Recommendations for the Role and Use of Insulin - POCN

Recommendations for the Role and Use of Insulin

Endocrinology | December 22, 2020

Launch Date:

December 22, 2020

Expiration Date:

December 22, 2021

primary audience:

Certified diabetes educators, Endocrinologists, Nurse practitioners, Pharmacists, Physician assistants, Primary care physicians

Relevant Terms:

Diabetes, Glp-1 ra therapy, Injectable diabetes therapy, Insulin, Insulin therapy, Multidisciplinary care, Pharmacological therapy, Shared decision-making, Therapeutic inertia, Type 1 diabetes, Type 2 diabetes

course faculty

Irl B. Hirsch, MD

Irl B. Hirsch, MD, is a Professor of Medicine and Diabetes Treatment and Teaching Chair at the University of Washington Diabetes Institute. He earned his medical degree at the University of Missouri. He completed an internal medicine residency at Mount Sinai Medical Center in Miami Beach, FL, and a metabolism and endocrinology fellowship at Washington University School of Medicine in St. Louis, MO. He is board certified in endocrinology and internal medicine.

He is the former chair of the Professional Practice Committee for the American Diabetes Association (ADA) and has served as editor-in-chief of two ADA journals, Clinical Diabetes and DOC News. He has authored over 260 papers, numerous book chapters, and six books both for patients and physicians. He is section editor for UptoDate. He received the American Diabetes Association’s Josiah K. Lilly Sr. Distinguished Service Award and was elected to a Mastership by the American College of Physicians.

Dr Hirsch’s career has focused on studying the best practices for the use of insulin therapy and innovations in technology for diabetes management. Past major clinical research trials include DCCT, ACCORD, STAR-1, the JDRF Sensor Trial, SEARCH, ORIGIN, GOLD, PERL, and WISDM. He has reported important observations with the T1D Exchange. He has a long history of interest in diabetes management in the hospital and currently is involved in the study of diabetes control in patients infected with COVID-19.

Davida F. Kruger, MSN, APN-BC, BC-ADM

Davida F. Kruger, MSN, APN-BC, BC-ADM, has been a certified nurse practitioner in diabetes at Henry Ford Health System in Detroit, MI, for more than 35 years. She earned her Master of Science in Nursing degree from Wayne State University in Detroit and her Bachelor of Science in Nursing degree from Boston College. Ms Kruger’s role includes both clinical practice and research. She is board certified in both primary care and advanced diabetes management.

Ms Kruger has been a co-investigator on numerous studies of diabetes interventions and care, including the National Institutes of Health-funded multicenter Epidemiology of Diabetes Interventions and Complications (EDIC) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials. She lectures extensively throughout the United States on maximizing outcomes in diabetes and diabetes management.

Ms Kruger is a past Chair of the American Diabetes Association (ADA) Research Foundation and has served on the ADA Research Policy Committee. She is also an ADA Past President, Health Care and Education. Ms Kruger has published more than 50 abstracts, articles, and chapters on diabetes management and authored the 2006 second edition of The Diabetes Travel Guide. She has also served as editor-in-chief of 2 ADA journals, Diabetes Spectrum and Clinical Diabetes.

Ms Kruger’s awards include the Florence Nightingale Award for Excellence in Research; ADA’s Rachmeil Levine Award for Distinguished Service, Award for Outstanding Service in Diabetes Research Funding, Wendell Mays Award, and 2017 Outstanding Educator in Diabetes Award; the 2014 Clara Ford Award for Nursing Excellence in Research and Education; the 2014 Wayne State University School of Nursing Alumna of the Year Award; and the 2017 International Diabetes Center Donnell Etzwiler Memorial Award.

Curtis L. Triplitt, PharmD, CDCES, FADCES

Curtis L. Triplitt, PharmD, CDCES, FADCES, educates and manages patients with diabetes in collaboration with an endocrinologist. He obtained his BS in pharmacy at the University of Iowa before receiving his PharmD from the University of Texas at Austin and the University of Texas Health Science Center at San Antonio. He completed an American Society of Health-System Pharmacists (ASHP)-accredited primary care pharmacy residency at the William S. Middleton Veterans Hospital in Madison, Wisconsin.  
Dr Triplitt has worked at the University of Texas Health Science Center at San Antonio for more than 22 years. In addition to patient care, he is extensively involved with diabetes and metabolism research.
Dr Triplitt recently served as the Vice-Chair of the Texas Diabetes Council, Texas Department of State Health Services for 12 years. He is Past-President of the South Texas American Diabetes Association (ADA) and Past-Chair of the ADA Diabetes Self-Management Education and Support Interest Group. Dr Triplitt is the current Editor-in-Chief of Diabetes Spectrum, an education-focused peer-reviewed journal published by the ADA.
Dr Triplitt has served as an investigator on multiple clinical trials focusing on the effects of medications on insulin sensitivity in overweight and obese subjects with hypertension and type 2 diabetes, as well as many type 2 diabetes medication trials. He has been involved in developing multiple clinical treatment algorithms for the prevention and treatment of diabetes in Texas. Dr Triplitt has published more than 50 peer-reviewed articles and 10 book chapters on diabetes. 

