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1 PARTICIPANT INFORMATION Please print clearly; illegible forms will delay your receiving credit/verification: First Name MI Last Name Address 1 Address 2 City State ZIP Country Daytime Telephone Fax Address Physicians: Are you licensed in the US? Yes No What is your professional title? MD DO Other Specialty: CME CREDIT ATTESTATION The Center for Accredited Healthcare Education designates this educational activity for a maximum of 0.75 category 1 credit(s) toward the AMA Physician s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity. This activity has been reviewed and is acceptable for up to 0.75 Prescribed credit(s) by the American Academy of Family Physicians. I certify that I completed this CME activity. The actual amount of time I spent in this activity was: hours minutes. Signature: (without a signature, credit cannot be issued) Date Completed: CME E-newsletter Evaluation Form

2 EVALUATION OF CONTENT AND SPEAKERS Please select one statement that best reflects your reason for participating in this CME activity: I have heard or read about the topics being presented and I want to learn more I needed assistance to help put this subject matter into practice I wanted to compare my current practice with what my peers and thought leaders are doing On a scale from 1 to 5 (with 1 being low and 5 being high) please rate the following statements pertaining to this CME educational activity. Please circle your response for each item. Low Avg High Overall, how would you rate this educational activity? Please rate the content of this educational activity in its effectiveness in meeting your level of understanding. Please rate the quality of the educational process (method of presentation and information provided). Please rate the degree to which this educational activity has enhanced your professional effectiveness by improving your ability to communicate with and treat/manage patients. Please evaluate how well the following learning objectives were met: Explain the importance of regular screening and early detection of diabetic peripheral neuropathy (DPN) and the necessity for such procedures for all patients with diabetes Describe screening and diagnostic devices for DPN and diabetic neuropathic pain that can be used in clinical practice Recognize the impact of diabetic neuropathic pain on the well-being of patients with DPN Discuss details about the underlying pathophysiology of DPN Describe current therapeutic paradigms to delay the onset and progression of DPN Discuss emerging treatments and those under investigation for delaying the onset and progression of DPN Identify current therapies and therapies in development for the treatment of diabetic neuropathic pain Based on content, please rate the effectiveness of the program in meeting your expectations and objectives. Please evaluate the relevance of this information to your clinical practice. What is the likelihood that you will incorporate the information presented in this educational activity into practice? Do you believe that the overall content of this educational activity was presented objectively and free of any bias? Yes No Does the content of this educational activity adequately reflect the topic? Yes No If no, please indicate why. What did you like best about this activity? What did you like least about this activity? CME E-newsletter Evaluation Form

3 Please rate the following presentations: Diabetic Microvascular Complications and the Impact on Patients Neil H Brooks, MD, FAAFP Poor Fair Good Very Good Excellent Thoroughness of content presented Usefulness of information presented Speaker s ability to communicate effectively and hold interest Speaker s use of audiovisual aids Do you think the speaker s presentation was balanced and fair? Yes No If no, why? Pathophysiology of Diabetic Peripheral Neuropathy and the Progress of Treatment Options Lawrence A Lavery, DPM, MPH Poor Fair Good Very Good Excellent Thoroughness of content presented Usefulness of information presented Speaker s ability to communicate effectively and hold interest Speaker s use of audiovisual aids Do you think the speaker s presentation was balanced and fair? Yes No If no, why? Diabetic Neuropathic Pain and Symptomatic Treatment Martin J Abrahamson, MD Poor Fair Good Very Good Excellent Thoroughness of content presented Usefulness of information presented Speaker s ability to communicate effectively and hold interest Speaker s use of audiovisual aids Do you think the speaker s presentation was balanced and fair? Yes No If no, why? CME E-newsletter Evaluation Form

4 Which speaker stood out as most effective? _ In what way? Do you think that the speakers provided an adequate explanation of current and potential therapies and their clinical values? Yes No NA If not, why? What one question remains unanswered concerning the areas of discussion in this activity? _ How will you integrate the information presented in this educational activity into your clinical practice? How would you change this program to make it more relevant to your practice? State at least one new piece of information that you learned from this presentation. What related topics would you like to be offered as CME programs in the future? Number of years in practice: >20 How many patients per week do you see who require treatment for diabetes? >20 How do you primarily like to obtain educational information? Print materials, eg, monographs Audiotapes CD-ROM Electronically (eg, e-newsletter) Web-based National conferences Regional conferences Local conferences (eg, hospital-based) Audio-On-Demand How did you learn about this educational activity? Caring for Diabetes Website ( Direct Mail Colleague Other CME E-newsletter Evaluation Form

