Improving Appropriate Basal Insulin Use in Clinical Practice—Impact of Physician Education on T2D Clinical Management

Abstract

Although insulin is among the most effective antihyperglycemic agents, initiation is often delayed. We studied whether online continuing medical education (CME) could improve the clinical performance and confidence of primary care physicians (PCPs) and endocrinologists (endos) regarding use of basal insulin. The CME activity consisted of an online, 30-minute, video-based roundtable panel discussion. Educational effects were assessed using 3 case-based and 1 self-efficacy repeated pair pre-/post-assessment questions and McNemar’s chi-squared test. The activity launched online August 16, 2016, and data were collected through December 20, 2016. Overall improvements were seen for PCPs (n = 197; P <.001) and endos (n = 27; P =0.014). Relative percent changes from pre- to post-assessment were between 15% and 126% for PCPs and -4% to 40% for endos. While only 7% of PCPs and 19% of endos answered all 4 questions correctly on the pre-assessment, 28% of PCPs and 41% of endos answered all correctly on the post-assessment. The greatest improvements were seen in dosing strategies for preventing hypoglycemia (44% improvement in PCP, P <.001, and 18% in endos, P = 0.025), individualizing therapy in a patient with high glucose variation (23% improvement in PCP, P <.001, and 7% in endos, P = 0.4), and insulin initiation (8% improvement in PCP, P = 0.039, and 22% in endos, P = 0.058). PCPs reported a confidence level of 2.86 on the pre-assessment and 3.45 on the post -assessment, for a total confidence shift of 20.6%. Endos reported a confidence level of 4.04 on the pre-assessment and 4.44 on the post -assessment for a confidence shift of 10.1%. This study demonstrates the success of an online, roundtable activity in improving performance of PCPs and endos regarding use of newer basal insulins. Studies have shown that case questions are an effective way to measure clinical performance in practice; therefore this activity is expected to translate into improved T2D management in clinical care. Disclosure A. Larkin: None. M. LaCouture: None. A. Le: None.