Diabetes: A Cardiovascular Disease Current Approaches to Treatment A Continuing Education Program

Transcription

1 Diabetes: A Cardiovascular Disease Current Approaches to Treatment A Continuing Education Program Sponsored by: Blue Cross and Blue Shield of New Mexico and New Mexico Health Care Takes On Diabetes Objectives: State expected learning content in terms of knowledge and skills and how it will help physicians in their practice. 1. Understand the impact of diabetes on cardiovascular disease. 2. Understand the role of glucose control in diabetic cardiovascular disease. 3. Understand the importance of hypertension in diabetic cardiovascular disease. 4. Understand lipid management in diabetic cardiovascular disease. Target Audience: Course Faculty: Media: Faculty Disclosure: New Mexico physicians and health care professionals who treat people with diabetes: Nurse Practitioners, Physician Assistants, and Certified Diabetes Educators Julie Broyles, MD ML Johnston, CDE Charm Lindblad, MHA Bruce A. Mann, MD, FACP Leslie Shainline, RN, MS Enduring material - CD and web site link The names listed below disclose that they have no financial arrangement related to the content of this activity. Julie Broyles, MD ML Johnston, CDE Leslie Shainline, RN, MS The names listed below disclose that they have a financial arrangement related to the content of this activity or the supports as identified. Jeremy Gleeson, MD, FACP, CDE - Financial relationship with Merck, Astra Zeneca, Novo Nordisk and Sanofi Aventis and receives honoraria Bruce A. Mann, MD, FACP - Salary support from Blue Cross and Blue Shield New Mexico, and Chair, New Mexico Health Care Takes On Diabetes Steering Committee Charm Lindblad, MHA - Salary support from New Mexico Health Care Takes On Diabetes Method of Participation: View CD. Respond to the questions provided for each segment on the answer sheet provided. Return the completed answer sheet to receive CME credit.

2 Estimated Time to Complete the Activity: Date of Release: Acknowledgment: Accreditation: One (1) hour October 1, 2007, date of expiration August 21, 2010 Provided with the support of Blue Cross and Blue Shield of New Mexico and with technical assistance from the University of New Mexico Hospital - Computer Learning Technologies This activity has been planned and implemented in accordance with the Essential Areas and Policies of the New Mexico Medical Society through the joint sponsorship of the Greater Albuquerque Medical Association and New Mexico Health Care Takes On Diabetes. The Greater Albuquerque Medical Association is accredited by the New Mexico Medical Society to provide continuing medical education for physicians. The Greater Albuquerque Medical Association designates this continuing medical education activity for a maximum of one (1) AMA PRA Category 1 Credit. Physicians should only claim credit commensurate with the extent of their participation in the activity. Other Professional Information: A certificate of CME, will be forwarded to you upon receipt of the completed answer sheet and questionnaire. Nurses may submit "educational programs and/or courses approved through GAMA or NMMS that enhance the licensee's scope of professional development as related to the licensee's activities in nursing. Licensee must provide justification, with licenses renewal, showing how the continuing education enhanced the licensee's professional development." New Mexico Health Care Takes On Diabetes will return a certificate of completion for the Diabetes: A Cardiovascular Disease - Current Approaches to Treatment CME activities; however, it is up to the individual nurse to submit the certificate to the nursing board to give credit for the completion of the CME activities. Other specialties must check their Board for credit. Copyright 2007 by New Mexico Health Care Takes On Diabetes. 2

3 Dear Viewer: The Continuing Medical Education (CME) questions/credit/response forms are on the following pages. If you are submitting for CME credit, please print pages 4-6 and fill out the contact information, mark your answers to the CME questions, and complete the evaluation of the presentation. Fax pages 5 and 6 to New Mexico Health Care Takes On Diabetes at If you are not submitting for CME credit, we ask that you complete the evaluation of the presentation (and your contact information if you so choose), and fax it to New Mexico Health Care Takes On Diabetes at To share this CD presentation with others, please make several copies of the CME response form. Each reader may then submit their CME response and evaluation separately. Thank you, New Mexico Health Care Takes On Diabetes Additional resource information about diabetes is available at 3

