Supplements | Emerging Type 2 Diabetes Treatment Strategies: Practical Solutions for a Complex Environment [CME/CPE]

CME Information

Release date: October 1, 2012  |  Expiration date: November 30, 2013
Estimated time to complete activity: 1.5 hours
Type of Activity: Application  |  Media: Online journal supplement

Jointly sponsored by Impact Education, LLC (, and Postgraduate Institute for Medicine (

This activity is supported by an educational grant from Amylin Pharmaceuticals, Inc, and Lilly USA, LLC.

Target Audience
This activity is designed to meet the educational needs of pharmacy directors, medical directors, clinical pharmacists, quality directors, care managers, and other managed care and payer organization professionals.

Statement of Educational Need/Program Overview
Proper glycemic control of type 2 diabetes is essential for the prevention of long-term complications of diabetes and the reduction of overall healthcare costs. If managed care organizations can help narrow the wide gap between recommendations on evidence-based diabetes care and actual care delivered to patients, thousands of patients could avoid heart attacks, strokes, amputations, blindness, or end-stage renal disease each year. Treatment regimens among US adults diagnosed with type 2 diabetes have changed substantially in recent years as insulin use declined and the use of newer agents increased. A decrease in the rates of glycemic control was also observed during this time period. The availability of new options may have a large impact on current antidiabetic therapy patterns and the rates of glycemic control, but it may also add to the complexity of clinical decision making and benefit management for plans and payers.

Overall Educational Objectives
After completing this activity, the participant should be better able to:
  • Explain how evolving type 2 diabetes treatment guidelines can integrate with a managed care algorithm for optimal value of therapeutic options
  • Apply the use of decision support tools such as comparative effectiveness research and pharmacoeconomic models to make fully informed and weighted decisions to appropriately invest resources on type 2 diabetes therapies within a health plan setting
  • Compare the safety and efficacy data of incretin-based therapies with other type 2 diabetes treatment options on glucose and further aspects of diabetes pathology
  • Recommend emerging pharmacy benefit management methods, including value-based designs, that managed care organizations can implement to improve the overall value of antidiabetic treatments
  • Provide accurate and appropriate counsel as part of the treatment team

Physician Accreditation Statement / Credit Designation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and Impact Education, LLC. Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Postgraduate Institute for Medicine designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Accreditation Statement Credit Designation
Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Postgraduate Institute for Medicine designates this continuing education activity for 1.5 contact hours (0.15 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number - 0809-9999-12-257-H01-P)

CME/CPE information continued on page S240.


Lawrence Blonde, MD, FACP, FACE

Director, Ochsner Diabetes Clinical Research Unit
Department of Endocrinology, Diabetes, and Metabolism
Ochsner Medical Center
New Orleans, Louisiana

Lawrence Blonde, MD, FACP, FACE, is director of the Ochsner Diabetes Clinical Research Unit in the Department of Endocrinology, Diabetes, and Metabolism and an associate internal medicine residency program director at the Ochsner Medical Center in New Orleans, Louisiana.

Dr Blonde’s clinical and research activities have focused on patients with diabetes mellitus and investigations of new therapies and healthcare delivery systems for them. He has also published and presented information about the use of computers to enhance medical education and patient care.

Dr Blonde is presently an associate editor for the journal Diabetes Care. In 2011, he was a member of the Executive Committee and immediate past chair of the Steering Committee of the National Diabetes Education Program, a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations working to “change the way diabetes is treated.” He was a cochair and coauthor for the 2011 American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan.

Dr Blonde has been a member of the board of directors of the American Association of Clinical Endocrinologists and the board of trustees of the American College of Endocrinology. He is presently a member of the board of directors of the Council for the Advancement of Diabetes Research and Education and has been a member of the
National Quality Forum Adult Diabetes Care Consensus Maintenance Committee. Dr Blonde has been chair of the American Diabetes Association (ADA) Doing Better Committee, is a former member of the ADA board of directors, and is former chair of the ADA Professional Practice Committee, which develops practice guidelines for the care of people with diabetes.

John M. Cruickshank, DO, MBA, CPE
Chief Medical Officer
Lovelace Health Plan
Albuquerque, New Mexico

John M. Cruickshank, DO, MBA, CPE, has enjoyed a diverse and distinguished career in healthcare. After receiving his undergraduate degree from Loyola University of Chicago, where he graduated with honors, he attended medical school on a military scholarship at the Chicago College of Osteopathic Medicine. He completed postgraduate
training at the Chicago Osteopathic Medical Centers and the Wilford Hall USAF Regional Medical Center in San Antonio, Texas.

Following completion of the USAF Aerospace Medicine Program at Brooks Air Force Base in San Antonio, Texas, Dr Cruickshank practiced family and flight medicine as an attending flight surgeon. In 1985, he received the USAF Systems Command Flight Surgeon of the Year Award and was also awarded the Meritorious Service Medal for his distinguished service.

