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This CME/CE activity is provided by PRIME Education, Inc. (PRIME®) and is accredited for a multi-disciplinary audience of health care practitioners. This activity is supported by contract number HHSA290201000006G from the Agency for Healthcare Research and Quality. User data collected through this activity will reside on PRIME's educational portal for use by AHRQ.

AHRQ's Comparative Effectiveness Research on Premixed Insulin Analogues for Adults with Type 2 Diabetes: Understanding and Applying the Systematic Review Findings

To Receive a Certificate for This Activity:

Course Image
  1. 1. Read the Program Overview on this page.
  2. 2. Review the Faculty Biographies, Accreditation Statements, and Disclosure tabs.
  3. 3. Access the Activity in full.
  4. 4. Complete the Post-Test & Evaluation.
  5. 5. A printable certificate will be available immediately following the activity.

Program Overview

Activity Description

Among people with type 2 diabetes who have severe pancreatic β-cell dysfunction, exogenous insulin treatment is essential for controlling glycemia and reducing risks of disease-related complications and mortality. Conventional human insulin preparations can be limited by their slow absorption and inability to adequately match the complex basal-bolus pattern of physiologic insulin activity. The development of insulin analogues, including premixed formulations that are designed to mimic physiologic insulin activity, has advanced diabetes management and afforded patients more convenient treatment options. Until recently, however, the benefits and harms of premixed insulin analogues had not been compared with outcomes of other insulin therapies and noninsulin oral antidiabetic agents. In 2008, under the auspices of the Agency for Healthcare Research and Quality (AHRQ), a systematic review on this topic was published.

This e-JMCP article is intended to familiarize health care professionals with the methods and key findings from AHRQ's comparative effectiveness research and systematic review on premixed insulin analogues. In addition, the article offers reflections on how the findings might be applied in clinical and managed care settings.

Learning Objectives

At the conclusion of this activity, the participant should be able to:

  • Compare the effectiveness, safety, and adherence outcomes of using premixed insulin analogues versus other insulin preparations for achieving optimal glycemic control in type 2 diabetes
  • Differentiate the effectiveness and safety of premixed insulin analogues across various subpopulations of patients with type 2 diabetes
  • Interpret the effectiveness and safety of premixed insulin analogues in patients receiving oral diabetes medications and with different blood glucose patterns or intensities of control
  • Apply AHRQ's systematic review findings on premixed insulin analogues to making patient-centered treatment and management decisions

Target Audience

This CME activity is designed to meet the educational needs of physicians, pharmacists, nurses, and case managers who manage patients with diabetes.

Method of Participation

To receive a certificate for this activity, you should:

  • Complete the learner assessment pretest
  • View the entire activity online
  • Complete an online evaluation & post-test
  • Print your certificate online

The estimated time to complete this activity, including review of the materials, is 2.5 hours.

Term of Approval

March 31, 2011 through March 30, 2013. Original release date: March 31, 2011

Acknowledgement of Support

There is no fee for this CME/CE activity. This activity is sponsored by PRIME Education, Inc (PRIME®) and funded under contract HHSA290201000006G from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS).

Faculty Biographies and Disclosures

Click faculty name to view full biography.

Author

Rehan Qayyum, MD, MHS
Assistant Professor of Medicine
Division of General Internal Medicine/Hospitalist Program
Johns Hopkins School of Medicine
Baltimore, MD
Lead investigator of the AHRQ's diabetes systematic review in comparative effectiveness research of premixed insulin analogues

Contributing Author

Diana I Brixner, RPh, PhD
Professor and Chair
Department of Pharmacotherapy
Executive Director Outcomes Research Center
Academy of Managed Care Pharmacy (AMCP) Board of Directors
Salt Lake City, UT

Contributing Author

Karen M Gunning, PharmD, BCPS, FCCP
Adjunct Associate Professor of Family & Preventive Medicine
University of Utah
College of Pharmacy
Department of Pharmacotherapy
Salt Lake City, UT

Contributing Author

Laurence Greene, PhD
Scientific Writer/Editor
Cleveland Clinic Florida

Planner

Heidi Wynn Maloni, PhD, ANP-BC
National Clinical Nursing Director
Department of Neurology
Multiple Sclerosis Center of Excellence, East
Veterans Affairs Medical Center
Adjunct Faculty
Trinity Nursing Program School of Professional Studies
Trinity Washington University
Clinical Preceptor and Instructor
Advanced Practice Programs
The Catholic University of America School of Nursing
Washington, DC

Planner

Michele B Kaufman, PharmD, B Pharm, RPh
President
PRN Communications, Inc
Clinical Pharmacist
New York Downtown Hospital
New York City, NY

Peer Reviewer

Arshag D Mooradian, MD
Professor and Chairman
Department of Medicine
University of Florida College of Medicine
Jacksonville, FL

Peer Reviewer

Brian J Quilliam, PhD, RPh
Associate Professor
University of Rhode Island College of Pharmacy
Kingston, RI

Peer Reviewer

Connie A Valdez, PharmD, MSEd, BCPS
University of Colorado School of Pharmacy
Boulder, CO

Peer Reviewer

Joshua J Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor
Department of Pharmacotherapy
College of Pharmacy
Washington State University/Elder Services
Pullman, WA

 

Peer Reviewer

R Keith Campbell, RPh, FASHP, FAPhA, CDE
Distinguished Professor in Diabetes Care/Pharmacotherapy
Washington State University College of Pharmacy
Pullman, WA

Peer Reviewer

Kathleen A Jarvis, MS, RN, CCM
Clinical Educator
Alere Healthcare
Ft Lauderdale, FL

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Accreditation/Credit Designation

Physician Credit Designation Statement

A C C M E Logo

PRIME Education, Inc. (PRIME®) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

PRIME® designates this journal-based CME activity for a maximum of 2.5 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Pharmacist Accreditation StatementA C P E Logo

This curriculum has been approved for 2.5 contact hours by PRIME®. PRIME® is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Universal Activity Number for this program is 0255-0000-11-004-HO1-P. This learning activity is Knowledge-Based.

