The Enduring Challenge of T2DM ─ Assessing Current Tools to Optimize Patient Outcomes - CME Information

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New developments in pharmacology and improved understanding of pathophysiology have led to refinements of recommended treatment algorithms. In type 2 diabetes mellitus (T2DM), "/><meta id="metaKeywords" name="keywords" content="Education Lab | CME,Endocrinology,Diabetes Education"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="designator" content="cme"/> <meta name="designators" content="cme"/> <meta name="PostedDate" content="2013-10-11"/> <meta name="ModifiedDate" content="2013-10-11"/> <meta name="specialties" content="Endocrinology"/> <meta name="specialty" content="Endocrinology"/> <meta name="primary_specialty" content="Endocrinology"/> <meta name="subspecialties" content="Diabetes Education"/> <meta name="subspecialty" content="Diabetes Education"/> <meta name="content_type" content="Education Lab"/> <meta name="additional_info" content="This activity is supported by an educational grant from Santarus."/> <meta name="pageid" content="{5040D1C5-9423-438D-B726-66937C981056}"/> <meta property="og:image" content="https://web.archive.org/web/20131026011000im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/healio_safe_image.png"/><meta name="authors" content="Lawrence Blonde MD FACP FACE, Samuel Dagogo-Jack MD FRCP, Alan J. Garber MD PhD, George Grunberger MD FACP FACE"/><meta name="activityid" content="{5040D1C5-9423-438D-B726-66937C981056}"/><meta name="legacyactivityid" content=""/><meta name="edu-acitivity-title" content="The Enduring Challenge of T2DM ─ Assessing Current Tools to Optimize Patient Outcomes"/><meta name="edu-activity-link" content="/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes"/><meta name="edu-source" content="Healio - Endocrinology Education Lab"/><meta name="edu-activity-type" content="Multimedia"/><meta name="edu-number-of-articles" content="3"/><meta name="author" content="Lawrence Blonde, MD, FACP, FACE"/><meta name="author" content=" Samuel Dagogo-Jack, MD, FRCP"/><meta name="author" content=" Alan J. 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href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab"> Education Lab/CME</a> <span>›</span> <a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes"> </a> </p>  <ul xmlns="http://www.w3.org/1999/xhtml" class="ed-lab-list">  <li class="img"><img src="/web/20131026011000im_/http://www.healio.com/~/media/Images/Education Lab/Covers/2013/07_July/J297 Cover.gif" alt="The Enduring Challenge of T2DM ─ Assessing Current Tools to Optimize Patient Outcomes" width="83" height="106"/></li> <li><span class="cme-flag-med">CME</span></li> <li><h4>The Enduring Challenge of T2DM ─ Assessing Current Tools to Optimize Patient Outcomes</h4>  <span class="earn-cme-btn"><a id="layout_0_maincontent_0_ctl00_EarnCMECreditLink" href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/posttest">Earn CME Credit »</a></span> </li> <li> <table cellspacing="0" cellpadding="0" border="0" width="650" style=""> <tbody> <tr> <td colspan="2"> <strong>Author(s)/Faculty: </strong> Lawrence Blonde, MD, FACP, FACE; Samuel Dagogo-Jack, MD, FRCP; Alan J. Garber, MD, PhD; George Grunberger, MD, FACP, FACE </td> </tr> <tr> <td colspan="2"> <strong>Source: </strong> Healio - Endocrinology Education Lab </td> </tr> <tr> <td width="195"> <strong>Type: </strong> Multimedia </td> <td width="195"> <strong>Articles/Items: </strong> 3 </td> </tr> <tr> <td width="195"> <strong>Release Date: </strong> 10/11/2013 </td> <td width="195"> <strong>Expiration Date: </strong> 10/11/2014 </td> </tr> <tr> <td width="195"> <strong>Credit Type: </strong> CME </td> <td width="195"> <strong>Number of Credit(s): </strong> 1.75 </td> </tr> <tr> <td width="195" class="last"> <strong>Cost: </strong> Free </td> <td width="195" class="last"> Provider: <img src="/web/20131026011000im_/http://www.healio.com/~/media/Images/Education Lab/Provider Logos/ACCE.jpg" alt="" width="100" height="95"/> </td> </tr> </tbody> </table> </li> <li class="overview" style="">This CME activity is based on the slides and lectures presented by the faculty at the symposium, The Enduring Challenge of T2DM ─ Assessing Current Tools to Optimize Patient Outcomes, on May 1, 2013, in Phoenix, Arizona. <br> </br> New developments in pharmacology and improved understanding of pathophysiology have led to refinements of recommended treatment algorithms. In type 2 diabetes mellitus (T2DM), research has shown the importance of the interrelationship of diabetes and cardiovascular risk. By considering these elements in concert when developing management strategies, clinicians may be able to achieve better outcomes for their patients. In this activity, leading clinicians will discuss how revisions to treatment algorithms will affect patient care, the rationale behind their development and their implementation by presenting state of the science data, and discussing them in the context of real-world cases.