Improving Outcomes for Women with Type 2 Diabetes

Improving Outcomes for WOMEN with TYPE 2 DIABETES Individualizing Evidence-Based Care

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Improving Outcomes

WOMEN with TYPE 2 DIABETES

for

Individualizing Evidence-Based Care

This activity is jointly provided by the American Association of Diabetes Educators and Integritas Communications.

This activity is supported by an educational grant from AstraZeneca Pharmaceuticals.

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CME/MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com

Improving Outcomes for WOMEN with TYPE 2 DIABETES Individualizing Evidence-Based Care

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FACULTY Eileen Egan, DNP, FNP-C, CDE Chief Nurse Practitioner Certified Diabetes Educator Winthrop Center for Comprehensive Diabetes Care Winthrop Endocrine, Diabetes, & Metabolism Faculty Practice Mineola, New York Adjunct Faculty Department of Graduate Studies & Advanced Practice Nursing Stony Brook University Stony Brook, New York Dr. Egan earned her bachelor’s of science in nursing from Villanova University in Pennsylvania. She earned her master’s of science in Nursing–Family Nurse Practitioner from Molloy College in Rockville Centre, New York, and a doctorate of Nursing Practice from Stony Brook University, New York.

Dr. Egan launched her career in diabetes education at the Winthrop Diabetes Education Center as a certified diabetes educator and insulin pump specialist caring for children and adults with diabetes. Upon completion of her NP degree, she joined the Winthrop Endocrine, Diabetes, & Metabolism Faculty Practice. Her current role, Chief Nurse Practitioner, includes direct patient care, staff education, preceptor to NP students, and mentor to fellows and residents. She has developed a unique Techmastery Program in the office to better assist patients with the use of new and emerging diabetes technology.

She has also spearheaded a transition program to facilitate the movement of patients from the pediatric to the adult diabetes team.

Dr. Egan is very involved in the diabetes community. She has held leadership positions in the American Association of Diabetes Educators, lectures for both the Juvenile Diabetes Research Foundation and the American Diabetes Association, and is involved in several clinical trials. She facilitated a support group for children with Type 1 diabetes and their families and is on the staff at Camp Nejeda, a sleepaway camp for children with Type 1 diabetes. She has served as an adjunct professor at Molloy College and is currently an adjunct professor at Stony Brook University. She is also on the faculty of the Diabetes Core Curriculum Workshop sponsored by Winthrop University Hospital.

Dr. Egan was named the 2012 NY Metropolitan Diabetes Educator of the Year.

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TARGET AUDIENCE This educational activity is targeted to an audience of diabetes educators, endocrinologists, and other providers involved in managing type 2 diabetes mellitus (T2DM).

EDUCATIONAL OBJECTIVES Upon completion of this activity, participants will be better prepared to: • Discuss how disease manifestations and outcomes differ between women and men with T2DM • Assess female patients for T2DM based on risk factors and appropriate laboratory testing • Construct evidence-based treatment regimens for women with T2DM to reflect the degree of hyperglycemia, cardiovascular risk, comorbidities, and patient preferences

STATEMENT OF NEED/PROGRAM OVERVIEW Diabetes disorders afflict nearly 29 million adult Americans, 49% of whom are women.1-3 A growing body of evidence has uncovered important clinical differences between men and women with T2DM, suggesting greater burden of disease for female patients. For example, over the last decade, the risk of cardiovascular disease has declined among male patients with T2DM, whereas little change has been observed among female patients.4 Women with diabetes have a 44% greater risk of incident coronary heart disease compared with men with diabetes.5 Compared with their male counterparts, women with diabetes are also at greater risk for stroke,6 and generally present with lower energy and higher levels of depression or anxiety.7 Because much of the research on gender differences in T2DM is newly published, diabetes educators, endocrinologists, and other healthcare providers will benefit from case-based education on the practical implications of the emerging evidence, with the goal of improving outcomes among women with T2DM. This Interactive Professor™ program will examine sex differences in T2DM, recommendations on assessing women with T2DM, and evidence-based treatment regimens for female patients.