Dr Cruickshank set up his family medicine practice in Scottsdale, Arizona, in 1987. He earned his MBA degree from Arizona State University. He is also a graduate of the renowned Scottsdale Leadership Program.

Dr Cruickshank is board certified in medical management by the American College of Physician Executives and is an active member of the college. He is a member of the American Osteopathic Association as well as the Arizona Osteopathic Association, for which he is a past vice president.

Dr Cruickshank has also held senior medical management positions with CIGNA Healthcare and PacifiCare of Arizona. Most recently, Dr Cruickshank served as chief quality officer for IASIS Healthcare, guiding clinical effectiveness, quality, and patient safety.

James T. Kenney, Jr, RPh, MBA
Pharmacy Operations Manager
Harvard Pilgrim Health Care, Inc
Wellesley, Massachusetts

James T. Kenney, Jr, RPh, MBA, is the pharmacy operations manager at Harvard Pilgrim Health Care (HPHC). HPHC is an independent practice association model health maintenance organization located in Wellesley, Massachusetts. Harvard serves more than 1,100,000 members in 3 states and has achieved the highest accreditation from the National  Committee for Quality Assurance and has been ranked as the number 1 health plan in America for 4 consecutive years. Mr Kenney has been with Harvard for more than 30 years and has corporate responsibility for the pharmacy contracting program with pharmaceutical manufacturers and specialty pharmacy providers in support of a budget of more than $850,000,000. He is also a member of the Pharmacy and Therapeutics Committee.

His accomplishments include creation and management of the network pharmacy program for the group practice model of Harvard, development of the pharmacy rebate program, creation of the Medicare Part D contracting program, and being coleader of the Pharmacy Materials Management System Project. Mr Kenney developed the specialty pharmacy program at HPHC for injectables, and a second program in support of infertility management. He is a pharmacy preceptor for the Massachusetts College of Pharmacy and Allied Health Sciences and currently serves on the Legislative Committee at the college. He is also an active member of the Academy of Managed Care Pharmacy, has served on the Nomination Committee, and currently serves as the chair of the Legislative and Regulatory Action Committee.

The authors thank Keith Engelke, PhD, Impact Education, LLC, for writing assistance in preparation of this supplement.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflicts of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CE activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CE activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. Within the past 12 months, the faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity:

Lawrence Blonde, MD, FACP, FACE
Honoraria: Amylin Pharmaceuticals, Inc, Gilead, GlaxoSmithKline, JanssenPharmaceuticals, Inc, Merck & Co, Inc, Novo Nordisk, sanofi-aventis, Santarus, Inc
Grants: Eli Lilly and Company, Novo Nordisk, sanofi-aventis
Lectureship fees: Amylin Pharmaceuticals, Inc, Boehringer Ingelheim Pharmaceuticals, Inc, Johnson & Johnson Diabetes Institute, LLC, Merck & Co, Inc,
Novo Nordisk, sanofi-aventis, Santarus, Inc
Stock ownership: Pfizer Inc

John M. Cruickshank, DO, MBA, CPE, and James T. Kenney, Jr, RPh, MBA, have no relevant financial relationships to disclose that are related to this activity.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity:

Steve Casebeer, MBA; Keith Engelke, PhD; Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD; Jan Schultz, RN, MSN, CCMEP; and Patricia Staples, MSN, NP-C, CCRN, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. 

The publishing staff at The American Journal of Managed Care has no relevant financial relationships to disclose.

The American Journal of Managed Care has no relevant financial relationships to disclose. Signed disclosures are on file at the office of The American Journal of Managed Care, Plainsboro, NJ.

Method of Participation
There are no fees for participating and receiving CME/CPE credit for this activity. During the period October 1, 2012, through November 30, 2013, participants must (1) read the learning objectives and faculty disclosures; (2) study the educational activity; (3) complete the posttest by recording the best answer to each question in the answer key
on the evaluation form; (4) complete the evaluation form; and (5) submit the evaluation form with answer key to Postgraduate Institute for Medicine (PIM).

PIM supports Green CME/CPE by offering your Request for Credit online. If you wish to receive acknowledgment for completing this activity, please complete the posttest and evaluation on On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 8635. Upon registering and successfully completing the posttest with a score of 70% or better and the activity evaluation, your certificate will be made available immediately. Processing credit requests online will reduce the amount of paper used by nearly 100,000 sheets per year.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Postgraduate Institute for Medicine (PIM), Impact Education, LLC (IE), and Novo Nordisk, Inc do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, IE, or Novo Nordisk. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

System Requirements
PC-based participants
Windows 7, Vista, XP, 2003 Server, or 2000

Macintosh®-based participants
Required: Mac OS X 10.4.11 (Tiger) or newer

© 2012 Managed Care & Healthcare Communications, LLC




The management of type 2 diabetes mellitus (T2DM) remains challenging. Limitations associated with many current therapies include hypoglycemia and weight gain. An increased understanding of the pathophysiology of T2DM has led to the development of incretin-related antihyperglycemic therapies.


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