The prevalence of diabetes has reached epidemic proportions globally, with the International Diabetes Federation estimating that in 2021, more than half a billion adults (537 million) will be living with the condition [1]. Type 2 diabetes (T2D) accounts for over 90% of all cases of diabetes worldwide and is strongly associated with overweight and obesity [1]. Obesity contributes to the etiopathogenesis of T2D and is associated with the development of T2D-associated complications [2]. To optimize outcomes, both obesity and T2D must be effectively managed together; for example, weight loss in patients with T2D improves insulin sensitivity and long-term outcomes [3].

Obesity rates are rising rapidly, and it is estimated that 1 in 5 women and 1 in 7 men will be living with obesity (defined as a BMI ≥30 kg/m²) by 2030 [4]. The treatment of obesity remains challenging with lifestyle modifications, such as calorie restriction and increased physical activity often not resulting in sustained weight loss when used as a stand-alone treatment [5]. Thus, effective pharmacotherapies that target the underlying pathophysiology of metabolic diseases, such as T2D and obesity, are an attractive treatment option and have been the focus of much research in recent decades.

Incretin hormones, such as glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), are gut peptides that are released in response to oral nutrient intake [6]. In healthy individuals, incretins have multiple functions, including inhibition of glucagon secretion, stimulation of glucose-dependent insulin secretion, decreased gastric emptying, and reduced food intake [7,8]. Over the past 2 decades, several incretin-based therapies, including GLP-1 receptor agonists (RAs) and dipeptidyl peptidase-4 (DPP-4) inhibitors, have been developed and approved for the treatment of both T2D and obesity. The GLP-1 RAs directly stimulate GLP-1 receptors in the pancreas and brain, leading to improved glycemic control and reduced appetite. Exenatide was the first GLP-1 RA to be approved by the US Food and Drug Administration as a treatment for T2D in 2005. Subsequently, liraglutide became the first GLP-1 RA to be approved as a treatment for both T2D (2010) and obesity (2014) [5]. The DPP-4 inhibitors prevent the breakdown and inactivation of GLP-1 and GIP, thus increasing their plasma half-lives. In 2006, sitagliptin became the first DPP-4 inhibitor to be approved for the treatment of T2D [9]. Since their initial development, the pharmacokinetic profile of GLP-1 RAs has been improved through various chemical modifications. This has led to the development of twice-daily, daily, and weekly subcutaneous formulations, as well as an oral formulation of semaglutide [5].

Emerging evidence has demonstrated that coinfusion of GLP-1 and GIP exerts a synergistic effect in healthy individuals [10], and new dual agonists have shown promising results in clinical trials [11-13]. For example, the dual GIP and GLP-1 RA tirzepatide at 5-15 mg was shown to be superior to basal insulin and to 1 mg of semaglutide weekly in reducing levels of hemoglobin A_1c (HbA_1c) and body weight in patients with overweight or obesity and T2D [11,12]. Subsequently, tirzepatide was approved by the US Food and Drug Administration for the treatment of T2D in 2022 and was described as having very high efficacy for reduction in HbA_1c and body weight in the 2022 American Diabetes Association and the European Association for the Study of Diabetes consensus statement [14].

The American Diabetes Association and the European Association for the Study of Diabetes guidelines recommend clinicians reassess and modify treatment after 3-6 months if HbA_1c levels consistently stay above target [14]. However, real-world data have shown that initial treatment intensification typically does not occur for over a year after first recognizing failure in achieving glycemic targets [15,16]. The reasons behind this delay remain to be fully elucidated; however, health literacy may be a barrier for patients in understanding the value of therapy intensification in T2D management [17]. There is also a need to improve training in weight management in T2D. Despite the urgent need for weight loss, a survey found that fewer than half (49%) of nurses and primary care physicians reported receiving specialty training in weight management since their initial medical training, yet 79% of them reported being interested in education on patient-directed weight management strategies [18], emphasizing the need for education on guideline-based disease management.

The importance of responsive and effective health care professional (HCP) education was highlighted by a position statement published by the Insights for Diabetes Excellence, Access, and Learning Group in 2020 to meet the increasing needs for diversity, specialization, cultural competence, advancing practice, and person-centeredness in diabetes care delivery [19]. Patients with T2D and diabetes can benefit from a coordinated approach with a dedicated multidisciplinary team (MDT) focused on weight loss, dietary advice, managing symptoms and side effects, and dosing of medications. The MDT may include a consultant endocrinologist and diabesity specialist nurse, a specialist dietitian, an exercise physiologist, and a psychologist [20,21]. Diabetes care and education specialists (DCESs; previously known as certified diabetes educators) also play a key role in the MDT model [22]. The value of DCESs to patient outcomes was shown in a recent meta-analysis that demonstrated greater improvements in HbA_1c following nurse- or DCES-based interventions compared with physician-based interventions [23].

