Using Multiple Measures of Glycemia to Support Individualized Diabetes Management: Recommendations for Clinicians, Patients, and Payers

CME Certification — 1.0 AMA PRA Category 1 Credit(s) ™ CME ACCREDITATION NEEDS ASSESSMENT/PROGRAM OVERVIEW There is a need for greater caution in interpreting glycated hemoglobin (A1C) results, which can be inaccurate in individual patients for a wide variety of reasons beyond the patient's control. In addition, A1C alone may not reflect critical aspects of glycemia. A panel of clinical experts from Europe and North America was convened to reexamine our glucose measuring tools and determine ways in which they can better be applied toward more purposeful processes of glycemic management. Among the main issues addressed were the clinical situations in which A1C should not be used, the role of alternative biomarkers in identifying aspects of glycemic dysregulation not captured by A1C, and the value of using patients' own glucose data to consolidate therapeutic, educational, and behavior-change objectives. TARGET AUDIENCE This activity has been designed to meet the educational needs of physicians and registered nurses involved in the management of patients with diabetes. ACCREDITATION AND CREDIT DESIGNATION Physician Continuing Education This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., and The Diabetes Education Group. Postgraduate Institute for Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Postgraduate Institute for Medicine designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nursing Continuing Education This educational activity for 1 contact hour is provided by Postgraduate Institute for Medicine. Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Initial Release Date: October 15, 2012 Expiration Date: October 15, 2013 Estimated Time to Complete Activity: 1 hour Instructions for Receiving Credit There are no fees for participating and receiving CME credit for this activity. During the period October 15, 2012 through October 15, 2013, participants must read the learning objectives and faculty disclosures and study the educational activity. Postgraduate Institute for Medicine supports Green CME by offering your Request for Credit online. If you wish to receive acknowledgment for completing this activity, please complete the posttest and evaluation available online at www.cmeuniversity.com On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 9068. Upon registering and successfully completing the posttest with a score of 70% or better and the activity evaluation, your certificate will be made available immediately. Processing credit requests online will reduce the amount of paper used by nearly 100,000 sheets per year. DISCLOSURE OF UNLABELED USE/DISCLAIMER This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., The Diabetes Education Group, and Bayer HealthCare, Diabetes Care do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., The Diabetes Education Group, and Bayer HealthCare, Diabetes Care. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. DISCLOSURE OF CONFLICTS OF INTEREST Postgraduate Institute for Medicine assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by Postgraduate Institute for Medicine for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. Postgraduate Institute for Medicine is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. FACULTY DISCLOSURES Irl B. Hirsch, MD Consulting: Roche Diagnostics, Johnson & Johnson, Abbott Diabetes Care Contracted Research: sanofi-aventis, Halozyme Therapeutics Stephanie A. Amiel, BSc, MD Consulting: Roche Diagnostics, Medtronic, Janssen Pharmaceuticals Ian R. Blumer, MD Consulting: AstraZeneca, Bayer Diabetes Care, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Novo Nordisk, Medtronic, sanofi-aventis Bruce W. Bode, MD Consulting: Bayer HealthCare Pharmaceuticals Steven V. Edelman, MD Consulting: Bayer HealthCare Pharmaceuticals, LifeScan, Abbott Laboratories, DexCom, Roche Diagnostics Jane J. Seley, DNP, MPH, MSN, BC-ADM, CDE Consulting: Abbott Diabetes Care, Bayer HealthCare Pharmaceuticals Carol A. Verderese, BA No relevant financial relationships to disclose Eric S. Kilpatrick, MD

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