Discuss course requirements, methods of instruction, expectations of student/instructor performance and conduct, outcomes measures and CE credit hours awarded

• CE Disclosure statement
• Orientation to base and WHASC
• Course requirements
• Course materials and CE hours awarded
• Measures of outcomes (pre-assessment, 30-day survey, 8-month post-assessment, practical application)
• Introduce CPG/QI Implementation Activity

1. Discuss the scope of diabetes
2. Define/describe role of Diabetes Champion
3. Outline strategies to facilitate change in the care system
4. Summarize benefits of having a champion and CPG team
5. Distinguish strategies to optimize provider and team behavior
6. Compare strategies to support patient behavior change
7. Introduce CPG/QI project requirement for course participation (part 1)
8. Analyze findings of previous courses

• Incidence Direct costs Indirect costs Quality of life
• Challenges in AFMS
• Role and duties of Diabetes Champion Implementation strategies
  • Secure executive buy-in
  • Develop/implement action plan
    • Team identification
    • Data collection
  • Facilitate Change
    • Identify barriers
    • Provide training
  • Monitor progress
    • Identify metrics
• Delineating Staff roles/responsibilities
• Implementing a system for planned visits for diabetes care
• Supporting the use of evidence-based guidelines Identify resources
• Using the patient registry (CarePoint)
• Incorporating diabetes management self-education and support into every visit
• Expectations for course clinical practice guideline/quality improvement (CPG/QI) project
• Previous course and participant examples
• Previous participant findings: Identifying barriers and finding solutions.

1. Identify risk factors and metabolic defects in diabetes and pre-diabetes
2. Describe principles of evidenced- based practice
3. Summarize the clinical practice guidelines from the VADOD and American Diabetes Association
4. Discuss treatment recommendations for diabetes

• Normal glucose metabolism Pre-diabetes: IGF, IGT Diabetes: Type 1, Type 2, other Glycemic goals in diabetes
• Diagnosis of diabetes and pre-diabetes
• Sources of evidence-based practice to guide clinical practice of diabetes management
• VADOD Diabetes Clinical Practice Guideline
• American Diabetes Association 2019 Medical Standards of Care
• Treatment goals for HTN and HLP
• Treatment algorithms

1. Identify diabetes services covered by TRICARE
2. Summarize resources to provide support to the multidisciplinary team
3. Outline programs at DCOE for patient and provider educational opportunities

• Diabetes Services available through TRICARE Professional Resources
  • CDC
  • AMEDD
  • CEMM Programs
  • Diabetes Central
  • Project ECHO (Diabetes and Prevention)
  • DCS Webinars

1. Discuss recognition and treatment of hypoglycemia
2. Outline strategies for sick day management
3. Summarize recognition and treatment of life-threatening acute complications

• Hypoglycemia
• Hyperglycemia(DKA)
• Concurrent illness (sick days)

1. Outline the role of insulin in treating/managing PWD
2. Compare the types of insulin available
3. Analyze the strategies for dosing and titrating insulin

• Onset, duration, precautions,pt education
• Insulin devices
• Pens

1. Compare strategies for initiating insulin
2. Outline titration/dosing of insulin
3. Demonstrate recognition of blood glucose patterns that could influence insulin dosing

• Presentation of case studies
  • When to initiate insulin
  • Recognition of blood glucose patterns
  • Strategies to titrate insulin
• Patient self-titration
• Case study 1 (Insoljin)
  • Assessment of health status
  • Medication considerations
• Psychosocial considerations

1. Discuss the research supporting primary diabetes prevention. CDC and GLB prevention programs
2. Outline implementation of a diabetes prevention and/or GLB program

• Review of diabetes prevention research
  • DPP
  • DPPOS
  • GLB/DPSC
• Discuss available prevention programs Facilitator Training
  • Recommendations for MTF implementation

1. Summarize the prevention, recognition, and treatment of cardiovascular complications of diabetes
2. Outline the prevention, recognition, and treatment of microvascular complications of diabetes
3. Analyze the significance of tobacco cessation

• Chronic complications of diabetes
  • Microvascular
  • Macrovascular
• Preventative screening
• Smoking Cessation Immunizations

1. Define classes oral/injectable medications, explain use to treat type 2 diabetes and assess effectiveness
2. State factors to consider when prescribing medications to treat diabetes and determine proper management
3. Apply VA/DOD sequential approach plan medical management of diabetes
4. Recognize elements in clinical case study to construct treatment plan

• Reasons for monitoring Continuous glucose monitoring Interpreting the numbers
• Classifications of diabetes medications
  • Purpose, action, dosing, side effects, precautions, patient education
  • Oral: Biguanides, sulfonylureas, TZDs, Alpha-glucosidase inhibitors, glinides, DPP-4 inhibitors, SGLT2 inhibitors, bile acid sequestrants
  • Injectable: incretin mimetics, amylin analogs
• Management of medication regimens
• Pattern management

1. Validate assessment skill for a comprehensive foot exam
2. Demonstrate techniques and data download for glucose monitoring devices
3. Identify techniques of pen injector devices and glucagon instruction
4. Show the function of insulin pumps and continuous glucose monitoring devices

