The growing prevalence of diabetes has placed a heavy demand on primary care physicians (PCPs) as their role in the care and management of patients with diabetes expands. Although most diabetes management occurs in the PCP setting, studies continue to document gaps in the quality of primary care. Many patients are failing to achieve glycemic control due in part to a lack of initiation or intensification of insulin. The natural progression of diabetes mellitus requires continuing medical care, early insulin intensification, and patient education to reduce the risk of long-term complications, including microvascular and macrovascular complications. The importance of glucose monitoring and intensification of insulin has become increasingly apparent. Thus, the onus is on the PCP to initiate and intensify insulin therapy in a population that requires individualized treatment and intense management. This educational case-based activity discusses the clinical safety and efficacy of insulins, barriers to adjusting treatment, interventions to decrease clinical inertia and optimize glycemic control, and methods for individualizing treatment plans.

To provide PCPs with up-to-date information on the management of patients with type 1 and type 2 diabetes.

This activity is designed for PCPs. No prerequisites required.

After completing this activity, the participant will demonstrate the ability to:

• Analyze the clinical safety and efficacy of available insulins used to intensify treatments.
• Identify barriers to adjusting treatment when caring for patients with diabetes requiring intensification of therapy with insulin.
• Assess interventions to decrease clinical inertia and optimize glycemic control when intensifying treatment with insulin is necessary.
• Formulate individualized treatment plans for patients with diabetes requiring intensification of treatment with insulin.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The estimated time to complete this activity: 1 hour and 30 minutes.

Release date: November 30, 2010. Expiration date: November 30, 2012.

The following interactive case activity consists of 3 sections: a pre-test, an interactive case with decision points, and a CME post-test with an evaluation. All 3 sections must be completed to receive CME credit. A certificate of participation will be available online immediately following successful completion of the module.

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Course Director, Planners, and Participating Faculty reported the following:

Course Director
Todd T. Brown, MD, PhD
Assistant Professor of Medicine
Division of Endocrinology and Metabolism
The Johns Hopkins University
Baltimore, Maryland
Dr Brown reports having no relationships with commercial interests related to this activity.

Participating Faculty
Mitchell King, MD
Associate Professor, Department of Family and Community Medicine
Associate Dean for Academic Affairs University of Illinois at Chicago
College of Medicine at Rockford
Rockford, Illinois
Dr King reports having no relationships with commercial interests related to this activity.

Susan Renda, CRNP, CDE
Nurse Practitioner and Certified Diabetes Educator
Johns Hopkins Diabetes Center
Baltimore, Maryland
Ms Renda reports having no relationships with commercial interests related to this activity.

Planners
No planners have indicated that they have any financial interests or relationships with a commercial entity.

Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

No faculty member has indicated that their presentation will include information on off-label products.

The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

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