Insulin Initiation and Intensification Strategies—Effect of Case-Based Online Education on Physician Competence and Confidence

Abstract

Purpose: To determine if case-based online medical education for primary care physicians (PCPs) and diabetologists/endocrinologists (diabs/endos) can improve competence and confidence regarding the appropriate initiation of insulin therapy and intensification with novel basal insulins/GLP-1 receptor agonist (GLP-1 RA) fixed-ratio combinations (FRCs) in complex patients with T2DM. Methods: This educational activity featured an interactive case study that challenged learners to develop and apply the skills needed for providing optimal treatment of T2DM. Educational effect was assessed with a repeated pairs pre- and post-assessment study with a 3-item, multiple-choice, competence, one-item confidence questionnaire in which participants act as their own controls. A χi-squared test assessed statistical significance at the P <.level. The activity launched April 25, 2017; data were collected until June 1, 2017. Results: Participation in the activity significantly improved competence of PCPs (average from 52% to 75%; n=869) and diabs/endos (from 55% to 71%; n=209) regarding the role of basal insulin analogs in improving glycemic control, the expected effects of a basal insulin/GLP-1 RA FRC on a patient’s weight and risk of hypoglycaemia, and the appropriate recommended starting dose of such a novel insulin FRC in a given case scenario (p<.05). Confidence levels in selecting appropriate treatment regimens for patients sub-optimally controlled on basal insulin also improved (41% in PCPs, 28% in diabs/endos). Conclusions: Participation in online interactive case-based education resulted in improvement of competence and confidence regarding the initiation and intensification of insulin therapy in a complex patient with T2DM. Further education is warranted on the utility of novel insulin formulations and intensification strategies, available novel FRCs, and their appropriate use in patients with poorly controlled T2DM. Disclosure G.A. Griffith: None. S. Del Prato: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, GlaxoSmithKline plc., Intarcia Therapeutics, Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Servier, Sanofi, Takeda Pharmaceuticals U.S.A., Inc.. Research Support; Self; Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Takeda Pharmaceuticals U.S.A., Inc.. Advisory Panel; Self; Janssen Biotech, Inc., Abbott. J. Trier: None.