For HCPs with busy clinical schedules, it can be difficult to find time to attend traditional face-to-face continuing medical education (CME) activities [24,25]. As an alternative, web-based activities have become increasingly popular, particularly in response to the limitations imposed by the COVID-19 pandemic [26]. Web-based activities are accessible to HCPs, irrespective of their location and training budget, and they can also be developed and viewed at a time convenient to both the expert faculty and learners [25]. Short-duration educational activities that are succinct and easy to digest have also recently become an important part of CME [27].

In this study, we developed and implemented a faculty-led, CME-accredited, web-based educational activity on the future role of incretin-based dual agonists and the importance of patient education in T2D and obesity. The objectives of this analysis were (1) to measure changes in knowledge, competence, and self-reported performance after participation; (2) to objectively evaluate changes in learners’ performance using anonymized patient data; and (3) to identify remaining educational gaps in this field.

Educational gaps and learning objectives were identified and formulated by touch Independent Medical Education, an organization that provides independent medical education for HCPs, through a review of the published literature and feedback from expert faculty specializing in the treatment of T2D and obesity.

A faculty-led, web-based, multidisciplinary (touchMDT) activity was developed by touch Independent Medical Education in collaboration with the faculty and was free to access on-demand on the touchENDOCRINOLOGY website [28] from March 28, 2022, to March 28, 2023. The activity comprised three 10-15–minute videos (providing 37 minutes of education in total) and involved MDT members (an endocrinologist specializing in diabetes, an endocrinologist specializing in obesity, and a DCES) discussing their role in the management of patients with T2D and obesity with a patient with T2D.

The target audience was endocrinologists based in the United States involved in the management of patients with T2D and obesity. CME accreditation was provided by the University of South Florida Health, which is accredited by the Accreditation Council for Continuing Medical Education as a provider of continuing professional development. Details of the activity and the learning objectives are provided in Multimedia Appendix 1. Communication channels used to reach the target audience are included in Multimedia Appendix 1.

Outcomes for both educational activities were assessed using a comprehensive system of analysis, in line with the 7-level framework for assessing the outcomes of CME programs developed by Moore et al [29] in 2009. For this study, Moore’s levels 1 to 5 were assessed (participation, satisfaction, knowledge, competence, and performance).

As part of the level 3 to level 5 questionnaires, respondents and learners were asked, “How confident are you in treating T2D and obesity?” (level 3 to level 4 questionnaire only), and learners were asked, “As a result of your participation in this session, will you make a change in your practice?” Mutually exclusive responses to the confidence question were not confident, a little confident, somewhat confident, moderately confident, and extremely confident; and to the change in practice question, they were yes, uncertain—more education needed, uncertain—practical limitations, no—more education needed, and no—practical limitations.

Four potential educational gaps were included in the level 3 to level 5 questionnaires, and participants were asked to rank them by importance. The results were analyzed by specialty using a Single Transferable Vote system as described previously [30]. Educational gaps were also identified through an analysis of responses to the questionnaires assessing level 3 to level 5 outcomes. Questions that were answered incorrectly by ≥30% of learners after completion of the educational activity were identified as outstanding educational gaps. The cutoff of 30% was based on an analysis of outcomes data from previous educational activities by touch Independent Medical Education.

The data were analyzed using SPSS Statistics (version 28.0.1; IBM Corp). Knowledge, competence, and self-reported performance (levels 3-5) outcomes were compared for the overall population using an independent sample t test and in subgroups defined by years of experience (<1-10 years, >10-20 years, and >20 years for levels 3-4; 0-20 and >20 years for level 5) using a 2-way ANOVA. Individual questions were analyzed with a paired sample t test followed by a 1-way ANOVA. For performance (level 5), as measured by anonymized patient data, a comparison between the pre- and postactivity data was made with a paired sample t test. The margin of error was 10%, based on the sample size of 50 for the pre- and postactivity data sets.

All consents and ethical confirmations were obtained within the questionnaire itself in accordance with British Healthcare Business Intelligence Association professional guidelines and General Data Protection Regulation consents. Where local markets have additional requirements, these were confirmed in line with the European Pharmaceutical Market Research Association’s professional guidance. This study did not report experiments on human participants; therefore, institutional review board approval and informed consent were not applicable.

From responses to the level 3 to 4 questionnaire, there was an increase in confidence in treating T2D from before to after the activity, with the proportion of respondents reporting that they felt “extremely confident” increasing from 70% (35/50) to 84% (42/50). This was mainly driven by a decrease in those feeling “moderately” confident (24%, 12/50 to 10%, 5/50). Very few respondents described themselves as being “not confident” or “a little confident,” both before (0%) and after the activity (1/50, 2%). Overall, 62% (31/50) and 58% (29/50) of learners in the level 3 to 4 and level 5 outcomes questionnaires, respectively, stated that they would make a change to their practice following their participation in the educational activity (Multimedia Appendix 8).

