President & CEOOfficers of the CorporationBoard of TrusteesFoundation BoardLeadership CouncilAbout Joslin ResearchAdvocacy & Gov't AffairsHistory
Newly DiagnosedManaging DiabetesChildhood DiabetesNutritionExerciseOnline Diabetes ClassesDiscussion BoardsJoslin Clinical ResearchInfo for Healthcare ProfessionalsJoslin Clinical Guidelines
Make an AppointmentmyJoslin | Patient PortalAdult ClinicYoung Adult Transition CarePediatricsEye CareWeight Management ProgramsDO ITMental Health & CounselingReferring PhysiciansBillingAfrican American ProgramsAsian ClinicLatino Diabetes InitiativeAbout Joslin ResearchVolunteer for Clinical Research StudiesInfo for Healthcare ProfessionalsClinical Guidelines
Directory of Joslin InvestigatorsDiabetes Research Center Alumni ConnectionVolunteer for Clinical Research Studies
Media RelationsNews ReleasesInside JoslinSocial Media
Affiliated CentersPharma & DeviceCorporate EducationPublicationsProfessional EducationInternationalCause MarketingHealthcare ProfessionalsCommercialization and VenturesJoslin Institute for Technology Translation (JITT)
Give NowHigh Hopes FundWays to GivePlanned GivingEventsGet InvolvedCorporate & Foundation SupportOur DonorsDevelopment Team

Outpatient Diabetes Care for Older Adults: Individualizing Strategies for Safety and Control

Activity Description

CME Release Date: 2/28/2011
CME Expiration Date: 4/3/2014

This Internet enduring material activity was developed as an original manuscript by the faculty.

The faculty reviewed and approved this activity on 4/3/13.

This activity is supported through an educational grant provided by sanofi-aventis U.S.

Topics

  1. Scope of the Problem: Diabetes in Older Adults
  2. Pathophysiology of Diabetes in Older Adults
  3. Presentation and Heterogeneity in Older Adults with Diabetes
  4. Comorbidities and Complex Interactions
  5. Hypoglycemia
  6. Glycemic Goals and Goal-Setting
  7. Monitoring Programs
  8. Pharmacotherapy
  9. Educational Strategies in Older Adults with Diabetes
  10. Practical Issues in the Care of Older Adults with Diabetes

Statement of Need

Currently, 1 in 5 people over age 65 has diabetes, and the number of people affected is projected to grow as the large "baby boom" generation grows older. Aging progressively alters all aspects of glucose metabolism, so physiologically based diabetes treatment strategies for elderly patients differ from those for younger adults. Health literacy, comorbidities, polypharmacy, higher risk for cognitive impairment and functional limitations, and financial challenges significantly affect the ability of geriatric patients to understand and follow complex treatment regimens, to benefit from diabetes education, and to successfully perform demanding diabetes self-management. Furthermore, these factors need to be reassessed regularly because new issues can arise as older patients age and their medical conditions progress.

Providing optimal care for elderly patients with diabetes therefore presents a unique and growing challenge to clinicians. Management plans must be carefully crafted by simplifying treatment regimens to fit patients' existing conditions and abilities to achieve optimal glycemic control while avoiding treatment complications. The goal of this activity is to provide clinicians with practical, flexible, and targeted strategies for effectively managing diabetes and its related conditions in this large and growing patient population.

Target Audience

This certified CME Internet enduring material activity has been developed for primary care providers, geriatricians, and both clinical and office staff in a primary care or long-term care setting who treat patients with diabetes. There is no fee to participate in this activity.

Learning Objectives

Participants will be provided with clinically relevant, evidence-based information.

Upon completion of this activity, participants should be able to:

  • Describe how the pathophysiology and presentation of type 1 and type 2 diabetes differs in older adults
  • Explain how to determine treatment goals for older people with diabetes based on an assessment of hypoglycemic risk and identification of relevant comorbidities
  • Discuss how the pharmacologic response of common diabetes treatments may differ in older patients
  • Describe adjustments in diabetes treatments that may be made in older people to reduce the risk of hypoglycemia and in that context optimize A1C, and address limitations created by comorbidities and other treatment barriers

Faculty and Disclosures

Medha Munshi, MD*
Assistant Professor of Medicine
Harvard Medical School
Director of Joslin Geriatric Diabetes Programs
Beth Israel Deaconess Medical Center
Boston, MA

Disclosure: Dr. Medha Munshi's spouse is a consultant for Celgene Corporation, Millennium Pharmaceuticals, Inc., and Novartis Pharmaceuticals Corporation.