</li> <li class="sponsor">This activity is supported by an educational grant from Santarus.</li> </ul> <script type="text/javascript"> </script> <div class="cme-tab-group"> <ul id="layout_0_maincontent_1_ctl00_tabs" class="cme-tabs"><li><a class="current" href="javascript:void(0)">CME Information</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/learner-bill-of-rights">Learner Bill of Rights</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/attestation">Attestation</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/pretest">Pretest</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/rethinking-treatment-algorithms">Rethinking Treatment Algorithms</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/compare-and-contrast-approaches-to-target-a1c">Achieving Glycemic Goals</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/glycemic-control-and-cv-risk-reduction">Glycemic Control and CV Risk Reduction</a></li> <li><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/bibliography">Bibliography</a></li> <li><a class="disabled" href="javascript:void(0)">Posttest</a></li> <li><a class="disabled" href="javascript:void(0)">Evaluation</a></li> </ul> </div> <div class="top-btnbox"><div class="earn-cme-btn"><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/posttest"></a></div><span class="login-note">You must be logged in to Healio.com to see this activity.</span><input type="submit" name="layout_0$maincontent_2$ctl10" value="" class="btnNext" align="right" style="margin:1px 0;"/></div> <a name="content"></a><div class="content"><p><strong><span style="text-decoration: underline;">Sponsorship Statement:</span></strong> This continuing medical education activity is sponsored by <img alt="" width="73" height="100" src="/web/20131026011000im_/http://www.healio.com/~/media/Images/Education Lab/Activity Images/2013/Endocrinology/07_July/J297/AACE Logo.jpg"/>.</p> <p><strong><span style="text-decoration: underline;">Educational Partner:</span></strong> <img width="77" height="19" alt="Vindico Medical Education" src="/web/20131026011000im_/http://www.healio.com/~/media/Images/Education Lab/Provider Logos/VindicoLogo4web.gif"/>.</p> <p><strong><span style="text-decoration: underline;"></span></strong></p> <p><strong><span style="text-decoration: underline;">Support Statement:</span></strong> This activity is supported by an educational grant from <img alt="" width="100" height="26" src="/web/20131026011000im_/http://www.healio.com/~/media/Images/Education Lab/Activity Images/2013/Endocrinology/07_July/J297/Santarus Logo.jpg"/>.<strong><span style="text-decoration: underline;"></span></strong></p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Target Audience</span></strong><span style="text-align: left;">: The intended audience for this activity is endocrinologists and other healthcare professionals involved in the treatment of patients with type 2 diabetes mellitus.</span></p> <p><strong><span style="text-decoration: underline;"></span></strong></p> <p><strong><span style="text-decoration: underline;">Learning Objectives: </span></strong></p> <p>At the conclusion of this activity participants should be able to:</p> <ul> <li>Evaluate guideline- and algorithm-based approaches to optimize glycemic control in patients with T2DM. </li> <li>Compare the advantages and disadvantages of currently available treatments for T2DM. </li> <li>Assess the effect current diabetes therapies have on cardiovascular risk and discuss current recommendations on the use of antidiabetic medications for the prevention of CV events. </li> <li>Design individualized treatment plans utilizing guideline- and algorithm-based approaches to achieve optimal patient outcomes. </li> </ul> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Needs Assessment:</span></strong><span style="text-align: left;"> Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by insulin resistance, a decreased functional β-cell mass, and several other metabolic/endocrine abnormalities. T2DM results in significant morbidity and mortality, and it remains a leading cause of cardiovascular disorders, end-stage renal failure, blindness, amputations, and hospitalizations. Restoration of normoglycemia can be difficult to achieve due to the multifactorial pathogenesis of the disease, and it often requires multiple antidiabetic therapies with different mechanisms of action to produce an additive effect. Patients require continuing medical care and support and ongoing education about self-management to help prevent acute complications and reduce the risk of long-term