Overcoming Barriers to Insulin Initiation, Intensification, and Adjustment: A Case-based Approach to Individualizing Therapy

Overcoming barriers to insulin initiation and intensification
1 AMA PRA Category 1 Credit(s)
Launch Date:
December 18, 2014
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Primary Care Physicians, Nurse Practitioners, Physician Assistants and other health care professionals treating diabetic patients

Relevant Terms:

Diabetes, Diabetes/Endocrine Nursing, Type 2 Diabetes

Dawn Smiley-Byrd, MD

Dawn Smiley-Byrd, MD
Associate Professor of Medicine, Emory University School of Medicine
Atlanta, GA

Dr. Smiley is an Associate Professor of Medicine at Emory University School of Medicine in Atlanta, Georgia and she received her Master of Science in Clinical Research degree from the Emory Graduate School of Arts and Sciences. She currently serves as the Grady Memorial Hospital site director for the Endocrinology Fellowship program and works with fellows in the inpatient and outpatient setting. In the past 4 years, her main funding has been from the NIH-NIDDK (K08 program) that funded her research focus in the area of ketosis-prone diabetes mellitus (KPDM). Dr. Smiley's investigations aim to correlate the patient response to treatment with the mechanism(s) and markers of short- and long-term remission and to determine the optimal therapeutic approach in order to prevent future glycemic decompensation in these patients. With the data from the current NIH-K08 study and collaborations in the field of epigenetics and insulin signaling mechanisms, Dr. Smiley anticipates getting further funding to research further avenues such as 1) validating a model for remission in subjects with KPDM and a model for subsequent failure after remission, 2) exploring the mechanistic link underlying glycemic decompensation which potentially could be altered (pharmacological activation vs. deactivation of an insulin signaling pathway) to change clinical outcomes and 3) establishing formal treatment guidelines for patients with KPDM.

Dr. Smiley also serves as a co-investigator in several research protocols supported by the Emory University School of Medicine/Grady satellite General Clinical Research Center that concentrate on the management of inpatient and outpatient hyperglycemia/insulin protocols, glycemic management in the long-term care facilities, pharmacoeconomic impact of inpatient diabetes management, and the effects of free fatty acids (FFAs) on endothelial function and inflammation. In addition to these areas, Dr. Smiley has expertise in doing physiometabolic studies such as modified oral glucose tolerance tests, glucagon stimulation tests, vastus lateralis muscle biopsies and euglycemic insulin clamps.

Dr. Smiley has been productive publishing original manuscripts and text chapters, including the 2014 American Diabetes Association's Greenbook chapter on perioperative glycemic management, presenting scientific abstracts at national and international meetings, obtaining funding for clinical research studies, and teaching the housestaff and ancillary staff. In addition to her NIH-KO8 award that she was recently completed, Dr. Smiley serves as the PI for an Abbott Nutrition protocol to assess the benefit of nutritional supplements in elderly patients admitted to the hospital and she is the co-PI/site investigator for the ADA-funded study evaluating the use of dipeptidyl dipeptidase 4 inhibitors in long-term care residents with type 2 diabetes.
Dr. Smiley has served as a journal reviewer for peer-reviewed journals such as Diabetes Care, JCEM, Diabetes, Obesity and Metabolism and Journal of Hospital Medicine and a post-hoc grant reviewer for the American Diabetes Association. She served as a co-chair for one of the 2008 Endocrine Society Annual Meeting abstract sessions and she serves as a board member and elected treasurer for the Georgia AACE Chapter.

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.
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

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.
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.
Dawn Smiley-Byrd, MD Dr. Smiley has received research funding from Abbott Nutrition, Merck, and Sanofi US. She has also served on advisory boards for Jansen, Boehringer-Ingelheim, and 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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