*Also on the Planning Committee

Planning Committee:

Richard S. Beaser, MD**
Associate Clinical Professor of Medicine
Harvard Medical School
Medical Executive Director
Professional Education
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Richard S. Beaser is a consultant for CeQur Ltd.

Julie A. Brown**
Director
Professional Education
Joslin Diabetes Center
Boston, MA

Disclosure: Julie A. Brown has no relevant financial relationships.

Karen J. Kuc**
Assistant Director, Grants and Projects
Professional Education
Joslin Diabetes Center
Boston, MA

Disclosure: Karen J. Kuc has no relevant financial relationships.

James E. Neighbours, MEd**
Associate Director, Education Design
Professional Education
Joslin Diabetes Center
Boston, MA

Disclosure: James E. Neighbours has no relevant financial relationships.

Jonathan Scoble**
Grants Manager
Professional Education
Joslin Diabetes Center
Boston, MA

Disclosure: Jonathan Scoble has no relevant financial relationships.

Kenneth J. Snow, MD, MBA**
Assistant Professor of Clinical Medicine
Harvard Medical School
Senior Physician, Adult Diabetes Section
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Kenneth J. Snow has no relevant financial relationships.

**Also on the CME Advisory Committee


CME Advisory Committee

Enrique Caballero, MD
Director, Medical Affairs
Professional Education
Director, Latino Diabetes Initiative
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Enrique Caballero is a consultant and on the speakers bureau and scientific advisory board for Amylin Pharmaceuticals, Inc., AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Daiichi Sankyo, Inc., and Eli Lilly and Company.

Jerry Cavallerano, OD, PhD
Optometrist
Beetham Eye Institute
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Jerry Cavallerano has no relevant financial relationships.

A. Patrick Egan, MD
Family Practice
Internal Medicine Specialist
Dorchester House Multi-Service Center
Boston, MA

Disclosure: Dr. A. Patrick Egan has no relevant financial relationships.

Ann E. Goebel-Fabbri, PhD
Instructor in Psychiatry
Harvard Medical School
Psychologist
Behavioral and Mental Health Unit
Joslin Diabetes Center
Boston, MA

Disclosure: Anne E. Goebel-Fabbri has no relevant financial relationships.

Osama Hamdy, MD, PhD, FACE
Assistant Professor of Medicine
Harvard Medical School
Medical Director, Obesity Clinical Program
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Osama Hamdy is on the speakers bureau for Amylin Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Merck & Co., Inc., Novo Nordisk Inc., sanofi-aventis U.S., and Takeda Pharmaceuticals North America, Inc.

Robert C. Stanton, MD
Associate Professor of Medicine
Harvard Medical School
Chief of Nephrology
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Robert C. Stanton has no relevant financial relationships.

Howard A. Wolpert, MD
Assistant Professor of Medicine
Harvard Medical School
Director, Insulin Pump Program
Senior Physician
Joslin Diabetes Center
Boston, MA

Disclosure: Dr. Howard A. Wolpert is a consultant for Abbott Diabetes Care; Becton, Dickinson and Company; Insulet Corporation; and Novo Nordisk, Inc.

Accreditation and Designation of Credit

Joslin Diabetes Center, Boston, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Joslin Diabetes Center designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credits.TM Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was planned and produced in accordance with ACCME Essentials.

Participants not eligible for continuing medical education credit will receive a certificate of participation.

Computer Requirements

To participate in this activity, your computer will need the following hardware and software:

Credit Instructions

  1. Read the learning objectives, accreditation information, and faculty disclosures at the beginning of the activity.
  2. Read the text and view the slides.
  3. Complete the posttest and evaluation.
  4. Physicians who receive a grade of 70% or better on the posttest and who complete the evaluation will receive immediate CME credit.
  5. All other participants who receive a grade of 70% or better on the posttest and who complete the evaluation will receive a certificate of participation.

Questions About This Activity

For questions regarding the content of this activity, contact the accredited provider for this CME activity: cme@joslin.harvard.edu

Start Now

Page last updated: October 31, 2014