Post-Test, Activity Evaluation Form and Application ... - epgonline.org

Post‐Test, Activity Evaluation Form and Application for Continuing Medical Education Credit
SGLT2 Inhibitors: Assessing the Evidence and the Potential Impact on Future Clinical Practice
An on-line multi-lingual independent medical education programme
Date of Activity: 12 January 2012
Expires: 12 January 2013
We greatly value your opinion. Please complete this post‐test and evaluation and fax it back to us. Your responses will be
used in future planning of activities and materials.
Post‐Test
Please circle the correct response for each question below
European countries spend approximately what proportion of their
≈ 1% ≈3‐6% ≈10% >10%
healthcare expenditure on diabetes?
What proportion of glucose reabsorption in the kidney is mediated by
SGLT2?
10% 30% 50% 90%
SGLT2 facilitates reabsorption of filtered glucose that is
Insulin‐dependent
Insulin‐independent
Dapagloflozin has been studied in
combination with
Metformin Sulfonylureas Insulin Thiazolidinediones
All of these
agents
A 65 year old patient on metformin 750 mg twice daily was
commenced on dapagliflozin 5 mg once daily. Based on clinical study
data, what further reduction in HbA1C would you expect?
‐ 0.1% ‐0.5% ‐0.7% ‐1.0%
Activity Evaluation
Please tick in one box for each objective
The learning objectives designed for this activity can help me strive
toward:
• State the rationale for targeting glucose reabsorption by the
kidney in patients with diabetes
Not
met
Reinforcement
Moderate
Improvement
Significant
Improvement
Improvement
• Describe current glycemic control of type 2 diabetes and current
unmet needs
• Evaluate the evidence for SGLT2 inhibitors as therapy of type 2
diabetes
• Identify how SGLT2 inhibitors might be incorporated into clinical
practice.
Please circle to indicate the extent of your agreement with the
following statements:
1. The information presented at this activity was pertinent to
my professional needs.
Strongly
Disagree
Not sure
Strongly
agree
1 2 3 4 5
2. The teaching and learning methods were effective 1 2 3 4 5
3. The information was presented in a fair and balanced
manner and examined the topic with scientific rigor.
1 2 3 4 5

4. The content of this activity contributes valuable information
that will assist me in improving patient outcomes.
5. Based on my experience today, I would recommend future
activities for diabetes similar to this to my colleagues.
Please rate the faculty:
6. What was your overall rating of the speaker?
– Professor John Wilding
1 2 3 4 5
1 2 3 4 5
Poor‐to‐
Fair
Fair‐to‐
Good
Excellent
1 2 3 4 5
7. Will the information presented cause you to make any changes in your practice? Yes No
Please explain the reason for your answer:
____________________________________________________________________________________________
8. Based upon the information presented in this educational activity, which of the following statements best
reflects your sentiment toward education for SGLT2 inhibitors (circle one)
a. I have learned everything I need to learn about SGLT2 inhibitors
b. I would like to learn more about SGLT2 inhibitors
9. We would be interested in using your topic suggestions as a means to develop future education. What general
comments or additional topics would you suggest for future activities?
______________________________________________________________________
______________________________________________________________________
10. Overall, was this activity satisfactorily free from commercial bias? Yes No
Comments:
____________________________________________________________________________________________
11. Mr DB is a 67 year old, obese, male patient (BMI = 31 kg/m 2 ) who was diagnosed with diabetes 1 year ago. He
has mild hypertension and NYHA Class II heart failure (treated with atenolol and enalapril) and dyslipidemia
(treated with simvastatin). His diabetes has been reasonably well controlled on metformin lg twice daily (the
highest dose he can tolerate) and glimepiride 4 mg once daily, but has had several episodes of hypoglycaemia
over the last two months and you have decided to stop his sulfonylurea.
Which of the following classes of drugs would NOT be an appropriate option in a patient such as Mr DB?
1. A DPP4 inhibitor
2. A thiazolidinedione
3. A SGLT2 inhibitor
4. A GLP1 agonist
12. Other comments:
______________________________________________________________________
______________________________________________________________________

Application for Continuing Medical Education Credit
For purposes of certification, please complete the following information. Please note that we will not forward
or sell your contact information. Please PRINT clearly.
First Name _______________________ Middle Initial __________ Last Name _____________________
Degree: MB/MD or equivalent DO MPharm/PharmD RN NP PA Other
Mailing Address:____________________________________________________________________
City: _________________________________ Country: ___________ Postal Code:_____________________
E‐mail Address (REQUIRED TO RECEIVE CERTIFICATE):___________________________________________
Global Education Group and Strategic Consultants International are interested in adding to our base of
faculty and educational development. To help us better plan for education in this area, and to invite you to
partake in future educational development, we may contact you for your expertise. If you opt NOT to be
contacted in the future, please check the box below:
NO, I do NOT want to be contacted in the future.
I certify my actual time spent to complete this educational activity to be (tick one):
I participated in the entire activity and claim 1.0 AMA PRA Category 1 Credit TM credits / 1 CPD Credit
I participated in only part of the activity and claim _________ credits.
I certify that I have participated in the continuing education activity entitled “SGLT2 Inhibitors: Assessing the
Evidence and the Potential Impact on Future Clinical Practice”
Signature: ___________________________________________
Date:____________________________
Please fax this form back to Global on 001 303 648 5311 or email to inquire@globaleducationgroup.com
Only completed forms will be processed for credit. Please allow 6‐8 weeks to receive your certificate. Thank
you for participating in this activity.
For Internal Use Only: Project ID: 1350E / 1351E Date: 5 January 2012