level 1 - 5 outcomes were measured in this activity...cv comorbidities in t2dm patients deepak l....

LEVEL 1 - 5 OUTCOMES WERE MEASUREDIN THIS ACTIVITY

THE SYMPOSIUM ATTRACTEDTHE APPROPRIATE AUDIENCES

PARTICIPANTS AGREED THAT THELEARNING OBJECTIVES WERE MET

After participating in this activity, attendees were better able to:

Describe comorbidities of CVD among patients with T2DM, including the prevalence and burden

95% Yes5% Somewhat

Incorporate evidence from recent CVOTs to develop T2DM treatment plans that improve glycemic control and reduce CV risk when appropriate based on guidelines, benefits and risks of second-line antihyperglycemic treatments, and patient profiles and preferences

Was this activity free from bias?

98% Yes2% Somewhat

98% Yes

Summarize current and emerging CV outcomes trials on SGLT2 inhibitors and GLP1-RAs in T2DM patients

N=93

N=93

N=167

N=158

ACTIVITY DESCRIPTION

Cardiovascular Risk Reduction in T2DM: Applying the Trial Data to Clinical Practice

Final Live Symposium Outcomes ReportLive Symposium Infographic Presentations:

Dr. Deepak Bhatt: http://cmhcrrbhatt.infograph-edtest.comDr. Lawrence Blonde: http://cmhcrrblonde.infograph-edtest.com

Dr. Harold Bays: http://cmhcrrbays.infograph-edtest.com

What is the average increased incidence of CVD risk in patients with T2DM compared to patients without T2DM?

A. 0.5X B. 1x C. 2XD. 3x

In this symposium, experts utilized a unique, infographic teaching format to review the latest cardiovascular outcomes studies of current antihyperglycemic therapies and compare the risks vs benefits as well as how to incorporate them into an individualized treatment plan for clinicians who treat patients with T2DM who are at a high risk for CVD.

PARTICIPANTS GAVE POSITIVE FEEDBACK

EDUCATIONAL GAINS WERE IDENTIFIED AS ARESULT OF THE EDUCATION

As a result of this educational activity, participants demonstrated established and increased knowledge and competency in regards to CVOT results, the benefits of antihyperglycemic treatments in relation to CVD risk reduction, and the individualization of T2DM therapy based on patient profiles; these educational gains were maintained long-term post-activity. Furthermore, the majority of participants indicated that they would consider the use of SGLT2 inhibitors or GLP1-RAs for treatment of T2DM patients at high risk for CVD demonstrating the success of this education.

Although increases in knowledge and competency were demonstrated as a result of this education, several CVOTs are currently ongoing to further elucidate the mechanisms by which each drug class, the SGLT2 inhibitors and GLP-1 RAs, reduce CVD risk. Therefore it is necessary to provide further education on these trials as results come out, so that clinicians will be better able to tailor T2DM treatment to each individual patient, providing the most benefit.

FUTURE EDUCATIONAL TARGETSWERE IDENTIFIED

Excellent update and individual input from all speakers

17% 10%

PA

4%

15%42%

MD/DO

9% 3%

27% 12%

4%

Endocrinology

29% 27%

Family/General/IM

Degree

Specialty

POTENTIAL PATIENT IMPACT*

14patients seen per week (on average)

by participants

2,338patients per week will potentially be affected by this educational activity

*Participants were asked approximately how many patients they see each week that would be affected by this education. This number was averaged among all participants that answered the evaluation. Total approximate number of patients potentially affected per week represents the average number of patients seen by participants per week multiplied by the number of attendees.

At the conclusion of the activity, a post-test and survey matching the pre-test knowledge and clinical case scenario multiple choice questions were given to the participants to provide an objective measure of change in clinician knowledge and competence from baseline. Inter-activity survey items were also given to participants with a focus on knowledge and clinical practices.A 30-45 day post-activity survey was administered to assess performance.

Prior to the activity, attendees were surveyed assessing their practice patterns, confidence, and knowledge relating to the educational objectives of the activity.

RN Other

Cardiology

Other

5%

Which of the following statements is TRUE?

