Survey

CRS Diabetes Registration

You are in the right spot to register for the annual Chief Residents Summit on Intensifying Diabetes Management. Before you register, we would like your input on a some initial survey questions that will help us make sure that the Summit addresses the issues and concerns that are most important to you.

Have you read either or both of the guidelines below?

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In patients with type 2 diabetes mellitus, the primary treatment goal is to control/reduce:

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Which one of the following points in managing T2DM do you find the most challenging?

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Please describe why this point in management is challenging for you

Please select one class of glucose-lowering medications and identify one question you have about that class

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What is your question about DPP-4 inhibitors

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What is your question about GLP-1RAs

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What is your question about Insulin

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What is your question about SGLT2 inhibitors

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What is your question about Sulfonylureas

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What is your question about TZDs

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Please identify the TWO greatest barriers you encounter when considering the initiation of basal insulin

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If other

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Which of the following patient/disease feature is correctly matched with a more stringent (lower) or less stringent (higher) A1c goal for a patient with T2D, according to the American Diabetes Association (ADA)?

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Which of the following drugs/classes has shown cardiovascular benefit in patients with T2D?

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Which of the following drug classes acts in the kidneys to lower blood glucose, and provide kidney and cardiovascular benefits in patients with T2D?

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Agree or Disagree? I am _________________ with each of the following aspects involved in managing patients with T2DM

Diabetes management in general

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Communication

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Patient education/coaching

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Shared decision-making

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Promoting patient adherence & self-management

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Nutrition and carb counting

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Titrating doses of medication

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Selecting initial dosing regimens of medications

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Managing adverse events related to medications

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Initiating and modifying therapy to meet each patient's needs, interests, & capabilities

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Initiating treatment with a DPP-4 inhibitor

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Initiating treatment with a GLP-1 receptor agonist

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Initiating treatment with an SGLT-2 inhibitor

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Adding prandial insulin to basal insulin in patients with T2DM

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Including glucagon in a hypoglycemic treatment plan

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Selecting appropriate medications to reduce cardiovascular risk

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Balancing efficacy and safety with insulin

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Identifying patients who are candidates for continuous glucose monitoring

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Inhalable insulin

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When do you discuss a hypoglycemia treatment plan with your patients with diabetes? Mark all that apply

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If you have a patient on two diabetes drugs that are available as a combination product, how often do you switch them to the combination product?

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Medications in which two classes have been shown to reduce the risk of cardiovascular events compared to placebo as part of standard care?

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How many patients with diabetes do you see per month?

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What is the greatest challenge you face in managing patients with diabetes?

Now on to the actual registration...and thank you for answering all those questions!

Are you a chief or senior resident? Note that if you are not, you are not eligible to participate and should stop filling out the registration form

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Name as you wish it to appear on your CRS Name Tag (First, Middle if you wish, Last, Suffix if needed)

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Cell Phone

[ Required ][ Invalid telephone (###)###-#### ]

Your non-Residency Program Email Address (gmail, yahoo, hotmail, etc.)

[ Required ][ Invalid e-mail address ]

Residency Program

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Residency Program Address

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Name of Residency Coordinator

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Residency Coordinator Email

[ Required ][ Invalid e-mail address ]

Name of Residency Director

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Residency Director Email

[ Required ][ Invalid e-mail address ]

Will you be arriving by ...

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To be reimbursed for your mileage, we require your arrival at the Tampa, FL airport hotel by 2 pm on Friday, Oct 25, and departure after 12 pm Sunday, Oct 27. After the Summit, just send us a map (a PDF of a google map or similar will be fine) showing the mileage from your residency program to the event and include your mailing address. We will reimburse you for mileage up to $200, based on current GSA mileage reimbursement guidelines.

We require that your flight arrive at the Tampa, FL airport by 2 pm on Friday, Oct 25, and that the scheduled departure be after 12:30 pm Sunday, Oct 27. We will refund up to $400 toward the price of your ticket Just send us proof of your purchase (the proof must include arrival and departure times as well as cost details, airline & flight #s) and your mailing address and we'll get the check on its way. Note that our reimbursement does not include seat upgrades or luggage charges.

Please indicate your awareness of the following by selecting "Yes" below to show your approval.

Pictures and videos taken during the Summit may show you in attendance. I give permission for my image to be used by organizers for promotional or educational purposes

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If I do not attend the Summit, I agree to pay back any funds PCEC has paid toward the cost of my airfare.

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You will spend part of your time at the Chief Residents Summit living as a patient with diabetes. You will be counting your carbs, and checking your blood sugar regularly. You will be outfitted with a continuous glucose monitoring (CGM) device. We think this makes a huge difference to your knowledge of the experiences and challenges your patients face, and we hope you will select "YES" below. May we sign you up for CGM at CRS?

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The most frequent question we receive from residents is about the scholarship that each accepted resident will receive. That scholarship covers the cost of your lodging during the conference (private room, we make the hotel reservations) and all meals during the event. You are responsible for all travel costs (with limited reimbursement of $400 (airfare) or $200 (mileage) or less from PCEC as described above), as well as any food before and after the Summit.

Your contact up until the time of the Summit is Desma Rozovics of the Illinois Academy of Family Physicians, drozovics@iafp.com (who will be onsite with you) or Nora Williams, nwilliams@pceconsortium.org, 704-752-0257. Don't hesitate to reach out with any questions.

AM I REGISTERED YET???: After all those questions, you still won't be registered after you fill out this form. The first fifty residents to fully complete registration will be accepted into the program. For your registration to be considered complete, we must receive two additional things:

1) An email from your program director or co-ordinator confirming that your schedule allows you to attend the Summit. You will need to arrive at the Tampa Airport by Friday afternoon at 2 pm, stay through Sunday at 12:30 pm. PLEASE ASK FOR THIS EMAIL TO BE SENT as soon as you SUBMIT below.

2) Anonymous patient A1c data from five (5) of your patients with T2DM and an A1c higher than 7.0. Try to pick patients whom you are likely to see regularly as we will be asking you to send another set of A1c test results from these patients in March of 2025. Every year we have been able to demonstrate real world improvements using this data and we look forward to helping you make a difference with these patients. Simply express the data as "Patient One: 9.6, Patient Two: 8.1..."

Email the information to drozovics@iafp.com at your earliest convenience as space is limited.

Space for the Summit is limited, and we are accepting residents as they complete registration, so please don't hesitate to get both of these tasks completed so that we may secure your spot. When we receive this form, as well as items 1 & 2 above (the note from your program and the anonymous A1c data), you will be considered registered for the program.

Shortly, after we have received those, we will also notify you whether you are one of the fifty accepted residents or have been waitlisted (which will mean fifty residents completed their registration before you). In case you are waitlisted, there will likely be additional spaces that open up closer to the event so you may still be able to attend. Note that only one resident is accepted per program, so if you are the second resident from your program, you will automatically be waitlisted.

Hope to see you in Tampa!