Accreditation Statement The Joslin Diabetes Center, Boston, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Joslin Diabetes Center designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits.™ Physicians should only claim credit commensurate with the extent of their participation in the activity. This CME activity was planned and produced in accordance with ACCME Essentials. Participants not eligible for continuing medical education credit will receive a certificate of participation. Sponsorship Statement Joslin Diabetes Center is the world’s preeminent diabetes clinic, diabetes research center, and provider of diabetes education. Joslin is dedicated to ensuring people with diabetes live long, healthy lives and offers real hope and progress toward diabetes prevention and a cure for the disease. Founded in 1898 by Elliott P. Joslin, MD, Joslin is an independent nonprofit institution affiliated with Harvard Medical School. For more information about Joslin, call 1-800-JOSLIN-1 or visit www.joslin.org. In 2006, Joslin was re-accredited by the Accreditation Council for Continuing Medical Education (ACCME) and received “Accreditation with Commendation” status, the highest rating achievable by a provider of CME. Program Overview/Statement of Need Clinical treatment guidelines have been developed by ADA, AACE, and Joslin Diabetes Center to provide common templates for patient care decisions upon which specialists and primary care providers can build individualized treatment for their patients. Because recent evidence suggests a gap in the knowledge and skill levels of many primary care providers in achieving the treatment goals for their patients, it is unclear whether these guidelines truly promote knowledge flow toward the primary care physician. This activity examines the role of clinical guidelines as a common template for clinical decision-making and treatment processes for people with type 2 diabetes. Faculty summarize the components of the major type 2 diabetes treatment guidelines (ADA, AACE, Joslin) and the evidence in support of key recommendations, then gauge attitudes toward these guidelines for the treatment of type 2 diabetes, how they influence treatment decisions, and how guidelines are perceived as playing a role in ongoing patient care interactions between primary care practices and regional specialists. The successful achievement of treatment goals for people with diabetes is a complex issue requiring multiple steps along the pathway from research to clinical care to patient outcomes. While it is important to recognize that many factors contribute to a clinical decision, the first step—the focus on the basic decision tree for clinicians—must be in place for other parts of the process to function. This activity will help participants develop a more comprehensive understanding of the evidence and rationale behind treatment algorithms for type 2 diabetes to help clinicians critically examine their own process for making therapeutic choices, and to determine which decision trees are useful to them in the care of their own patients as well as in their interactions with primary care physicians. Learning Objectives Upon completion of this activity, participants will be able to: • Describe evidence supporting recommendations in major type 2 diabetes treatment algorithms for goals and methods of therapy • Describe differences in algorithms and how each algorithm may impact treatment decisions in similar or different ways • Apply nationally recognized treatment guidelines to clinical practice to close gaps in specialty care for people with type 2 diabetes • Utilize preferred clinical guidelines to optimize care and communication through ongoing interprofessional interactions between primary care physicians and specialists Target Audience and Prerequisites Diabetologists, endocrinologists, and internists with a clinical focus on the treatment of diabetes, and primary care providers caring for people with diabetes within their practice. Planning Committee Richard S. Beaser, MD Associate Clinical Professor of Medicine Harvard Medical School Medical Executive Director, Professional Education Joslin Diabetes Center Boston, MA Julie A. Brown Director Professional Education Joslin Diabetes Center Boston, MA James Neighbours, MEd Assistant Director Education Technology Services Professional Education Joslin Diabetes Center Boston, MA List of Faculty with Their Affiliations Om P. Ganda, MD Associate Clinical Professor of Medicine Harvard Medical School Director, Lipid Clinic Joslin Diabetes Center Boston, MA Paul S. Jellinger, MD, MACE Professor of Medicine, Voluntary Faculty University of Miami Miami, FL Past President, American College of Endocrinology American Association of Clinical Endocrinologists (AACE) Bernard Zinman, MD, MDCM, FACP, FRCP Professor of Medicine University of Toronto Director, Leadership Sinai Centre for Diabetes Mount Sinai Hospital Toronto, Ontario Disclosure Policy Statement As part of its accreditation with the Accreditation Council for Continuing Medical Education, Joslin Diabetes Center, Boston, must disclose to the audience of a Joslin continuing medical education activity the existence of any relevant financial relationships between Joslin and/or its planning committee members, speakers, and their spouses/partners and commercial entities. Joslin and its planning committee members and speakers must disclose any relationships they and their spouses/partners have or have had in the prior 12 months with proprietary entities producing healthcare goods or services, with the exception of nonprofit or government organizations and non–healthcare-related companies, which are exempt. Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fees, honoraria, ownership interests (e.g., stocks, stock options, or other ownership interest, excluding diversified mutual funds) or other financial benefit in any amount. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. If a faculty or planning committee member has no information to disclose, this information will also be provided. If a faculty or planning committee member refuses to disclose, he/she will not be able to participate in the planning, management, presentation, or evaluation of any Joslin Diabetes Center CME activity. In addition, faculty have been asked to disclose when a product or device is not labeled for the use under discussion. The opinions and comments expressed in this program are those of the speakers and should not be considered the opinions or comments of the Joslin Diabetes Center. Faculty Disclosure Policy It is the policy of Joslin Diabetes Center to ensure fair balance, independence, objectivity, and scientific rigor in all activities. All faculty participating in CME activities sponsored by Joslin Diabetes Center are required to present evidence-based data, identify and reference off-label product use, and disclose all relevant financial relationships with those supporting the activity or others whose products or services are discussed. Faculty disclosure will be provided in the activity materials. Faculty Disclosures Planning Committee Richard S. Beaser, MD Dr. Beaser is on the academic advisory board for AstraZeneca/Bristol-Myers Squibb. Julie A. Brown Ms. Brown has no relevant financial relationships. Om P. Ganda, MD Dr Ganda is on the speakers bureau for Abbott Laboratories, AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals, Inc., GlaxoSmithKline, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc, and sanofi-aventis U.S. LLC; is on the speakers bureau and the advisory board for Takeda Pharmaceuticals North America, Inc.; is on the speakers bureau and receives grant/research support from Eli Lilly and Company; and is a consultant and on the speakers bureau for Daiichi Sankyo, Inc. James Neighbours, MEd Mr. Neighbours has no relevant financial relationships. Faculty Om P. Ganda, MD Also on the Planning Committee; see above. Paul S. Jellinger, MD, MACE Dr. Jellinger is on the speakers bureau for Amylin Pharmaceuticals, Inc., Eli Lilly and Company, GlaxoSmithKline, Merck & Co., Inc., Novo Nordisk Inc., and Takeda Pharmaceuticals North America, Inc. Bernard Zinman, MD, MDCM, FACP, FRCP Dr. Zinman is a consultant for Amylin Pharmaceuticals, Inc., Eli Lilly and Company, and Novartis Pharmaceuticals Corporation; is a consultant and receives grant/research support from GlaxoSmithKline; and receives grant/research support from and is a consultant and on the speakers bureau for Merck & Co., Inc., and Novo Nordisk Inc. Credit Designation Statement The Joslin Diabetes Center designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits.™ Physicians should only claim credit commensurate with the extent of their participation in the activity. Estimated Time to Complete Activity 1.5 hours Release/Expiration Dates Release date: August 19, 2009 Expiration date: August 19, 2010 Off-label/Unapproved Uses Statement and Summary It is the policy of Joslin Diabetes Center to ensure fair balance, independence, objectivity, and scientific rigor in all activities. All faculty participating in CME activities sponsored by Joslin Diabetes Center are required to present evidence-based data, identify and reference off-label product use, and disclose all relevant financial relationships with those supporting the activity or any others whose products or services are discussed. Statement of Evidence-based Content See off-label statement Commercial Support Statement This activity is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals, Inc. Contact CME Provider Joslin Diabetes Center Professional Education One Joslin Place Boston, MA 02215 Contact this Provider Posttest Questions When you have viewed all of the webcast presentations, click here to go to the Joslin Professional Education Web site and take the posttest. Before beginning the posttest, you will need to register and enter the passcode found on the Program page. Evaluation The activity evaluation will be available online after you have completed the posttest on the Joslin Professional Education Web site. Credit and Evaluation After you have successfully completed the posttest and evaluation on the Joslin Professional Education Web site, you will be able to print out your certificate immediately. How to Obtain Credit: Read the target audience, learning objectives, and faculty disclosures. Study the educational content online. Go to the Joslin Professional Education Web site at http://www.professionaled.joslin.org/CMEWeb/Posttest_Listing.aspx and select the online posttest for this activity. Before beginning the posttest, you will need to register and enter the passcode found on the Program page. Physicians who receive a grade of 70% or better on the posttest and complete the evaluation will receive immediate CME credit. All other participants who receive a grade of 70% or better on the posttest and who complete the evaluation will receive a certificate of participation. Affiliated Support Program: The Joslin Professional Education Consortium (JPEC™) JPEC (www.jpec.joslin.org) is an innovative, comprehensive Web-based resource designed to improve practice quality and efficiency. JPEC activities extend the educational experience into the patient-care setting through additional advanced educational programs; office-based treatment tools and guidelines; moderated discussion boards and a Journal Club; and an easy-to-use, structured Performance Improvement (PI) CME methodology providing a clear path toward better efficiency, improved patient care, and potentially higher reimbursement rates from public and private payors. Specifically, JPEC features include: Performance Improvement CME (PI CME) – a ready-to-use system that awards AMA PRA Category 1 Credits™ for physicians who complete the 9-step process of assessing their current practice and implementing changes (based on ready-to-use interventions provided) to improve both performance and patient outcomes Joslin Virtual Clinic – an exciting new way to bridge the gap between educational activities and clinical practice through realistic patient scenarios presented on a visit-by-visit basis to mimic clinic experience and maximize learning of practical skills Joslin Journal Club – regularly updated links to key references and important evidence-based recommendations selected by Joslin faculty Moderated Discussion Board – allows participants to explore diabetes-related topics peer-to-peer and offers creative discussion towards overcoming barriers to care, and to the adoption of performance improvement Downloadable and Ready-to-Use Staff Support Materials and Patient Management Resources – tips and tools (such as flow sheets and registries) and ready-to-use patient education materials to help you and your clinical and support staff improve efficiencies, treatment, and patient care Visit www.jpec.joslin.org to find out more.