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REFERENCES 1. Dabelea D, Bell RA, D’Agostino RB Jr, et al. Incidence of diabetes in youth in the United States. JAMA. 2007; 297(24):2716-2724.

2. Centers for Disease Control and Prevention. Diabetes Report Card, 2012. http://www.cdc.gov/ diabetes/pubs/pdf/diabetesreportcard.pdf. Accessed July 2, 2015.

3. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. http://www.cdc.gov/diabetes/pubs/ statsreport14/national-diabetes-report-web.pdf. Accessed July 2, 2015.

4. Arnetz L, Ekberg NR, Alvarsson M. Sex differences in type 2 diabetes: focus on disease course and outcomes. Diabetes Metab Syndr Obes. 2014;7:409-420.

5. Peters SA, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia. 2014;57(8):1542-1551.

6. Peters SA, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet. 2014;383(9933):1973-1980.

7. Siddiqui MA, Khan MF, Carline TE. Gender differences in living with diabetes mellitus. Mater Sociomed. 2013;25(2):140-142.

FACULTY DISCLOSURES It is the policy of the American Association of Diabetes Educators to require that anyone who has an opportunity to affect continuing education activity content (eg, authors, presenters, and program planners) with products or services from a commercial interest in which s/he has financial relationship/s reveal these commercial entities to participants.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of the presentation.

Relevant disclosures (or lack thereof) among education activity planners and faculty are as follows: Eileen Egan, DNP, FNP-C, CDE has no relevant financial disclosures to report.

Planners: John Tyler Nancy Stonis, RN, BSN, MJ Jim Kappler, PhD

has no financial disclosures to report. has no financial disclosures to report. has no financial disclosures to report.

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ACCREDITATION STATEMENT The American Association of Diabetes Educators is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This program provides 0.5 contact hours of continuing education credit.

The AADE is also accredited by the California Board of Registered Nursing (CEP#10977).

The American Association of Diabetes Educators, (AM001) is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 0.5 continuing professional education units (CPEUs) for completion of this program. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials.

The American Association of Diabetes Educators is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program provides 0.5 contact hours (0.5 CEUs) of continuing education credit.

ACPE Universal Activity Number 0069-9999-15-195-H01-P 0069-9999-15-195-L01-P (knowledge) Effective Dates: August 4, 2015 to August 4, 2017.

The approval of this educational offering by AADE does not imply endorsement of specific therapies, treatments, or products discussed in the presentations.

Certified Diabetes Educators: To satisfy the requirements for renewal of certification for the National Certification Board of Diabetes Educators (NCBDE), continuing education activities must be diabetes related and approved by a provider on the NCBDE list of Approved Providers (www.ncbde.org). NCBDE does not approve continuing education. The American Association of Diabetes Educators (AADE) is on the NCBDE list of Approved Providers.

SUCCESSFUL COMPLETION To receive a Statement of Credit, you must attend the entire session. Your Statement of Credit will be issued to you electronically immediately upon submission of the evaluation form. If you have any questions, please contact Sean O’Toole at sotoole@integritasgrp.com.

Improving Outcomes for WOMEN with TYPE 2 DIABETES Individualizing Evidence-Based Care

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GUIDELINES American Diabetes Association—Standards of Medical Care in Diabetes—2015 American Diabetes Association. Diabetes Care.

2015;38(suppl 1):S1-S93. »» http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/ Documents/January%20Supplement%20Combined – Final.pdf

American Diabetes Association—Diagnosis and Classification of Diabetes Mellitus American Diabetes Association. Diabetes Care.

