Free Diabetes and Endocrinology CME

Activity Description / Statement of Need:

In this online, self-learning activity:

Growth hormone deficiency (GHD) is characterized by inadequate secretion of growth hormone by the pituitary gland. The condition may arise from a variety of causes, including tumors, radiation, medications, traumatic brain injury, or genetic defects. In children, GHD is characterized by pronounced short stature, defined as 2 or more standard deviations from the mean based on age and sex. Because short stature may be caused by a variety of other factors, including genetics, hypothyroidism, and Turner syndrome, estimating the prevalence of GHD in the pediatric population is challenging. Studies suggest that GHD may occur in 1 out of every 4,000 children. There are also related conditions whose features overlap, including idiopathic short stature (ISS), and primary insulin-like growth factor-I deficiency (PIGFD), complicating diagnosis.

This program has been designed to bring HCPs’ knowledge of the rationale behind management of pediatric GHD up to date and to enhance their competence and practice in caring for pediatric patients with GHD. Topics addressed will include: clinical presentation, diagnostic tests, and safety and efficacy of present and emerging therapy, including dose selection, monitoring, transition into adulthood, and providing patient-centered care.

Target Audience:

The following HCPs: Endocrinologists, pediatricians, and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in endocrinology; and any other HCPs with an interest in or who clinically encounter patients with GHD.

In this online CME self-learning program: Mucopolysaccaridoses (MPS) are group of genetic disease characterized by a deficiency of lysosomal enzymes responsible for the hydrolysis of glycosaminoglycans (GAGs), whose manifold biological roles resulting in a variety of clinical manifestations in patients presenting with MPS. MPS has seven different subcategories, of which Hunter syndrome is MPS II. A deficiency in iduronate 2-sulfatase results in relatively high levels of the GAGs heparan and dermatan sulfate, resulting in physical signs similar to MPS I with the addition of aggressive behavior and developmental delay. Hunter syndrome is an X-linked recessive genetic disease, with males more likely to develop disease and females more likely to be carriers

Target Audience:

The following healthcare professionals: Pediatricians, neurologists, endocrinologists and primary care physicians; physician assistants, nurse practitioners, nurses, and pharmacists; and any other healthcare professionals with an interest in or who may clinically encounter patients with Hunter syndrome.

By the end of the session the participant will be able to:

• Determine the likelihood of a Hunter syndrome diagnosis using established diagnostic methods, given a patient case.
• Describe current and investigative options available for management of Hunter syndrome, and design a medical plan to treat a patient with Hunter syndrome.
• Describe present barriers to care in the treatment of patients with Hunter syndrome.
• Describe the clinical outcomes associated with Hunter syndrome treatment.
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Osteoporosis is a disease common among elderly patients and is increasing in frequency as senior citizens begin to represent a larger share of the US population. In the US, osteoporosis is associated with about 2 million broken bones each year, leading to over 500,000 hospitalizations, 800,000 emergency room visits, and 200,000 nursing home placements. By 2040, osteoporosis is expected to cause 3.2 million fractures per year in the United States at a cost of over $95 billion. Despite the morbidity and mortality associated with osteoporosis, practice gaps related to suboptimal screening, risk assessment, and management practices have led to underdiagnosis and undertreatment of this condition. Osteoporosis screening may identify people at increased risk of low-trauma fracture who may benefit from interventions to minimize risk. The US Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone mineral density (BMD) testing in all women 65 years or older and in postmenopausal women younger than 65 years but at increased risk of osteoporosis. Risk for osteoporosis should be determined by a formal clinical measurement tool, such as FRAX™, which assesses 10-year fracture risk.

Target Audience:

HCPs specializing in endocrinology, internal medicine, and women’s health; physician assistants, nurse practitioners, and pharmacists who practice in those areas of specialty; and those who otherwise commonly care for or clinically encounter patients with postmenopausal osteoporosis.

By the end of the session the participant will be able to:

• Recall how the results of diagnostic imaging and pertinent past medical history to determine risk of fracture.
• List the criteria for initiation of pharmacotherapy for postmenopausal osteoporosis treatment and prevention and apply them to a patient case.
• Describe challenges associated with treating patients with postmenopausal osteoporosis, focusing specifically on the risks of the agents used to treat and prevent osteoporosis, and apply the information to optimize patient care in a patient case.
• Identify recently approved and emerging pharmacotherapeutic treatments for management of postmenopausal osteoporosis, and describe their mechanisms of action.

