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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Glucose Monitoring: Making An Impact On Diabetes Care


GOAL
To provide endocrinologists, diabetologists, and primary care physicians with up-to-date information on the management of patients with diabetes.

TARGET AUDIENCE
This activity is designed for endocrinologists, diabetologists, and primary care physicians.
No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine and the American Association of Diabetes Educators take responsibility for the content, quality, and scientific integrity of this CE activity. At the conclusion of this activity, the participant should be able to:

  • Illustrate the importance of glycemic control in diabetes care and define the goals of optimal blood glucose management.
  • Detect obstacles to achieving normoglycemia and devise strategies for overcoming these barriers.
  • Appraise the role of self-monitoring blood glucose in diabetes management and incorporate this strategy into standard patient care.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the ACCME through the joint sponsorship of the Johns Hopkins University School of Medicine and The American Association of Diabetes Educators. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical
education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: December 15, 2005. Expiration date: December 15, 2007.

The American Association of Diabetes Educators is accredited by the American Council on Pharmacy Education (ACPE) as a provider of continuing pharmacy education.  This program provides 1.5 contact hours (1.5 CEUs) of continuing education credit. ACPE Universal Program Number: 069-999-06-001-H04. Effective date: December 6, 2005, to December 6, 2007.

This continuing nursing education activity was approved by the American Association of Diabetes Educators, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.  This program, 0506-035, is approved for 3.4 contact hours.

The American Association of Diabetes Educators (AM001) is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR) from June 1, 2003, to May 31, 2006.  Registered dieticians (RD) and dietetic technicians, registered (DTR) will receive 2.0 continuing professional education units (CPEUs) for completion of this program. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Abbott Diabetes Care.

Full Disclosure Policy Affecting CE Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

Christopher D. Saudek, MD
Hugh P. McCormick Family Professor of Endocrinology and Metabolism
Director, The Johns Hopkins Diabetes Center
Program Director, General Clinical Research Center
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Saudek reports receiving grants/research support from Metrika, Inc.; and receiving honoraria from Lifescan, Inc.

PARTICIPATING FACULTY

Bruce W. Bode, MD, FACE
Diabetes Specialist
Atlanta Diabetes Associates
Atlanta, Georgia
Dr Bode reports receiving grants/research support from and serving as a consultant for Abbott Laboratories, Dexcom, Johnson & Johnson (Lifescan, Inc.), and Medtronic Diabetes; holding stock in Abbott Laboratories and Johnson & Johnson; and receiving honoraria from Abbott Laboratories and Medtronic Diabetes.

Mary G. Gabb, MS
Senior Clinical Editor
Advanced Studies in Medicine
Somerville, New Jersey
Ms Gabb reports having no financial or advisory relationships with corporate organizations related to this activity.

Annabelle Rodriquez, MD
Assistant Professor of Medicine
Division of Endocrinology
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Rodriquez reports receiving grants/research support from GlaxoSmithKline; and receiving honoraria from Aventis.

Notice: The audience is advised that articles in this CE activity contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Bode—continuous sensors.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Glucose Monitoring: Making An Impact On Diabetes Care
Christopher D. Saudek, MD

November is American Diabetes Month. Cosponsored by the American College of Cardiology and the American Diabetes Association (ADA), this initiative aims to increase public awareness of the link between diabetes and heart disease, just one of the several potentially lethal and/or permanent complications of diabetes. The timing of this "call to arms" is critical; the Centers for Disease Control and Prevention announced that the number of Americans with diabetes continues to increase, rising from 18.2 million in 2003 to 20.8 million in 2005—a 14% increase from just 2 years ago.1 In 2005 alone, 1.5 million Americans aged 20 years or older will be newly diagnosed with diabetes. Another 41 million Americans have prediabetes, a state of impaired glucose regulation that often precedes frank diabetes.1 Increasing the challenge for diabetes educators is the disproportionate increase in prevalence rates among minorities, namely African Americans and Latino Americans, in whom prevalence rate increases have approached 20% and higher since 2003.2

The diabetes epidemic, so frequently cited in the United States, is now reaching across the globe. Published estimates predict a 50% increase in diabetes prevalence worldwide from 151 million in 2000 to 220 million by 2010. Most cases are type 2 diabetes, which means they are largely preventable and potentially reversible.3,4

Diabetes, type 1 or type 2, has serious clinical, psychosocial, and financial implications. Several large international clinical trials have shown that hyperglycemia increases the risk of microvascular complications (eg, retinopathy, neuropathy, and nephropathy) and macrovascular complications (eg, heart disease and stroke). In fact, heart disease and stroke are the cause of death in an estimated 2 of 3 persons with diabetes.2 Diabetes incurs significant financial costs to the healthcare system in not only its management but also treatment of these complications. Diabetes also incurs a psychosocial cost in patients' fear of hypoglycemia and diabetic ketoacidosis, 2 potentially lethal outcomes of poorly controlled diabetes.
Good glycemic control is the cornerstone of diabetes management, and much of this control is wielded by patients. However, patients are often unaware of the extent to which they control their own disease process. With the advent and evolution of technology for self-monitoring blood glucose levels, patients have greater information and thus options and flexibility in managing their diabetes and incorporating diabetes management into their everyday lives.

This issue of Advanced Studies in Medicine reviews the importance of glucose control in diabetes management by focusing on 2 commonly used tests—glycosylated hemoglobin and self-monitoring of blood glucose levels. Annabelle Rodriguez, MD, with Mary G. Gabb, MS, presents the clinical evidence to support the importance of glycemic control and the special risk of hypoglycemia, not only because of its potential lethality and impact on neurologic function but also its effect on the patient's psyche and risk for future hypoglycemic episodes. She also discusses strategies to empower patients, thus they will embrace self-monitoring and begin to take more responsibility for their own diabetes care.

Bruce W. Bode, MD, FACE, reviews the importance of and information provided by measuring glycosylated hemoglobin (HbA1c), in addition to the latest technology for self-monitoring by patients. He also reviews the ADA recommendations for self-monitoring (type 1 and type 2 diabetes) and the relationship between self-monitoring and HbA1c testing. Importantly, he also discusses some of the obstacles to self-monitoring of blood glucose for patients and physicians.

This monograph also includes 3 case studies that illuminate some of the myriad challenges to good glycemic control for type 1 and type 2 diabetes. Diabetes management strategies are dictated by the type of diabetes; however, the success of these strategies is affected by the patient's psychosocial profile and  history and the patient's and care team's understanding of glycemic control.

The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his/her article and all its contents.


REFERENCES

1. Number of Americans with diabetes continues to increase [press release]. Atlanta, Ga: Centers for Disease Control and Prevention; October 26, 2005. Available at: www.cdc.gov/od/oc/media/pressrel/fs051026.htm. Accessed November 4, 2005.
2. Rising diabetes rates prompt renewed emphasis on prevention of related heart disease and stroke [press release]. Alexandria, Va: American Diabetes Association;
November 8, 2005. Available at: www.diabetes.org/uedocuments/DiabetesMonthRelease2005.pdf. Accessed November 8, 2005.
3. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-1053.
4. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782-787.


*Hugh P. McCormick Family Professor of Endocrinology and Metabolism, Director, The Johns Hopkins Diabetes Center, Program Director, General Clinical Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Christopher D. Saudek, MD, Hugh P. McCormick Family Professor of Endocrinology and Metabolism, Director, The Johns Hopkins Diabetes Center, Program Director, General Clinical Research Center, Johns Hopkins University School of Medicine, Osler 576-Endocrinology, 600 North Wolfe Street, Baltimore, MD 21287. E-mail:
csaudek@jhu.edu.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.