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Shifting Paradigms in Type 2 Diabetes:
Managed Care Perspectives

Case 1: Type 2 Diabetes Mellitus: Pathophysiology, Current Treatment Guidelines, and Considerations in the Medicare Patient
Kimberly Vernachio, PharmD, RPh

OVERVIEW
Affecting over 11% of the adult US population, type 2 diabetes mellitus (T2DM) is a chronic and disabling disease that is associated with substantial morbidity from both macro- and microvascular complications. It is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among American adults, and is a major cause of heart disease and stroke. In addition, managing patients with T2DM poses an enormous economic burden on both patients and healthcare providers alike.

Aggressive glycemic control can help to improve patient outcomes and reduce diabetes-related expenditures. Although an array of medications is available for the treatment of patients with T2DM, adherence rates remain inadequate. Nonadherence is typically due to educational deficits, lack of communication with healthcare providers, high pill burden, complex therapeutic regimens, and drug-related adverse effects. Sodium-coupled glucose transporter 2 (SGLT2) inhibitors, agents that reduce renal glucose reabsorption, may eliminate some of the adverse effects and administration issues associated with conventional therapy. However, it is also important that healthcare providers educate patients and encourage open communication regarding disease management. In addition, managed care pharmacists should utilize patient-specific characteristics to develop treatment regimens that best accommodate patient needs. Utilizing an interactive, case-based format, this activity discusses the role of current and emerging therapy for the treatment of patients with T2DM and reviews the strategies that may be used to improve patient adherence and optimize disease management.

GOAL
The goal of this activity is to provide managed care pharmacists with timely information regarding the management of patients with T2DM and to review the impact of SGLT2 inhibition on glycemic control. In addition, this activity offers strategies that managed care pharmacists may use to improve patient adherence to drug therapy.

TARGET AUDIENCE
This activity is designed for managed care pharmacists who manage patients with T2DM. No prerequisites required.

LEARNING OBJECTIVES
The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. At the conclusion of this activity, the participant should be able to:

  • IDENTIFY the implications of β-cell dysfunction and renal impairment and their involvement in the pathophysiology of patients with T2DM.
  • REVIEW current guidelines for the treatment of patients with T2DM and tailor these guidelines to the elderly population.
  • DISCUSS the role of Medication Therapy Management Programs and Quality Ratings Systems for Medicare patients.

ACCREDITATION STATEMENT
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists.

CREDIT DESIGNATION STATEMENT
acpe logoThe University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this application-based educational activity will provide a statement for 1.0 contact hour credit (0.10 CEUs) and will be available for download following successful completion of the activity. Successful completion includes taking the pre-test, participating in the activity, completing a self-assessment instrument with a score of at least 70%, and completing an evaluation instrument. If you score less than 70% on the self-assessment instrument, you will be allowed to complete the examination two more times. ACPE Program # 0064-0000-11-223-H01-P. Beginning in 2012, your CE credits will also be submitted electronically to NABP. Pharmacists or pharmacy technicians with questions regarding their NABP e-Profile or CPE Monitor should refer to the FAQ section on the NABP website (www.nabp.net/programs/cpe-monitor/cpe-monitor-service) or contact NABP Customer Service: custserv@nabp.net or telephone 847-391-4406.

The estimated time to complete this activity: 1.0 hour.

Release date: December 31, 2011. Expiration date: December 31, 2013.

FULL DISCLOSURE POLICY AFFECTING CPE ACTIVITIES
As an accredited provider by the ACPE, it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Course Director and Participating Faculty reported the following:

Christa M. George, PharmD, BCPS, CDE (Course Director)
Associate Professor of Clinical Pharmacy
University of Tennessee Health Science Center
Memphis, Tennessee
Dr George reports that her spouse received speaker fees from Forest Pharmaceuticals, Inc, Ortho-McNeil, and Pfizer, Inc.

Kimberly Vernachio, PharmD, RPh
President
Vernachio Managed Care Consulting, LLC
Canton, Georgia
Dr Vernachio reports serving as a consultant for Gilead.

Marty Mattei, PharmD
Corporate Development Director
MedImpact
Denver, Colorado
Dr Mattei reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

OFF-LABEL PRODUCT DISCUSSION
In accordance with ACPE Criteria for Quality, the audience is advised that authors in this CPE activity may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices. The authors will inform the reader of when they discuss or reference an unapproved, unlabeled, or investigational use of therapeutic agent or biomedical device.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of The University of Tennessee College of Pharmacy name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

GRIEVANCE POLICY
A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing at gfarr@utasip.com. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review.

There is no fee for this educational activity.

ACTIVITY
Instructions: The following is an interactive educational case module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, an interactive case study, and a CPE post-test. All 3 sections must be completed to receive CPE contact hours.

Pre-Test

Type 2 Diabetes Mellitus: Pathophysiology, Current Treatment Guidelines, and Considerations in the Medicare Patient
Kimberly Vernachio, PharmD, RPh

Post-Test


This activity is supported by an educational grant from Bristol-Myers Squibb and AstraZeneca LP.

procced to pretest
University of Tennessee Advanced Studies in Pharmacy (ISSN-1558-0350), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.