Hypoparathyroidism is a rare disorder characterized by decreased function of parathyroid glands resulting in low levels of parathyroid hormone (PTH). There are a variety of causes, including autoimmune disease, congenital defects, unintended parathyroid removal during thyroidectomy, or damage caused by radiation therapy. In a normal functioning parathyroid gland, PTH is secreted in response to low serum-ionized calcium. According to one study, nearly 60,000 people in the United States have been diagnosed with the disorder, with about 73% caused by surgery. Another study estimated the prevalence of primary hypoparathyroidism at 40 per 100,000 people in the United States.

Target Audience:

The following healthcare professionals: endocrinologists and primary care physicians; physician assistants, nurse practitioners, nurses, and pharmacists who practice in endocrinology and internal medicine; and any other healthcare professionals with an interest in or who clinically encounter patients with hypoparathyroidism.

By the end of the session the participant will be able to:

• Describe the pathophysiology and manifestations of hypoparathyroidism and discuss how they may have relevance to treatment targets.
• Define patient-specific goals, identify treatments directly treating hypoparathyroidism, and incorporate both in the development of a treatment plan in patient cases.
• Describe goals and mainstays of supportive care in hypoparathyroidism and apply them to patient cases.
• Describe barriers to care in the optimal treatment of hypoparathyroidism and suggest strategies for ameliorating them.

The Evolution of Insulin Replacement Therapy consists of 4 presentations with discussion:
• Session 1: Insulin Options for Diabetes: Update on their Evolution
• Session 2: Advancing to Insulin Therapy for Type 2 Diabetes: The Impact of the New Insulin Options
• Session 3: Physiologic Insulin Replacement: Practical Approaches for the Primary Care Provider
• Session 4: The Evolution of Glycemic Monitoring and Insulin Delivery Devices: Why the Primary Care Provider Should Understand the Options

At the conclusion of The Evolution of Insulin Replacement Therapy, you will be able to:
• Identify clinically relevant pharmacokinetic and pharmacodynamic properties of the new insulins and insulin combinations
• Discuss the clinical importance of similarities and differences between a biosimilar insulin and a reference insulin
• Recognize the indications for advancement to insulin replacement therapy for people with T2DM
• Identify clinically relevant pharmacokinetic and pharmacodynamic properties of the new insulins and insulin combinations
• Describe initiation and titration methods for new insulin-based therapies to optimize achievement of glycemic goals while minimizing adverse effects
• Discuss strategies to overcome patient and clinician barriers to the successful initiation and utilization of insulin therapy in the context of the new insulin-based therapies, and monitoring and delivery devices

Target Audience:
This program is intended for US-based primary care providers, clinical endocrinologists/diabetologists, nephrologists, cardiologists, emergency department specialists, pharmacists, and other clinicians caring for patients with type 2 diabetes mellitus (T2DM).

Activity Description / Statement of Need:

Mucopolysaccharidoses (MPS) are a group of genetic diseases characterized by a deficiency of lysosomal enzymes responsible for the hydrolysis of glycosaminoglycans (GAGs), whose manifold biological roles contribute to a variety of clinical manifestations in patients presenting with MPS. MPS has seven different subcategories, of which Hunter syndrome, an X-linked recessive genetic disease, is MPS II. The syndrome is characterized by a deficiency in iduronate 2-sulfatase, which results in relatively high levels of the GAGs heparan and dermatan sulfate, leading to physical signs similar to MPS I, with the addition of aggressive behavior and developmental delay. The major complications of Hunter syndrome have to do with its widespread and varied symptoms. The nature of this disease is that multiple organ systems are impacted simultaneously, considerably decreasing patient quality of life. The most common symptoms are facial disfigurements, hepatosplenomegaly, and skeletal joint stiffness, but presentation can fluctuate widely between patients.

This accredited educational activity would identify the critical components of the management process and offer solutions to close gaps in diagnosis and care, with the ultimate goals being the improvement of Hunter’s disease management, treatment adherence,  and health and cost outcomes. 

Target Audience:

Pediatricians, neurologists, endocrinologists, and primary care physicians; physician assistants, nurse practitioners, and pharmacists; and any other HCPs with an interest in or who may clinically encounter patients with Hunter syndrome.