Nurse Accreditation StatementA N C C Logo

PRIME Education, Inc. (PRIME®) is an Approved Provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

PRIME® designates this activity for 2.5 contact hours.

Case Manager Accreditation Statement

The Commission for Case Manager Certification designates this educational activity for 2.0 contact hours for certified case managers.

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Faculty Disclosures

Faculty Name
Advisory Board Consultant Grants / Research Salary / Contractual Supported Promotional Education Stock / Shareholder Other Financial Support
Rehan Qayyum, MD, MHS
Author
None None None None None None None
Diana I Brixner, RPh, PhD
Contributor
none novo nordisk, novartis, abbott None None None None None
Karen M Gunning, PharmD, BCPS, FCCP
Contributor
none None None None None None None
Laurence Greene, PhD
Contributor
None None None None None None None
Heidi Wynn Maloni, PhD, ANP-BC
Planner
none None None None None None None
Michele B Kaufman, PharmD, B Pharm, RPh
Planner
None None None None None None None
Arshag D Mooradian, MD
Reviewer
none None None Washington University None None None
Brian J Quilliam, PhD, RPh
Reviewer
None None research funding to University of RI from Takeda and Ortho McNeil Janssen None None None None
Connie A Valdez, PharmD, MSEd, BCPS
Reviewer
none None None None None None None
Joshua J Neumiller, PharmD, CDE, CGP, FASCP
Reviewer
None None research funding to Washington University from Amylin, Johnson and Johnson, Merck, NovoNordisk Washington University None None None
R Keith Campbell, RPh, FASHP, FAPhA, CDE
Reviewer
None None None None Eli Lilly None None
Kathleen A Jarvis, MS, RN, CCM
Reviewer
none None None None None None None
Chris R Prostko, PhD
Scientific Program Director
NoneNoneNonePRIME®NoneNoneNone
Lynn Goldenberg, RN, BSN
Director of Accreditation & Compliance
NoneNoneNonePRIME®NoneNoneNone

Disclosure Policy

PRIME Education Inc (PRIME®) endorses the standards of the ACCME, as well as those of the AANP, ANCC and ACPE, that require everyone in a position to control the content of a CME/CE activity to disclose all financial relationships with commercial interests that are related to the content of the CME/CE activity. CME/CE activities must be balanced, independent of commercial bias and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession.

Aconflict of interest is created when individuals in a position to control the content of CME/CE have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks or other financial benefits.

PRIME willidentify, review and resolve all conflicts of interest that speakers, authors, course directors, planners, peer reviewers, or relevant staff disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Disclosure information for speakers, authors, course directors, planners, peer reviewers, and/or relevant staff are provided with this activity.

Presentations that provide information in whole or in part related to non FDA approved uses of drugs and/or devices will disclose the unlabeled indications or the investigational nature of their proposed uses to the audience. Participants should refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. Participants should verify all information and data before treating patients or employing any therapies prescribed in this educational activity. The opinions expressed in the educational activity are those of the presenting faculty and do not necessarily represent the views of PRIME®, the ACCME, AANP, ACPE, ANCC and other relevant accreditation bodies.

Content validation methods are consistently utilized by PRIME to ensure that all program content is evidence-based, fair-balanced, and developed with scientific rigor and integrity. All clinical recommendations are based on evidence accepted within the medical profession. All scientific research referred to, reported or used to support a clinical recommendation conforms to accepted standards of experimental design, data collection and analysis. In addition to review of content by course directors and expert faculty, content is also validated through independent peer reviewers selected for their expertise in the content area, as well as their experience in the intended audience. All peer reviewers, planners, course directors, faculty and relevant staff utilized by PRIME complete disclosures which are related to their role in the educational activity.

Accessibility

PRIME®is committed to providing access to our CME programs for individuals with disabilities as identified in Section 508 of the Rehabilitation Act for all web-based programs. This website is 508 compliant.

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Pretest

To access the activity, please complete this brief Pretest.

  • Returning user? Login Here!
  1. Before accessing this educational activity, were you aware of the AHRQ-supported comparative effectiveness research on premixed insulin analogues?

  2. According to the 2010 American Diabetes Association report on the diagnosis and classification of diabetes mellitus, the diagnostic cutoffs are ________ for fasting plasma glucose, _______ for postprandial plasma glucose, and ________ for hemoglobin A1c.

  3. In AHRQ's systematic review of studies comparing premixed insulin analogues versus long-acting insulin analogues, pooled analyses indicated that the premixed preparations were ____ effective for lowering fasting glucose and _____ effective for lowering hemoglobin A1c.

  4. How would you describe your current level of confidence in applying comparative effectiveness research to your practice?

  5. How valuable is comparative effectiveness research for educating patients about treatment and management options?

  6. If you had clinician/consumer guides on premixed insulin analogues, what would you most likely do?

  7. MJ, a 33-year-old woman with type 2 diabetes mellitus and a BMI of 34 has been taking metformin plus a DPP-4 inhibitor for the previous year. Her current A1C levels are >8.0%. What factors are most appropriate to consider if you were to recommend that this patient initiate insulin therapy with a premixed analogue?

Post-Test & Evaluation

You must access the activity before receiving credit!