Clinical Diabetes Digital Publication
Optimizing the Use of Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes
John Anderson, MD, Frist Clinic, Nashville, Tennessee | James R. Gavin III, MD, PhD, Emory University, Atlanta, Georgia | Davida Kruger, MSN, APN-BC, BC-ADM, Henry Ford Health System, Detroit, Michigan | Eden Miller, DO, Diabetes and Obesity Care, Bend, Oregon
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Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are recommended in several clinical situations for people with type 2 diabetes (T2D), due in part to a better understanding of the pathophysiology of diabetes. In this short video series moderated by John Anderson, MD, an expert panel of clinicians who provide care to people with T2D discusses the clinical profile of GLP-1RAs, including recent investigations regarding cardiovascular safety and benefits. In addition, these clinicians provide insights into best practices to promote improved self-management by incorporating GLP-1RA therapy into the treatment plan for people with T2D.
These discussions will facilitate better utilization of therapy that will improve patient health outcomes by focusing on the evidence supporting a burgeoning role for glucagon-like receptor agonists, along with recommendations for collaborating with patients to optimize long-term use of GLP-1RAs.
The videos can be viewed in their entirety below, and an executive summary of the panel’s recommendations is available on the Clinical Diabetes website at https://doi.org/10.2337/cd22-0020 or by clicking the thumbnail to the left.
This peer-reviewed publication was developed in adherence with Good Publication Practice (GPP3) guidelines. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have disclosed all potential conflicts of interest.
Learning Objectives
• Compare the glycemic and extraglycemic profile of GLP-1RAs with other classes of medications for type 2 diabetes
• Contrast the similarities and differences among currently available GLP-1RAs
• Describe the latest evidence regarding the safety and tolerability of the GLP-1RAs
• Individualize GLP-1RA therapy for patients with T2D and established atherosclerotic cardiovascular disease as recommended by the ADA Standards of Medical Care in Diabetes—2022
• Describe the role of GLP-1RAs and their role in patients with cardiovascular disease
• Select and optimize GLP-1RA therapy in collaboration with the patient to facilitate long-term patient self-management and adherence
*The United States Food and Drug Administration approved a 2.0 mg dose of semaglutide SC on March 28, 2022.
About the Authors
John Anderson, MD, received his Bachelor of Arts with high distinction, Phi Beta Kappa, at the University of Virginia and his internal medicine medical degree and residency at Vanderbilt University. Dr. Anderson practices internal medicine and diabetes at the Frist Clinic in Nashville, Tennessee. He is Past President of the 38-member multispecialty clinic and has served in leadership roles at Centennial Medical Center, a 670-bed HCA tertiary care referral hospital. He has served as Chair of the Department of Medicine for two separate terms and has been a member and Chair of the Board of Trustees of Centennial. He has received numerous honors, including recognition as a "Top Doctor," Nashville Business Journal 2010–2017, and Honorary Fellow of India College of Physicians and Doctor of Humane Letters, New York College of Podiatric Medicine.
Dr. Anderson is Past President, Medicine & Science, of the American Diabetes Association (ADA), and he has served two separate terms on the National Board of Directors as well as three years on the Executive Committee. Dr. Anderson has been an ADA volunteer for more than 25 years, both locally and nationally. He has participated on multiple committees and task forces, including Chair of the Advocacy Committee and Co-Chair of the ADA’s Health Reform Task Force, among others. In 2013, Dr. Anderson received the Banting Medal for Scientific Achievement, the highest scientific award of the ADA, for his service as President of Medicine & Science.
In addition to his primary care practice, Dr. Anderson continues to consult and lecture both nationally and internationally, with a focus on improving the care of people with diabetes in the primary care setting. He has authored numerous publications in The Journal of Family Practice, Diabetes Therapy, Diabetes Care, Clinical Diabetes, and Postgraduate Medicine.
James R. Gavin III, MD, PhD, is a clinical professor of medicine at Emory University. He serves as Chief Medical Officer of Healing Our Village, Inc., and is Past President of the Morehouse School of Medicine in Atlanta. He also served as the senior scientific officer at the Howard Hughes Medical Institute (HHMI).
Dr. Gavin is a Past President of the ADA and Past Chair of the National Diabetes Education Program (NDEP). He served as National Program Director of the Harold Amos Program and is a Trustee Emeritus of the Robert Wood Johnson Foundation. He is also Chairman Emeritus of the Partnership for a Healthier America (PHA). He belongs to many organizations, including the National Academy of Medicine of the National Academies of Sciences. He has received numerous awards and honors, including being named a “Living Legend in Diabetes” by the American Association of Diabetes Educators (AADE), and received the Laureate Mentor of the Year Award for 2021 from the Endocrine Society. He serves on the board of trustees for Emory University, Livingstone College, and is on the board of the Association of Diabetes Care and Education Specialists (ADCES). He has published more than 150 articles and 3 books. He received a BS in chemistry from Livingstone College, a PhD in biochemistry from Emory University, and his MD from Duke University.
