Basal Insulin in Clinical Practice—Can Virtual Patient Simulation Improve Use in T2D?

Abstract

We sought to determine if online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es) in evidence-based use of basal insulin for T2D. The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a 2-tailed paired t-test to determine P values. Significant improvements were observed after CG: Case 1 (n=417 PCPs; n=100 D/Es):Appropriate basal insulin initiation: 44% absolute improvement among PCPs (24% pre-CG vs. 68% post-CG; P<.001), 50% improvement among D/Es (30% pre-CG vs. 80% post-CG; P<.001) Order diabetes self-management education (DSME) in newly diagnosed patient: 19% absolute improvement among PCPs (50% pre-CG vs. 69% post-CG; P<.001), 14% improvement among D/Es (59% pre-CG vs. 73% post-CG; P=.017) Titration plan: 27% improvement among PCPs (28% pre-CG vs. 55% post-CG; P<.001), 26% absolute improvement among D/Es (29% pre-CG vs. 55% post-CG; P<.001). Case 2 (n= 537 PCPs, n=132 D/Es): Selection of longer-acting basal insulin in T2D patient complaining of hypoglycemia: 34% absolute improvement among PCPs (31% pre-CG vs. 65% post-CG; P<.001), 39% improvement among D/Es (39% pre-CG vs. 75% post-CG; P<.001) Titration plan: 22% improvement among PCPs (29% pre-CG vs. 51% post-CG; P<.001), 21% absolute improvement among D/Es (34% pre-CG vs. 55% post-CG; P<.001) VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to use of basal insulin in T2D. Disclosure A. Larkin: None. M. LaCouture: None. M. Warters: None. G.S. Littman: None.