Adult Endocrinology and Metabolism — Core of Discipline

C5 Managing diabetes with insulin therapy and the use of diabetes technologies

Key Features:
- This EPA focuses on prescribing insulin therapy for individuals with type 1 and type 2 diabetes, gestational diabetes, and other forms of diabetes.
- This includes ensuring that the individual has appropriate follow-up to assist with titration of insulin and providing appropriate monitoring for side effects (e.g., hypoglycemia and DKA).
- It also includes demonstrating expertise in transitioning patients from basal-bolus insulin to a continuous subcutaneous insulin infusion system/insulin pump therapy.
- It also includes interpretation of continuous glucose monitoring (CGM).

Assessment Plan:
Direct and/or indirect observation by supervisor or diabetes or pump educator
Use Form 1. Form collects information on:
- Type of diabetes: congenital; cystic fibrosis-related; diabetes in pregnancy; monogenic; post-pancreatic surgery; secondary diabetes; type 1; type 2
- Treatment: CGM; multiple daily injections; insulin pump; transition to pump
Collect 10 observations of achievement
- At least 2 diabetes in pregnancy
- At least 1 individual with congenital, cystic fibrosis-related, monogenic, post-pancreatic surgery or secondary diabetes
- At least 3 continuous glucose monitoring
- At least 3 multiple daily injections
- At least 3 insulin pumps
- At least 1 transition to pump
- At least 2 different observers

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of intensive diabetes management, including the use of diabetes technologies

• ME 2.2. Interpret the results of glucose monitoring

• ME 3.4. Select and prescribe an insulin regimen based on individual needs and glycemic targets

• COM 3.1. Educate and counsel patients about their condition and the treatment options

• COM 3.1. Provide written and/or visual materials to supplement health teaching

• ME 3.4. Provide anticipatory guidance for management of diabetes-technology malfunction, including a back-up plan

• COL 1.2. Work effectively with diabetes nurse educators

• ME 4.1. Establish a follow-up plan

• HA 1.1. Facilitate patient access to needed resources and services

Context Variables

• Type of diabetes (single-choice)
  • congenital
  • cystic fibrosis-related
  • diabetes in pregnancy
  • monogenic
  • post-pancreatic surgery
  • secondary diabetes
  • type 1
  • type 2
• Treatment (single-choice)
  • CGM
  • multiple daily injections
  • insulin pump
  • transition to pump

Requirements

• Collect 10 observations of achievement (minimum 10)
• At least 2 diabetes in pregnancy (minimum 2)
  • Only counts when Type of diabetes is diabetes in pregnancy
• At least 1 individual with congenital, cystic fibrosis-related, monogenic, post-pancreatic surgery or secondary diabetes (minimum 1)
• At least 3 continuous glucose monitoring (minimum 3)
  • Only counts when Treatment is CGM
• At least 3 multiple daily injections (minimum 3)
  • Only counts when Treatment is multiple daily injections
• At least 3 insulin pumps (minimum 3)
  • Only counts when Treatment is insulin pump
• At least 1 transition to pump (minimum 1)
  • Only counts when Treatment is transition to pump
• At least 2 different observers (minimum 2)
  • Counted once per distinct Assessor