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The Management of Diabetic Neuropathy and Glycemic Control in Long-Term Care Facilities (Part I of III)

ISSN: 1524-7929 VOLUME: 17 PUBLICATION DATE: Jan 01 2009

Sidebars_in_article:

Issue Number:

1 Jan 09 Supplement

author:

Richard Bedlack, MD, PhD Activity Medical Director Associate Professor of Neurology Duke University School of Medicine Durham, NC

Click here for Part II of III

Release date: January 15, 2009
Expiration date: January 14, 2011
Estimated time to complete: 1.75 hours

The Management of Diabetic Neuropathy and Glycemic Control in Long-Term Care Facilities
A Multisupported CME Monograph

Richard Bedlack, MD, PhD
Activity Medical Director
Associate Professor of Neurology
Duke University School of Medicine
Durham, NC

Stephen M. Caiola, MS
Activity Reviewer
Associate Professor and Director
Division of Pharmacy Practice and Experiential Education
University of North Carolina Eshelman School of Pharmacy
Chapel Hill, NC

_____________________________

Statement of Need

One of the most frequent microvascular complications of type 2 diabetes is diabetic neuropathy, which affects sensory, autonomic, and motor neurons of the peripheral nervous system. Diabetic neuropathy is estimated to be present in half of the people living with diabetes mellitus, can affect nearly every tissue or organ in the body, and can lead to pain, morbidity, and mortality. While the challenge of treating diabetic neuropathy may be daunting, research shows that by controlling hyperglycemia and implementing lifestyle modifications and aggressive pharmacotherapies, diabetic neuropathy may be effectively managed. Furthermore, research shows that clinicians who forge trusting relationships with patients and empower them through education and support have a better chance at producing positive outcomes.

Recent significant increases in the incidence and prevalence of diabetes make understanding the high prevalence of chronic diabetic neuropathy and its associated pain essential for clinicians. This educational activity provides clinicians with the tools and knowledge necessary to diagnose and treat diabetic neuropathy, including tools to assess disease severity, tips on diagnosis, information on patient education and empowerment, and recent clinical trial data on pharmacotherapies.

Target Audience

This activity is designed for medical directors, directors of nursing, primary care physicians, physician assistants, nurse practitioners, nurses, and pharmacists who treat diabetes and neuropathic pain in the elderly population, with a particular focus on long-term care.

Learning Objectives

Upon completion of this education-based activity, participants should be able to:

1. Describe the definition of diabetic peripheral neuropathy, and how to exclude disorders that mimic it
2. List the complications of diabetic neuropathy, and utilize a management plan for preventing its complications
3. Review the importance of tight glycemic control as it pertains to the development of diabetic neuropathy
4. Initiate pain management with efficient pharmacotherapy, and implement tight diabetes control to slow disease progress
5. Devise strategies for improving communication gaps between elderly long-term care patients with type 2 diabetes and healthcare providers

Unapproved Use Disclosure Statement

Duke School of Medicine requires CME faculty (authors) to disclose to attendees when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not U.S. Food and Drug Administration [FDA]-approved); and any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Faculty may discuss information about pharmaceutical agents that is outside of FDA-approved labeling. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information.

Disclaimer

The information provided in this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

Staff and Content Validation Reviewer Disclosure

The staff involved with this activity and any content validation reviewers of this activity have reported no relevant financial relationships with commercial interests.

Resolution of Conflicts of Interest

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support of CME, the Duke University School of Medicine implemented mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this CME activity.

Planning Committee/Faculty Disclosure

The following authors and/or planning committee members have indicated that they have no relationships with industry to disclose relative to the content of this CME activity:

Jason Jenkins
Karin Yao
Stephen M. Caiola, MS

The following authors and/or planning committee members have indicated that they have relationships with industry to disclose:

Richard Bedlack, MD, PhD, has indicated that he is a speaker for Eli Lilly and Company and Pfizer Inc., and is a principal investigator for UCB Inc.

Accreditation

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the ACCME through the joint sponsorship of the Duke University School of Medicine, the UNC Eshelman School of Pharmacy, and The Customer Link, Inc. The Duke University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

Physicians

The Duke University School of Medicine designates this educational activity for a maximum of 1.75 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity has been reviewed and is acceptable for up to 1.75 Prescribed credit(s) by the American Academy of Family Physicians (AAFP). AAFP accreditation begins 01/01/09. Term of approval is for 2 years from this date, with option for yearly renewal.

The AAFP invites comments on any activity that has been approved for AAFP CME credit. Please forward your comments on the quality of this activity to cmecomment@aafp.org.

Physician Assistants

The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for Category I credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.75 hours of Category I credit for completing this program.

Nurse Practitioners

This program is approved for 1.0 contact hour(s) of continuing education (which includes 0.2 hours of pharmacology) by the American Academy of Nurse Practitioners. Program ID 0811553.

Nurses

The Customer Link, Inc. is a provider approved by the California Board of Registered Nursing, Provider Number 15225, for 1.2 contact hours.

Pharmacists

The University of North Carolina Eshelman School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program, ACPE 046-999-08-293-H01-P, will provide 1.75 contact hours upon successful completion of this posttest.

Instructions on How to Receive CME Credit

To receive CME credit for reviewing this self-study monograph, participants must review CME information (learning objectives, disclosures, etc), review the entire self-study monograph, and complete the activity evaluation and posttest.

To complete the evaluation form and take the posttest, please visit http://www.totalmeded.com/diabeticneuropathy. Certificates will be provided via e-mail within 8 weeks after completion of the evaluation form and posttest.

Questions about the monograph, AANP or Nursing credit:

The Customer Link, Inc.
Telephone: 919-467-0006 ext. 233
E-mail: questions@totalmeded.com

Questions about AMA or AAFP-Prescribed credit:
Duke Office of Continuing Medical Education
Telephone: 919-401-1200
E-mail: cme@mc.duke.edu

Questions about ACPE credit:
UNC Eshelman School of Pharmacy
Telephone: 919-966-1128

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