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, which focuses on the critically ill hospitalized patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss how to formulate preoperative and postoperative intensive care unit plans. In addition, a thorough review of the evidence for intraoperative glycemic control and a discussion of how to transition patients off of an insulin drip are provided.

To provide hospitalists with up-to-date information about managing diabetes and hyperglycemia in the critically ill patient.

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 will demonstrate the ability to:

1. Evaluate the current scientific evidence regarding glycemic control in the critically ill hospitalized patient, especially in the postoperative patient.
2. Formulate a preoperative plan for patients with diabetes.
3. Appraise the evidence for intraoperative glycemic control and make recommendations for intraoperative care.
4. Formulate a postoperative intensive care unit treatment plan, including insulin drips and glucagon-like protein-1 infusion.
5. Summarize the indications and process to transition off of an insulin drip, including computation of a subcutaneous insulin regimen.

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 enduring material for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Release date: July 15, 2011. Expiration date: July 15, 2013.

Estimated time to complete activity: 2 hours

As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control the content of a CME activity sponsored by OCME. Members of the Planning Committee are required to disclose all relationships regardless of their relevance to the content of the activity. Faculty are required to disclose only those relationships that are relevant to their specific presentation. The following relationships have been reported for this activity:

Leonard Feldman, MD (Chair and Planner)
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Johns Hopkins Consultative Medicine Essentials for Hospitalists
Baltimore, Maryland

Faculty
Pedro Ramos, MD
Assistant Clinical Professor of Hospital Medicine
University of California, San Diego Medical Center
San Diego, California

Diana Childers, MD
Assistant Clinical Professor
Hospital Medicine
University of California, San Diego Medical Center
San Diego, California

Gregory A. Maynard, MD, MSc (Reviewer)
Health Sciences Professor of Medicine
Chief, Division of Hospital Medicine
University of California, San Diego
San Diego, California

Planner Disclosures
No planner has indicated that they have any financial interests or relationships with a commercial entity.

Participating Faculty Disclosures
No speaker has indicated that they have any financial interests or relationships with a commercial entity whose products or services are relevant to the content of their presentation(s).

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 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.

CONFIDENTIALITY DISCLAIMER FOR CME ACTIVITY PARTICIPANT

I certify that I am participating in this Johns Hopkins University School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am participating in this capacity, I may be exposed to "protected health information," as that term is defined and used in Johns Hopkins policies and in the federal HIPAA privacy regulations (the "Privacy Regulations"). Protected health information is information about a person’s health or treatment that identifies the person. I also understand that while I am participating in this capacity I will be treated as a temporary member of Johns Hopkins for purposes of the Privacy Regulations only.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-502-7983, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins University School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

Johns Hopkins University School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03)

HARDWARE AND SOFTWARE REQUIREMENTS

Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, sound card and speakers, Adobe Acrobat Reader.

References
Click here to download the references for this educational activity.

Instructions
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 Lilly USA, LLC, and Novo Nordisk.