Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This module will evaluate the current scientific evidence regarding glycemic control and discuss which medications are best for controlling blood glucose levels in the hospital. In addition, a thorough discussion of how to determine the appropriate insulin dose and develop an insulin regimen for hospitalized patients is provided.

To provide hospitalists with the information necessary to appropriately manage patients with diabetes and hyperglycemia in the hospital setting.

This activity is designed for hospitalists who manage the treatment of patients with diabetes and hyperglycemia. No prerequisites required.

After completing the module, the participant should be able to:

1. Analyze the current state of the scientific evidence regarding glycemic control in the critically ill hospitalized patient, including the optimal glycemic target for these patients.
2. Evaluate the current state of the scientific evidence regarding glycemic control in the noncritically ill hospitalized patient, including the optimal glycemic target for these patients.
3. Describe which medications are best for controlling blood glucose levels in the hospital.
4. Compute an appropriate dose of insulin for a given patient to manage hyperglycemia in the hospital.
5. Formulate an anticipatory, physiologic insulin regimen for a given hospital patient.
6. Judge the importance of matching nutritional insulin with the actual nutritional intake, and discuss ways of accomplishing this.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: November 15, 2009. Expiration date: November 15, 2011.

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Clinical Assistant Professor of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

Conflict of Interest: Dr Wesorick reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Off-Label Product Discussion: All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: David Wesorick, MD, Clinical Assistant Professor of Internal Medicine, University of Michigan Medical School, 1500 E Medical Drive, 3116 TC SPC 5376, Ann Arbor, MI 48103. E-mail: davidwes@umich.edu.

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.