In an analysis of answers to the postactivity level 3 to 4 questionnaire, 48% (24/50) of learners were unable to demonstrate procedural knowledge on the efficacy of cotadutide regarding weight loss in patients with T2D and overweight.

When asked what they considered to be their most important unmet educational needs, learners from the level 3 to 4 and level 5 questionnaires highlighted “understanding the biology and psychology of obesity and approaches for its prevention and management.” In addition, learners from the level 3 to 4 questionnaire highlighted “efficacy and safety data for incretin-based dual agonists and their future role in clinical practice,” and learners from the level 5 questionnaire highlighted “the role of the diabetes educator or DCES in the T2D and obesity multidisciplinary team” as their most important unmet educational needs (Multimedia Appendix 9).

In this study, HCPs expressed high levels of satisfaction and improvements in their knowledge and competence in T2D and obesity management. Improvements in knowledge and competence were observed; modest improvements in self-reported performance were also recorded, although these were limited by the high levels of performance demonstrated before the activity.

Previous studies have shown that self-reported performance can be subjective and liable to bias (eg, recall bias or social desirability bias) [31,32]. Using a more objective method, such as analyzing patient records to assess changes in patient management, can help validate self-reported outcomes and provide insights into the impact of the educational activity on patient management. In this study, the analysis of anonymized patient data showed that patients were being treated more intensively after the educational activity. In particular, increases in the number of patient visits per year were observed, and there was a reduction in the number of patients without a follow-up visit scheduled. This suggests a reduction in clinical inertia, enabling prompt treatment intensification where required. In addition, there was an increased number of referrals to a combination of specialists, including diabetes educators or DCESs, diabetes nurse specialists, and nutritionists or dietitians in particular. This indicates that the educational activity may have been effective in communicating the importance of MDT care for patients with T2D and obesity. There was also a move away from monotherapy and an increase in patients receiving triple therapy with metformin, an injectable GLP-1 RA, and an SGLT2i. All physicians who added a GLP-1 RA to their patient’s treatment regimen stated that they did so with the aim of achieving weight loss, suggesting that the educational activity was effective in communicating the benefits of GLP-1 RAs beyond glycemic control. Taken together, these factors may explain why there was no overall increase in the volume of referrals after the educational activity—patients may have been achieving better overall outcomes due to the combination of increased visits, treatment intensification, and attention from a combination of specialists in the MDT. As such, the need for more specialist referrals was not warranted.

In agreement with the improvements in knowledge, competence, and performance, physicians reported increased confidence in the treatment of patients with T2D and obesity after participating in the educational activity. In addition, almost two-thirds stated that they would make a change to their practice. This is consistent with a previous study showing a correlation between improvements in confidence and a commitment to change clinical practice [33]. Practical limitations were cited as the reason why 25% of learners could not change their practice. This may reflect a lack of access to certain antihyperglycemic therapies, diabetes education channels, or both. Insights from another recent study on factors that impact HCPs’ intent to put newly acquired learning into practice suggest that the consequences of adopting new clinical behaviors and a lack of self-belief in one’s capabilities can also prevent HCPs from converting key learnings into tangible actions [34].

This study had several limitations:

The results presented here are consistent with a similar study that demonstrated that short, case-based, web-based CME led to improvements in knowledge, competence, and self-reported performance in T2D management [36]. Similarly, in another recent study, primary care physicians who participated in a tele-education program reported increased confidence in diabetes management and improvements in their ability to prescribe, manage, and troubleshoot diabetes technology [37].

Participant feedback on educational activities is important to refine future educational activities, and several unmet educational needs were identified as part of this activity. Self-reported educational gaps were: “understanding the biology and psychology of obesity and approaches for its prevention and management,” suggesting that physicians are interested in the root causes of obesity and its prevention, not solely how to manage it; “efficacy and safety data for incretin-based dual agonists and their future role in clinical practice,” showing that physicians understand the potential impact of these agents and wish to be prepared to prescribe them to patients; and “the role of the diabetes educator or DCES in the T2D and obesity MDT,” showing that how diabetes educators or DCESs can be integrated into the MDT is not yet fully understood, but physicians are willing to learn more.

This study demonstrated that a short-duration, free-to-access web-based CME activity on the management of T2D and obesity can lead to improvements in HCP knowledge, competence, and performance (both self-reported and as assessed by patient data). Several remaining unmet needs were identified, which can be used to inform the content of future educational activities in this disease area. Further studies will be valuable in defining the clinical impact of CME, particularly regarding the long-term impact of education on HCP performance and the benefits for patient and community health.