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Update on Insulin Management in Type 2 Diabetes

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This supplement was sponsored by the Supplement to Primary Care Metabolic Group and the Primary Care Education Consortium and is supported by funding from Novo Nordisk Inc. It was edited and peer reviewed by The Journal of Family Practice. Copyright © 2012 Quadrant HealthCom Inc. www.PCECoNsortiuM.orG www.PCMG-us.orG VOL 61, NO 5 | May 2012 | www.jfponline.com Update On Insulin Management in Type 2 Diabetes Introduction Stephen Brunton, MD, FAAFP The Evolution of Insulin Therapy in Diabetes Mellitus Michael Heile, MD Doron Schneider, MD, FACP Individualizing Insulin Therapy Luigi Meneghini, MD, MBA Timothy Reid, MD Advances in Insulin Therapy: A Review of Insulin Degludec Allen King, MD Faculty and Affiliations ics of rapid-acting and long-acting insulin analogs with recombinant human insulins Introduction • List the features of pens and other devices used to stephen Brunton, Md, FaaFP deliver insulin adjunct clinical Professor TAKE-HOME POINTS • Describe the role of insulin in the management of department of Family Medicine patients with type 2 diabetes mellitus university of north carolina • The “treat to target” approach is to quickly • Identify strategies to address patient barriers to insu- chapel Hill, nc achieve the target glycosylated hemoglo- lin therapy Executive Vice President for Education bin (AIC) goal of <7% in most people, and • Identify different approaches to initiate insulin Primary care Education consortium then intensify or change therapy as needed therapyto maintain glycemic control charlotte, nc • Describe the results of phase 3 trials of ultra–long- • acting Results insulin of an online degludec survey demonstrate The Evolution of Insulin Therapy in Diabetes Mellitus uncertainty regarding the clinical Michael Heile, MD SponsodifferencesR disclosu betweenre s tatglucagon-likeement peptide Family Medicine, diabetes (GLP-1) agonists and dipeptidyl peptidase the Family Medical Group other Pc(DPP)-4Ec clinical inhibitors staff have provided financial disclosure cincinnati, oH and have no conflicts of interest to resolve related to this activity. The increasingly important roles of the doron schneider, Md, FacP • GLP-1 agonists and DPP-4 inhibitors stem center for Patient safety and Healthcare Quality Facultyfrom Hono their overallRaRiu goodM d efficacyisclosu reand andsafety internal Medicine Residency Program EditoRprofilesial assistanc comparedE with other treatment abington Memorial Hospital options abington, Pa Each author received editorial assistance and fees from the Primary care Education consortium in the development of this activity. Individualizing Insulin Therapy luigi Meneghini, Md, MBa statement oF SponsoRsHiP and suppoRt Professor of clinical Medicine division of Endocrinology, diabetes, and Metabolism this program is sponsored by the Primary care Metabolic department of Medicine Group and the Primary care Education consortium and is university of Miami Miller school of Medicine supported by funding from novo nordisk inc. Miami, Fl The authors received editorial assistance from director Facultythe Primary disclosu Care Educationres Consortium and WriteHealth, LLC in the development of this diabetes Research institute dr. Brunton disclosed that he is on the advisory boards and activity and honoraria from the Primary Care Kosow diabetes treatment center speakers’ bureaus for Eli lilly, KoWa, and novo nordisk. Education Consortium. They have disclosed Miami, Fl that Dr Campbell is on the advisory board for dr. Heile disclosed that he is on the advisory board and is timothy Reid, Md Daiichi-Sankyo and the speakers bureau for a speakerEli Lilly for and novo Co; Drnordisk, Cobble isand on theis a advisory speaker for amylin department of Family Medicine Pharmaceuticals.board for Abbott Laboratories, AstraZeneca, Mercy diabetes center and Eli Lilly and Co and speakers bureau for Janesville, Wi dr. schneiderAbbott Laboratories, disclosed that AstraZeneca/Bristol he is on the advisory board for novo nMyersordisk. Squibb, Eli Lilly and Co, GlaxoSmith- Advances in Insulin Therapy: Insulin Degludec Kline, and Novo Nordisk Inc; Dr Reid is on the allen King, Md dr. Meneghiniadvisory board disclosed and speakersthat he isbureau on the for advisory Amylin board and associate clinical Professor is a consultantPharmaceuticals, for novo Medtronic, nordisk, Novo is on Nordisk the advisory board Inc, and sanofi-aventis; and Dr Shomali is on university of california for sanofi diabetes, is a consultant for Valeritas, and has the advisory board for Novo Nordisk Inc and san Francisco, ca receivedspeakers grants bureau or research for Amylin support Pharmaceuticals, from Boehringer ingel- Medical director heim, EliMannkind, Lilly and Co, and