Treatment Advances for Challenging Patients with Type 2 Diabetes: The Role of Emerging Insulin Combinations

Provided by the American Association of Clinical Endocrinologists. Program management provided by ASiM.

This activity is supported by an educational grant from Sanofi US.

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Release date: January 15, 2018

Valid through: January 15, 2019

Specialty: Endocrinology

Topic: T2DM

Media: Internet

Estimated Time to Complete Activity: 1 hour, 45 minutes

Target Audience

This activity is designed for endocrinology care providers and other healthcare providers who manage patients with T2DM. There are no prerequisites.

Program Overview

In patients with type 2 diabetes mellitus (T2DM), improving adherence and outcomes with conventionally available insulin products is challenging as these agents can fail to overcome many of the barriers associated with insulin therapy, such as fear of hypoglycemia, potential for weight gain, and concerns regarding the injection process and frequency. Newly available insulin fixed-ratio combination products, such as insulin/glucagon-like peptide receptor agonists (GLP-1 RAs), offer improved hemoglobin A1c control with less potential for hypoglycemia and weight gain and less stringent injection requirements. Such products have demonstrated positive effects in patients’ fasting and postprandial plasma glucose. In the archived activity, the faculty review the current safety and efficacy data of these therapies, the roles they play in clinical management of patients with T2DM, and practical considerations through clinical case studies and discussion.

Learning Objectives

Upon completion of this activity, participants should be better able to:

  • EVALUATE evidence supporting the use of GLP-1RA/insulin combinations as a means to overcome barriers to achieving glycemic control.
  • ASSESS the potential role of insulin/GLP-1RA combination therapies in management, particularly as it relates to more complicated T2DM patients.
  • IDENTIFY clinical situations relevant to endocrinology practices in which the use of a GLP-1RA/insulin combination may be beneficial.

Credit Available

  • Physicians — maximum of 1.75 AMA PRA Category 1 Credit(s)

All other healthcare professionals completing this course will be issued a statement of participation.


Lawrence Blonde, MD, FACP, MACE (Chairperson)

Director, Ochsner Diabetes Clinical Research Unit
Frank Riddick Diabetes Institute
Department of Endocrinology
Ochsner Medical Center
New Orleans, Louisiana

Martin J. Abrahamson, MD

Associate Professor of Medicine
Harvard Medical School
Director Division of CME
Department of Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Alan J. Garber, MD, PhD, FACE

Departments of Medicine, Biochemistry and Molecular Biology, and Molecular and Cellular Biology
Baylor College of Medicine
Houston, Texas
Past President, American Association of Clinical Endocrinologists and
the American College of Endocrinology
Senior Editor, Diabetes Obesity and Metabolism

Physician Continuing Medical Education

Accreditation Statement

The American Association of Clinical Endocrinologists (AACE) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

The American Association of Clinical Endocrinologists (AACE) designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Declaration of Disclosure and Conflicts of Interest

It is the policy of AACE to ensure balance, independence, objectivity and scientific rigor in all of its CME activities. Presentation content may include discussion of an unlabeled or an investigational use of a product. AACE requires that participating faculty disclose to the audience any product(s) and its use(s) discussed in the educational activity that are unapproved/unlabeled for the use by the FDA or still considered investigational in nature.

Everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. “Relevant financial relationships” are financial relationships in any amount occurring within the past 12 months that create a conflict of interest. AACE requires speakers, faculty, CME Committee and other individuals who are in a position to control the content of this educational activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly evaluated by AACE for fair balance, scientific objectivity of studies mentioned in the presentation and educational materials used as basis for content, and appropriateness of patient care recommendations.

The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial influence.

AACE has reviewed all disclosures and resolved or managed all identified conflicts of interest for this educational activity, as applicable.