complications. Despite the availability of several therapeutic options and national guidelines, half of all patients do not reach the recommended hemoglobin A1C (HbA1C) target. Therefore, further education is necessary regarding the use of guidelines and algorithm-based approaches to glycemic control, approaches to target A1C, glycemic control as it relates to cardiovascular disease risk reduction, and individualized treatment for patients with T2DM. </span></p> <p><strong><span style="text-decoration: underline;"></span></strong></p> <p><strong><span style="text-decoration: underline;">Co-Chairs:</span></strong></p> <p><strong>Alan J. Garber, MD, PhD<br/> </strong><span style="text-align: left;">Professor of Medicine, Biochemistry & Molecular Biology, and Molecular & Cellular Biology<br/> </span><span style="text-align: left;">Baylor College of Medicine<br/> </span><em style="text-align: left;">Houston, TX</em></p> <p><strong style="text-align: left;">Lawrence Blonde, MD, FACP, FACE<br/> </strong>Director, Ochsner Diabetes Clinical Research Unit<br/> <span style="text-align: left;">Department of Endocrinology<br/> </span><span style="text-align: left;">Ochsner Medical Center<br/> </span><em style="text-align: left;">New Orleans, LA</em></p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Faculty:</span></strong></p> <p><strong>Samuel Dagogo-Jack, MD, FRCP<br/> </strong>A. C. Mullins Professor & Director<br/> <span style="text-align: left;">Division of Endocrinology, Diabetes and Metabolism<br/> </span><span style="text-align: left;">Director, Clinical Research Center<br/> </span><span style="text-align: left;">UTHealth Science Center<br/> </span><em style="text-align: left;">Memphis, TN</em></p> <p><strong style="text-align: left;">George Grunberger, MD, FACP, FACE<br/> </strong>Chairman, Grunberger Diabetes Institute<br/> <span style="text-align: left;">Clinical Professor<br/> </span><span style="text-align: left;">Department of Internal Medicine<br/> </span><span style="text-align: left;">Center for Molecular Medicine & Genetics<br/> </span><span style="text-align: left;">Wayne State University School of Medicine<br/> </span><span style="text-align: left;"><em>Detroit, MI</em></span></p> <p><strong><span style="text-decoration: underline;">Accreditation:</span></strong></p> <p>The American Association of Clinical Endocrinologists (AACE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. </p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Credit Designation:</span></strong></p> <p>The American Association of Clinical Endocrinologists (AACE) designates this enduring material for a maximum of 1.75 <i>AMA PRA Category 1 Credit(s)</i>™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. </p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">How To Participate in this Activity and Obtain CME Credit:</span></strong></p> <p>To participate in this CME activity, you must read the objectives, answer the pretest questions, watch the presentations, complete the CME posttest, and fill in the evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 70% of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, you will be awarded a certificate for <em>AMA PRA Category 1 Credit(s)</em>™ or certificate of attendance for nonphysicians.</p> <p><strong></strong></p> <p><strong><span style="text-decoration: underline;">Disclosures:</span></strong></p> <span style="text-align: left;"> <p style="border: medium none;"><span style="text-decoration: underline;">Declaration of Disclosure and Conflicts of Interest:</span></p> <p style="text-align: justify;">It is the policy of AACE to ensure balance, independence, objectivity and scientific rigor in all of its CME activities.  Presentation content may include discussion of an unlabeled or an investigational use of a product.  AACE requires that participating faculty disclose to the audience any product(s) and its use(s) discussed in the educational activity that are unapproved/unlabeled for the use by the FDA or still considered investigational in nature.  </p> <p style="text-align: justify;">Everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. “Relevant financial relationships” are financial relationships in any amount occurring within the past 12 months that create a conflict of interest.  AACE requires speakers, faculty, CME Committee and other individuals who are in a position to control the content of this educational 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 evaluated by AACE for fair balance, scientific objectivity of studies mentioned in the presentation and educational materials used as basis for content, and appropriateness of patient care recommendations.  </p> <p style="text-align: justify;">The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments.  