Evolving strategies to tacklediabetes and thyroid disorders20 May, 2017 - Milan, Italy

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CMe Provider EXCEMED is a non-profit foundation dedicated, since the last four decades, to the development of high-quality medical education programmes all over the world. EXCEMED adheres to the guidelines and standards of the European Accreditation Council for Continuing Medical Education (EACCME®) which states that continuing medical education must be balanced, independent, objective, and scientifically rigorous.

EXCEMED adheres to the principles of the Good CME Practice group (gCMEp).

OverviewDiabetes and thyroid disorders are two of the most prevalent non-communicable chronic diseases worldwide, both having a heavy impact on patients’ quality of life and life expectancy. The number of people affected by diabetes mellitus is close to half a billion and the rising trend in diabetes prevalence worldwide is far from slowing, with catastrophic outcomes in terms of morbidity, mortality and healthcare expenditures. Type 2 diabetes, characterized by a systemic resistance to insulin action, is the most common form of diabetes mellitus. While efforts should be made to prevent overt diabetes, when this is not possible, a deep knowledge of the most up-to-date treatment strategies is crucial to ensuring a longer life expectancy and good quality of life for diabetic patients. Disorders in thyroid function are also very common and can lead to severe consequences if not promptly recognized and treated. Thyroid receptors have been found on several cell types, suggesting that thyroid hormones are involved in the regulation of the homeostasis of several tissues and organs. In particular, several studies have now clarified the relevant action of thyroid hormones on endothelial cells and cardiomyocytes. Indeed, even subclinical thyroid disorders are associated with adverse cardiovascular outcomes. In addition, thyroid nodules affect more than 50 percent of the general population, challenging the clinicians in daily clinical practice. This live educational programme has been organised by EXCEMED to review the most recent and significant research advances in the fields of pre-diabetes, diabetes and thyroid diseases, with the goal of having immediate clinical impact.

Learning objectivesBy attending this conference, participants will be able to:•Identify and manage insulin-resistance states in diabetic and non-diabetic subjects•Update their clinical practice with the newest advances in terms of diagnosis and management

of diabetes and its complications•Manage thyroid diseases in difficult clinical settings including cardiovascular patients,

pregnancy and advanced thyroid cancer

Target audienceThis programme is intended for endocrinologists and specialists involved in the diagnosis and management of patients with diabetes and thyroid disorders.

Chairspaolo pozzilli Department of Endocrinology and DiabetesUniversity Campus Bio-MedicoRome, Italy

Salman razviInstitute of Genetic Medicine Newcastle UniversityNewcastle upon Tyne, UK

Evolving strategies to tacklediabetes and thyroid disorders

The CME conference “Evolving strategies to tackle diabetes and thyroid disorders” held on 20 May 2017 in Milan, Italy is designated for a maximum of 3 (three) hours of European CME credits (ECMEC). Each medical specialist should claim only those credits that he/she actually spent in the educational activity. EACCME® credits are recognized by the American Medical Association (AMA) towards the Physician’s Recognition Award (PRA). To convert EACCME® credit to AMA PRA category 1 credit, please contact the AMA.

Continuing Medical educationEXCEMED (www.excemed.org) is accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) to provide the following CME activity for medical specialists. The EACCME® is an institution of the European Union of Medical Specialists (UEMS), www.uems.net

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Our programme allows you to add your voice to the conversation. We wish you a unique learning experience.Express your opinion, pose questions and engage with us. During this conference we offer feedback formats suited to all tastes: short lectures, real-time surveys, dynamic Q&A sessions, question cards, engaging roundtables, interactive workshops. Our objective is to help you get the most from your learning experience with us.

WorkshopsLearning: it’s also fun and games. During the working groups, challenge yourself by completing the interactive clinical case on the Ipad. Confront your subgroup’s opinions through gaming: make strategic decisions based on clinical information and see if you can provide the best option. Understanding, treating and managing diabetes and thyroid disorders are brought together in this digital approach. The first subgroup to achieve the top score will win a gift from the the Scientific Chairs Paolo Pozzilli and Salman Razvi during the closing plenary.

Have a question for the experts? Please ask: use a question card.

Evolving strategies to tackle diabetes and thyroid disorders

Question card

VenueThis conference will take place at the:milan marriott HotelVia Giorgio Washington 66Milan, Italy

LanguageThe official language of this live educational conference will be English.