• Part 1: Comprehensive foot exam
• Part 2: Glucose monitoring devices (patient use and downloading)
• Part 3: Pen injector device & Glucagon teaching Strategies
• Part 4: Insulin pumps & Continuous Glucose Monitoring Systems

1. Discuss identified gaps in practice
2. Develop an action plan
3. Apply strategies to implement action plan

• Practical application of:
  • Implementation strategies
  • Identify Diabetes Team
• Develop strategies to implement action

1. Explain the importance of preconception counseling for women with diabetes of childbearing age
2. Summarize the importance of glucose management before, during, and after pregnancy
3. Identify the diabetes/hypertensive/ cholesterol medications contraindicated during pregnancy
4. Discuss follow-up of women with gestational diabetes post pregnancy

• Preconception Care/Counseling
• Implications of poor glucose control on pregnancy
• Medications contraindicated during pregnancy
• Post-partum considerations
• Gestational Diabetes

1. Analyze the healthcare team workflow, roles and actions in the management of a PWD
2. Discuss strategies for initiation of insulin therapy
3. Summarize implication of a diagnosis of diabetes for the active duty patient
4. Review Military Evaluation Board (MEB) process

• Case study 1 (Babbe)
  • Assessment of health status
  • Medication considerations
  • Psychosocial considerations
  • Preconception Counseling
  • Medical Evaluation Board process
• Case study 2 (Pennerknie)
  • Assessment of health status
  • Medication considerations
  • Psychosocial considerations
  • Medical Evaluation Board process

1. Describe MTF action plan
2. Identify gaps in practice
3. Explain strategies to implement action plan

1. Review current recommendations for medical nutritional therapy (MNT) for people with diabetes (PWD)
2. Distinguish the goals of nutrition therapy for PWD
3. Compare strategies to facilitate healthy eating behaviors

• CPG recommendations for MNT (VA/DoD, ADA, AND)
• Healthy eating instruction
• Meal planning strategies: Carb Counting, Food Guide Pyramid, Plate Method, Glycemic Index

1. Summarize exercise/physical activity recommendations for PWD
2. List strategies to facilitate behavior change to increase activity level
3. Identify ways to reduce risk of hypoglycemia during exercise

• Expected benefits: weight, lipids, glucose control, BP in Type 1, Type 2 and pre-diabetes
• Frequency and type of exercise Exercise and Glycemic control
• Presence of non-optimal glycemic control

1. Review current CPG (VA/DoD, ADA) recommendations for lifestyle management
2. Outline strategies for providing Diabetes Self-Management Education and Support (DSMES) to PWD

• Review of research supporting diabetes education
• Define level of diabetes education providers
• Current standards of care/CPG recommendations
  • Group vs individual
  • Defining “support”
• Process for recognition and reimbursement.

1. Summarize strategies for assessment of psychological and social situation>
2. Identify resources available for assessment and management of psychosocial issues in PWD
3. Analyze strategies to facilitate behavioral change

• Review of psychological and social problems associated with diabetes
• Identifying depression
• Use of BHOP in the PCMH
• Barriers to self-care
• Review of Motivational Interviewing techniques. Presentation of scenarios/case studies to facilitate discussion.
• Guided practice session for participants.

1. Outline considerations for PWD when scheduling elective surgeries
2. Summarize changes in medication regimens for known surgical or diagnostic procedures
3. Compare strategies for follow-up post hospitalization

• Pre-operative evaluation (suitability)
• Medication management changes in peri-operative care
  • Orals
  • Insulin
• Re-establishing the “home” regimen of medical care

1. Describe the obesity epidemic in the US and the world
2. Define obesity in children and how to make the diagnosis
3. Evaluate a pediatric patient with overweight/obesity for secondary causes and co morbidities
4. Discuss and apply techniques utilizing motivational interviewing in the encounter with an overweight/obese patient
5. Summarize the Primary Care role in the management of the pediatric diabetes patient

• Managing the Pediatric Diabetes Patient
• Childhood obesity
• Rates of childhood obesity
• Cycle of childhood obesity
• Importance
• Barriers to discussing and treating obesity
• Healthy Habits Clinic
• Readiness to Change
• Motivation Interviewing
• Goal Setting
• ADA Criteria for T1DM and T2 DM
• Special considerations for pediatric patients
• Federal and State laws and regulations on equal Access
• Management of pediatric sick days
• BG Management Goals

1040-1110 Case Study

1. Analyze the healthcare team workflow, roles and actions in the management of a PWD
2. Develop strategies for initiation of insulin therapy

• Case study 3 (Foote)
• Assessment of health status
• Medication considerations
  • Regimen
  • hypoglycemia
• Psychosocial considerations

1. Describe MTF action plan.
2. Identify gaps in practice

• Practical application of:
  • Implementation strategies
  • Identify Diabetes Team
• Present strategies to implement action plan

• ECHO™ conference: Diabetes and Obesity

• Collect evaluations
• Question and Answer
• Distribute certificates/Dismissal