Case Study: A 57-Year-Old Woman With T2DM and Hypertension

The SGLT-2 Agents and Their Place in T2DM Treatment
0.75 AMA PRA Category 1 Credit(s)
Launch Date:
December 30, 2013
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

No primary audience was provided.

Relevant Terms:

No primary audience was provided.

Silvio Inzucchi, MD

Course Director
Silvio Inzucchi, MD
Yale University School of Medicine
Professor of Medicine
Section of Endocrinology
New Haven, CT

Silvio Inzucchi, MD, is Professor of Medicine at the Yale University School of Medicine in New Haven, where he also serves as Clinical Director of the Section of Endocrinology and Program Director of the Endocrinology and Metabolism Fellowship Program. He is also the Director of the Yale Diabetes Center at Yale-New Haven Hospital. He received his undergraduate degree from Fordham University in the Bronx and his MD from Harvard Medical School in Boston. He completed his residency in Internal Medicine and his post-doctoral Fellowship in Endocrinology and Metabolism at Yale-New Haven Hospital, in New Haven, CT.

Dr. Inzucchi has been an invited lecturer both nationally and internationally, on many topics pertaining to the clinical management of diabetes. He has authored or co-authored more than 300 manuscripts, chapters, and abstracts. His research has been published in leading peer-reviewed medical journals, including the New England Journal of Medicine and JAMA. His practical booklet The Yale Diabetes Center Diabetes Facts & Guidelines has an annual circulation in excess of 100,000 copies. A former member of the editorial board of Diabetes Care, Dr. Inzucchi is currently an Associate Editor of the Journal of Clinical Endocrinology and Metabolism.

In addition to his academic achievements, Dr. Inzucchi maintains a large clinical practice involving a wide spectrum of patients with endocrine diseases. His current research interests include diagnostic criteria for diabetes; the link between type 2 diabetes, insulin resistance, and cardiovascular complications; the evaluation of the asymptomatic diabetic patient for coronary artery disease; and the inpatient management of hyperglycemia.

Elliot Sternthal, MD

CME Course Reviewer
Elliot Sternthal, MD
Director of Outpatient Diabetes Program
Boston Medical Center
Assistant Professor of Medicine
Boston University School of Medicine
Boston, MA

Clinical Service
In 2000 I was recruited to Boston Medical Center to direct both inpatient and outpatient diabetes care. I brought organizational and care coordination skills and diabetes care skills developed during 13 years in private practice and 6 years at the Joslin Diabetes Center. I recruited additional nurse practitioners to BMC and worked with certified diabetes educators to achieve and maintain American Diabetes Association recognition of our outpatient education program. I oversaw the expansion of the insulin pump program and use of continuous glucose sensors. In 2005, I petitioned for the establishment of a dedicated inpatient diabetes service. From 2008-2013, I have served as Director of Outpatient Diabetes Program at BMC where my goal was applying the chronic disease care model to diabetes.

Since joining the faculty in the Section of Endocrinology, Diabetes and Nutrition I have had the opportunity to expand upon my passion for teaching. I have lectured to BUSM and BUSDM students on basic pathophysiology and pharmacology of diabetes in didactic lectures and to residents and fellows on more advanced topics in conferences. While I enjoy the challenge of providing concise, up-to-date lectures in an ever-changing area in this structured teaching setting, I particularly excel at teaching at bedside rounds or in case-based formats. I enjoy stimulating understanding of disease mechanisms by the use of the Socratic teaching method. While it is relatively easy for learners to provide "what and when" information, I emphasize the importance of teasing out answers to the "how and why" questions. I believe this approach allows a learner better reflection and lasting understanding, which are more likely to foster a behavioral change.

Continuing Medical Education
I am deeply committed to advancing CME in diabetes care to primary care providers in light of the burgeoning epidemics of diabetes and obesity in the US and the predicted shortage of clinical endocrinologists. Recently, I have helped develop "loosely structured" case-based programs that promote active participation by attendees and focus primarily on the process of arriving at a therapeutic decision rather than "right or wrong" answers. Continuing with innovation in teaching, I have collaborated with Dr. John Weicha of BUSM Family Medicine in developing web-based CME programs, and I used the virtual reality learning environment of Second Life to deliver a lecture to PCPs through the use of avatars. The majority of participants preferred it over a standard CME lecture.

I believe the pinnacle of my CME teaching was the realization of my long-time conceptualized Preceptorship in Type 2 Diabetes. With the logistic support of BUSM CME, this unique one-week immersion program highlighted the acquisition of practical knowledge, diagnostic and therapeutic skills and coordination of care. The hands-on contact with actual clinic patients taught that each patient's distinct clinical presentation required individualized care. Follow-up of program completers over the last two years have shown that they are more comfortable in proactively addressing therapeutic challenges by using newer agents and defining strategies of care.   

I am continuing my diabetes CME activities through academic outreach programs delivered on site to primary care providers and through the development of enduring educational materials (recently highlighting diabetes complications) as well as web-based programs.
1. Describe the various sites of action of currently available and experimental drugs for T2DM
2. Discuss the potential clinical advantages and disadvantages of the new and traditional T2DM agents
3. Implement effective, comprehensive strategies for a patient with hypertension and poorly controlled T2DM