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New Considerations for Diabetes in 2008

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   The development of type 2 diabetes mellitus (T2DM) involves three different mechanisms: insulin resistance, impaired insulin secretion, and excess production of glucose from the liver. Researchers are constantly seeking new drug therapy targets, and less invasive, more convenient routes of drug administration. As treatment for T2DM becomes more complicated and more clinical experience is gained with the drugs currently available, new issues and considerations inevitably arise. Whether these issues involve new insight into possible drug side effects, changes in glycemic treatment goals, or new thoughts involving our monitoring paradigms, it is in your best interest and your patients’ best interest to stay up-to-date.

   This article summarizes 6 recent developments in the treatment of T2DM: the link between thiazolidinediones (e.g., Avandia®, Actos®) and bone fracture, the potential for heart attacks and heart failure associated with thiazolidinedione use, recent findings regarding tight glucose control and cardiovascular risk, the potential link between inhaled insulin (Exubera®) and lung cancer, use of the lipid-lowering drug colesevelam (WelCholTM) in patients with T2DM, and the potential benefits and drawbacks of self-monitoring of blood glucose (SMBG) in patients who are not using insulin. Each topic is accompanied by patient discussion points to aid you in your efforts to guide them through these recent developments.


Publication Date: 12/01/2008
Expiration Date: 12/01/2011
CE Credit: 1.5 (0.5 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Joshua J. Neumiller, PharmD, CGP, FASCP, Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University/Elder Services, Spokane, WA; Brian J. Gates, PharmD, Clinical Associate Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, WA; Shelby Bottemiller, PharmD, Duvall Family Drugs, Duvall, WA; and R. Keith Campbell, RPh, MBA, CDE, FASHP, Distinguished Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Pullman, WA.

Disclosure Statement

The authors reported no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Guest Editorial Advisor

Lisa A. Kroon, PharmD, CDE

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Discuss recent developments concerning thiazolidinediones, including the increased risk of cardiovascular events and bone fracture. Discuss the clinical relevance of these findings and suggest appropriate patient counseling information.
    2. Discuss the results of recent studies that evaluated intensive T2DM treatment (ACCORD, ADVANCE, UKPDS). Describe the clinical implications for newly diagnosed patients and older patients with long-standing T2DM and high cardiovascular risk.
    3. Outline important considerations and counseling points for patients who were previously on inhaled insulin therapy.
    4. Describe the role of colesevelam in T2DM therapy.
    5. Provide practical guidance to patients regarding self-monitoring of blood glucose and appropriate A1C goals.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 428-0000-08-011-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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