Activity 6: Next Steps for Patients with Sub-Optimal Glycemic Control

Program Overview

Despite the development of new drugs in recent years, the management of diabetes continues to pose challenges. In fact, recent analysis of National Health and Nutrition Examination Survey (NHANES) data showed that only 57% of patients with diabetes achieve recommended target A1C goals.1

In this first activity, Next Steps for Patients with Sub-Optimal Glycemic Control, the faculty describes practical strategies for individualizing and meeting glycemic goals in patients who have not achieved optimal glycemic control. The faculty reviews key recommendations from the 2012 American Diabetes Association (ADA) standards of care and considers factors that influence medication choice for specific patient groups. In particular, the faculty reviews the role of incretin mimetics in therapy. Finally, patient cases are used to illustrate key learning points from the program. 

  1. Ong KL, Cheung BM, Wong LY, Wat NM, Tan KC, Lam KS. Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999–2004. Ann Epidemiol 2008;18:222–9.

Intended Audience

This continuing medical education program is intended for family physicians and other primary care providers who care for patients with diabetes. 

Learning Objectives

After completing this activity, family physicians will be better able to:

  • Apply patient-specific criteria to initial selection and ongoing adjustments of the most effective treatment options for type 2 diabetes.
  • Describe the various insulin options for patients whose blood glucose levels are not controlled on oral therapy.
  • Describe the various oral agents available for the management of type 2 diabetes, together with their advantages and disadvantages, and describe strategies for adjusting therapy to optimize patient outcomes.
  •  Describe the current and potential role in therapy of new agents and delivery options.


Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Philadelphia, PA
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Serena Cardillo, MD
Assistant Professor of Medicine
Division of Endocrinology, Diabetes, and Metabolism
Penn Rodebaugh Diabetes Center
Hospital of the University of Pennsylvania
Philadelphia, PA

CME Accreditation

This enduring material activity, Next Steps for Patients with Sub-Optimal Glycemic Control, has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins May 8, 2012. Term of approval is for two year(s) from this date with the option of yearly renewal.

The evidence-based CME clinical content developed for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Introduction and Opening Remarks
Module 1. ADA Standards of Care Update
Module 2. A New Perspective on Old Agents
Module 3. Where Do Incretins Fit In?
Module 4. Optimization of Glycemic Control: A Case-Based Discussion
Closing Remarks


It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, they are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects, LLC staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Dr. Cardillo returned a disclosure form indicating that she has no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material. Dr. Skolnik returned a disclosure form indicating that he has served as a consultant or advisory board member for AstraZeneca, Boehringer Ingelheim, MannKind, Merck, and Purdue; he has also served on speakers’ bureaus for AstraZeneca, Merck, and Purdue. Dr. Skolnik is the owner of Redi-Reference, Inc.


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