CME ProviderEXCEMED - Excellence in Medical EducationProgramme Manager: Michela Fiuzzi T +39 06 420413 252 - F +39 06 420413 677 michela.fiuzzi@excemed.orgMedical Advisor: Ernesto Maddaloni

for any logistic inquiry, please contact:Meridiano Congress International Senior Event Manager: Titty Alvino T +39 06 88 595 310 - F +39 06 88595 234 titty.alvino@meridiano.it

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ralph anthony Defronzo (joining via Skype)Department of Medicine - DiabetesUniversity of Texas Health Science Center San AntonioTexas Diabetes Institute - University Health systemSan Antonio, (TX) USA

tim Korevaar Erasmus MC, Academic Center for Thyroid DiseasesRotterdam, The Netherlands

richard David graham leslie Centre for DiabetesBlizard InstituteBarts and The London School of Medicine and DentistryLondon, UK

Ernesto maddaloniDepartment of Endocrinology and DiabetesUniversity Campus Bio-MedicoRome, Italy

mario luca morieriJoslin Diabetes Center - Harvard Medical School Department of Genetic & Epidemiology at Joslin Diabetes CenterBoston, USAandUniversity of Ferrara - Department of Medical SciencesFerrara, Italy

paolo pozzilli Department of Endocrinology and DiabetesUniversity Campus Bio-MedicoRome, Italy

Salman razviInstitute of Genetic Medicine Newcastle UniversityNewcastle upon Tyne, UK

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08.20 Welcome & opening

Session i focused answers to key questions on insulin resistance states

chairs: P. Pozzilli (Italy), S. Razvi (UK)

08.30 l1 insulin resistance beyond glycaemia M.L. Morieri (USA)

Discussion with panelists

09.05 l2 focus on pre-diabetes P. Pozzilli (Italy)

Discussion with panelists

09.40 l3 cardiovascular effects of antidiabetic drugs R.D.G. Leslie (UK) Discussion with panelists

10.15 roundtable the insulin resistant pregnant woman: what consequences for the off-spring? P. Pozzilli (Italy), M.L. Morieri (USA), R.D.G. Leslie (UK)

Question time

10.50 coffee break

Session ii focused answers to key questions on thyroid disorders

chairs: P. Pozzilli (Italy), S. Razvi (UK)

11.05 l4 thyroid hormones and the cardiovascular system S. Razvi (UK)

Discussion with panelists

Saturday, 20 may 2017

11.40 l5 thyroid and pregnancy T. Korevaar (The Netherlands)

Discussion with panelists

Session iii Working groups

12.15 Working groups: clinical case solving

clinical case 1 clinical case 2 clinical case 3

thyroid noduleS. Razvi (UK)

T. Korevaar (The Netherlands)

morbid obesityR.D.G. Leslie (UK)M.L. Morieri (USA)

frail patient with type 2 diabetes

P. Pozzilli (Italy)E. Maddaloni (Italy)

13.15 Working groups: outcome presentation in plenary

chairs: P. Pozzilli (Italy), S. Razvi (UK), R.D.G. Leslie (UK)

group 1 group 2 group 3

13.15 - 13.30clinical case 1

13.30 - 13.45clinical case 2

13.45 - 14.00clinical case 3

14.00 Knl the changing face of diabetes R.A. DeFronzo (USA, joining via skype)

Discussion

14.35 concluding remarks

End of the conference

closing lunch

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l : Lecture : Discussion : Roundtable Question time Knl: Keynote lecture

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EXCEMED adheres to guidelines of the European Accreditation Council for Continuing Medical Education (EACCME®) and all other professional organisations, as applicable, which state that programmes awarding continuing education credits must be balanced, independent, objective and scientifically rigorous. Investigative and other uses for pharmaceutical agents, medical devices, and other products (other than those uses indicated in approved product labeling/package insert for the product) may be presented in the programme (which may reflect clinical experience, the professional literature or other clinical sources known to the presenter). We ask all presenters to provide participants with information about relationships with pharmaceutical or medical equipment companies that may have relevance to their lectures. This policy is not intended to exclude faculty who have relationships with such companies; it is only intended to inform participants of any potential conflicts so that participants may form their own judgements, based on full disclosure of the facts. Further, all opinions and recommendations presented during the programme and all programme-related materials neither imply an endorsement nor a recommendation on the part of EXCEMED. All presentations represent solely the independent views of the presenters/authors.