4 1) In the East West and OASIS studies the cardiovascular mortality of people with diabetes was: (slides 7, 8) a) Significantly greater than those with a previous MI b) Similar to those with a previous MI c) Significantly less than those with a previous MI d) The findings from the two studies were inconsistent 2) Insulin resistance is associated with: (slide 14) a) Hypertension b) Small dense LDL particles c) Dyslipidemia with elevated triglyceride and low HDL d) All of the above Part 1 3) The risk of heart disease in diabetes begins at an A1c of: (slide 21) a) >7.0 b) >6.5 c) 6.0 d) Within the normal range 4) In the Diabetes Control and Complications Trial (DCCT), a significant reduction in cardiac events: (slide 23) a) Was seen in the tight control group during the main trial b) Was seen in the follow period (EDIC) in those in the previous tightly controlled group, despite convergence in A1c levels c) Was seen only in those who maintained A1c<7 during follow-up d) Was not apparent at any point in the trial or follow-up 5) In the PROACTIVE trial comparing pioglitazone (Actos) to other glucose lowering treatments:(slide 31) a) There as a significant increase in heart failure with pioglitazone (Actos) b) There was no significant difference in the primary endpoint of all cardiovascular events c) There was a significant reduction in a pre-specified secondary endpoint which included MI and cardiac death in the pioglitazone group d) All of the above 6) In the United Kingdom Prospective Diabetes Study, a reduction of blood pressure of 10/5 mmhg: (slide 5) a) Showed greater reduction in diabetes related death when compared to a difference in A1c of 0.9% b) Showed less reduction in diabetes related death when compared to a in A1c difference of 0.9% c) Was ineffective in reducing cardiovascular events d) Was effective in reducing microvascular endpoints only Part 2 7) In the Heart Outcomes Prevention Evaluation (HOPE) Study, treatment with ramipril when compared to other blood pressure therapies: (slide 9) a) Was associated with a lower rate of cardiovascular death b) Was associated with a reduction in overt nephropathy c) Both d) Neither 8) In the VA HDL Intervention Trial (VA-HIT) using gemfibrosil: (slide 30) a) There was a decrease in all cause mortality b) A significant reduction in LDL c) Improvement in HDL and triglyceride levels d) A and C 9) The American Diabetes Association recommends statin therapy in people with diabetes: (slide 37) a) Patients with an LDL>100 mg/dl b) Patients over 40 with a total cholesterol >135 mg/dl c) All patients with type 2 diabetes d) B and C 10) Non HDL Cholesterol is: (slide 38) a) Recommended as a secondary goal when triglyceride >200 mg/dl b) Can be obtained on a non-fasting specimen c) Uses treatment goals 30 mg/dl above the corresponding LDL goal d) All of the above 4

5 Continuing Medical Education Credit Sheet Name Address City, state, zip Phone Fax Answers to Questions in Part 1: Answers to questions in Part 2: 1. (slides 7, 8) 6. (slide 5) 2. (slide 14) 7. (slide 9) 3. (slide 21) 8. (slide 30) 4. (slide 23) 9. (slide 37) 5. (slide 31) 10. (slide 38) 11. I would like to see future presentations include the following information or topics: If you are submitting for CME credit, please print pages 4-6 and fill out the contact information, mark your answers to the CME questions, and complete the evaluation of the presentation. Fax pages 5 and 6 to New Mexico Health Care Takes On Diabetes at If you are not submitting for CME credit, we ask that you complete the evaluation of the presentation (and your contact information if you so choose), and fax it to New Mexico Health Care Takes On Diabetes at To share this CD presentation with others, please make several copies of the CME response form. Each reader may then submit their CME response and evaluation separately. Thank you, New Mexico Health Care Takes On Diabetes 5

6 If you are not submitting for CME credit, we ask that you complete the evaluation of the presentation (and your contact information if you so choose), and fax it to New Mexico Health Care Takes On Diabetes at Additional resource information about diabetes is available at Evaluation Form Diabetes: A Cardiovascular Disease Current Approaches to Treatment Date completed training: Please indicate your profession: MD RN/LPN PhD/EdD MSW Counselor NP RT Pharmacist PA DDS Other (please specify): 1. Please indicate your overall satisfaction with the training Very Satisfied Not Satisfied 2. The training delivered balanced and objective, evidence based content Strongly Agree Strongly Disagree 3. Do you feel there was any commercial bias in the educational presentation of this program? No Yes. If yes, please explain: 4. Please rate the course in terms of its ability to provide you with: a) knowledge about the impact of diabetes and cardiovascular disease? b) understanding the role of glucose control in Diabetic Cardiovascular disease? c) understanding the importance of hypertension in Diabetic Cardiovascular disease? d) understanding lipid management in Diabetic Cardiovascular disease? e) practical suggestions you can apply in your practice Strongly Agree Strongly Disagree 5. How much of what you have learned here will change your practice? Very Much Very Little a) Changes that I am going to make: b) If no changes, what are the barriers to change in my practice? May we follow up with you in 3-6 months regarding changes made in your practice? Yes No If yes: Name Phone Thanks! 6

7 For any questions concerning the presentation: Diabetes: A Cardiovascular Disease Current Approaches to Treatment clind48535@aol.com Credits: Special thank to the following individuals who were instrumental in this presentation: Julie Broyles., MD Daniel Caimi, MA Jeremy Gleeson, MD, FACP, CDE ML Johnston, CDE Charm Lindblad, MHA Bruce A. Mann, MD, FACP Leslie Shainline, RN, MS Alfonso Trujillo, MBA 7