2014;37(suppl 1):S81-S90. »» http://care.diabetesjournals.org/content/37/ Supplement–1/S81.full.pdf

National Standards for Diabetes Self-Management Education and Support Haas L, et al. Diabetes Care. 2014;37(suppl 1):S144-S153. »» http://care.diabetesjournals.org/content/37/ Supplement–1/S144.full.pdf

American Association of Clinical Endocrinologists and American College of Endocrinology—Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan—2015 Handelsman Y, et al. Endocr Pract. 2015;21(suppl 1):1-87. »» https://www.aace.com/files/dm-guidelines-ccp.pdf

Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach—Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes Inzucchi SE, et al. Diabetes Care. 2015;38(1):140-149. »» http://care.diabetesjournals.org/content/38/1/140.full.pdf

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SUGGESTED READING Sex Differences in Type 2 Diabetes: Focus on Disease Course and Outcomes Arnetz L, et al. Diabetes Metab Syndr Obes. 2014;7:409-420. »» http://www.dovepress.com/sex-differences-in-type-2-diabetes-focus-on-disease-course-andoutcome-peer-reviewed-article-DMSO

Polycystic Ovary Syndrome: Important Underrecognised Cardiometabolic Risk Factor in Reproductive-Age Women Baldani DP, et al. Int J Endocrinol. 2015;2015:786362. »» http://www.hindawi.com/journals/ije/2015/786362/

Parity and Diabetes Risk Among Hispanic Women From Colombia: Crosssectional Evidence Cure P, et al. Diabetol Metab Syndr. 2015;7:7. »» http://www.dmsjournal.com/content/pdf/s13098-015-0001-z.pdf

Women Are Diagnosed With Type 2 Diabetes at Higher Body Mass Indices and Older Ages Than Men: Korea National Health and Nutrition Examination Survey 2007-2010 Kwon SK. Diabetes Metab J. 2014;38(1):74-80. »» http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950198/

Impact of Sex on the Heart’s Metabolic and Functional Responses to Diabetic Therapies Lyons MR, et al. Am J Physiol Heart Circ Physiol. 2013;305(11):H1584-H1591. »» http://ajpheart.physiology.org/content/ajpheart/305/11/H1584.full.pdf

Diabetes Abrogates Sex Differences and Aggravates Cardiometabolic Risk in Postmenopausal Women Mascarenhas-Melo F, et al. Cardiovasc Diabetol. 2013;12:61. »» http://www.cardiab.com/content/pdf/1475-2840-12-61.pdf

Sex Differences in the Excess Risk of Cardiovascular Diseases Associated With Type 2 Diabetes: Potential Explanations and Clinical Implications Peters SAE, et al. Curr Cardiovasc Risk Rep. 2015;9(7):36. »» http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442131/

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Sex Differences in the Metabolic Syndrome: Implications for Cardiovascular Health in Women Pradhan AD. Clin Chem. 2014;60(1):44-52. »» http://www.clinchem.org/content/60/1/44.full.pdf

Factors Associated With a Diabetes Diagnosis and Late Diabetes Diagnosis for Males and Females Roche MM, Wang PP. J Clin Transl Endocrinol. 2014;1(3):77-84. »» http://www.jctejournal.com/article/S2214-6237(14)00023-4/pdf

Sex Differences in All-Cause and Cardiovascular Mortality, Hospitalization for Individuals With and Without Diabetes, and Patients With Diabetes Diagnosed Early and Late Roche MM, Wang PP. Diabetes Care. 2013;36(9):2582-2590. »» http://care.diabetesjournals.org/content/36/9/2582.full.pdf

EDUCATIONAL MATERIALS for PATIENTS, FAMILY MEMBERS, and CAREGIVERS American Diabetes Association—Women »» http://www.diabetes.org/living-with-diabetes/treatment-and-care/women/

WomensHealth.gov—The Healthy Woman: A Complete Guide for All Ages— Type 2 Diabetes »» http://womenshealth.gov/publications/our-publications/the-healthy-woman/ type –2– diabetes.pdf

CDC.gov—Diabetes in Women »» http://www.cdc.gov/diabetes/risk/gender/women.html

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NOTES

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