The following faculty provided information regarding significant commercial relationships and/or discussions of investigational or non-EMEA/FDA approved (off-label) uses of drugs:

t. Korevaar Declared receipt of honoraria or consultation fees from Berlin-Chemie and Goodlife Healthcare.

r.D.g. leslie Declared no potential conflict of interest.

E. maddaloni Declared receipt of honoraria or consulation fees from EXCEMED.

m.l. morieri Declared no potential conflict of interest.

p. pozzilli Declared receipt of grants and contracts from Lilly, Astra Zeneca, GSK and Sanofi; receipt of honoraria and consultation fees from Sanofi and Lilly; to be member of a company advisory board, boards of directors or other similar groups of Lilly.

S. razvi Declared no potential conflict of interest.

The following faculty have provided no information regarding significant relationship with commercial supporters and/or discussion of investigational or non-EMEA/FDA approved (off-label) uses of drugs as of 8 May 2017.

r.a. Defronzo

faculty disclosures

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tim Korevaar

Erasmus MC, Academic Center for Thyroid DiseasesRotterdam, The Netherlands

Tim Korevaar studied medicine at the Erasmus University in Rotterdam, the Netherlands, during which he got acquainted with research during a 7-month research internship at the Oxford Center for Diabetes, Endocrinology and Metabolism studying disease of the pituitary and adrenals (Dr. Niki Karavitaki and Prof. Ashley Grossman). He then obtained a Master’s degree in Clinical Epidemiology at the Netherlands Institute of Health Sciences, and subsequently obtained his PhD (cum laude) on determinants, interpretation and consequences of thyroid hormone availability during pregnancy at the Erasmus University (Prof. Robin Peeters, Prof. Eric Steegers and Prof. Theo Visser). In the last few years, Dr. Korevaar has had the privilege to receive six international awards and recently

initiated and co-founded an international research consortium (the Consortium on Thyroid and pregnancy). He currently works as a visiting postdoctoral scientist at the Harvard School of Public Health, Boston, USA, (Prof. Russ Hauser) and aims to extend the work of his PhD to fill clinical knowledge-gaps on the role of thyroid function in pregnancy and reproduction.

ralph anthony Defronzo

Department of Medicine - DiabetesUniversity of Texas Health Science Center San AntonioTexas Diabetes Institute - University Health systemSan Antonio, (TX) USA

Ralph Anthony DeFronzo, MD is a Professor of Medicine, the Chief of the Diabetes Division at the University of Texas Health Science Center and the Deputy Director of the Texas Diabetes Institute, San Antonio, Texas. Dr. DeFronzo served as Member of Scientific Advisory Board at Diamedica Inc. since June 2014. Dr. DeFronzo has served as an Advisory Board member for several pharmaceutical companies and has delivered numerous keynote speeches at major national and international conferences on diabetes and its complications. His major interests focus on the pathogenesis and treatment of type 2 diabetes mellitus and the central role of insulin resistance in the metabolic-cardiovascular cluster of disorders known collectively as the Insulin Resistance Syndrome. Using the euglycemic insulin clamp technique in combination with radioisotope turnover methodology, limb catheterization, indirect calorimetry and muscle biopsy, he has helped to define the biochemical and molecular disturbances responsible for insulin resistance in type 2 diabetes mellitus. With more than 650 articles published in peer-reviewed medical journals, Dr. DeFronzo is a distinguished

diabetes researcher, clinician and teacher and is a recipient of several prestigious national and international awards. In 2008, Dr. DeFronzo received the Banting Award from the American Diabetes Association (ADA) and the Claude Bernard Award from the European Association for the Study of Diabetes (EASD). In 2008, Dr. DeFronzo also received the Italian Diabetes Mentor Prize and the Philip Bondy Lectureship at Yale University. He also is the recipient of the ADA’s Albert Renold Award (2002) for lifetime commitment to the training of young diabetes investigators. For his work in this area, Dr. DeFronzo received the prestigious Lilly Award (1987) from the ADA, the Banting Lectureship (1988) from the Canadian Diabetes Association and the Novartis Award (2003) for outstanding clinical investigation worldwide. Dr. DeFronzo is a graduate of Yale University (BS) and Harvard Medical School (MD) and completed his training in Internal Medicine at the Johns Hopkins Hospital. He completed fellowships in Endocrinology at the National Institutes of Health and Baltimore City Hospitals and in Nephrology at the Hospital of the University of Pennsylvania.

