Improving Management of Diabetic Peripheral Neuropathy 1: Recognition and Differential Diagnosis of DPN

Title:	Improving Management of Diabetic Peripheral Neuropathy 1: Recognition and Differential Diagnosis of DPN
Topic:	Diabetology
Relevant Terms:	Diabetes, Diabetes Leg Pain, Endocrinology, Neurology, Neuropathy, Peripheral Diabetic Neuropathy
Primary Audience:	Primary care practitioners and other healthcare professionals who treat adults with diabetes and peripheral neuropathy including neurologists; podiatrists; and endocrinologists
Launch Date:	31-Dec-09
Credits:	0.25 AMA PRA Category 1 Credit™
Expiration Date:	The accreditation for this activity has expired.

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Learning Objectives

Upon completion of the activity, participants should be able to:

Evaluate the lower extremities of people with diabetes based on history and physical examination, focusing on estimation of underlying pathology and accurate quantification pain to make a differential diagnosis
Determine the need for, and identify specific types of, further evaluative testing for painful diabetic feet based on differential diagnosis
Design effective preventive and treatment strategies for diabetic peripheral neuropathies utilizing interventions specifically targeting functional preservation
Initiate, manage, modify, and titrate medical therapies for diabetic peripheral neuropathies early in their natural history to optimize clinical impact

Faculty

Richard S. Beaser, MD
Associate Clinical Professor of Medicine
Harvard Medical School
Executive Director, Continuing Medical Education
Joslin Diabetes Center
Boston, MA

Richard S. Beaser, MD

Richard Beaser, MD, is the Medical Executive Director of Professional Education, Joslin Diabetes Center. He is a practicing physician in the Joslin Clinic and holds the position of Associate Clinical Professor of Medicine at Harvard Medical School.

Dr. Beaser graduated in 1973 from Trinity College, Hartford, and received his medical degree from Boston University School of Medicine in 1977. He served as a resident in internal medicine at the University of Massachusetts Medical Center in Worcester from 1977-1980. He was a fellow in endocrinology at the Joslin Diabetes Center, Boston, MA 1980-81, and in Endocrinology at the Lahey Clinic Medical Center, Burlington, MA 1981-82.

Dr. Beaser has been on the staff of the Joslin Diabetes Center since 1982. He has held numerous past positions at Joslin, including Section Chief of the Adult Diabetology Practice, Medical Director of the Diabetes Treatment Unit, Coordinator of the Patient Education Section, and Medical Director of Joslin TrialNet, a clinical trials network. He has been a clinical research investigator, including the landmark Diabetes Control and Complications Trial. Dr. Beaser has authored 4 books: Joslin Diabetes Manual, Outsmarting Diabetes, The Joslin Guide to Diabetes, and Joslin's Diabetes Deskbook: A Guide for Primary Care Providers. Dr Beaser is a well-known national lecturer on clinical diabetes and its comorbidities. He is the author of numerous publications in peer review journals, review articles, and book chapters.

Dr. Beaser is currently the Medical Executive Director of Professional Education at Joslin Diabetes Center, a department he co-founded with the Executive Director in 1990. The Professional Education Department was incorporated into the Joslin Strategic Initiatives Division in 2000. As Medical Executive Director of this department, Dr. Beaser has overall responsibility for departmental activities. He specifically focuses on development or oversight of all educational content for the department, targeting physicians, other medical professionals, and patients. He is responsible for the business and project development aspects of the department, working collaboratively to conceive, develop, and seek funding for all departmental projects and activities.

John M. Giurini, DPM
Associate Professor in Surgery
Harvard Medical School
Chief, Division of Podiatry
Beth Israel Deaconess Medical Center
Boston, MA

Roy Freeman, MD
Professor of Neurology
Harvard Medical School
Director, Center for Autonomic and Peripheral Nerve Disorders
Beth Israel Deaconness Medical Center
Boston, MA

Roy Freeman, MD

Roy Freeman, MD, is Professor of Neurology at Harvard Medical School and director of the Center for Autonomic and Peripheral Nerve Disorders in the Department of Neurology at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

Dr. Freeman's clinical and research expertise is in the physiology and pathophysiology of the autonomic nervous system and small nerve fibers. He is also an authority on the neurological complications of diabetes; neuropathic pain; the autonomic complications of Parkinson's disease and multiple system atrophy; and the diagnosis and treatment of autonomic and peripheral nervous system disorders. Dr. Freeman is widely published in these areas.

