Action Plan for Frank
Frank is a 62-year-old patient with T2DM who works a part-time job with irregular hours. His treatment regimen includes high-dose basal insulin. He is frustrated by the discomfort associated with these U-100 glargine equivalent injections and by the need for multiple daily injections.
But even with the high dose of insulin that Frank is using (1.23 U/kg/d), he is not attaining his glycemic goal of A1C less than 7%. As a general rule of thumb, increasing insulin doses beyond 0.5 U/kg/d may be ineffective,59 but patients like Frank who are insulin resistant may achieve further improvements in glycemic control with increasing doses.74 However, increasing Frank’s insulin dose without reducing the volume of the injections will cause further discomfort and may exacerbate lack of adherence to insulin therapy.
Three different concentrated basal insulins are currently available in the United States: U-200 degludec, U-300 glargine, and U-500 regular human insulin.15 U-500 regular human insulin must be administered 2 to 3 times daily15; Frank is already having difficulty adhering to his current twice-daily injection regimen, so U-500 regular human insulin would not be the best choice for him at the current time. U-200 degludec and U-300 glargine need to be administered only once daily, and, with currently available pens, doses of up to 160 U can be given in a single injection.15 The final decision about which insulin to choose will likely depend on Frank’s insurance formulary and the out-of-pocket cost.
There are pre-assessment questions associated with the content of this program that should be accessed at www.caringfordiabetes.com/CRinsulin prior to participating in this activity.
This activity is provided by the Institute for Medical and Nursing Education, Inc.
Current type 2 diabetes mellitus (T2DM) guidelines emphasize individualizing care and prioritizing treatment regimens that minimize hypoglycemia and weight gain. Several new insulins have recently been approved, some of which are available in concentrations not previously available in the United States. Among these are next generation longer-acting (ultralong-acting) basal insulin analogues, which are associated with a lower risk of hypoglycemia than previous long- acting basal insulin analogues. With the availability of new basal insulins, there is a need to educate nurse practitioners (NPs) and physician assistants (PAs) about initiating, titrating, and individualizing insulin therapy.
This activity will review current evidence and best practices for individualizing and intensifying antihyperglycemic therapy using current basal insulin options to achieve patient-centered goals in individuals with T2DM. Additionally, participants in this activity will learn about the rationale for and role of different basal insulins for the treatment of patients with T2DM. To enhance the written information, embedded QR codes will feature video clips of patient cases and audio clips of faculty discussion, offering realistic insight regarding the personal and professional experiences of participants and expert opinions of program faculty in providing optimal diabetes care in patients with T2DM.
- Explain the role and appropriate use of next-generation longer-acting (ultralong-acting) basal insulins for addressing the underlying pathophysiology of T2DM
- Compare next-generation longer-acting (ultralong-acting) and other basal insulins regarding therapeutic characteristics, including pharmacokinetic/pharmacodynamic profiles, efficacy, safety, and dosing
- Develop patient-centered treatment regimens that include next-generation longer-acting (ultralong-acting) insulins to minimize barriers to successful use of basal insulin therapy
CME AND CE ACCREDITATION AND CREDIT DESIGNATION STATEMENTS
The Institute for Medical and Nursing Education, Inc. (IMNE), is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
IMNE designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For Physician AssistantsThe American Academy of Physician Assistants (AAPA) has determined that AMA PRA Category 1 Credit(s)™ is acceptable to meet AAPA CME requirements for PAs.
For Nurse Practitioners and Nurses
IMNE is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC’s) Commission on Accreditation.
This educational program provides 1.5 contact hours of continuing education credit.
IMNE has determined the 1.25 hours of this program will satisfy ANCC’s pharmacotherapeutics contact hour requirement for ANCC certified Clinical Nurse Specialists and Nurse Practitioners. The CEU certificate will reflect this credit.
For Certified Diabetes Educators
ANCC-accredited providers have been approved by the National Certification Board for Diabetes Educators (NCBDE) as providers of continuing education (CE). Individuals seek-ing recertification from the NCBDE can use the CE contact hours received through their participation in this activity.
METHOD OF PARTICIPATION
To receive a maximum of 1.5 AMA PRA Category 1 Credits™ or ANCC continuing nursing education credit, participants should:
- Complete the preassessment questions at www.caringfordiabetes.com/CRinsulin
- Read the entire activity
- Complete the activity posttest and evaluation at http://www.cvent.com/d/pbqrw7/7E
- A CME/CE certificate will be emailed or mailed to you upon achieving a score of 80%.
CME/CE CREDIT QUESTIONS
For questions about the content or obtaining CME/CE credit, please contact IMNE:
Steve Weinman RN, CHCP
Email: [email protected]
Activity Release Date: December 1, 2018
Expiration Date: November 30, 2019
It is the policy of IMNE to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All individuals involved in planning (eg, faculty, CME/CE provider staff, and educational partner staff) are expected to disclose any significant financial relationships with commercial interests over the past 12 months. It is also required that faculty identify and reference off-label product or investigational uses of pharmaceutical agents and medical devices.
Resolutions of conflict of interest have been made in the form of external peer review.
The following disclosures have been made:
Vanita Aroda, MD
Consultant: Novo Nordisk; Sanofi
Research Grants: AstraZeneca/Bristol-Myers Squibb; Calibra; Eisai; Janssen; Novo Nordisk; Sanofi; Theracos
Davida Kruger, MSN, APN-BC, BC-ADM
Advisory Board: Abbott; Dexcom; Eli Lilly; Intarcia; Janssen; Novo Nordisk; Sanofi
Speakers’ Bureau: Abbott; AstraZeneca; Boehringer Ingelheim; Dexcom; Eli Lilly; Insulet; Janssen; Novo Nordisk; Valeritas
Research Grants: AstraZeneca; Dexcom; Eli Lilly; The Leona M. and Harry B. Helmsley Charitable Trust; Lexicon; Novo Nordisk
All staff of IMNE in a position to influence content have filed statements of disclosure with the continuing education provider. Any conflicts of interest were identified and resolved prior to their involvement in planning this activity. These disclosures are available for review by contacting Steve Weinman at 1-609-936-7015 or [email protected].
Ms. Carbonara has nothing to disclose.
Margery Tamas, HBSE, MPH
Ms. Tamas has nothing to disclose.
Steve Weinman, RN, CHCP
Director of Accreditation
Mr. Weinman has nothing to disclose.
External CME/CE Reviewers
Martin Quan, MD
Dr. Quan has nothing to disclose.
Darilyn Paul, APRN
Ms. Paul has nothing to disclose.
This activity is designed for HCPs for educational purposes. Information and opinions offered by the faculty/presenters represent their own viewpoints. Conclusions drawn by the participants should be derived from careful consideration of all available scientific information. While IMNE makes every effort to have accurate information presented, no warranty, expressed or implied, is offered. The participant should use his/her clinical judgment, knowledge, experience, and diagnostic decision-making before applying any information, whether provided here or by others, for any professional use.
COMMERCIAL SUPPORT ACKNOWLEDGMENT
This activity is supported by an educational grant from Sanofi US.