sanofi-aventis, Pfizer. dr. Meneghiniand Takeda is also a self- diabetes care center managedPharmaceuticals. stock/shareholder in dexcom. salinas, ca dr. Reid disclosed that he is on the advisory boards and speakers’ bureaus for novo nordisk and sanofi. LeaRninG Objectives after reading this supplement, the family physician will be dr. King disclosed that he is a speaker and consultant for, and able to: has received research support from, Eli lilly, novo nordisk, • Compare the pharmacokinetics and pharmacodynam- and sanofi. S2 May 2012 | Volume 61, No 5 | Supplement to The Journal of Family Practice Update on Insulin Management in Type 2 Diabetes TAKE-HOME POINTS Introduction............................................................................................................. S4 Stephen Brunton, MD, FAAFP • The “treat to target” approach is to quickly Adjunct Clinical Professor achieve the target glycosylated hemoglo- Department of Family Medicine bin (AIC) goal of <7% in most people, and University of North Carolina then intensify or change therapy as needed Chapel Hill, NC to maintain glycemic control Executive Vice President for Education Results of an online survey demonstrate Primary Care Education Consortium • uncertainty regarding the clinical Charlotte, NC differences between glucagon-like peptide (GLP-1) agonists and dipeptidyl peptidase The Evolution of Insulin Therapy in Diabetes Mellitus(DPP)-4 inhibitors...........................................S6 Michael Heile, MD • The increasingly important roles of the Family Medicine, Diabetes GLP-1 agonists and DPP-4 inhibitors stem The Family Medical Group from their overall good efficacy and safety Cincinnati, OH profiles compared with other treatment options Doron Schneider, MD, FACP Center for Patient Safety and Healthcare Quality Internal Medicine Residency Program Abington Memorial Hospital Abington, PA Individualizing Insulin Therapy.............................................................................S13 Luigi Meneghini, MD, MBA The authors received editorial assistance from Professor of Clinical Medicine the Primary Care Education Consortium and Division of Endocrinology, Diabetes, and Metabolism WriteHealth, LLC in the development of this Department of Medicine activity and honoraria from the Primary Care University of Miami Miller School of Medicine Education Consortium. They have disclosed Miami, FL that Dr Campbell is on the advisory board for Director Daiichi-Sankyo and the speakers bureau for Diabetes Research Institute Eli Lilly and Co; Dr Cobble is on the advisory board for Abbott Laboratories, AstraZeneca, Kosow Diabetes Treatment Center and Eli Lilly and Co and speakers bureau for Miami, FL Abbott Laboratories, AstraZeneca/Bristol Timothy Reid, MD Myers Squibb, Eli Lilly and Co, GlaxoSmith- Department of Family Medicine Kline, and Novo Nordisk Inc; Dr Reid is on the advisory board and speakers bureau for Amylin Mercy Diabetes Center Pharmaceuticals, Medtronic, Novo Nordisk Janesville, WI Inc, and sanofi-aventis; and Dr Shomali is on the advisory board for Novo Nordisk Inc and speakers bureau for Amylin Pharmaceuticals, Advances in Insulin Therapy: A Review of InsulinEli Lilly Degludec and Co, sanofi-aventis,.............................. and Takeda S28 Allen King, MD Pharmaceuticals. Associate Clinical Professor University of California San Francisco, CA Medical Director Diabetes Care Center Salinas, CA Cover images: Top Center: Image Source; Mid Left and Mid Right: B Boissonnet/Age Photo Stock; Bottom Left: AJ Photo/Photo Researchers, Inc. Supplement to The Journal of Family Practice | Vol 61, No 5 | May 2012 S3 Introduction stephen Brunton, MD, fAAfP he clinical milieu of type 2 diabetes mellitus (T2DM) is undoubtedly one of Adjunct Clinical Professor the most challenging faced by family physicians. The association of T2DM Department of Family Medicine with other chronic diseases, such as hypertension, dyslipidemia, cardio- University of North Carolina vascular disease, and obesity, speaks to the complex issues that must be Chapel Hill, NC Taddressed. Considering the complexity of these issues, it is important to recognize Executive Vice President for that, as a chronic disease, T2DM is largely self-managed and patients mostly control Education Primary Care Education their own DM-related health outcomes. To assist patients with T2DM to successfully Consortium take on this responsibility, family physicians should raise and discuss the treatment Charlotte, NC options available to achieve agreed upon goals, and, in consultation with the patient, recommend treatment options that best address the patient’s clinical issues and Dr. Brunton disclosed that he is on the meet the patient’s needs. These steps are important to help motivate the patient and advisory boards and speakers' promote long-term
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