Faculty Disclosures

  Commercial Interest What Was Received For What Role
Lawrence Blonde, MD, FACP, MACE

1. Eli Lilly & Co.
2. Lexicon Pharmaceuticals
3. GlaxoSmithKline
4. Intarcia Therapeutics
5. Janssen Pharmaceuticals
6. Merck & Co., Inc.
7. AstraZeneca
8. Novo Nordisk A/S
9. Sanofi-aventis
1. Grant/Research support
2. Grant/Research support
3. Honoraria
4. Honoraria
5. Honoraria
6. Honoraria
7. Grant/Research support; Honoraria
8. Grant/Research support; Honoraria
9. Grant/Research support; Honoraria
1. Investigator
2. Investigator
3. Consultant
4. Consultant
5. Speaker/Consultant
6. Speaker/Consultant
7. Investigator; Speaker/Consultant
8. Investigator; Speaker/Consultant
9. Investigator; Speaker/Consultant
Alan J. Garber, MD, PhD, FACE

1. Intarcia
2. Novo Nordisk A/S

1. Honoraria; Consulting fee
2. Honoraria; Consulting fee

1. Consultant-Member; Advisory board
2. Consultant-Member; Advisory board
Martin Abrahamson, MD

1. Health IQ
2. Novo Nordisk A/S
3. WebMD Health Svs
1. Stockholder
2. Honoraria
3. Honoraria
1. Advisor
2. Advisory board
3. Advisory board


CME Accreditation Committee Disclosures


  What Was Received For What Role Commercial Interest
Myriam Allende-Vigo, MD, MBA, FACP, FACE



Abbott Laboratories
Janssen Pharmaceuticals Inc.

Merck & Co., Inc.
David S.H. Bell, MD, FACE, FACP



Janssen Pharmaceuticals, Inc.
Novo Nordisk A/S
Philip Raskin, MD, FACE
Research grant to the University of Texas Independent contractor Amylin Pharmaceuticals
Joseph M. Tibaldi, MD, FACE


Speaker; Consultant


Novo Nordisk A/S

Merck & Co, Inc.

Intarcia Therapeutics
Dace L. Trence, MD, FACE
Medtronic, Inc.
sanofi-aventis U.S. LLC.
Jagdeesh Ullal, MD, FACE, ENCU

Research funding


Principal investigator


Novo Nordisk A/S

Corcept Therapeutics

Jeff Unger, MD, FACE





Janssen Pharmaceuticals, Inc.

Novo Nordisk A/S

Abbott Laboratories
Janssen Pharmaceuticals


Nothing to Disclose


Joshua I. Barzilay, MD, FACE
Felice Caldarella, MD, FACP, CDE, FACE
Richard Correa, MD
Stephen Crespin, MD, FACE
Phillip D.K. Lee, MD, FAAP, FACE
Jad Sfeir, MD



The American Association of Clinical Endocrinologists (AACE) recognizes that you are a life-long learner who has chosen to engage in continuing medical education to identify or fill a gap in knowledge, skill or performance. As part of AACE’s duty to you as a learner, you have the right to expect that your continuing medical education experience with AACE includes:



  • Promotes improvements or quality in healthcare;
  • Is valid, reliable and accurate;
  • Offers balanced presentations that are free of commercial bias for or against a product/service;
  • Is vetted through a process that resolves any conflicts of interests of planners, teachers or authors;
  • Is driven and based on learning needs, not commercial interests;
  • Addresses the stated objectives or purpose; and
  • Is evaluated for its effectiveness in meeting the identified educational need.


  • Supports learners’ ability to meet their individual needs;
  • Respects and attends to any special needs of the learners;
  • Respects the diversity of groups of learners; and
  • Is free of promotional, commercial and/or sales activities.


  • Relevant financial relationships planners, teachers and authors have with commercial interests related to the content of the activity; and
  • Commercial support (funding or in-kind resources) of the activity.

Instructions for Participation and Credit

Please complete the pre-assessment, listen to the following presentations, and complete the post-assessment and evaluation to receive CME credit for this activity. A certificate of participation will be available online immediately following successful completion of the activity.

Table of Contents


Activity Goals
Lawrence Blonde, MD, FACP, MACE

Traditional Approaches to Intensifying from Basal Insulin
Alan J. Garber, MD, PhD, FACE

New and Emerging Insulin Combination Therapies
Martin J. Abrahamson, MD

Translation to Clinical Practice (Clinical Vignettes)
Faculty Panel

Question & Answer Session
Faculty Panel

Concluding Remarks
Lawrence Blonde, MD, FACP, MACE


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For questions regarding this CME activity, please contact:
AACE CME Department
Phone: (904) 353-7878

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