Activity Description / Statement of Need:

In this online, self-learning activity:

Cardiovascular (CV) disease (CVD) is the leading cause of mortality and morbidity in adults worldwide, accounting for around one-third of mortality in the United States. High blood pressure, diabetes, and obesity are health conditions that can increase the risk of heart disease, and over half of American adults have at least one major risk factor for adverse cardiovascular events. In particular, T2DM is a risk factor, with CV events implicated in the mortality of two-thirds of patients with T2DM. About one and a half million new cases of diabetes mellitus are diagnosed in in the United States each year, and the incidence of T2DM is increasing owing in part to Western-style diets, sedentary lifestyle, and changing demographics, and the disease is the largest contributor to a number of vascular outcomes, including end-stage chronic kidney disease (CKD) and blindness in individuals under age 75. CKD is itself a major CVD risk factor and affects millions, yet the literature shows that patients with CKD are underserved with respect to CV risk reduction efforts.

This activity has been proposed to enhance the knowledge, competence, and performance of several members of HCPs in mitigating heart and kidney disease risk in patients with T2DM while addressing barriers to optimal care.

Target Audience:

The following HCPs: Endocrinologists, nephrologists, cardiologists, and primary care physicians; certified diabetes educators, physician assistants, nurse practitioners, nurses, and pharmacists who practice in diabetes and endocrinology; and any other HCPs with an interest in or who clinically encounter patients with diabetes.

Activity Description / Statement of Need:

Growth hormone deficiency (GHD) is characterized by inadequate secretion of growth hormone by the pituitary gland. The condition may arise from a variety of causes, including tumors, radiation, medications, traumatic brain injury, or genetic defects. In children, GHD is characterized by pronounced short stature, defined as 2 or more standard deviations from the mean based on age and sex. Because short stature may be caused by a variety of other factors, including genetics, hypothyroidism, and Turner syndrome, estimating the prevalence of GYHD in the pediatric population is challenging. Studies suggest that GHD may occur in 1 out of every 4,000 to 10,000 children. There is no gold standard for diagnosis of GHD in children. Clinical practice guidelines from the Pediatric Endocrine Society currently caution against the use of growth hormone provocation testing in the diagnosis of GHD given the unreliability of results. Auxology, biochemical evaluation, imaging, and physical examination remain the cornerstones of GHD diagnosis in children. Clinicians should be aware of appropriate strategies of diagnosis of GHD in pediatric patients, as improper diagnosis may delay effective treatment and increase risk for secondary complications.

Target Audience:

The following healthcare professionals: Endocrinologists, pediatricians, and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in endocrinology; and any other healthcare professionals with an interest in or who clinically encounter patients with GHD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Gaucher disease (GD) is characterized by a deficiency of the lysosomal enzyme glucocerebrosidase, resulting in the accumulation of sphingolipids throughout the body but most manifesting prominently in the bones. GD is subcategorized based on clinical features: type 1 GD is the non-neuronopathic form and affects mainly the inner organs, while types 2 and 3 are the acute and sub-acute neuropathic forms, whose pathology manifests predominantly within central nervous system. GD has an estimated prevalence of 0.70 to 1.75 per 100 000 in the general population, it affects individuals of Ashkenazi Jewish heritage in significantly higher numbers. One of the first of GD’s complications is the chronic anemia and a persistent bleeding risk. Another is the hepatosplenomegaly, which may be a part of the initial clinical presentation, as may the anatomical abnormalities of bone deformities and stunted growth.

This learning activity has been designed to bring healthcare professionals’ knowledge of the strategies for treatment and management of GD up to date and to improve their competence and performance in treating it.

Target Audience:

The following healthcare professionals: Pediatricians, neurologists, endocrinologists, and primary care physicians; physician assistants and nurse practitioners in those areas of specialty; pharmacists who practice in specialty pharmacies that treat patients with rare diseases; and any other healthcare professionals with an interest in or who may clinically encounter patients with GD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Non-alcoholic steatohepatitis (NASH) is a form of non-alcoholic fatty liver disease (NAFLD) characterized by steatosis, with the accumulation of fat in the liver in excess of five percent of the liver’s weight, together with hepatic inflammation in the presence or absence of fibrosis. Risk factors for NASH include a number of comorbid metabolic diseases and disorders, including metabolic syndrome, obesity, type 2 diabetes, hypertension, and dyslipidemia. The prevalence of NASH is estimated to be 1.5%-6.45% of the U.S. population, and prevalence of NASH among NAFLD patients to be 59.1% globally.

Target Audience:

The following HCPs in: Gastroenterology, hepatology, and endocrinology; physician assistants, nurse practitioners, and pharmacists who practice in the aforementioned areas of specialty; and those who otherwise have an interest in or commonly care for or clinically encounter patients with NAFLD.