Abstract
CME Certification — 1.0 AMA PRA Category 1 Credit(s)™
There is a need for greater caution in interpreting glycated hemoglobin (A1C) results, which can be inaccurate in individual patients for a wide variety of reasons beyond the patient's control. In addition, A1C alone may not reflect critical aspects of glycemia. A panel of clinical experts from Europe and North America was convened to reexamine our glucose measuring tools and determine ways in which they can better be applied toward more purposeful processes of glycemic management. Among the main issues addressed were the clinical situations in which A1C should not be used, the role of alternative biomarkers in identifying aspects of glycemic dysregulation not captured by A1C, and the value of using patients' own glucose data to consolidate therapeutic, educational, and behavior-change objectives.
This activity has been designed to meet the educational needs of physicians and registered nurses involved in the management of patients with diabetes.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., and The Diabetes Education Group. Postgraduate Institute for Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Postgraduate Institute for Medicine designates this journal-based CME activity 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 educational activity for 1 contact hour is provided by Postgraduate Institute for Medicine.
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Initial Release Date: October 15, 2012
Expiration Date: October 15, 2013
Estimated Time to Complete Activity: 1 hour
There are no fees for participating and receiving CME credit for this activity. During the period October 15, 2012 through October 15, 2013, participants must read the learning objectives and faculty disclosures and study the educational activity.
Postgraduate Institute for Medicine supports Green CME by offering your Request for Credit online. If you wish to receive acknowledgment for completing this activity, please complete the posttest and evaluation available online at
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., The Diabetes Education Group, and Bayer HealthCare, Diabetes Care 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 Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., The Diabetes Education Group, and Bayer HealthCare, Diabetes Care. 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 on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
Postgraduate Institute for Medicine assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by Postgraduate Institute for Medicine for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. Postgraduate Institute for Medicine 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.
Consulting: Roche Diagnostics, Johnson & Johnson, Abbott Diabetes Care
Contracted Research: sanofi-aventis, Halozyme Therapeutics
Consulting: Roche Diagnostics, Medtronic, Janssen Pharmaceuticals
Consulting: AstraZeneca, Bayer Diabetes Care, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Novo Nordisk, Medtronic, sanofi-aventis
Consulting: Bayer HealthCare Pharmaceuticals
Consulting: Bayer HealthCare Pharmaceuticals, LifeScan, Abbott Laboratories, DexCom, Roche Diagnostics
Consulting: Abbott Diabetes Care, Bayer HealthCare Pharmaceuticals
No relevant financial relationships to disclose
Consulting: Bayer HealthCare Pharmaceuticals
The following Postgraduate Institute for Medicine planners and managers—Trace Hutchison, PharmD; Samantha Mattiucci, PharmD; Jan Schultz, RN, MSN, CCMEP; Laura Excell, ND, NP, MS, MA, LPC, NCC; and Patricia Staples, MSN, NP-C, CCRN—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 staff at Mary Ann Liebert, Inc. and The Diabetes Education Group 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.
This activity is jointly sponsored/co-provided by Postgraduate Institute for Medicine, Mary Ann Liebert, Inc., and the Diabetes Education Group.
This activity is supported by an unrestricted educational grant from Bayer HealthCare, Diabetes Care.
After completing this activity, the participant should be better able to: • Recognize the potential limitations of A1C when evaluating individual patients • Identify nonglycemic factors, other than methodical inaccuracies, that can falsely raise or lower A1C levels • Enumerate current methods for measuring short-term variations in blood glucose • Utilize patients' own self-monitoring of blood glucose data as a tool for diabetes education • Provide appropriate care and counsel for patients and their families
Media: Online and Print Journal article
By the year 2030, the diabetes pandemic will likely affect more than 10% of the world's population. The personal, public health, and economic crises implicit in this trend call for decisive action. Yet, escalating dilemmas thwart full realization of current therapies. First, controversial studies, such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, have amplified calls to individualize glycated hemoglobin (A1C) targets in the absence of adequate infrastructures for supporting personalized care. Second, costlier medications and technologies addressing more nuanced aspects of metabolic dysfunction are expanding options for diabetes management amidst growing disparities between “affordable” and “best” care. Third, common clinical quandaries, such as discrepancies between A1C and self-monitoring of blood glucose data, as well as misconceptions about long-term glycemic assessment, compound entrenched cycles of inadequate self-care, delayed intervention, and suboptimal glycemic outcomes. Because individual, clinical, and public policy responses to these conflicting forces are based largely on methodologies for glucose measurement, a panel of clinical experts from Europe and North America was convened to reexamine our glucose measuring tools and determine ways in which they can be better applied toward more purposeful processes of glycemic management. Among the main issues addressed were the need for caution in interpreting A1C for individual patients, the role of alternative biomarkers in identifying aspects of glycemic dysregulation not captured by A1C, and the value of using patients' own glucose data to consolidate therapeutic, educational, and behavior-change objectives.
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