Activity 4: Challenging Cases in Effective Management of Type 2 Diabetes

Program Overview

While early on patients with type 2 diabetes may be effectively managed with a simple regimen, the progressive nature of the disease eventually mandates the use of multiple medications and, ultimately, insulin in order to maintain tight glycemic control. Determining the most appropriate approach to care for the more complicated patient can be particularly challenging for clinicians. In addition, the rising prevalence of obesity in this nation is impacting the age of onset of type 2 diabetes, with a higher percentage of younger patients now presenting with this form of diabetes. As such, type 2 diabetes needs to become a consideration in the diagnosis of adolescents with new onset diabetes. Coupled with the new recommendations regarding glucose control in hospitalized patients, the management landscape of type 2 diabetes continues to change.

In Challenging Cases in Effective Management of Type 2 Diabetes, faculty present three patient scenarios (adolescent, mid-life and elderly) likely to be seen and managed in a primary care setting. While typical, each case integrates a degree of complexity related to diagnosis, treatment or both. Join Dr. John Russell, a practicing family physician, and Dr. Serena Cardillo, an endocrinologist at the Hospital of the University of Pennsylvania, as they discuss these cases, examine important issues and guidelines related to their management, and offer family physicians insights into more challenging aspects of diabetes care.

Intended Audience

This continuing medical education program is intended for family practitioners and other healthcare professionals who manage type 2 diabetes.

Learning Objectives

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

• Select appropriate medical therapy to achieve and maintain optimal glycemic control in patients with type 2 diabetes, including insulin
• Apply evidence-based treatment recommendations for patients with type 2 diabetes
• Put evidence-based treatment recommendations into practice
• Apply appropriate strategies for maintaining optimal glycemic control
• Identify challenges and barriers to the prevention/management of type 2 diabetes and implement effective solutions

Faculty

John Russell, MD
Associate Director of Family Medicine Residency
Abington Memorial Hospital
Clinical Associate Professor of Family and Community Medicine
Temple University School of Medicine

Serena Cardillo, MD
Assistant Professor of Medicine
Division of Diabetes, Endocrinology, and Metabolism
Hospital of the University of Pennsylvania

Planning Committee

Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Serena Cardillo, MD
Assistant Professor of Medicine
Hospital of the University of Pennsylvania
Philadelphia, PA

Frances Love, MSN, RN, CDE, BC-ADM
Clinical Nurse Specialist/Diabetes Education Coordinator
PENN Rodebaugh Diabetes Center, Univ of Pennslyvania
Philadelphia, PA

John Russell, MD
Associate Director of Family Medicine Residency
Abington Memorial Hospital
Clinical Associate Professor of Family and Community Medicine
Temple University School of Medicine

CME Accreditation

This activity has been reviewed and is acceptable for up to 1.0 Prescribed credit by the American Academy of Family Physicians. AAFP accreditation begins November 1, 2009. Term of approval is for 2 years from this date with the option of yearly renewal. This Prescribed credit conforms to the AAFP criteria for evidence-based CME clinical content. It is not necessary to label credit as evidence-based CME for reporting purposes.

The EB CME credit awarded for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

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

The American Academy of Family Physicians designates this education activity for a maximum of 1 AMA PRA Category 1 credit ™.

Agenda

Introduction and Opening Remarks
Module 1: New Onset Type 2 Diabetes With a Twist
Module 2: The Rising A1C on Multiple Medications
Module 3: The Complicated Hospitalized Elderly Patient
Closing Remarks

Disclosures:

It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interests and, if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Skolnik, Cardillo, Love, and Russell have returned a disclosure form indicating that she/he have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material.

Please note that faculty is required to disclose all relevant relationships prior to the beginning of the activity.