Insulin therapy addresses the core pathophysiology of T2DM by surmounting the insulin deficit that results from the loss of β-cell function, reversing glucotoxicity, and reducing blood glucose levels.1,2 Insulin therapy also suppresses hepatic glucose production and reduces plasma-free fatty acids, overcoming the effects of insulin resistance.1,4 Insulin is also a versatile therapy, since it can be used at any stage of disease progression and in any patient—regardless of their comorbidities.5 Basal insulin is recommended as the first step in insulin therapy for patients with T2DM.5,6
Basal insulins are available with intermediate, long, and very long durations of action (Table 1, Figure 1).15 The insulins U-100 degludec, U-200 degludec, and U-300 glargine all have durations of action that may exceed 36 hours.15 And, unlike some older insulins,19 these newer, longer-acting insulins need to be injected only once-daily. Furthermore, these longer-acting insulins are less likely to cause hypoglycemia than shorter-acting insulins (Table 4).46
Some patients with T2DM require high doses of insulin to attain glycemic control, which also increase the injection volume.5,74,77 Doses may exceed the amount that can be injected with U-100 insulin pens.15 Moreover, such injections become increasingly uncomfortable as the volume of injectate increases.77 Concentrated insulins reduce the volume of injectate, improving injection comfort and potentially reducing the number of injections that must be administered.77,92 U-200 degludec and U-300 glargine are newer concentrated insulins associated with higher patient preference and/or persistence with insulin therapy compared with older basal insulins.92,93
Patients encounter many barriers to the use of basal insulin therapy, including irregular schedules, variability in the peak and/or duration of action of their insulin, and out-of-pocket medication costs.17,53,72,73,83,97 HCPs are urged to share decision making with patients and adjust treatment plans so that patients can reach their clinical, psychosocial, and behavioral goals, individualized to their schedules and insurance plans.53 Current basal insulin analogues offer considerable flexibility for individualizing treatment regimens.
To complete assessment questions and earn CE/CME credit, please visit
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.