Perc

enta

ge re

spon

dent

s (%

)

COMPETENCE - INTENT TO CHANGE

PARTICIPANTS IDENTIFIED BARRIERS TOIMPLEMENTING CHANGES TO PRACTICE

Key

OtherLack of knowledge regarding

evidence-based strategies

Lack of convincing evidence to

warrantchange

Patient adherence/resistance to change

5%

9% 2%11%42%

Insurance, reimbursement

or legal issues

61%N=141 Multiple responses were allowed

CLINICAL CONCLUSIONAlthough there was an increase in knowledge regarding the cardiovascular outcomes trials for antihyperglycemic agents, including patient populations, methods, and efficacy, the majority of participants would benefit from additional education in this area to better understand how these agents can be used to treat patients with T2DM.

A 67-year old woman with T2DM and stage 2 chronic kidney disease at follow up has a HbA1c of 8.4%. She has been on metformin for 3 years and post-prandial insulin was added to her medication regimen 3 months ago. She also has a history of hypoglycemia. In order to achieve glycemic control and reduce the risk of a CV event, what is the next best step in the management of this patient?

A. Continue current therapyB. Add a sulfonylurea to current therapyC. Add a GLP-1 RA to current therapyD. Remove post-prandial insulin from her

current therapy and add a GLP-1 RA.

A 63-year-old man has T2DM and a history of hypertension. His HbA1c is 8.1% and body mass index (BMI) is 30.6kg/m2. He has been taking metformin for the past year. In order to better control his T2DM and reduce his risk of a cardiovascular event, what is the next best step for the treatment of this patient?

A. Continue current therapyB. Add a DPP-4 to current therapyC. Add a SGLT2 inhibitor to current therapyD. Add insulin to his current therapy

How often do you plan to make the following changes to your practice as a result of the information provided in this activity?

Consider the use of SGLT2 inhibitors or GLP1-RAs for treatment of T2DM patientsat high risk for CVD

8%

Analyze new and ongoing CVOT results to provide optimal treatments for T2DMpatients with CVD

Consider up-to-date evidence-based guideline recommendations to selectappropriate treatment regimens for T2DM patients with or high risk for CVD

9%

Assess patients with T2DM for risk of CVD

1% 7% 32% 52%

1% 2% 30% 58%

9% 2% 7% 29% 53%

57% 12% 7% 23%

N=93

N=93

N=93

N=93

N=93

Lack of time/resources

to consider change

27%

size indicates % responses

I already do this Never Sometimes Most of the time AlwaysKey

Hospitalist

Do you intend to make changes as a result of the information receivedin this activity?

96% Yes4% No

PARTICIPANT GEOGRAPHICAL LOCATION ACROSS THE US

13%

59%8%

15%1%

Northeast

Southwest

Midwest

South

Mid-Atlantic

West

4%

Great session will give me more reason to try and push GLP1-RAs and SGLT2 onto the appropriate patients

KNOWLEDGE WAS MEASURED

A. In the EMPA REG and LEADER trials, the majority of patients were on standard of care therapy, including metformin, insulin, and sulfonylureasB. The patient profiles in the cardiovascular outcomes studies to date are the sameC. The reduction in cardiovascular events in the positive cardiovascular outcomes trials is predominantly due to reduction in HbA1c levels.D. Head-to-head trials demonstrate that SGLT2 inhibitors demonstrate a significant decrease in cardiovascular events in patients with T2DM compared to DPP4 inhibitors

US-Based Audience Location (92%)

96% Yes1% No

2% No

A++ program

p=0.35; effect size: d = 0.2

Perc

enta

ge re

spon

dent

s (%

)

Pre Activity Post Activity

0

20

40

60

80

100

N=490

20

40

60

80

100

N=890

20

40

60

80

100

N=18

30-45 Days

Correct answer

A 10% relative increase in knowledge was observed from baseline to post-test

10%

B

C CC

DDD

Incorrect answers

To date, which of the following class of drugs as a whole has demonstrated superiority in regards to CV primary endpoints in CVOTs?

