Early Combination Therapy in the Treatment of Type 2 Diabetes


This webcast will cover the current guideline recommendations for the treatment of type 2 diabetes and will review the benefits and risks of various classes of antihyperglycemic agents including SGLT-2 inhibitors, discuss considerations for early combination therapy, and strategies for reducing clinical inertia. 

Target Audience
This CME initiative was designed for nurse practitioners, physician assistants, and primary care providers working in diabetes care. 

Learning Objectives
  1. Review current guideline recommendations for the initiation and intensification of therapy in patient with type 2 diabetes
  2. Discuss the benefits and risks of various classes of antihyperglycemic agents
  3. Discuss clinical considerations for early combination therapy
  4. Implement strategies to reduce clinical inertia in the treatment of patients with type 2 diabetes

Activity Launch Date - 12/4/18
Expiration Date - 12/4/19

Supporter Acknowledgment Statement
This activity is supported by an independent educational grant from Merck.

Disclosure of Unlabeled Use
This educational activity may contain 
discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity 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 the planners.  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 and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Statement of Independence
Horizon CME educational activities are developed and conducted in accordance with the ACCME's Essential Areas and Policies.  It is the mission of Horizon CME to develop and present educational activities that are timely, fair balanced, scientifically rigorous, and that serve to improve patient outcomes.  To that end, we welcome comments about how to better serve your needs.

Copyright Information
© 2018 by Horizon CME.  All rights reserved.  No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from Horizon CME. 


Vivian Fonseca, MD, FRCP 
Professor of Medicine and Pharmacology 
Tullis Tulane Alumni Chair in Diabetes 
Chief, Section of Endocrinology 
Tulane University Health Sciences Center 
New Orleans, LA 

Faculty Bio
Vivian A. Fonseca, MD, FRCP, is Professor of Medicine, the Tullis–Tulane Alumni Chair in Diabetes, and chief of the Section of Endocrinology at Tulane University Medical Center in New Orleans, Louisiana. He currently serves on the Board of Directors of the American Association of Clinical Endocrinologists (AACE), and the Board of Trustees of the American College of Endocrinology. He is a Past President for Science and Medicine of the American Diabetes Association (2012), and has held a leadership role and served on various committees in several other organizations including the American Diabetes Association, the American College of Endocrinology and the American Board of Internal Medicine.
He is Editor in Chief of the Journal of Diabetes and its Complications. He was Editor in chief of Diabetes Care from 2007-2011, having formerly been the associate editor. He was until 2006 Editor in Chief of the Journal of the Metabolic Syndrome and related disorders. He served on the editorial board of the Journal of Clinical Endocrinology and Metabolism (2003-2006) and is an ad hoc reviewer for several other journals, including New England Journal of Medicine, JAMA, Diabetes, etc.
Dr. Fonseca is a fellow of the American Association of Clinical Endocrinologists, the Royal College of Physicians (London), and the American College of Physicians. Dr. Fonseca has served on and been chairman of the clinical practice committee of the American Diabetes Association, the ADA Disaster Task Force, ADA strategic planning committee and the joint ADA/ACC “Make the Link” Program. He has played a significant role in developing guidelines for treating diabetes, managing chronic disease and clinical trials after a natural disaster and in drawing attention to the global epidemic of diabetes, particularly in Asia. 
The American Diabetes Association awarded him the ADA Banting Medal for Leadership and Service and the Southern Medical Association awarded him the Seale – Harris award. He has received several teaching awards and was elected to the Alpha Omega Alpha Honor Medical Society and has been listed among the Best Doctors in the USA, LA, and AR. 
Dr. Fonseca's research interests include the prevention and treatment of diabetic complications and risk factor reduction in cardiovascular disease, particularly on the role of inflammation and other novel risk factors. He has a research program evaluating inflammation in diabetes and using technology to improve diabetes care in underprivileged populations. He has been an investigator in several NIH and Industry-funded clinical trials including the Action to Control Cardiovascular Risk in Diabetes (ACCORD/ ACCORDION) study and TINSAL –2D trial. He is the co –PI of the Louisiana Clinical Data Research Network (LACDRN), funded by PCORI/ PCORNET and serves on the PCORNET Clinical Trials Task Force. He serves on several Steering and Ancillary studies committees and Data Safety monitoring boards. 
Dr. Fonseca has lectured in the United States and abroad. He has published over 300 papers and is the editor of the textbook “Clinical Diabetes: Translating Research into Practice” (El Sevier) and several monographs and book chapters.
Faculty Disclosure Statement
Dr. Fonseca has served as a Consultant and given lectures for Takeda, Novo Nordisk, Sanofi- Aventis, Eli Lilly, Astra- Zeneca, Intarcia, Asahi. Tulane University has received Research Grants from Bayer and Boehringer Ingelheim.

Content Chair 
Curtis Triplitt, PharmD, CDE
Texas Diabetes Institute
University Health System
Associate Professor of Medicine
Clinical /Div. of Diabetes
University of Texas Health Science Center at San Antonio
San Antonio, TX 

Disclosures: Dr. Triplitt has served on a Speakers Bureau for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, and Janssen Pharmaceuticals. 

External Reviewer
Felice Caldarella, MD, FACE, FACP, CDE
Endocrinologist Center for Endocrine Health
Hunterdon Medical Center
Clinton, NJ 

Disclosures: Dr. Caldarella discloses no relevant financial relationships with an ACCME-defined commercial interest in the last 12 months. 

Planning Committee & Non-faculty Contributors 
Additional non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose in the last 12 months. 

Learner Assurance Statement
Horizon CME requires instructors, planners, managers and other individuals who are in a position to influence the content of this activity to disclose any real or apparent conflict of interest (COI) which may arise as a result of prospective faculty members' relevant relationships with drug or device manufacturer(s). Horizon CME is committed to resolving all conflicts of interest and retaining only those speakers with financial interest conflicts that can be reconciled with the goals and educational integrity of the CME activity.


Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of Horizon CME. Horizon CME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Horizon CME designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

How To Claim Credit

  • Read the learning objectives and faculty disclosures
  • Complete the Pre-test
  • Participate in the activity
  • Complete the Post-test and answer at least 2/3 questions correctly
  • Complete Final Evaluation