5 As a result of participating in this educational activity, please identify one or more concrete, measurable changes you would like to implement in your practice. This information will enable us to review specific examples of how this program may affect your practice. In an effort to assess the overall effectiveness of our CME program, we plan to survey a convenience sample of participants at 3 months and 1 year to assess the ongoing educational effectiveness of this activity. Please indicate your preferred method of contact: Telephone Regular mail Additional comments: Thank you for participating in this educational activity CME E-newsletter Evaluation Form

6 E-newsletter Post Test POST TEST 1. Which of the following diabetic microvascular complications (DMC) affects the greatest number of patients with diabetes? a. Diabetic nephropathy b. Diabetic retinopathy including diabetic macular edema c. Diabetic peripheral neuropathy (DPN) d. There is currently no agreement regarding the prevalence of each DMC 2. In April of 2005 the American Diabetes Association (ADA) published a statement that addresses DPN screening schedules for patients with type 1 and type 2 diabetes. Which of the following schedules adheres to those guidelines? a. Type 1 patients should be screened 5 years after diagnosis of diabetes, type 2 patients at the time of initial diagnosis b. Type 1 and type 2 patients should be screened 5 years after diagnosis of diabetes c. Type 1 and type 2 patients should be screened at the time of initial diagnosis of diabetes or at the onset of DPN symptoms d. Type 1 and type 2 patients should be screened at the onset of DPN symptoms 3. Which of the following symptoms can be present among patients with damage to small nerve fibers resulting from DPN? a. Weakness b. Reduced light touch sensation c. Muscle wasting d. Depressed ankle tendon reflexes 4. Which of the following devices is most effective for detecting early stages of DPN among patients that are asymptomatic? a. 5.07/10 gram Semmes-Weinstein monofilament b. 128 Hz tuning fork c. Vibration perception threshold devices d. Electromyography (EMG) 5. What percent of patients with DPN develop new foot ulcers each year? a. Less than 1% b. Approximately 2% c. Ranging from 3 to 5% d. Close to 10% E-newsletter Post Test

7 E-newsletter Post Test 6. Which of the following factors that contribute to the underlying pathophysiology of DMC are targets of potential therapeutic agents that are currently under investigation? a. Advanced glycation endproducts b. Protein kinase C (PKC) β c. Reactive oxygen species (ROS) d. Aldose reductase inhibitor 7. Among patients suffering from painful DPN, the pain is not likely to subside without treatment if it persists for more than: a. 6 months b. 3 months c. 1 month d. Less than 1 month among patients in severe stages 8. Which of the following treatment algorithms follows the recommendations from a recently published ADA statement? a. Tricyclic antidepressants antiepileptics stabilize glycemic control opioid or opioid-like drug consider pain clinic referral b. Stabilize glycemic control consider pain clinic referral tricyclic antidepressants antiepileptics opioid or opioid-like drug c. Consider pain clinic referral stabilize glycemic control tricyclic antidepressants antiepileptics opioid or opioid-like drug d. Stabilize glycemic control tricyclic antidepressants antiepileptics opioid or opioid-like drug consider pain clinic referral 9. The recently published 12-week trial in which duloxetine was used to treat patients with neuropathic pain had which of the following results: a. Duloxetine 120 mg/day and 60 mg/day groups had statistically significant improvements in painful DPN when compared to the placebo group b. Duloxetine 120 mg/day group had statistically significant improvements in painful DPN when compared to the 60 mg/day and placebo groups c. Duloxetine 60 mg/day group had greater improvements in painful DPN when compared to the placebo group than the duloxetine 120 mg/day group d. Neither of the duloxetine 120 mg/day and 60 mg/day groups improvements in painful DPN when compared to the placebo group 10. Which of the following treatment options for painful DPN have recently been shown to have the greatest efficacy? a. Morphine b. Gabapentin c. Neither morphine nor gabapentin provided significant efficacy compared to placebo d. A combination of morphine and gabapentin had significantly greater efficacy than either alone E-newsletter Post Test