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Program Detail

Program Title

Why, When, and How to Initiate Insulin Therapy in Elderly Patients with Type 2 Diabetes: A Case-based Approach
Release Date: November-18-06
Credit Expiration Date: February-01-08
UAN: 203-999-06-081-H01


Jerry Meece, RPh, FACA, CDM, CDE
Director of Clinical Services
Plaza Pharmacy and Wellness Center
Gainesville, Texas

Jerry Meece, RPh, FACA, CDM, CDE, is a pharmacist and Certified Diabetes Educator who is owner of Plaza Pharmacy and Wellness Center in Gainesville, Texas, one of the first freestanding pharmacies in the country to achieve Provider Education Recognition from the American Diabetes Association. Mr. Meece has spoken across this country and internationally on the subject of diabetes, disease state management and clinician/patient behavior in the healthcare setting, and has written numerous articles on diabetes care and insulin use in the patient with diabetes.

Teresa L. Pearson, MS, RN, CDE
Director, Diabetes Care
Fairview Health Services
Minneapolis, Minnesota

Teresa L. Pearson, MS, RN, CDE, received a Bachelor of Science degree from Winona State College–School of Nursing in Winona, Minnesota, a Master of Science degree from the University of Minnesota–School of Nursing in Minneapolis, and a Mini-MBA in Health Care Administration from the University of St. Thomas, also in Minneapolis. She is a Certified Diabetes Educator and a Certified Trainer in Choices and Changes from the Bayer Institute. Author or coauthor of 40 journal and newsletter articles, book chapters, and audio and video programs, Ms. Pearson has written about quality improvement intervention in diabetes care, primary care and diabetes self-management, and identifying individuals at risk for developing type 2 diabetes. Ms. Pearson is a member of the American Association of Diabetes Educators, having served as a past First Vice President. She has served the American Diabetes Association, Professional Section; the European Association for the Study of Diabetes; and the Minneapolis-St. Paul Diabetes Educators.

Theresa Plog, PharmD
Ambulatory Care Clinical Pharmacist
Shore Health System Memorial Hospital
Easton, Maryland

Theresa Martin Plog, PharmD, is a Clinical Pharmacist at Shore Health System Memorial Hospital in Easton, Maryland. She is also a Clinical Assistant Professor at the University of Maryland School of Pharmacy in Baltimore and a Guest Lecturer (endocrine, respiratory, musculoskeletal) for the Wilmington College Certified Nurse Practitioner Program in New Castle, Delaware. Dr. Plog received a Bachelor of Science degree in Pharmacy and a Doctor of Pharmacy degree from the Philadelphia College of Pharmacy and Science in Pennsylvania. She completed training in the Cardiac Anticoagulation Clinic at the Loma Linda VA Medical Center in California, and an ASHP Research and Education Foundation–Type 2 Diabetes Patient Care Traineeship Program at the Joslin Diabetes Center, and the University of Maryland in Baltimore. She has coauthored a guide for pharmacy-based diabetes screening and education programs. Dr. Plog participates in grand rounds and gives presentations to nursing and pharmacy staff as well as to diabetes support groups and senior citizen groups on diabetes medications, the role of cholesterol/blood pressure monitoring in diabetic patients, and current therapy for Alzheimer's disease, among other topics.

Credit Hours

1.75 Contact Hours


Podcast (MP3 & PDF)

Program Description

Originally presented as a live program (ACPE #203-999-06-081-L01) at Senior Care Pharmacy ‘06, ASCP’s 37th Annual Meeting and Exhibition.

Attendees who received CPE credit for attending the live program are not eligible to receive credit for this online release.


More than 20 million Americans have diabetes—a number that continues to increase in all age groups and all ethnic groups. Of these, 10 million, or 21%, of older Americans(>60 years) have diabetes. Based on death certificate data, diabetes contributed to more than 220,000 deaths in 2002. Studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported. Type 2 diabetes is the most prevalent form of the disease, accounting for more than 90% of all reported cases. Type 2 diabetes increases the risk of patients developing many serious complications, including cardiovascular disease, retinopathy, neuropathy, and nephropathy. The majority of patients with type 2 diabetes will eventually fail to adequately respond to oral drug therapy alone. Recently, the American Association of Clinical Endocrinologists reported that 2 out of 3 patients are inadequately treated to reach glycemic targets. Insulin replacement in the form of insulin analogs may be used to reduce glycemic burden and improve outcomes in patients with type 2 diabetes.