Davida F. Kruger, MSN, APN-BC, BC-ADM, has been a certified nurse practitioner in diabetes for more than 30 years at Henry Ford Health System in Detroit, Michigan. Her role includes both clinical practice and research. She is board certified by the American Nurses Association Credentialing Center in Primary Care and by the American Association of Diabetes Educators in Advanced Diabetes Management. She is Past Chair of the ADA Research Foundation and has served on the ADA's Research Policy Committee. She is also a Past President, Health Care and Education, of the ADA. She served as editor of Diabetes Spectrum from 2005 to 2008. She served as the Editor In Chief of Clinical Diabetes from 2011 to 2016.
Ms. Kruger has been a principal investigator on numerous research projects and has written widely on diabetes care, authoring the book The Diabetes Travel Guide, 2nd ed. (2006). Her awards include the Florence Nightingale award for excellence in research, ADA’s Rachmeil Levine Award for Distinguished Service, ADA’s Award for Outstanding Service in Diabetes Research Funding, ADA Wendell May’s Award, the 2014 Clara Ford Award for Nursing Excellence in Research and Education, and Wayne State University School of Nursing 2014 Alumna of the Year.
Eden Miller, DO, a board-certified family physician, received her medical degree from Kirksville College of Osteopathic Medicine in 1997. Returning to the Northwest, she completed her residency in family practice at East Moreland Hospital in Portland, Oregon. Recently completing her certification in obesity management, she is the founder of Diabetes Nation, a nonprofit organization, and is CEO and a practicing physician at Diabetes and Obesity Care in Bend, Oregon.
Dr. Miller has cultivated a special interest in diabetes since contracting type 1 diabetes while in medical school. Out of that personal experience, her practice has extended into a subspecialty in diabetes care. An impassioned speaker, Dr. Miller has given over 1,000 lectures in the field of diabetes, to health care professionals and patients alike, on subjects such as diabetes management, continuous glucose monitoring technology, insulin pump therapy, obesity, metabolism intervention, clinical research, and health care policy. Her adage for care is that she “only succeeds as a clinician if she turns patients into experts on their own disease.” Dr. Miller believes that a “physiologic patient-individualized approach to diabetes intervention is crucial to success.”
Disclosures
The Illinois Academy of Family Physicians adheres to the conflict-of-interest policy of the ACCME and the AMA. All individuals in a position to control the content disclose any relationships they may have with commercial companies whose products or services may be mentioned so that participants may evaluate the objectivity of the presentations. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Only participants who have no conflict of interest or who agree to an identified mitigation process prior to their participation were involved in the CME activity.
John Anderson, MD, serves as an advisor/consultant and/or speaker for Alfa Sigma, AstraZeneca, Abbott Diabetes Care, Bayer, Eli Lilly, Gelesis, Novo Nordisk, and Sanofi. James R. Gavin, MD, PhD, serves on speaker’s bureaus and/or as a consultant to Abbott Diabetes Care, Boehringer-Ingelheim, Eli Lilly, Intuity Technologies, Novo Nordisk, and Xeris. Davida F. Kruger, MSN, APN-BC, BC-ADM serves on advisory boards and/or speaker’s bureaus for Abbott Diabetes Care, Cequr, Dexcom, Eli Lilly, Novo Nordisk, Sanofi, and Xeris and has stock options in Pendulum. Eden Miller, DO, serves on advisory boards and/or speaker’s bureaus or is a consultant to Abbott Labs, AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Merck, and Novo Nordisk and has received research support from Abbott Labs and Pendulum. Gregory Scott, PharmD, RPh (Editorial Support), disclosed no relevant financial relationship or interest with a proprietary entity producing, marketing, reselling or distributing health care goods or services. All relevant financial relationships have been mitigated.
Sponsorship
This activity is sponsored by the Illinois Academy of Family Physicians, the Primary Care Metabolic Group, and the Primary Care Education Consortium.
Support
The production of this video series and associated materials was funded by an unrestricted educational grant from Novo Nordisk, Inc., in Plainsboro, NJ.
Acknowledgement
The authors received writing/editorial support in the preparation of this digital manuscript and executive summary from Gregory Scott, PharmD, RPh, on behalf of the Illinois Academy of Family Physicians, Primary Care Metabolic Group, and Primary Care Education Consortium. The content for this article and the associated video series were produced according to the policies of the Accreditation Council for Continuing Medical Education (ACCME). Novo Nordisk had no input into the topic, forum discussion, or any content for this article and the accompanying videos.
