Overcoming Barriers to Insulin Initiation in the Management of a 68-Year-Old Woman with Type 2 Diabetes In-depth Patient Case

Overcoming barriers to insulin initiation and intensification
1 AMA PRA Category 1 Credit(s)
Launch Date:
August 19, 2014
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Primary care providers and other healthcare professionals who treat adults with diabetes

Relevant Terms:

Diabetes, Endocrine Nursing, Insulin Management, Type 2 Diabetes

Dr. Christopher Newton

Christopher Newton, MD
Atlanta Diabetes Associates
Atlanta, GA

Dr. Christopher Newton is an Endocrinologist with the Atlanta Diabetes Associates in Atlanta, Georgia. He earned his undergraduate degrees from Duke University and his Master’s degree in biomedical engineering from Rensselaer Polytechnic Institute. He completed medical school at Mount Sinai School of Medicine in New York City, residency in Internal Medicine at the University of North Carolina at Chapel Hill, and fellowship in Endocrinology at the University of Texas Southwestern at Dallas. He joined the faculty at the Brody School of Medicine at East Carolina University in 2003, where he was the medical director of the inpatient diabetes management program, until he moved to Atlanta and joined the Emory University School of Medicine faculty in 2007. Dr. Newton practices general endocrinology but specializes in the management of type 1 and type 2 diabetes and empowering patients to self-manage their diabetes day to day. He has been actively involved with over 50 different research studies in the area of diabetes and its complications, has more than 20 peer-reviewed publications and has given over 100 local, national and international invited lectures. He serves as a member of the board of directors for the Diabetes Association of Atlanta, is a past-president of the Georgia Chapter of the American Association of Clinical Endocrinologists and actively serves on several of the committees for that organization nationally.

Dr. Robert Tanenberg

Robert J. Tanenberg, MD, FACP
Professor of Medicine, Division of Endocrinology Medical Director,
Diabetes and Obesity Institute, East Carolina University
Medical Director, Inpatient Diabetes Program, Vidant Medical Center
Greenville, NC

Robert J. Tanenberg, MD, FACP, is Professor of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University in Greenville, North Carolina. He serves as Medical Director of the E.C.U. Diabetes and Obesity Institute and Director of the Clinical Diabetes Fellowship. Dr. Tanenberg is also the medical director of the Inpatient Diabetes Program at Vidant Medical Center, a 900 bed teaching and tertiary referral medical center in Greenville, NC. In addition, Dr. Tanenberg directs the East Carolina University-Diabetes Research Center for Clinical Trials where has been a principal investigator for over 60 diabetes research studies. Dr. Tanenberg is board certified in internal medicine, and in endocrinology and metabolism.
After earning his medical degree from the University of Illinois, Chicago, Dr. Tanenberg completed a medicine residency at the Mayo Clinic, Rochester, Minnesota, and an endocrine fellowship at the University of Minnesota, Minneapolis. He was also fellowship trained in diabetes at the Joslin Diabetes Center, Boston, Massachusetts. He was formerly on the faculty of Georgetown University School of Medicine and Director of the Diabetes Treatment Center at Georgetown University Hospital. He was also a consultant to the NIH for the landmark Diabetes Control and Complications Trial.
With special interests including insulin therapy, Type 1 diabetes, and treatment of patients with diabetic neuropathy, severe insulin resistance, and metabolic syndrome, Dr. Tanenberg has over 100 publications including articles, book chapters and abstracts. He has been published in scientific journals including Diabetes, Metabolism, Endocrine Practice, Diabetes Care, Mayo Clinic Proceedings and the New England Journal of Medicine. He has been endocrinology editor for Hospital Physician and is an editor of the lay journal, Diabetes Health. He lectures throughout the country on the treatment of diabetes and the prevention and treatment of diabetic complications.
1. Apply strategies to individualize antihyperglycemic therapy in patients with type 2 diabetes to personalize A1C goals
2. Incorporate appropriate management strategies for timely initiation, selection, titration, and self-management of insulin in patients with type 2 diabetes
3. Discuss the advantages and disadvantages of basal-plus, basal-bolus, and pre-mixed insulin regimens for the treatment of patients with type 2 diabetes
4. Implement strategies for overcoming the barriers to insulin initiation, persistence and adherence
5. Discuss how emerging basal insulins address current unmet needs for improved PK and PD profiles

This activity has been designed to meet the educational needs of primary care clinicans, NPs, PAs and other health care professionals involved in the care of patients with diabetes.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and Horizon CME. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Postgraduate Institute for Medicine designates this enduring material 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.
This program is supported through an education grant from Sanofi US Diabetes and Lilly USA, LLC.
This activity jointly provided by Postgraduate Institute for Medicine and Horizon CME.
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  PIM 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.
Name of Faculty Reported Financial Relationship
Christopher Newton, MD Dr. Newton has no relevant financial relationships to disclose.
Robert Tanenberg, MD Dr. Tanenberg has received research grants and served on advisory boards for Sanofi US.

The planners and managers reported the following financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity:

The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CCMEP, and Jan Schultz, RN, MSN, CCMEP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The planners and managers at Horizon CME, Brian Lee, PharmD and Elizabeth Wilkerson, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. Cara Williams, PharmD reported that her husband has served on an advisory board for Sanofi U.S.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity 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 the planners. 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 and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
By reviewing the course content and successfully completing the post-test and evaluation, physicians are entitled to receive 1.0 AMA PRA category 1 credits™. Statement of credit will be available to print from your user history page.
  • Read the learning objectives and faculty disclosures.
  • Participate in the activity.
  • Complete the post-test and activity evaluation.
  • Physicians who successfully complete the post-test and evaluation will receive CME credit. You must score with a 80% or higher on the post-test to receive credit for this activity.
  • All other participants who successfully complete the post-test and evaluation will receive a certificate of participation.

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