Program Developer/Facilitator


Target Audience

This educational activity is intended for pharmacists and nurses involved in the care of elderly patients at risk for the adverse effects of type 2 diabetes.

Learning Objectives

Upon completion of this educational activity, the participant should be able to:

  1. Identify elderly patients with type 2 diabetes who are not meeting established treatment goals for glycosylated hemoglobin (A1C), postprandial glucose (PPG) targets, and fasting plasma glucose (FPG) targets.
  2. Describe how to transition elderly patients with type 2 diabetes who are not meeting treatment goals to more intensive and effective therapeutic regimens to attain and maintain A1C, PPG, and FPG targets.
  3. Differentiate the benefits and risks of regular insulin mixes, premixed insulin analogs, and basal-bolus insulin treatment strategies for elderly patients.


In accordance with the guidelines set forth by the Accreditation Council for Pharmacy Education, it is the policy of the American Society of Consultant Pharmacists to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities including those which are sponsored and cosponsored. All faculty are expected to disclose any significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation. The intent of this disclosure is not to prevent a presenter with significant financial interest or other relationship from making the presentation, but rather to provide the audience with information with which they can make their own judgments. It remains for the audience to determine whether the speaker’s interest or relationships may influence the presentation with regard to exposition or conclusion. Faculty are also
expected to openly disclose any off-label, experimental, or investigational use of drugs or devices in their presentations.

Jerry Meece, RPh, FACA, CDM, CDE discloses the following. Grant/research support: Pfizer; consultant: Eli Lilly, LifeScan, Novartis, and Novo Nordisk; Stock Shareholder: Metrika; and speaker with honorarium: Eli Lilly, LifeScan, Novo Nordisk, Bayer, Sanofi-Aventis, Pfizer.

Teresa L. Pearson, MS, RN, CDE discloses the following. Consultant: LifeScan, Novo Nordisk, AmeriSource-Bergen; speaker with honorarium: LifeScan, Roche, Novo Nordisk, Bayer, Abbott, and Pfizer.

Theresa Plog, PharmD discloses the following. Speaker with honorarium: Novo Nordisk and Sepracor.

Credit Statements

Pharmacists: The American Society of Consultant Pharmacists is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is accredited for 1.75 contact hours (0.175 CEUs) of continuing education credit. Universal Program Number 203-999-06-081-H01.

Nurses: NADONA/LTC is an approved provider of continuing nursing education by Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation #1087. This program provides 1.75 contact hours by NADONA/LTC.

Participants must pass a post-test and complete a program evaluation to receive credit.

Commercial Support Statements

Supported through an educational grant from Novo Nordisk.


This program consists of a Podcast/MP3 audio file and PDF syllabus. You may play the audio on line or download the file to an MP3 audio player such as an iPod. You will also need Adobe Acrobat Reader to view and print the syllabus portion of the program. The activity will require approximately 105 minutes to complete.

  1. Click on the "Start program" icon. If you are not already logged in to the site, this will bring you to the login/registration page where you will be able to register as a new member or check existing registration information. When ready, click on the "Continue to Program" icon at the bottom of the screen.
  2. Save the PDF file to your computer or open the file using the Adobe Acrobat Reader. Print a copy of the syllabus, which includes the post-test and program evaluation. The syllabus also contains a link to the online post-test and evaluation.
  3. Download or play the audio file by clicking on the appropriate button. Instructions for utilizing this program on a portable MP3 player such as an iPod can be found on this page. Images of the slides discussed during the presentation can be found in the syllabus PDF file.
  4. After viewing the syllabus and listening to the audio, follow the link to the post-test found on page 66 of the syllabus. Succesful completion of the post-test and evaluation online will enable you to immediately print a statement of credit. Alternately, complete the post-test and evaluation found on the last two pages of the syllabus. Mail the pages according to the printed instructions. A statement of credit for satisfactory completion (70% or better) will be mailed within 4 to 6 weeks.

Certificate Fee



This activity is based on a symposium presented by Global Directions in Medicine, Inc. None of the contents may be reproduced in any form without prior written permission from the publisher. The opinions expressed in this activity are those of the speakers and do not necessarily reflect the opinions or recommendations of their affiliated institutions, the publisher, the American Society of Consultant Pharmacists, the National Association of Directors of Nursing Administration in Long-Term Care, or Novo Nordisk. Any medications or other diagnostic or treatment procedures discussed by the program speakers should not be utilized by clinicians without evaluation of their patients’ conditions and possible contraindications or risks, and without a review of any applicable manufacturer’s product information and comparison with the recommendations of other authorities.

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