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
Continuous glucose monitoring (CGM) is a major technological advance in diabetes management. A recently published study showed a 0.5% reduction in A1C among adults with type 1 diabetes using CGM, and this improved glycemic control was not accompanied by more frequent hypoglycemia episodes. Hypoglycemia is the major limiting factor in the intensification of diabetes control with intermittent (fingerstick) glucose monitoring, and the ability of CGM to prevent this complication of tight glucose control highlights the potential of this technology to revolutionize diabetes care.
However, clinical trials and experience indicate several practical problems faced by patients using CGM, including increased glycemic variability caused by overreacting to glucose spikes and drops. Alarms, a key benefit of CGM technology negated when they sound so frequently that patients ignore them, can be difficult to set optimally. Patients need to understand that discrepancies between sensor and fingerstick measurements are the result of physiological lag, not CGM device inaccuracy. Finally, patients using CGM must learn to avoid information overload that can trigger frustration and disengagement from self-care.
Most of these practical hurdles can be overcome with careful guidance and clinical follow-up. However, because CGM is a fairly new technology, relatively few diabetes healthcare providers are familiar with the key issues or have the experience needed to provide optimal care and guidance for the CGM patient. This activity will educate practices in the use of CGM devices, including interpretation of the data output as well as the development of patient support systems so these devices and the data they provide can be optimally utilized.
Learning Objectives
Participants will be provided with clinically relevant, evidence-based information.
Upon completion of this activity, participants should be able to:
- Describe realistic expectations for use of continuous glucose monitoring (CGM) from the perspectives of medical professionals as well as patients
- Describe physiologic lag and differences between fingerstick (blood) and sensor (interstitial) glucose measurements
- Discuss and teach the use of CGM hardware, including calibration and considerations in setting alarm thresholds
- Design patient self-care strategies for preventing hypoglycemia
- Determine need for (and recommendations for developing) a CGM program in clinical
practice
Target Audience and Prerequisites
Healthcare professionals, including clinical endocrinologists and diabetologists, who treat patients with diabetes.
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
Suzanne Ghiloni, RN, BSN, CDE
Diabetes Nurse Educator
Joslin Diabetes Center
Boston, MA
Irl B. Hirsch, MD
Professor of Medicine
University of Washington Medical Center—Roosevelt
Seattle, WA
Howard Wolpert, MD
Director, Insulin Pump & Continuous Glucose Monitoring Program
Senior Physician
Joslin Diabetes Center
Boston, MA
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.
James Neighbours, MEd
Mr. Neighbours has no relevant financial relationships.
Howard Wolpert, MD
Dr. Wolpert is a consultant for F. Hoffmann-La Roche Inc., Insulet Corporation, and Novo Nordisk Inc.
Faculty
Suzanne Ghiloni, RN, BSN, CDE
Ms. Ghiloni owns stock in Bayer Corporation, Insulet Corporation, and Medtronic, Inc., and serves on the CDE advisory board for AgaMatrix, Inc., and Can-Am Care, LLC.
Irl B. Hirsch, MD
Dr. Hirsch receives grant support from sanofi-aventis U.S. LLC, and is a consultant for F. Hoffmann-La Roche Inc., Johnson & Johnson, and Valeritas, Inc.
Howard Wolpert, MD
Also on the Planning Committee; see above.
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 15, 2009
Expiration date: August 15, 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 the Medtronic Diabetes/LifeScan Alliance.
Contact CME Provider
Joslin Diabetes Center
Professional Education
One Joslin Place
Boston, MA 02215
Contact this provider
Privacy Policy
Joslin Diabetes Center respects your privacy and is committed to protecting it as you participate in our activities and visit our Web site to use the features and services we provide. Below is the link to our privacy policies.
Provider privacy and confidentiality statement
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
complete the evaluation will receive a certificate of participation.
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