A. DPP-4 inhibitorsB. SGLT-2 inhibitors C. InsulinD. Sulfonylureas

p=0.32; effect size: d = 0.2

Perc

enta

ge re

spon

dent

s (%

)

Pre Activity Post Activity

0

20

40

60

80

100

N=520

20

40

60

80

100

N=820

20

40

60

80

100

N=18

30-45 Days

Correct answer

A 6% relative increase in knowledge wasobserved from baseline to post-test

AA,C,D

B

C,D Incorrect answers

CLINICAL CONCLUSIONBoth prior to and following this educational activity the majority of participants demonstrated knowledge of which T2DM therapies provided CVD risk benefits in patients with T2DM.

BB

D

6%

p=0.22; effect size: d = 0.2

Pre Activity Post Activity

0

20

40

60

80

100

N=500

20

40

60

80

100

N=830

20

40

60

80

100

N=18

30-45 Days

Correct answerA

A

A

Incorrect answers

B

DD

A 26% relative increase in knowledge was observed from baseline to post-test

26%

C CB

Perc

enta

ge re

spon

dent

s (%

)

p=0.77; effect size: d = 0.03

Pre Activity Post Activity

0

20

40

60

80

100

N=540

20

40

60

80

100

N=780

20

40

60

80

100

N=18

30-45 Days

Correct answerD DD

A Incorrect answers

C CC

1%

A

A 1% relative increase in knowledge wasobserved from baseline to post-test

CLINICAL CONCLUSIONBoth prior to and following this educational activity the majority of participants demonstrated competency of the efficacy of SGLT2 inhibitors in reducing both HbA1c levels and CVD risk compared to DPP-4 inhibitors and insulin therapy.

Perc

enta

ge re

spon

dent

s (%

)

p=0.58; effect size: d = 0.1

Pre Activity Post Activity

0

20

40

60

80

100

N=650

20

40

60

80

100

N=750

20

40

60

80

100

N=18

30-45 Days

Correct answer

A Incorrect answers

2%

A 2% relative increase in knowledge wasobserved from baseline to post-test

BDA

CCC

CLINICAL CONCLUSIONAlthough answer C could also be a potential next step in this patient’s treatment, it would not be the best step due to the patient’s history of hypoglycemic events as insulin use has a higher risk of hypoglycemia. Additional education on the use of GLP-1RAs and insulin therapy in patients with T2DM would be beneficial.

61%67%

61%

90%

42%

53%

43%

71%72% 75%

91%

AGENDA

Welcome and IntroductionRobert H. Eckel, MD (Chair)

CV Comorbidities in T2DM PatientsDeepak L. Bhatt, MD, MPH

Review of Recent CVOTs Results and Clinical ImplicationsLawrence Blonde, MD

Individualization of Treatment in T2DM Patients with CVDHarold E. Bays, MD

Conclusions and Audience Q&AAll Faculty

Deepak L. Bhatt, MD, MPH

Robert H. Eckel, MD

Lawrence Blonde, MD

CVOT Data in Your Clinical Practice: Patient CasePresenter: Deepak L. Bhatt, MD, MPHPanel: Robert H. Eckel, MD (Chair); Harold E. Bays, MD; Lawrence Blonde, MD

Harold E. Bays, MD

3% Somewhat

ABA

BA

A,CD

95%100%

B B,C

D

BA

COMPETENCY WAS MEASURED

CC91%

93%

BDA

DBA

1%

Great format

In addition, most participants indicated that they made changes to their practice as indicated by the long-term post-activity survey, with the top self-reported change being the consideration of SGLT-2 inhibitors or GLP-1 RAs for treatment of T2DM patients with a high risk for CV events.

CLINICAL CONCLUSIONAs a result of this activity, clinicians had a better understanding of those patients at an increased risk for CVD, specifically those with T2DM.

An online enduring virtual symposium, a recording of the live CMHC Annual Symposium was launched in January 2019; the activity is posted on CMHC's Education Resource Center and hosted on myCME.com.CMHC Education Resource Center link:https://www.cardiometabolichealth.org/online/2018-virtual-symposium-cardiovascular-risk-reduction-in-t2dm-applying-the-trial-data-to-clinical-practice.html

myCME link:https://www.mycme.com/2018-virtual-symposium-cardiovascular-risk-reduction-in-t2dm-applying-the-trial-data-to-clinical-practice/activity/5712/

167 Attendees

100% of participantsagreed that their knowledge increased surroundingthe managementof patients with T2DM and CVD risk.