Dr. Freeman received his MB ChB at the University of Cape Town Medical School in South Africa. Subsequently, he completed his neurology residency and served as Chief Resident in neurology at Brigham and Women's Hospital and at the Beth Israel Hospital in Boston.

A frequent invited lecturer, Dr. Freeman has presented his works at national and international scientific forums on topics including the autonomic nervous system, diabetic peripheral neuropathy, and neuropathic pain.

He has authored more than 150 original reports, chapters, and reviews.

Dr. Freeman is the principal investigator on National Institute of Health funded studies on the pathophysiology of orthostatic intolerance, and hypoglycemia and the autonomic nervous system.

Dr. Freeman is the chairman of the World Federation of Neurology research group on the autonomic nervous system. He is the former President of the American Autonomic Society and former Chairman of the Autonomic Nervous System Section of the American Academy of Neurology.

Dr. Freeman has served as chair of scientific sessions at the American Academy of Neurology and other national and international meetings. He has been a member of the scientific program committee of the American Academy of Neurology and the American Autonomic Society.

Dr Freeman is Co-Editor of the journal, Autonomic Neuroscience and on the editorial board of the journal Clinical Autonomic Research. Additionally, he has served as an ad hoc reviewer for several publications, including Neurology, Annals of Neurology, Brain, Pain, Diabetes, Diabetes Care, New England Journal of Medicine and the American Journal of Physiology.

Planning Committee:

Richard S. Beaser, MD

Associate Clinical Professor of Medicine

Harvard Medical School

Medical Executive Director

Professional Education

Joslin Diabetes Center

Boston, MA

Julie Brown
Director
Professional Education
Joslin Diabetes Center
Boston, MA

James Neighbours, MEd
Assistant Director, Education Technology Services
Professional Education
Joslin Diabetes Center
Boston, MA

DISCLOSURE POLICY STATEMENT
As part of its accreditation with the Accreditation Council for Continuing Medical Education, Joslin Diabetes Center, Boston, must disclose to the audience of a Joslin continuing medical education activity the existence of any relevant financial relationships between Joslin and/or its planning committee members, speakers, and their spouses/partners and commercial entities. Joslin and its planning committee members and speakers must disclose any relationships they and their spouses/partners have or have had in the prior 12 months with proprietary entities producing healthcare goods or services with the exception of nonprofit or government organizations and non–healthcare-related companies, which are exempt.

Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fees, honoraria, ownership interests (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds) or other financial benefit in any amount. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected.

If a faculty or planning committee member has no information to disclose, this information will also be provided. If a faculty or planning committee member refuses to disclose, he/she will not be able to participate in the planning, management, presentation, or evaluation of any Joslin Diabetes Center CME activity. In addition, faculty have been asked to disclose when a product or device is not labeled for the use under discussion. The opinions and comments expressed in this program are those of the speakers and should not be considered the opinions or comments of the Joslin Diabetes Center.

Dr. Beaser is on the academic advisory board for AstraZeneca Pharmaceuticals LP and Bristol-Myers Squibb Company.
Dr. Giurini has no relevant financial relationships.
Dr. Freeman is a consultant for Avigen, Inc., Chelsea Pharmaceuticals International Ltd., Eli Lilly and Company, GlaxoSmithKline, Keryx Biopharmaceuticals, Inc., NeuroMetrix, Inc., Pfizer Inc, Solace Pharmaceuticals, and XTL Biopharmaceuticals Ltd., and is on the speakers bureau for Eli Lilly and Company and Pfizer Inc.
Ms. Brown has no relevant financial relationships.
Mr. Neighbours has no relevant financial relationships.

ACCREDITATION STATEMENT
The Joslin Diabetes Center, Boston, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION
Joslin Diabetes Center designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

To Obtain CME Credits
• Read the learning objectives and faculty disclosures.
• Participate in the activity.
• Complete the post-test and activity evaluation.
• Physicians who successfully complete the post-test and evaluation will receive CME credit.
• You must score with a 60% or higher on the post-test to receive credit for this activity.
• All other participants who successfully complete the post-test and evaluation will receive a certificate of participation.

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Release Date: December 31, 2009
Expiration Date: December 30, 2010

ACKNOWLEDGEMENT
This activity is sponsored by Joslin Diabetes Center.

This activity is supported by an educational grant from Pfizer Inc.

If you have any questions regarding this activity, send an email to profedweb@joslin.harvard.edu.

Copyright © 2009 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any rebroadcast, distribution, or reuse of this presentation or any part of it in any form for other than personal use without the express written permission of Joslin Diabetes Center is prohibited.

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