Informed learners are the final safeguards in assuring that a CME activity is independent from commercial influence.  </p> <p style="text-align: justify;">AACE has reviewed all disclosures and resolved or managed all identified conflicts of interest for this educational activity, as applicable. <b><span style="text-decoration: underline;"></span></b></p> </span> <p><span style="text-decoration: underline;">CME Accreditation Committee Disclosures:</span></p> <p style="text-align: justify;"><b>Dr. Fernando Ovalle</b> reports that he has received speaker/consultant honoraria and research grant support for his role as an investigator from Janssen Pharmaceuticals, Inc, and consultant honoraria and research grant support for his role as an investigator from Novo Nordisk A/S and sanofi-aventis US LLC.</p> <p style="text-align: justify;"><b></b></p> <p style="text-align: justify;"><b>Dr. Mushtaq A. Syed</b> reports that he has received speaker and consultant honoraria from Janssen Pharmaceuticals, Inc., Novo Nordisk A/S, and Takeda Pharmaceutical Company Limited.  </p> <p style="text-align: justify;"><b>Dr. Joseph M. Tibaldi</b> reports that he has received speaker honoraria from Daiichi-Sankyo company, Limited, Janssen Pharmaceuticals, and Merck & Co., Inc., and speaker/consultant honoraria from Novo Nordisk A/S.</p> <p style="text-align: justify;"><b></b></p> <p style="text-align: justify;"><b>Dr. Dace</b><b> L. Trence</b> reports that she has received research grant support from Eli Lilly and Company and is a stockholder of Medtronic, Inc. and  sanofi-aventis U.S. LLC.</p> <p><span style="text-decoration: underline;">Co-Chair Disclosures:</span></p> <p style="text-align: justify;"><b>Dr. Lawrence Blonde </b>reports that he has received consultant/speaker honoraria from Amylin Pharmaceuticals, LLC, Janssen Pharmaceuticals, Inc., Merck and Co., Inc., and Santarus, Inc.; consultant honoraria from GlaxoSmithKline plc. and Pfizer Inc.; speaker honoraria from Johnson and Johnson Services, Inc.; consultant/speaker honoraria and research grant support to Ochsner for his role as investigator from Novo Nordisk A/S and sanofi-aventis U.S. LLC; and research grant support to Ochsner for his role as investigator from Eli Lilly and Company. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Blonde has an identified conflict of interest and it has been resolved accordingly.  He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.</p> <p style="text-align: justify;"><strong>Dr. Alan J. Garber</strong> reports that he has received Advisory Board, consultant, and Speaker’s Bureau’s fees from Merck & Co., Inc., Novo Nordisk A/S, and Vivus Inc.; Advisory Board fees from Halozyme Therapeutics; Advisory Board and Speaker’s Bureau fees from Janssen Pharmaceuticals, Inc.; Advisory Board and consultant fees from Takeda Pharmaceuticals North America, Inc.; consultant and Speaker’s Bureau fees from Santarus Inc.; consultant fees from Tethys Bioscience and Viking Therapeutics; and Speaker’s Bureau fees from Eisai Co, Ltd. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Garber has an identified conflict of interest and it has been resolved accordingly. He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.</p> <p><span style="text-decoration: underline;">Faculty Disclosures:</span></p> <p><b>Dr. Samuel Dagogo-Jack </b>reports that he has received consultant honoraria from Amylin Pharmaceuticals, LLC, Merck & Co., Inc., Novo Nordisk A/S, and Santarus Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product.  Dr. Dagogo-Jack has an identified conflict of interest and it has been resolved accordingly.  He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.</p> <p><b>Dr.  George Grunberger </b>reports that he has received speaker honoraria and research support for his role as Investigator from Amylin Pharmaceuticals, LLC, Eli Lilly and Company, Novo Nordisk A/S, and Valeritas, Inc.; speaker honoraria from Amarin Corp. and Santarus Inc.; and research support for his role as Investigator from GlaxoSmithKline plc. and Janssen Pharmaceuticals, Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Grunberger has an identified conflict of interest and it has been resolved accordingly.  He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information. </p> <p style="text-align: justify;"><b></b></p> <p><span style="text-decoration: underline;">Vindico Medical Education staff report the following relationship(s):</span></p> <p>No relevant financial relationships to disclose.</p> <p><span style="text-align: left;">Signed disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.