How2Torial™ Diabetes in the Elderly: Best Practices in Personalizing Multimodal Therapy
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Jointly sponsored by Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC.
This activity is supported by an educational grant from Lilly USA, LLC.
At the completion of this activity, participants should be better prepared to:
- Craft individualized glucose treatment goals based on a patient’s specific clinical profile and comorbidities
- Utilize patient education materials to ensure optimal adherence to the treatment plan and effective self-monitoring
- Monitor and adjust therapy to reach treatment goals, while avoiding adverse effects
Needs Assessment and Learner’s Gap
The prevalence of diabetes increases dramatically with age—in fact, percentages increase from 10.8% among those aged 40 to 59 years to over 23% among those aged 60 or older.1 The diagnosis and management of diabetes in the elderly pose several challenges. For example, elderly patients often present with neuropathies such as gastroparesis and neurogenic bladder rather than the thirst and polyuria normally associated with diabetes.2 Comorbidities in elderly patients, including hypertension, dyslipidemia, renovascular disease, frailty, and sarcopenia, may complicate treatment decisions.3 Additionally, age-related cognitive impairment can interfere with patient-physician communication and contribute to treatment nonadherence.4 The considerable heterogeneity in clinical presentation among elderly patients with diabetes suggests that an increased focus on individualizing treatment may be beneficial.5 However, few data exist to support clinical decision making, and current guidelines provide only limited recommendations for these patients. As a result, physician judgment assumes a greater role in managing these patients.6 Together, these factors highlight the need for practical, clinical insights to guide clinicians in the long-term management of diabetes for this important patient population. This program focuses on best practices in the early detection of diabetes in elderly patients; evaluates strategies for optimization of therapy based on patient comorbidities, disabilities, and preferences; and examines strategies for ensuring long-term treatment adherence and risk reduction.
- CDC. National diabetes fact sheet: general information and national estimates on diabetes in the United States. 2007. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed January 4, 2011.
- Meneilly GS. Diabetes. In: Evans JW, Williams TF, Beattie BL, eds. Oxford Textbook of Geriatric Medicine. 2nd ed. Oxford, England: Oxford University Press; 2000:210-217.
- Araki A, Ito H. Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int. 2009;9:105-114.
- Feil DG, Pearman A, Victor T, et al. The role of cognitive impairment and caregiver support in diabetes management of older outpatients. Int J Psychiatry Med. 2009;39:199-214.
- Bayliss EA, Edwards AE, Steiner JF, Main DS. Processes of care desired by elderly patients with multimorbidities. Fam Pract. 2008;25:287-293.
- Cornali C, Franzoni S, Di Fazio I, Trabucchi M. Implementation of guidelines for type 2 diabetes mellitus in a post-acute geriatric setting. Aging Clin Exp Res. 2009;21:338-343.
This activity is intended for primary care physicians and other healthcare professionals who treat elderly patients with diabetes.
Joel Zonszein, MD, CDE, FACE, FACP
Professor of Clinical Medicine
Albert Einstein College of Medicine
Clinical Diabetes Center
Montefiore Medical Center
Bronx, New York
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Albert Einstein College of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period of May 31, 2011, to May 30, 2012, participants must (1) read the learning objectives and disclosure statements, (2) complete the Pre-Activity Questionnaire, (3) participate in the educational activity, (4) complete the Posttest (Post-Activity Questionnaire), and (5) click on “Get Credit” to complete the Evaluation and request credit.
Conflict of Interest Statement
The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Presenters whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present.
Albert Einstein College of Medicine also requires that faculty participating in any CME activity and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.
Faculty and Planning Committee Disclosures
Zachary T. Bloomgarden, MD
AstraZeneca/Bristol-Myers Squibb (consultant); Baxter International, Inc. (stockholder); Biodel Inc. (consultant); Boehringer Ingelheim GmbH (consultant, speaker’s bureau); Caremark, L.L.C. (stockholder); Dainippon Sumitomo Pharma America, Inc (consultant); Forest Laboratories, Inc. (consultant); GlaxoSmithKline plc. (speaker’s bureau); Hoffmann-La Roche Inc. (stockholder); Medtronic, Inc. (consultant, speaker’s bureau); Merck & Co., Inc. (consultant, speaker’s bureau); Novartis Pharmaceuticals Corporation (consultant, stockholder); Novo Nordisk Inc. (speaker’s bureau); and St. Jude Medical, Inc (stockholder).
Paul Knoepflmacher, MD
Has no relevant financial relationships to disclose.
Joel Zonszein, MD, CDE, FACE, FACP
Amylin Pharmaceuticals, Inc. (speaker’s bureau); Lilly USA, LLC (speaker’s bureau); Merck & Co., Inc. (speaker’s bureau); Novo Nordisk A/S (grant, speaker’s bureau); sanofi-aventis U.S. LLC (speaker’s bureau); and Takeda Pharmaceutical Company Limited (advisory board, speaker’s bureau).
Steven Jay Feld of Albert Einstein College of Medicine, or a member of his household, owns securities in Bioheart, Inc.; Chelsea Therapeutics, Inc.; and Pharmacopeia, Inc.
Alan Morrice, PhD, of Asante Communications has no relevant financial relationships to disclose.
The opinions, ideas, recommendations, and perspectives expressed in this program and accompanying materials are those of the presenting faculty only and do not necessarily reflect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Albert Einstein College of Medicine, Montefiore Medical Center, Asante Communications, or the activity’s commercial supporters.
Copyright © 2011 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. All rights reserved. No part of this program may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.