Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIaMonD) trial
with Janet B. McGill, MD, MA, FACE and Andrew J. Ahmann, MD

INTENDED AUDIENCE

Endocrinologists, Primary Care Physicians, Nurse Practitioners, Pharmacists, Certified Diabetes Educators and other Health Care Professionals interested in the management of diabetes.

STATEMENT OF NEED

Self-monitoring of blood glucose (SMBG) is a core component of a diabetic patient‘s management but only provides a measurement of blood glucose levels at a specific point in time, often missing trends, hyperglycemic or hypoglycemic excursions. HbA1c is even more limited and reports an average reading over 90 days; therefore incapable of alerting the patient of fluctuations in blood glucose at any point in time.

As Real Time (RT) Continuous Glucose Monitoring (CGM) continues to improve, treatment guidelines by leading societies have incorporated this technology to reduce glycemic excursions, episodes of dangerous hypoglycemic events, and reduce HbA1c. In 2011, The Endocrine Society recommended CGM use starting at 8 years of age for anyone with Type 1 diabetes (T1D) able to use it on a near-daily basis. More recently, the American Diabetes Association (ADA) added CGM to the 2014 Standards of Care, noting its potential benefits to lower HbA1c in adults ≥25 and preventing hypoglycemic events in all age groups. Multiple studies, however, indicate that the benefits of RT-CGM are only realized if it is used more than 70% of the time (≥5 days per week).

Other experts have focused on the use of CGM in the notification and prevention of hypoglycemic events, particularly in children, those who require supervision, and those with hypoglycemia unawareness. Despite the urgency of treating hypoglycemia, CGM is not commonly used in T1D children at this juncture. Reports show that <30% of children with T1D have an HbA1c <8%, and children experience episodes of severe hypoglycemia more frequently than adults. The ASPIRE trial of 247 patients showed that sensor augmented insulin pump therapy with a low glucose suspend significantly reduced nocturnal hypoglycemia, without increasing A1C levels for those >16 years of age.

CGM may also offer benefits for the Type 2 diabetes (T2D) adult. In addition to the potential to lower HbA1c and warn of hypoglycemic events and other glycemic excursions, the information provided can serve as an educational and motivational tool for these T2D patients by influencing their eating and exercise options.

Selection of an appropriate CGM device is important because improvements in accuracy and reliability are ongoing. RT-CGM is one cornerstone of optimal glycemic control. Each varies; relying on different sensing technology and requiring the traditional finger-stick for confirmation of alerts. The Mean Absolute Relative Difference (MARD) between sensor readings and reference glucose levels can vary by as much as 20% with worrisome discrepancies in the hypoglycemic range. But new generation devices have significantly improved MARD measurements. These devices have shorter lag times and improvements in accuracy. Many physicians are lacking the appropriate level of knowledge to employ CGM as part of their practices.

Significant improvements in accuracy of Continuous Glucose Monitoring (CGM) sensors and device algorithms have made CGM-based decisions a near-term possibility. This program will evaluate the potential clinical application and use of CGM in diabetes management decisions and the importance of various aspects of CGM to guide optimal treatment.

EDUCATIONAL OBJECTIVES

At the conclusion of this activity, participants should be better able to:

  1. Define the role of CGM in diabetes management treatment decisions for intensive insulin therapy patients
  2. Employ novel management strategies in personal and professional RT-CGM
  3. Identify patient types, via clinical case reports, that will most benefit from RT-CGM

ACCREDITATION AND CERTIFICATION

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Evolve Medical Education LLC and CogniMed Inc. Evolve Medical Education LLC is accredited by the ACCME to provide continuing medical education for physicians.

Evolve Medical Education LLC designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Statements of CME Credit will be provided by email following activity participation and upon completion and return of the Posttest and Evaluation Forms to CogniMed Inc. via submission at the end of the activity. Please allow 4 to 6 weeks for the delivery of your statement.

CPE Consultants LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE). The Universal Activity Number (UAN) for this activity is 0864-0000-16-056-H04. The activity is accredited for 1.0 contact hour (0.1 CEUs). The official release date for this activity is January 31, 2017 and the expiration date is January 31, 2018.

Statement of ACPE Credit will be provided upon completion of the requirements for this activity (completing the pretest, viewing the webcast and successfully passing the posttest) by the approved provider, CPE Consultants LLC.

Your continuing education credits will be electronically be uploaded to CPE Monitor within 48 hours. Please check your CPE Monitor account to make sure your credits were accurately reported. We encourage participants to keep a printed copy of all statements of continuing education credit.

CONTENT REVIEW STATEMENT

To resolve identified/potential conflicts of interest, the educational content was fully reviewed by a physician member of the Evolve Medical Education LLC Clinical Content Review Committee as well as a pharmacist member of CPE Consultants LLC, who have no financial relationships with commercial interests. The resulting certified activity was found to provide educational content that is current, evidence based, and commercially balanced.

DISCLOSURE STATEMENTS

It is the policy of Evolve Medical Education LLC to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All faculty participating in sponsored programs are expected to identify and reference off-label product use and disclose any significant relationships with those supporting the activity or any others whose products or services are discussed. The faculty for this activity have disclosed that there will not be discussion about the use of products for non-FDA-approved indications. In accordance with the Accreditation Council for Continuing Medical Education standards, parallel documents from other accrediting bodies, and Evolve Medical Education LLC policy, the following disclosures have been made:

Evolve Medical Education LLC Staff
Cheryl Cavanaugh has no relevant commercial interests to disclose.

It is the policy of CPE Consultants LLC that faculty and other individuals who are in the position to control the content of this activity disclose any real or apparent conflict of interests relating to the topics of this educational activity. CPE Consultants LLC has full policies in place that will identify and resolve all conflicts of interest prior to this educational activity.

CPE Consultants, LLC Staff
Anne Hermiller and John Stanovich, RPh, have nothing to disclose.

CogniMed Inc. Staff
Jeffrey Rosenberg has no relevant commercial interests to disclose.

Faculty
Andrew Ahmann, MD has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Speaker’s Bureau for: Boehringer Ingelheim; Calibra; Dynavax; Dexcom; Janssen; Merck; and Novo Nordisk. Grant/Research Support from: Dexcom; Lexicon; Metronic; NovoNordisk; and Sanofi-Aventis.

Janet McGill, MD has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant/Speaker’s Bureau for: Dexcom; Horizon CME and Novo Nordisk. Grant/Research Support from: BMS-AZ; Dexcom; Lexicon; and Novartis.

This activity is an enduring material and consists of an audio recording and slide presentation. Successful completion is achieved by listening to the audio and viewing the slide presentation, reflecting on the content's implications in your practice, and completing the assessment component.

The estimated time to complete this activity is 1.00 hour.

To receive credit for this activity, participants must complete the posttest with a passing score of 80% and then complete the evaluation.

Jointly provided by CogniMed Inc., Evolve Medical Education LLC and CPE Consultants LLC.

This activity is supported by an independent educational grant provided by Dexcom.

© 2017 CogniMed Inc. All rights reserved.

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