Insulin Therapy: Barriers and Solutions

Martin S. Lipsky, MD,
Richard Bergenstal, MD,

Module 1: Overcoming barriers to insulin

Module 2: Effective initiation of insulin: Matching the right regimen to the right patient

Module 3: HbA1c and self-monitoring of blood glucose (SMBG): Tools to reach targets

Module 4: HbA1c still stuck at 9%: Next steps

Introduction

Although type 2 diabetes is a progressive disorder with continual loss of beta cells which ultimately will require the initiation of insulin therapy in most patients, there is both physician and patient reluctance to initiate insulin therapy. Martin Lipsky, MD, Professor of Family and Community Medicine and Dean, University of Illinois College of Medicine at Rockford and Richard Bergenstal, MD, Executive Director of the International Diabetes Center, Park Nicollett Institute and Adjunct Professor of Medicine, University of Minnesota discuss both the patient and physician barriers to what is considered the most effective means of controlling blood glucose. Dr. Lipsky poses a number of questions from the primary care perspective to Dr. Bergenstal on what insulin regimens to employ and considerations in the selection of either basal, premixed insulin, or basal/bolus.

Intended Audience

This continuing medical education program is intended for primary care physicians and other healthcare professionals who manage patients with type 2 diabetes.

Educational Objectives

After completing this activity, participants should be better able to:

Describe the patient and physician barriers to the use of insulin in the patient with type 2 diabetes
Apply effective approaches to patient selection and matching the appropriate insulin regimen
Utilize effective tools to achieve HbA_1c and blood glucose targets
Describe the relationship between HbA_1c and blood glucose levels and the clinical potential of a new blood glucose reporting approach
Appraise the approach to the patient who remains at an HbA_1c of 9 when the target is 7.

Information on CME credit

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Medical Association designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nonphysicians may receive a certificate of participation for completing this activity.

Instructions for CME credit

This online enduring material is presented as an audio webcast with attendant slide presentation. To receive credit, please view all of the presentations of this CME activity and evaluate the content presented. Complete both the pre- and post-test and activity evaluation.

The estimated time to complete this activity, including pre-test, review of the materials, and self-assessment and evaluation is 1.0 hour.

Principal Faculty

Richard M. Bergenstal, MD, Author/Presenter
Vice President, Science and Medicine
American Diabetes Association
Executive Director, International Diabetes Center
Adjunct Professor, Department of Medicine
University of Minnesota
Sr. Vice President, Park Nicollet Institute
Minneapolis, MN

Stanley H. Hsia, MD, FRCPC, FACE, Planning Committee, Content Reviewer
Program Director, Endocrinology, Metabolism & Molecular Medicine
Assistant Professor of Medicine, Division of Endocrinology and Metabolism
Charles R. Drew University of Medicine and Science
UCLA School of Medicine
Los Angeles, CA

Daniel Einhorn, MD, FACP, FACE, Planning Committee, Content Reviewer
Medical Director, Scripps Whittier Institute for Diabetes
Clinical Professor of Medicine, UCSD
President, Diabetes and Endocrine Associates
La Jolla, CA

Martin S. Lipsky, MD, Author/Presenter
Dean, University of Illinois College of Medicine at Rockford
Professor, Department of Family and Community Medicine
Rockford, IL

Col. Robert A. Vigersky, MD, Planning Committee, Content Reviewer
Director, Diabetes Institute
Walter Reed Health Care System
Clinical Associate Professor, Department of Medicine
Georgetown University School of Medicine
Washington, DC

R. Mark Evans, PhD, Planning Committee
Director, Healthcare Education Products and Standards
American Medical Association
Chicago, IL

Kristi Eidsvoog, PhD, Planning Committee
Content Manager
MedEd Architects, LLC
Chicago, IL

Patti Fitzgerald, Planning Committee
Manager, Product Development, Healthcare Education Products and Standards
American Medical Association
Chicago, IL

Disclosure Policy

In order to assure the highest quality of CME programming, and to comply with the ACCME Standards for Commercial Support, the AMA requires that all faculty and planning committee members disclose relevant financial relationships with any commercial or proprietary entity producing health care goods or services relevant to the content being presented. We therefore obtain a completed disclosure and attestation form to inform the participant of any pertinent relationships disclosed, provided here.

These materials have been peer-reviewed by the members of the CME Advisory Board and the AMA Editorial Board to ensure the continued scientific accuracy and medical relevance of information presented and its independence from commercial bias. The AMA has control over all final

Dr. Bergenstal^*: Research Grants, Eli Lilly, sanofi-aventis; Advisory Board, Novo Nordisk. *Compensation received for these activities is provided directly to the nonprofit Park Nicollet Institute for Research and Education

Dr. Einhorn: Research Grants, Aventis, Allergan, Lilly, Medtronic, Pfizer, sanofi-aventis; Consultant, Amylin, Lilly, MannKind, Medtronic, Takeda; Speaker’s Bureau, Amylin, Merck, sanofi-aventis, Takeda; Significant Shareholder, MannKind.

Dr. Hsia: Consultant, Merck.

Dr. Lipsky: Nothing relevant to disclose.

Dr. Vigersky: Research Grants, DexCom, NovoNordisk, Pfizer, Roche; Stockholder, Merck.

Dr. Eidsvoog: Nothing relevant to disclose.

Dr. Evans: Nothing relevant to disclose.

Ms. Fitzgerald: Nothing relevant to disclose.

Acknowledgement of Support

This CME publication was supported through an independent education grant from Takeda Pharmaceuticals and produced in accordance with the AMA Standards for Industry-Supported Multimedia Continuing Medical Education and Other Communications.