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richard David graham leslie

Centre for DiabetesBlizard InstituteBarts and The London School of Medicine and DentistryLondon, UK

Richard David Graham Leslie is Professor of Diabetes and Autoimmunity at the Barts and the London School of Medicine and the Blizard Institute, University of London. He has published 12 books and more than 200 peer-reviewed papers and received grants from many agencies including the EU, Wellcome Trust and MRC. In 2012 He was elected President of the Association of Physicians of Great Britain and Ireland. His research is based on the use of cutting-edge technology applied to unique cohorts (e.g. twins and adult onset autoimmune diabetes patients) to define the nature and origins of type 1 diabetes. These results led to work as Principle Investigator of three major EU programmes (EXALT, BLUEPRINT and Action LADA). He has held Visiting Chairs in USA (Chicago and Kansas) and Europe (Rome) and he his an Emeritus Professor

in China (Central South University). He was Senior Examiner Chinese University Hong Kong in 2013 and he is currently the founding Chairman of T1DUK, a UK consortium of leading UK researchers set up to investigate and prevent type 1 diabetes. Notable awards include: a Medical Research Council Travelling Fellowship to USA, and Welcome Trust Senior Fellowship in Clinical Science. He was co-author of an award-winning textbook (BMA Book of the Year Award 2009), Co-Editor of Diabetes Metab. Res. Rev., Reviews Editor of Diabetic Medicine and served on the Editorial Board of Diabetes Care.

Ernesto maddaloni

Department of Endocrinology and DiabetesUniversity Campus Bio-MedicoRome, Italy

Ernesto Maddaloni qualified in Medicine at the University Campus Bio-Medico, Rome, Italy, and he actually works as a medical doctor at the department of Medicine, Unit of Endocrinology and Diabetes, at the University Campus Bio-Medico. He is involved in diabetes research as he is a clinical investigator in several international clinical trials, including trials for the prevention of type 1 diabetes and for the evaluation of cardiovascular outcomes of new agents for the treatment of type 2 diabetes. In 2015 Dr. Maddaloni completed his Post-Doctoral Research Fellowship at the Vascular Cell Biology Section, Research Division, of the Joslin Diabetes Center, Harvard Medical School, in Boston, MA, USA. His commitment to research is also demonstrated by several peer-reviewed papers in the field of diabetes and endocrinology. He has been

awarded the “2014 Campus Bio-Medico Alumni Association award for the Internationalization of Research” and the “2015 Albert Renold fellowship” of the European Foundation for the Study of Diabetes.

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mario luca morieri

Joslin Diabetes Center - Harvard Medical School Department of Genetic & Epidemiology at Joslin Diabetes Center - Boston, USAand University of Ferrara - Department of Medical SciencesFerrara, Italy

Mario Luca Morieri graduated in 2008 (Medical Degree cum laude at University of Bologna – Italy), then completed the Internal Medicine Specialization in 2015 at the University of Ferrara (Italy). In those years, he developed a special clinical and research interest in the field of diabetes, obesity and lipid disorders, focusing his work on the relationship between insulin resistance, genetic variants, and cardiovascular disease. These projects prompted his current interest in translating genetic findings into clinical practice, in order to guide physicians toward a more patients-tailored medicine. Driven by such interest, since 2015 he has started working with Prof. Alessandro Doria at the Joslin Diabetes Center (affiliated with Harvard Medical School, USA), who leads a research program on the genetic modulators of CVD-preventing interventions in type 2 diabetes. Currently, his most relevant publications are: a comment with original data on genetic variants influencing CV response to fenofibrate in type 2 diabetes (Morieri

ML et al., N Engl J Med 2016); report of GWAS study on genetic predictors of cardiovascular mortality during intensive glycemic control (Shah H et al., Diabetes Care 2016); Observational study in the relationship between insulin resistance, metabolic syndrome and cardiovascular disease in the elderly (Zuliani et al., Atherosclerosis. 2014).

paolo pozzilli

Department of Endocrinology and DiabetesUniversity Campus Bio-MedicoRome, Italy

Paolo Pozzilli is Full Professor of Endocrinology and Metabolism at University Campus Bio-Medico in Rome where he is Director of the Unit of Endocrinology & Diabetes and of the Post-Graduate School of Endocrinology & Metabolic Diseases. He is the coordinator of the PhD Program in Integrated Biomedical Sciences and Bioethics. He is also Professor of Diabetes at the Blizard Institute, St.Bartholomew’s and the London School of Medicine, Queen Mary University of London. His main research activities include the study of the pathogenesis of type 1 diabetes and its complications, the introduction of novel treatments and the application of technology to the management of this condition. He participated in the design of algorithms for treatment of type 2 diabetes and is P.I. for Italy in several clinical trials in diabetes. For his research he is funded at present by the Juvenile Diabetes Research Foundation, the EASD Foundation, the Italian Ministry of University and the