learning objectives
1. DEVELOP individualized plans for the timely initiation, modification, and intensification of insulin therapy for diabetes according to patient-specific factors
2. EVALUATE clinical efficacy and safety of insulin therapy for patients with diabetes
course information
Moving the Needle: Collaborative Strategies to Overcome Barriers to Insulin Initiation and Adherence
This educational activity is jointly provided by the Postgraduate Institute for Medicine and Spire Learning.
This activity is supported by an educational grant from Eli Lilly and Company.
In support of improving patient care, this activity has been planned and implemented by Postgraduate Institute for Medicine and Spire Learning. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians: Postgraduate Institute for Medicine designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Pharmacists: Postgraduate Institute for Medicine designates this continuing education activity for 0.25 contact hour(s) (0.2 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number – JA4008162-9999-20-2504-H01-P)
Nurse Practitioners/Nurses: The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours. 
Type of Activity: Internet based activity
Hardware/software requirements: Internet connectivity
There is no fee to participate in this activity. In order to receive CME/CE credit, you must complete:
• Pretest

• Activity
• Posttest
• Activity evaluation
Your certificate can be printed immediately.
The Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COIs are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
The planning staff and content managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
Irl B. Hirsch, MD
Professor of Medicine
Diabetes Treatment and Teaching Chair
University of Washington
Medical Director 
Diabetes Care Center 
University of Washington Medical Center
Seattle, WA
Disclosure Statement:
Consulting Fees: Abbott Laboratories; Bigfoot Biomedical, Inc
Contracted Research: Insulet Corp; Medtronic PLC 
Davida F. Kruger, MSN, APN-BC, BC-ADM
Certified Nurse Practitioner
Division of Endocrinology, Diabetes, and Bone Disorders
Henry Ford Health System
Detroit, MI
Disclosure Statement:
Advisory Board: Abbott Laboratories; Boehringer Ingelheim/Lilly; Dexcom, Inc; Eli Lilly and Company; Janssen Pharmaceuticals, Inc; Merck & Co, Inc; Novo Nordisk; Pendulum Therapeutics; Sanofi-Aventis
Speakers Bureau: Abbott Laboratories; AstraZeneca; Boehringer Ingelheim/Lilly; Dexcom, Inc; Eli Lilly and Company; Insulet Corp; Janssen Pharmaceuticals, Inc; Novo Nordisk; Valeritas 
Grant/Research Support: Abbott Laboratories; Dexcom, Inc; Helmsley Foundation; Lexicon Pharmaceuticals Inc; Novo Nordisk
Stock: Pendulum Therapeutics
Curtis L. Triplitt, PharmD, CDCES, FADCES
Clinical Associate Professor of Medicine
Division of Diabetes
University of Texas Health Science Center at San Antonio 
Texas Diabetes Institute
University Health System 
San Antonio, TX
Disclosure Statement:
Advisory Board: Xeris Pharmaceuticals, Inc
Speakers Bureau: AstraZeneca; Eli Lilly and Company; Janssen Pharmaceuticals, Inc; Novo Nordisk
Postgraduate Institute for Medicine
Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CHCP; Judi Smelker-Mitchek, MBA, MSN, RN; and Amanda Glazar, PhD, CHCP: No relevant financial relationships with any commercial interests.
Spire Learning
Ashton Beggs, PharmD, BCACP; Allison Goldberg, MPA; and Lisa Colombo: No relevant financial relationships with any commercial interests.
Patient Planners: No relevant financial relationships with any commercial interests.
This educational activity may contain discussion of published and/or investigational uses of therapies that are not indicated by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, participants are encouraged to consult appropriate resources for any product or device mentioned in this program.


The opinions expressed in this educational activity are those of the faculty and do not represent those of the Postgraduate Institute for Medicine (PIM) or Spire Learning. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically and draw conclusions only after careful consideration of all available scientific information. 
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Copyright © 2020 by Spire Learning, LLC, and its Licensors. All rights reserved. No part of this publication or activity may be reproduced or transmitted in any form, by any means, without prior written permission of Spire Learning, LLC. Spire Learning, LLC, and Postgraduate Institute for Medicine (PIM) will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication or activity, including any claims related to the products, drugs, or services mentioned herein.

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