochum, both in Germany. read more

Prof. Nauck has a particular research interest in the role of gastrointestinal peptide hormones (incretins: glucose-dependent insulinotropic polypeptide [GIP] and glucagon-like peptide-1 [GLP-1]) in the physiological regulation of metabolism and in the pathophysiology of type 2 diabetes. He has contributed to pivotal studies proving the therapeutic potential of GLP-1 in type 2 diabetes, and has contributed to the development of incretin-based glucose-lowering medications, such as GLP-1 receptor agonists and inhibitors of dipeptidyl peptidase-4. Additional areas of interest include spontaneous hypoglycaemia (insulinomas), pancreas transplantation, cardiovascular complications of type 2 diabetes, and the modification of cardiovascular risk in patients with type 2 diabetes with glucose-lowering pharmacotherapy.

His scientific contributions have been honoured with several awards, including the Ferdinand-Bertram Award (1993), the Werner-Creutzfeldt Award (2007) and the Paul Langerhans Medal (2012) of the German Diabetes Association.

Prof. Nauck has served as reviewer for all major diabetes journals and has published more than 240 original articles and 130 reviews and book chapters. His publications have been quoted >55,000 times, his ‘H-index’ is 102, and he has been a ‘highly-cited researcher’ (among the top 1%) in 2019 (Web of Science).

Prof. Nauck is a member of a number of professional societies, including the German, European and American Diabetes Associations and the International Diabetes Federation.

Prof. Dr med. Michael Nauck discloses: Advisory board or panel fees from AstraZeneca, Berlin-Chemie, Genentech, GlaxoSmithKline, Sun Pharma and Takeda (all relationships terminated). Consultant fees from Regor Pharmaceuticals. Other fees from Altimmune (Drug Monitoring and Safety Board).
Prof. Dr Şeyda Özcan

Atlas University, Istanbul, Turkey

Prof. Dr Şeyda Özcan is Head of the Department of Nursing in the Faculty of Health Sciences, Atlas University, Istanbul, Turkey. read more

Prof. Özcan has over 30 years’ of clinical and academic experience in diabetes nursing, in both international and national settings. She graduated from Florence Nightingale School of Nursing at Istanbul University in 1991, and completed her Master’s degree and PhD in diabetes nursing in 1995 and 1999, respectively.

Prof. Özcan has been a member of the Foundation of European Nurses in Diabetes (FEND) since 1999 and has served as executive committee member (ECM) and special advisor. She was a member and European representative of the Diabetes Education Consultative Section and the Insulin and Other Medicines Committee at the International Diabetes Federation, ECM and General Secretary of the Turkish Diabetes Nursing Association, and a member of the Board of Trustees of the Turkish Diabetes Foundation.

Prof. Özcan has published several articles and books and has participated in research projects in Turkey, China, Europe and the USA. She has received several awards, most recently the FEND Recognition Award that acknowledges diabetes specialist nurses who have made significant contributions to diabetes care, research and education, and the Prof. Dr Perihan Velioğlu Honour Award for leadership in national and international nursing research, education and practice.

Prof. Dr Şeyda Özcan has no financial interests/relationships or affiliations in relation to this activity.
Ms Kelly Ann Hardy

Margate, UK

Kelly Ann Hardy was diagnosed with type 2 diabetes in 2014 and is a patient advocate affiliated with a support group that she created, which now has more than 10,000 members globally. The support group’s mission is to provide help and information to anyone starting, or on, specific long-acting glucagon-like peptide-1 receptor agonist therapies.

Kelly is a full-time carer to her daughter, and in her spare time runs the support group and attends university from home.

Kelly’s goal is to help anyone who is struggling with their diagnosis and to ensure they find the information and assistance they need to secure, and succeed on, appropriate treatment.

Ms Kelly Ann Hardy has no financial interests/relationships or affiliations in relation to this activity.
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This Activity Is Funded By:

An independent medical education grant from Novo Nordisk A/S.
This activity 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: 14 April 2022. Date credits expire: 14 April 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 of these statements describes some of the effects of GLP-1 RAs in people with type 2 diabetes?

GLP-1 RA, glucagon-like peptide-1 receptor agonist.
Correct

In response to ingestion of glucose or nutrients, the gastrointestinal tract secretes incretin hormones such as GLP-1 and glucose-dependent insulinotropic polypeptide, which affect organ systems that support glucose homeostasis. GLP-1 effects include activation of receptors that stimulate insulin secretion and decreased glucagon secretion. Central effects mediated via the brain include a slowing of gastric emptying and an increase in satiety. The discovery of the role of GLP-1 in glucose regulation paved the way for the GLP-1 RA class of agents.

Abbreviations

GLP-1, glucagon-like peptide-1; RA, receptor agonist.

Reference

Chun JH, Butts A. JAAPA. 2020;33:3–18.

Question 2/4
Your 48-year-old patient with type 2 diabetes is due to begin GLP-1 RA therapy at the next visit. Which of these steps would you take to help minimize the potential gastrointestinal side effects of the drug, such as nausea and vomiting?

GLP-1 RA, glucagon-like peptide-1 receptor agonist.
 Correct

GI side effects are the most common across the GLP-1 RA class, particularly nausea, vomiting, and diarrhoea. GI side effects appear to be somewhat dose-related, are usually mild–moderate, and often diminish with continued treatment. Titration dosing can help to minimize the GI adverse reactions. Nausea can be limited by increasing the GLP-1 RA dose slowly and advising patients to eat smaller meals and stop eating at the first sign of satiation.

Abbreviations

GI, gastrointestinal; GLP-1 RA, glucagon-like peptide-1 receptor agonist.

Reference

Chun JH, Butts A. JAAPA. 2020;33:3–18.

Question 3/4
What action should you take in your patients who have type 2 diabetes and renal impairment if they report recurrent vomiting and diarrhoea as a side effect of GLP-1 RA therapy?

GLP-1 RA, glucagon-like peptide-1 receptor agonist; SGLT2, sodium-glucose cotransporter-2.
 Correct

In patients treated with GLP-1 RAs, there have been postmarketing reports of acute renal failure and worsening of chronic renal failure. Many cases occurred along with GI adverse reactions, such as nausea, vomiting, and diarrhoea leading to dehydration. In patients with renal impairment who experience severe GI complaints and/or dehydration, it is recommended to monitor renal function carefully and make dose adjustments cautiously.

Abbreviations

GI, gastrointestinal; GLP-1 RA, glucagon-like peptide-1 receptor agonist.

Reference

Chun JH, Butts A. JAAPA. 2020;33:3–18.

Question 4/4
In your patients with type 2 diabetes with indicators of high ASCVD risk, what considerations should you make before prescribing GLP-1 RA therapy?

A1c, glycated haemoglobin; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; GLP-1 RA, glucagon-like peptide-1 receptor agonist.
 Correct

A 2019 US/European consensus report on type 2 diabetes management recommends that to reduce the risk of MACE, GLP-1 RAs can be considered in patients with type 2 diabetes and indicators of high CVD risk. In these individuals, the decision to treat with a GLP-1 RA should be considered independently of baseline A1c or individualized A1c target. The GLP-1 RA should have proven CVD benefit, i.e. a label indication of reducing CVD events.

Abbreviations

A1c, glycated haemoglobin; CVD, cardiovascular disease; GLP-1 RA, glucagon-like peptide-1 receptor agonist; MACE, major adverse cardiovascular events.

Reference

Buse JB, et al. Diabetes Care. 2020;43:487–93.

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