Italian Ministry of Health. He is the recipient of several awards including among others, the Andrew Cudworth Memorial Award by Diabetes UK, the GB Morgagni Young Investigator Award by the Society of Metabolism, the Marie Kugel Award by the Juvenile Diabetes Research, Foundation, the Celso Prize by the Italian Diabetes Society and the Joseph Hoet Memorial Award for his contribution to the field of type 1 diabetes prevention. Currently Editor of Diabetes Metabolism Research & Review, he has published 452 papers (Pubmed) in the area of diabetes and related fields.

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Salman Razvi is a Senior Lecturer in Endocrinology at Newcastle University and a Consultant Endocrinologist at Queen Elizabeth Hospital. His major research interest is the action of thyroid hormones particularly on the cardiovascular system. His research focus has been on investigating the association of thyroid function on the cardiovascular system in various populations. He is the chief investigator of several projects funded by various statutory funding bodies as well as charities. He has more than 50 peer-reviewed publications mainly relating to thyroid dysfunction. His main research programmes include investigating treatment of subclinical hypothyroidism with thyroid hormones in acute myocardial infarction and age-appropriate treatment of hypothyroidism in elderly.

Institute of Genetic Medicine Newcastle UniversityNewcastle upon Tyne, UK

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focus on pre-diabetesP. Pozzilli (Italy)L2

insulin resistance beyond glycaemiaM.L. Morieri (USA)L1

NOTES NOTES

Learning objectives:•Understand the relevance of pre-diabetes•Acquire skills to manage pre-diabetes •Learn the foundations of type 2 diabetes prevention

Learning objectives:•Understand the differences between metabolically healthy and unhealthy obese•Learn the systemic detrimental effects of insulin-resistance besides hyperglycaemia•Acquire knowledge about the effects of insulin-sensitizers besides glycaemia

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the insulin resistant pregnant woman: what consequences for the off-spring?

Learning objectives:•Acquire knowledge about the effects of hyperinsulinemia on the fetus•Understand the exposure to hyperinsulinemia during intra-uterine life increase metabolic

risk later in life•Acquire skills to manage insulin-resistance during pregnancy

P. Pozzilli (Italy), M.L. Morieri (USA), R.D.G. Leslie (UK)RTcardiovascular effects of antidiabetic drugsR.D.G. Leslie (UK)L3

NOTES NOTES

Learning objectives:•Acquire skills to personalise the glycaemic target based •Learn the cardiovascular side-effects of anti-diabetic drugs•Learn the cardiovascular benefits associated to some anti-diabetic drugs

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Learning objectives: •Learn the influence of thyroid hormones on cardiovascular homeostasis•Promote the treatment of thyroid disorders to ameliorate cardiovascular risk factors•Promote the screening of thyroid disorders in patients with cardiovascular disease

thyroid hormones and the cardiovascular systemS. Razvi (UK)L4

NOTES NOTES

Learning objectives:•Learn the consequences of dysthyroidism during pregnancy in the off-spring•Acquire skills to manage dysthyroidism during pregnancy

thyroid and pregnancyT. Korevaar (The Netherlands)L5

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NOTES NOTES

Working group morbid obesityR.D.G. Leslie (UK), M.L. Morieri (USA)CC2

Working group thyroid noduleS. Razvi (UK), T. Korevaar (The Netherlands)CC1

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Working group frail patient with type 2 diabetesP. Pozzilli (Italy), E. Maddaloni (Italy)CC3

NOTES NOTES

Learning objectives:•Describe the new advancements in knowledge about the pathophysiology of diabetes•Learn the impact of diabetes on goes beyond classical micro- and macro-vascular complications•Understand how to manage new anti-diabetic drugs

Knl the changing face of diabetesR.A. DeFronzo (USA, joining via skype)KNL

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All EXCEMED programmes are organized solely to promote the exchange and dissemination of scientific and medical information. No forms of promotional activities are permitted. There may be presentations discussing investigational uses of various products. These views are the responsibility of the named speakers, and do not represent an endorsement or recommendation on the part of EXCEMED. This programme is made possible thanks to an educational grant received from Merck KGaA, Darmstadt, Germany and San Raffaele Hospital, Milan.

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