CME Hours / Accreditation Information

This activity is being sponsored by Boston University School of Medicine.

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

Boston University School of Medicine designates this educational activity for a maximum of 10 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Each module will require about 2 hours per week for up to 5 weeks of participation. Participation includes reading and listening to online presentations, taking part in online group discussions, reading and responding to in-depth case studies, applying knowledge and practice to patients, and completing a final self-evaluation.

Physicians can earn additional AMA PRA Category 1 Credit(s)™ in the following ways:

• Participate in a “card study”: With the guidance of the course director, participants will identify 4-6 patients meeting the criteria for intervention discussed in each educational module; specific patient information will be collected on the cards; cards will be stored within the participant’s office; at three months post-intervention, updated patient information will be reviewed, de-identified, and reported.

Boston University School of Medicine designates this educational activity for a maximum of 5 AMA PRA Category 1 Credit(s)™.

• Create a Performance Improvement component to augment any module: This component will require chart reviews of 10 randomly selected patients; the development and implementation of an action plan; and a follow-up chart review after three months.

Boston University School of Medicine designates this educational activity for a maximum of 20 AMA PRA Category 1 Credit(s)™.

Each of the above augmentations requires an additional time commitments. Contact the Boston University CME office (617) 638-4605 or www.bu.edu/cme for more information and to enroll.

Term of Approval

Date of Release: September, 2007
Expiration Date: September, 2010

Course Director

John M. Wiecha, MD, MPH,
Associate Professor
Director, Distance Education for Health
Director of Predoctoral Education
Department of Family Medicine
Boston University School of Medicine
Faculty Member has nothing to disclose with regards to commercial interests.

Course Faculty

Elliot Sternthal, MD
Division of Endocrinoloty
Boston Medical Center
Faculty Member is on the speakers’ bureaus of Eli Lilly, Amylin, Merck, Astra Zeneca, GlaxoSmithKline, Takeda, and Novartis.

Disclosure Policy

Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve apparent conflicts of interest. In addition, faculty members are asked to disclose when any discussion of unapproved use of pharmaceuticals and devices occurs.

Target Audience

Primary care physicians.

Educational Needs Addressed

Physicians in solo and small-group practices, due to financial constraints and relentless patient care demands, experience barriers to accessing professional development programs essential for maintaining high standards of clinical care and patient safety.  A high-quality, internet-based, interactive CME program may address some of the educational inadequacies, and meet the needs of solo and small-group practice clinicians in providing improved practice performance and patient care.1

Chronic illnesses are the most commonly managed condition by primary care physicians yet most physicians report that their training in chronic disease was inadequate.2  Strategies effective in changing physician behavior and improving patient outcomes include those using multiple interventions including clinical education, audit/feedback, reminder systems, enhanced role of nurses (care management), and greater coordination between primary and secondary care (consultants).3,4  These activities are included in the Chronic Disease Model.5  It recognizes that suboptimal outcomes result from: rushed practitioners not following established practice guidelines; lack of care coordination; and lack of active follow-up to ensure the best outcomes.4 

This module focuses specifically on management of diabetes.  In the United States, diabetes now affects and estimated 20.8 million people (7% of the population).6  Further, the incidence of diabetes rose 41% between 1997 and 2003.7  Unfortunately, although diabetes is recognized to be at epidemic proportions, current care is lacking.  In fact, fewer than 2% of American adults with diabetes are receiving optimal quality of care.8Among the many reasons for this may be the failure of some clinicians to respond quickly to elevations in A1C levels.6 

Current guidelines (from the American Diabetes Association and the American College of Endocrinologists/American Association of Clinical Endocrinologists, among others) recommend an A1C below 7%; however, a survey based on the National Health and Nutrition Examination Survey found that only 42% of individuals with diabetes had A1C levels that low. 6

While drug intensification appears to be a key factor to improving glycemic control, hence diabetes care, physicians need a deeper and broader knowledge of the treatment options, as well as increased skills in presenting those options to their patients.

Module Learning Objectives

At the conclusion of the seven modules of this program, participants will be able to:

• Describe how to combine oral medications rationally to bring down HbA1c.
• Determine when and how to start patients on insulin or other injectable medications.
• Determine which injectable to use, as well as dosing, monitoring, and adjustment of injectable medications, including prandial dosing of ultra short acting insulin.
• Explain which premixed formulations are most useful.
• Describe how to adjust oral medications when starting injectables.

Disclaimer

THESE MATERIALS AND ALL OTHER MATERIALS PROVIDED IN CONJUNCTION WITH CONTINUING MEDICAL EDUCATION ACTIVITIES ARE INTENDED SOLELY FOR PURPOSES OF SUPPLEMENTING CONTINUING MEDICAL EDUCATION PROGRAMS FOR QUALIFIED HEALTH CARE PROFESSIONALS. ANYONE USING THE MATERIALS ASSUMES FULL RESPONSIBILITY AND ALL RISK FOR THEIR APPROPRIATE USE. NEITHER TRUSTEES OF BOSTON UNIVERSITY NOR THE DEVELOPERS OF THE MATERIALS MAKE ANY WARRANTIES OR REPRESENTATIONS WHATSOEVER REGARDING THE ACCURACY, COMPLETENESS, CURRENTNESS, NONINFRINGEMENT, MERCHANTABILITY, OR FITNESS FOR A PARTICULAR PURPOSE OF THE MATERIALS. IN NO EVENT WILL THE TRUSTEES OF BOSTON UNIVERSITY OR THE DEVELOPERS OF THESE MATERIALS BE LIABLE TO ANYONE FOR ANY DECISION MADE OR ACTION TAKEN IN RELIANCE ON THE MATERIALS. IN NO EVENT SHOULD THE INFORMATION IN THE MATERIALS BE USED AS A SUBSTITUTE FOR PROFESSIONAL CARE.

Funding

This project was made possible through a grant from the Physicians' Foundation for Health Systems Excellence and is supported in part by unrestricted educational grants from Pfizer and GlaxoSmithKline.