The Amazing Race to Tight Glycemic Control: A Team Approach to Insulin Analog Therapy
Interactive Case Studies

Faculty
Martin J. Abrahamson, MD
Associate Professor of Medicine
Harvard Medical School
Medical Director, Joslin Diabetes Center
Boston, MA

William Polonsky, PhD, CDE
Associate Clinical Professor
University of California, San Diego
President, Behavioral Diabetes Institute
San Diego, CA

Activity Overview
The prevalence of type 2 diabetes is increasing at an alarming rate, and timely treatment is needed to prevent or delay the devastating complications of this disease. Since type 2 diabetes is characterized by progressive β-cell failure, earlier and more aggressive use of insulin therapy is often required to help patients meet their glycemic targets. As healthcare professionals (HCPs) face the growing number of patients who require more specialized and complex care, they will need practical strategies for managing complex patients. The goal of this online activity is to reinforce the need for a team approach between HCPs and patients with type 2 diabetes to achieve tight glycemic control on insulin therapy. This online activity is based upon content originally presented at a symposium held on June 7, 2008, in San Francisco, California.

Intended Audience
This activity is intended for primary care physicians, endocrinologists, diabetologists, diabetes educators, nurse practitioners, nurses, physician assistants, and other HCPs who treat patients with type 2 diabetes.

Learning Format
This online activity consists of 3 interactive case studies. After a brief review of the patient’s medical history and current laboratory data, the participant will be asked to select a strategy for intensifying glycemic control. The benefits and limitations of each approach will be described in detail. Methods for initiating and intensifying glycemic control with insulin therapy will also be discussed. Of note, patient concerns that may accompany insulin initiation or intensification will be addressed. Each answer and its explanation must be viewed before proceeding to the next case. Participants may pause between cases to make it easier to accommodate their busy schedules.

Learning Objectives
Upon completion of this activity, the participant should be able to:

1. Select appropriate insulin therapy for patients unable to achieve adequate glycemic control on oral agent therapy
2. Explain how to advance insulin therapy if intensification is required
3. Describe strategies to address challenges patients may face with initiation or intensification of insulin therapy

CME/CE Accreditation Statements
For Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Institute for Medical and Nursing Education (IMNE) and International Medical Press (IMP). IMNE is accredited by the ACCME to provide continuing medical education for physicians.

IMNE designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

For Nurses: IMNE is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC’s) Committee on Accreditation.

IMNE designates this educational activity for 1.5 contact hours (0.15 CEUs). Accreditation by the ANCC’s Committee on Accreditation refers to recognition of educational activities and does not imply approval or endorsement of any product.

ANCC Accredited Providers have been approved by the National Certification Board for Diabetes Educators (NCBDE) as providers of continuing education (CE). Individuals seeking recertification from the NCBDE can use the CE contact hours received through participation in this activity.

Disclosures
In compliance with the ACCME and ANCC, it is the policy of IMNE and IMP to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All individuals involved in planning (eg, CME/CE provider staff, faculty, and planners) are expected to disclose any significant financial relationships with commercial interests over the past 12 months. IMNE also requires that faculty identify and reference off-label products or investigational use of pharmaceutical agents and medical devices.

In accordance with ACCME and ANCC Standards for Commercial Support, parallel documents from other accrediting bodies, and IMNE policy, identification and resolution of conflict of interest have been made in the form of external peer review of educational content. The following disclosures have been made:

Faculty Disclosures
Martin J. Abrahamson, MD
Speakers Bureau: Amylin Pharmaceuticals, Eli Lilly and Company, GlaxoSmithKline, Merck, Novo Nordisk, Inc, Novartis, Pfizer Inc, sanofi-aventis, Takeda Pharmaceutical Company Limited
Research Activities: Pfizer Inc

Dr Abrahamson discloses that he will address off-label use of drug combinations and agents that are not yet FDA-approved in this activity.

William Polonsky, PhD, CDE
Formal Advisor: Amylin Pharmaceuticals, Eli Lilly and Company, Roche Diagnostics
Research Activities: Roche Diagnostics
Consultant: Abbott Laboratories, Roche Diagnostics, sanofi-aventis
Honoraria: Roche Diagnostics

CME Provider and Educational Partner Staff Disclosures
All staff of IMNE and IMP in a position to influence content have filed statements of disclosure with the CME provider. Any conflicts of interest were identified and resolved prior to their involvement in planning this activity.

Joelle Escoffery, PhD
Scientific Director, IMP
Conflict of Interest Disclosure: None

Amy Groves
Project Services Director
Conflict of Interest Disclosure: None

Paige Shee
Program Development Manager, IMP
Conflict of Interest Disclosure: None

Marge Tamas
Senior Medical Writer, IMP
Conflict of Interest Disclosure: None

Steven Weinman
Senior Director, IMNE
Conflict of Interest Disclosure: None

Robert Hash, MD
Vice Dean for Academic Affairs
Texas A&M Health Science Center College of Medicine
Conflict of Interest Disclosure: None

Martin Quan, MD
Professor of Clinical Family Medicine
David Geffen School of Medicine at UCLA
Conflict of Interest Disclosure: None

Dianne Ryan, RN, MS
CE Reviewer
Nurse Planner
New York Presbyterian Hospital
Conflict of Interest Disclosure: None

Eric Szillus, RN, MSN, ARNP
CE Reviewer
Maimonides Medical Center
Conflict of Interest Disclosure: None

3 Online Interactive Cases

For some patients with type 2 diabetes, oral agent therapy alone may not be enough to achieve glycemic control and insulin therapy may be a consideration. This activity will help you guide your patients through a number of challenges associated with initiation and intensification of insulin therapy.

Start the Race

Hosted by the Caring For Diabetes Educational Forum