The 2017 NY CERC delivers state-of-the-art clinical updates and strategies aimed directly at the intersection of metabolic and cardiovascular (CV) disease prevention. This activity will present highlights for binge eating disorder (BED) and cardiovascular outcomes in type 2 diabetes (T2D). The activities will address clinically relevant topics in cardiometabolic health, including CV disease prevention, dyslipidemia, diabetes, obesity management, hypertension, and/or other cardiometabolic risk factors. This clinical connection conference will offer cardiometabolic health care professionals (HCPs) the opportunity to advance their understanding and knowledge of chronic cardiometabolic diseases and associated comorbidities.
Instructions for This Activity and Receiving Credit
This educational activity is directed toward cardiologists, endocrinologists, specialty nurse practitioners, specialty physician assistants, certified diabetes educators, other specialty allied health professionals, and other HCPs interested in the treatment of cardiometabolic disorders.
After completing this educational activity, you should be able to:
Carlos M. Grilo, PhD
Professor of Psychiatry, Yale School of Medicine
Professor of Psychology, Yale University
Director, Program for Obesity Weight and Eating Research (POWER), Yale School of Medicine
New Haven, Connecticut
Disclosure: Research funding: National Institutes of Health; Consultant: Shire, Sunovion; Book royalties (academic books): Guilford Press, Taylor & Francis Publishing
Silvio E. Inzucchi, MD
Professor of Medicine
Clinical Director, Section of Endocrinology
Medical Director, Yale Diabetes Center
Director, Endocrinology & Metabolism Fellowship
Director, Yale Affiliated Hospitals Program
New Haven, Connecticut
Disclosure: Research funding: National Institute of Diabetes and Digestive and Kidney Diseases; Consultant: Boehringer Ingelheim, AstraZeneca, Novo Nordisk, VTV Pharmaceuticals, Janssen, Sanofi/Lexicon, Eisai
The staff of PER® have no relevant financial relationships with commercial interests to disclose.
The following contributors have no relevant financial relationships with commercial interests to disclose.
Physicians’ Education Resource®, LLC (PER®)
Planning Staff—David Heckard; Maryjo Dixon, RPh; and Kate Bowen.
Global Education Group
Lindsay Borvansky; Andrea Funk; and Liddy Knight
This activity is jointly provided by Global Education Group and Physicians’ Education Resource®, LLC. AMA PRA Category 1 Credit™ is provided by Global Education Group.
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 joint providership of Global Education Group and Physicians’ Education Resource®, LLC. Global Education Group is accredited by the ACCME to provide continuing medical education for physicians.
Global Education Group designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation
in the activity.
Global Education Group (Global) requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
This CME/CE activity may or may not discuss investigational, unapproved, or off-label uses of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME/CE activity is for continuing medical and nursing education purposes only and is not meant to substitute for the independent clinical judgment of a physician or nurse relative to the diagnostic, treatment, and management options for a specific patient’s medical condition.
The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of Physicians’ Education Resource®, LLC, or any of the companies that provided commercial support for this activity.
Individuals with binge eating disorder (BED) experience recurrent episodes of binge eating (defined as eating unusually large quantities of food while experiencing a subjective sense of lack of control), but without inappropriate compensatory behaviors to prevent weight gain (eg, self-induced vomiting or laxative abuse). The episodes of binge eating typically involve at least 3 of the following characteristics: eating more quickly than usual, eating until physically uncomfortable, overeating despite not being hungry, eating alone due to embarrassment, and feeling disgust and shame afterward. The BED diagnosis requires marked distress about binge eating, that binge eating occur at least weekly for at least 3 months, and that the person does not meet criteria for either bulimia nervosa or anorexia nervosa. BED is now considered the most prevalent eating disorder in the United States,1 affecting 1% to 5% of the general population, and is recognized as a distinct cause of obesity.2-5
BED is associated strongly with obesity and with heightened risk for other psychiatric and medical comorbidities. The heightened medical comorbidities associated with BED appear largely due to the excess weight in many persons with BED. Medical comorbidities associated with BED include cardiometabolic conditions such as hypertension, hypercholesterolemia, heart disease, and type 2 diabetes.2 Metabolic syndrome is present in more than 40% of obese patients with BED and comprises a constellation of symptoms, including elevated triglycerides, abdominal obesity, hypertension, low HDL cholesterol, and type 2 diabetes.6Thus, BED is considered a major public health issue that presents both medical and psychiatric issues that impair patients’ quality of life. As of 2013, BED was included in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition,7 as a specific, formal eating disorder with a corresponding diagnosis code.
HCPs should be aware of the diagnosis criteria for BED and be prepared to discuss BED with patients at risk for or suspected of having the disorder. Interacting with patients in a nonjudgmental, compassionate manner and discussing available treatment options is vital. Most patients are embarrassed or secretive about BED symptoms because they have likely encountered stigma or shaming from family members or health care providers about their weight. Being willing to discuss binge-eating symptoms with patients and speak to them without bias is critical. This will help patients feel understood and be more receptive to recommendations, which will allow the provider to outline the range of available nonpharmacologic and pharmacologic treatment options.
Examining Cutting-Edge Data and Clinical Implications for Patient Care
The aims of managing patients with type 2 diabetes (T2D) are to avoid acute osmotic symptoms of hyperglycemia, avoid instability in blood glucose over time, and prevent/delay the development of diabetes complications without adversely affecting quality of life.1-3 Individuals with uncontrolled diabetes commonly develop macrovascular and microvascular complications. Reducing macrovascular complications is essential because persons with diabetes are 2 to 4 times more likely than those without diabetes to die from a cardiovascular (CV) disease, which accounts for 65% of deaths in persons with diabetes.4 For individuals with diabetes, poor glycemic control and CV risk factors (dyslipidemia, being overweight/obese, and/or hypertension), the risk of having a CV event (myocardial infarction [MI], stroke, and/or death) is increased.5Thus, glycemic control and management of one or more CV risk factors are essential to reduce the risk of a CV event in these individuals.
In 2008, the FDA required assessment of CV safety for all antidiabetic drugs to be licensed in the future.6 So far, several drug classes that have been studied in large, randomized clinical trials meet this mandate, including basal insulin, sodium glucose cotransporter-2 (SGLT2) inhibitors, and glucagonlike peptide-1 (GLP-1) receptor agonists. The following are summaries of those trials:
Within the next several years, results from other large-scale clinical outcomes studies evaluating various drug classes will be available, which will allow clinicians to decide which drug is best for the overall management of persons with T2D who have a high–CV-risk profile.
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