</span></p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Hardware and Software Requirements Needed to Participate:</span></strong></p> <ul> <li>A computer with an Internet connection. </li> <li>Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser. </li> <li>Adobe Flash Player and/or an HTML5 capable browser may be required for video or audio playback. </li> <li>Occasionally other additional software may be required such as PowerPoint or Adobe Acrobat Reader </li> </ul> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Unlabeled and Investigational Usage:</span></strong></p> <p>The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non-FDA approved or investigational use of products/devices.</p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Copyright Statement:</span></strong></p> <p>Copyright 2013, AACE. All rights reserved. No part of this publication may be reproduced or transmitted in any other form or by any other means, electronic or mechanical, without firstobtaining written permission from AACE.</p> <p><strong style="text-align: left;"><span style="text-decoration: underline;">Provider Contact Information:</span></strong></p> <p>For questions regarding this CME activity, please contact:<br/> AACE c/o Lauren Hogan<br/> Phone: (904) 353-7878<br/> Email: <a href="https://web.archive.org/web/20131026011000/mailto:lhogan@aace.com">lhogan@aace.com</a> </p> <p> </p> <p><strong></strong></p> <p> </p></div> <div class="bottom-btnbox"><div class="earn-cme-btn"><a href="/web/20131026011000/http://www.healio.com/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes/posttest"></a></div><span class="login-note">You must be logged in to Healio.com to see this activity.</span><input type="submit" name="layout_0$maincontent_2$ctl05" value="" class="btnNext" align="right" style="margin:1px 0;"/></div> <span id="layout_0_maincontent_2_debugtext"></span> <input name="layout_0$maincontent_2$activitymaster" type="hidden" id="layout_0_maincontent_2_activitymaster" value="{F081216C-4CEC-4F9E-BB88-31DB1D64032E}"/> <div class="social-links"> <div class="fb-like" data-send="false" data-width="300" data-show-faces="true" data-action="recommend"></div> <ul class="share"> <li><a href="javascript:void(0)" id="twitter" class="twitter-link" target="_new">Tweet</a></li> <li><a href="javascript:void(0)" id="facebook" class="facebook-link" target="_new">Share</a></li> <li class="linkedin"><a href="javascript:void(0)" id="linkedin" class="linkedin-link">Link</a></li> <li><span class="db-wrapper"><span class="g-plusone" data-size="tall" data-annotation="none"></span></span></li> <li><a href="javascript:void(0)" id="email">Email</a></li> <li class="last"><a href="javascript:void(0)" id="print">Print</a></li> </ul> <input name="layout_0$maincontent_3$articleItemForTweet" type="hidden" id="layout_0_maincontent_3_articleItemForTweet"/> <input name="layout_0$maincontent_3$tweettext" type="hidden" id="layout_0_maincontent_3_tweettext" class="tweettext" value="The Enduring Challenge of T2DM ─ Assessing Current Tools to Optimize Patient Outcomes "/> <input name="layout_0$maincontent_3$tweeturl" type="hidden" id="layout_0_maincontent_3_tweeturl" class="tweeturl" value="http://goo.gl/nXJUF8"/> </div> </div> <input name="layout_0$hfActivityid" type="hidden" id="layout_0_hfActivityid"/> <input name="layout_0$hfAttemptid" type="hidden" id="layout_0_hfAttemptid"/> <input name="layout_0$hfStepid" type="hidden" id="layout_0_hfStepid"/> <span id="layout_0_el2cDebug"></span> <script type="text/javascript"> function displayAlert(vsURL) { alert("You are now leaving the CME activity: >" + vsURL + "<"); window.location.href = vsURL; } function linkMods(_warnExternal) { var warnExternal = true; if (_warnExternal != null) warnExternal = _warnExternal; if (warnExternal) { var anchors = document.getElementsByTagName('a'); var imgTypes = new Array("jpg", "gif", "png", "ashx"); var tgtTypes = new Array("blank", "new", "media"); var ignoreids = new Array("print", "email", "digg", "facebook", "twitter"); var fileExt; var activitylink = '/endocrinology/education-lab/2013/07_july/assessing-current-tools-to-optimize-patient-outcomes'; activitylink = activitylink.toLowerCase(); var hostname = window.location.hostname.toLowerCase(); var protocol = window.location.protocol.toLowerCase(); var domainurl = protocol + "//" + hostname; var activityurl = domainurl + activitylink; activityurl = activityurl.toLowerCase(); for (var x = 0; x < anchors.length; x++) { var inactivity = false; var rules = ""; var h = anchors[x].href.toLowerCase().replace(domainurl, ""); var t = anchors[x].target.toLowerCase().replace("_", ""); var i = anchors[x].id.toLowerCase(); var tmp = h.split("."); fileExt = tmp[(tmp.length - 1)]; if ((h.indexOf('javascript:void(0)') == 0 || h.indexOf('https://web.archive.org/web/20131026011000/http://javascript:void(0)') == 0) || imgTypes.indexOf(fileExt) > -1 || tgtTypes.indexOf(t) > -1) { inactivity = true; rules = rules + ((rules.length > 0) ? 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