Continuum Health Partners, Inc. St. Luke's Roosevelt Hospital Center
University Hospital of Columbia University College of Physicians and Surgeons

GUIDE for THE EVALUATION and MANAGEMENT of HYPERGLYCEMIA in the INPATIENT SETTING (with emphasis on subcutaneous insulin Rx)

SPONSORED BY:St. Luke's Roosevelt Hospital Center
Department of Medicine and Division of Endocrinology, Diabetes and Nutrition

WELCOME:
Dear Participant,
In 2007, 17.5 million people in the U.S. were diagnosed with diabetes and the total estimated cost was $174 billion. Hospital inpatient care was 50% of the excess medical expenditure. Hyperglycemia is associated with adverse outcomes in a wide range of hospital patients and improved glycemic control is associated with improved outcomes in several different patient populations. Hypoglycemia may also occur frequently in hospitalized patients, is associated with discomfort and may be potentially dangerous. The following course will discuss means by which inpatient management of hyperglycemia will result in safe glucose goals, use of insulin as the drug of choice, in an anticipatory, physiologic manner and other recommendations regarding treatment and discharge planning for the majority of non-critically ill inpatients with hyperglycemia. Outlines and explanations for new PRISM order sets for insulin orders are also presented. Estimated time for completion of this course is 2 hours.

OBJECTIVES:

The Objectives of this continuing medical education activity have been developed so that, after taking this course, participants will be able to:

1) Find the appropriate treatment for inpatient hyperglycemia depending on previous history of diabetes, type of diabetes present, previous blood glucose control, previous treatment, present illness and nutritional status, pre-existing conditions and/or co-morbidities present

2) Evaluate and understand different treatment options and drug classes (i.e. oral agents, subcutaneous insulin and respective doses) based on patient’s condition during hospital stay and overall patient health including concomitant medications taken

3) Determine basal and prandial insulin dosing and correction insulin scales

4) Understand the onset, peak, and effective duration for insulin preparations and assess risks for hyper and hypoglycemia depending on patient medical history and current health

5) Become familiar with the initial inpatient hyperglycemia management and the new PRISM insulin order sets

6) Develop a discharge plan that recognizes the immediate and long term needs of the patient in terms of follow-up and diabetes education and self-management

TARGET AUDIENCE:This course is intended for all providers (MD, DO, NP, PA) with prescriptive authority in the hospital setting.

ACCREDITATION STATEMENT: Beth Israel Medical Center and St. Luke's and Roosevelt Hospitals are accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION: Beth Israel Medical Center designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ESTIMATED TIME FOR COMPLETION OF THIS ACTIVITY: 2.0 hours

DATE OF RELEASE: August 1, 2008

DATE OF EXPIRATION: August 1, 2010

After completing this activity you will be required to complete an online evaluation and then be able to download a copy of your CME Certificate

COPYRIGHT: This material is protected by copyright and other intellectual property laws. It may not be copied, transmitted or published.

ORGANIZING COMMITTEE:
Chair
Jeanine Albu M.D.

Associate Professor of Clinical Medicine
Columbia University College of Physicians and Surgeons
Attending Physician, Division of Endocrinology
Associate Chief, Obesity Research Center
 St. Luke's and Roosevelt Hospital Center

Faculty
St. Luke's and Roosevelt Hospitals
Rajan Gurunathan M.D.

Senior Faculty, Division of General Medicine; Director, Hospitalist and Inpatient Services
Byrne Lee M.D.
Attending Surgeon, Division of Surgical Oncology
Danielle Witman P.A.
Senior Physician Assistant, Orthopedic Surgery
F. X. Pi-Sunyer M.D.
Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons
Chief, Obesity Research Center
Sandra Foo M.D.
Associate Clinical Attending, Division of Endocrinology, Metabolism and Nutrition
James Jones, M.D.
Attending Physician, Division of Nephrology, St. Luke's-Roosevelt Hospital Center
V. Privman M.D.
Chief, Division of Endocrinology, Department of Internal Medicine
Assistant Professor of Medicine (SUNY)

ACKNOWLEDGMENTS:

  • Division of Endocrinology, St. Luke's-Roosevelt Hospital Center, New York, NY;
  • Endocrinology PRISM Order Sets Committee: Drs. J. Albu, V. Privman, A. Busta, E. Liao, C. Boxhill, the Continuum Hospitals, New York NY ;
  • The Society of Hospital Medicine http://www.hospitalmedicine.org/2008
  • Office of Continuing Medical Education, Lois Grossman, Director

POLICY ON FACULTY AND PROVIDER DISCLOSURE: It is the policy of Beth Israel Medical Center and St. Luke's and Roosevelt Hospitals that faculty and providers disclose real or apparent conflicts of interest relating to the topics of this educational activity, and also disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentation(s). Beth Israel Medical Center and St. Luke's and Roosevelt Hospitals have established policies in place that will identify and resolve all conflicts of interest prior to this educational activity.

Course Director Jeanine Albu, MD has received honoraria and served as a researcher to Amylin Pharmaceuticals, Eli-Lilly, and Merck and has served on the advisory board for Amylin Pharmaceuticals and Eli-Lilly. Committee
Sandra Foo, MD has received honoraria from Eli Lilly
F. Xavier Pi-Sunyer, MD has received honoraria from Amylin Pharmaceuticals, Lilly, McNeil Nutritionals, NovoNordisk, Sanofi-Aventis and Weight Watchers, has received research funding from Arena, AstraZeneca, Merck, Novartis, NovoNordisk, Orexigan, Schering-Plough, Vivus and Wrigley, has served on the advisory committee for Amylin Pharmaceuticals, Lilly, McNeil Nutritionals, NovoNordisk, Sanofi-Aventis, Schering-Plough, Wrigley, and Weight Watchers, has served as an investigator to Arena, AstraZeneca, Merck, Novartis, NovoNordisk, Orexigan and Vivus, has a modest relationship with Lilly, Merck and Schering Plough and has a significant relationship with Novartis
Vladimir Privman, MD has received honoraria and served as a speaker to GlaxoSmithKline
The following have reported that they do not have any financial relationships to disclose:
Rajan Gurunathan, MD
James Jones, MD
Byrne Lee, MD
Danielle Witman, PA-C

* Indicates the intention to reference unlabeled/unapproved uses of drugs or products in his presentation.

HARDWARE AND SOFTWARE REQUIREMENTS: Internet Explorer 6x or 7x

INSTRUCTIONS:

    NOTE -- RIGHT CLICK ON SLIDE TO USE "Previous" or "Next" options.
  • Click "View Module One". The course will be viewed in a popup window. Near the end of the course you will find a Quiz. Review Each question and determine the correct answer.
  • Click "View Module Two" to complete the course. When complete, close the popup window and return to this screen.
  • Finally, click the "Register for Credit" button to evaluate the course and register for credit
  • MUST USE INTERNET EXPLORER TO VIEW THE MODULES

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