Learning objectiveswere met.

Attendees were overall satisfied with the quality and content that the experts presented in this activity.

96% of learners indicated that this activity provided practical information that will improve competence and clinical skills.

The top-reportedchange toincorporateinto practice was toconsider up-to-dateevidence-basedguidelinerecommendations toselect appropriatetreatment regimens forT2DM patients with orhigh risk for CVD.

Knowledge

LEVEL 3Competence

LEVEL 4

Satisfaction

LEVEL 2

Participation

LEVEL 1

93 Evaluations

91% of learnersindicated that they made changes to their practice as a result of this activity.

The top self-reported practice change was to consider the use of SGLT2 inhibitors or GLP1-RAs for treatment of T2DM patients at high risk for CVD.

Performance

LEVEL 5

NP CDE/RD

PharmD

Supported by an independent educational grants from AstraZeneca and Novo Nordisk.Jointly Provided by Global Education Group and Cardiometabolic Health Congress

PATIENT CASE- PART 1

64-year-old woman with T2DM for 12 years

Medical History: NSTEMI 2 years ago with DES implanted in mid LAD, 40% proximal LCx lesion notedHTNElevated LDLElevated triglycerides

Current Medications: AspirinClopidogrelAtorvastatin 80 mgLisinopril 10 mgMetoprolol 25 mgMetformin 1000 mg

Physical History: BMI: 31 kg/m2Blood pressure: 136/87 mmHgPulse: 84 bpm

Labs:HbA1c 7.8%LDL 83 mg/dLTriglycerides 210 mg/dLeGFR 63 mL/min/1.73 m²Complains of exertional chest pain, with recent stress echo showing no ischemia

51%

Percentage of Participants (%)

2%

N =100

A. PCSK9 inhibitorB. GLP-1 RAC. SGLT2 inhibitor D. Over the counter omega-3 fish oil

39%

What would you do for her medical therapy?

8%

CLINICAL CONCLUSIONWhile the majority of participants chose an SGLT2 inhibitor as the next best step in the treatment of this patient, 39% also chose a GLP-1 RA. Both treatments could be considered as the best next step; however, based on signals seen in clinical events of the CVOTs, the expert panel suggested that a GLP-1 RA would be best here. Taken together, the results of this survey demonstrated that participants were well informed of the benefits of both GLP-1RAs and SGLT2 inhibitors in patients with T2DM and CVD.

A

B

C

D

PATIENT CASE- PART 264-year-old woman with T2DM for 12 years

1.5 years later, describes dyspnea on exertion, pedal edemaStress echo shows no ischemia, normal LV function, some diastolic dysfunction

48%

Percentage of Participants (%)

10%

N =93

A. FurosemideB. GLP-1 RAC. SGLT2 inhibitor D. ARB 11%

What would you do for her medical therapy?

31%

CLINICAL CONCLUSIONBased on the present signs of heart failure in this patient and recent clinical trial data demonstrating reduced hospitalization for heart failure with treatment of SGLT2 inhibitors, the expert panel agreed that an SGLT2 inhibitor would be the best choice for the patient at this time. As additional CVOT results are published, additional education in this area would be beneficial for clinicians.

A

B

C

D

PERFORMANCE – SELF-REPORTED CHANGEAs a result of this educational activity,

did you make any changes to your practice?

Assess patients with T2DM for risk of CVD

Analyze new and ongoing CVOT results to provide optimal treatment for T2DM patients with CVD

Consider the use of SGLT2 inhibitors or GLP1-RAs for treatment of T2DM patients at high risk for CVD

Consider up-to-date evidence-based guideline recommendations to select appropriate treatment regimens for T2DM patients with or high risk for CVD

58%

96%

56%

N=23 Multiple responses allowed

91%

of participants indicated that they made changes as a result of the information received in this activity.

61%

N=16