EWER THAN HALF OF US ADULTS with type 2 diabetes reach a hemoglobin A 1c (HbA 1c ) level of less than 7% despite several available therapies. 1 Ineffective implementation of existing pharmacotherapies is a significant factor contributing to suboptimal care. 2 However, efficacy of available therapies, even when used appropriately, diminishes as the disease progresses because of a steady, relentless decline in pancreatic beta cell function. 3 Furthermore, current therapies for type 2 diabetes are often limited by adverse effects such as weight gain, edema, or hypoglycemia, and most do not target postprandial hyperglycemia effectively. Therefore, therapies targeting the decline in pancreatic beta cell function without causing weight gain and with minimal adverse effects are desirable.Recently, improved understanding of the incretin effect on the pathophysiology of type 2 diabetes has led to development of new hypoglycemic agents. The incretin effect is the augmentation of glucose-stimulated insulin secretion by intestinally derived peptides, which are released in the presence of glucose or nutrients in the gut. 4 The theory evolved from the observation that an oral glucose load was more effective at releasing insulin compared with the same amount of glucose given intravenously. 5 The actions of incre-

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Introduction Given the increasing prevalence of diabetes mellitus, trainees should have a strong foundation in the management of diabetes. Published literature on the knowledge base and comfort level of medical trainees in diabetes care describes varying levels of exposure to diabetes management in both inpatient and outpatient settings. Methods This eight-module curriculum provides a foundation in the diagnosis, evaluation, and management of diabetes mellitus in the adult patient, as well as pharmacological treatment, patient education, and complications. Specifically, the modules consist of an introduction to diabetes, diagnosis and glycemic goals, patient education, basic nutrition, noninsulin therapies, insulin therapies, complications of diabetes, and financial considerations and cost. Each is a stand-alone presentation that may be viewed nonsequentially. We estimate each module taking 15 to 30 minutes to read. Students received a postsurvey. Results We received responses from 23 (18%) of the total eligible residents over the course of 3 years. Approximately 50% of respondents completed an endocrinology elective as either a medical student or first-year resident. Overall, the majority of respondents felt that the modules had the correct amount of content, the online format was adequate, their understanding of diabetes was enhanced, and the curriculum led to altering their care. Discussion This resource is unique to MedEdPORTAL as it includes basic information on diabetes education and medical-nutritional therapy. We have required completion of these modules by our internal medicine residents since the class that enrolled in 2013. The curriculum is directed towards incoming first-year internal medicine residents but may also be used by trainees in other primary care fields.

Background: Sheehan syndrome (SS) is a rare complication of severe postpartum hemorrhage or hypotension during the processes of labor and delivery that results in ischemic pituitary infarction and necrosis. In this case report, we describe an unusual presentation of SS without inciting factors. Case Presentation: A 30-year-old multiparous woman presented 2 hours after a normal spontaneous vaginal delivery with a profound severe headache, and subsequent agalactia, dry skin, and mood changes. She was managed conservatively until 10 months postdelivery when she complained of persistent symptoms including amenorrhea. A brain magnetic resonance (MR) with pituitary imaging revealed findings consistent with SS. The patient's symptoms improved and ultimately resolved after levothyroxine, estrogen replacement therapy, and hydrocortisone were instituted. Conclusions: SS can present without recognized inciting factors. During the initial phase, women may present with profound headache and/or visual disturbances warranting neurological evaluation. A high index of suspicion and a brain MR with pituitary imaging should prompt early consideration of SS to aid in the diagnosis.

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