An expert panel at the 81st Scientific Sessions will consider the question: Is Continuous Glucose Monitoring (CGM) an Effective Diabetes Management Tool in Primary Care?
Amy Criego, MD, MS, Medical Director at International Diabetes Center (IDC) and Department Chair of Park Nicollet Pediatric Endocrinology, will lead off the session at 8:00 a.m. ET Monday, June 28, discussing what it will take for CGM data to be automatically integrated into the electronic health record.
Patient support and workflow factor into CGM success, according to the session’s second speaker, Thomas W. Martens, MD, Medical Director at IDC, HealthPartners Institute.
“The key to making it work is really to create workflows so that you’ve got what you need when you need it, and you can walk into a visit without too much prework and have a quality discussion with the person with diabetes—the shared decision-making to help move management forward,” said Dr. Martens, who will share lessons learned from Continuous Glucose Monitoring in T2D Basal Insulin Users, also known as the MOBILE Study.
Primary care practices are not well set up to leverage technology compared to endocrinology practices, where providers can create one-off processes to focus on glycemic management, Dr. Martens said.
“What you’re often doing in a primary care practice is toggling back through a meter, looking at glucose values,” he explained. “That’s where it tends to fall apart. People are checking their glucose by fingerstick, but using that data doesn’t work very smoothly.”
The technological advancements behind CGM create new potential for improving diabetes management, especially insulin-managed diabetes.
“The technology itself doesn’t improve the care,” Dr. Martens said. “It’s a matter of how you use the technology and how effective you are at being able to do that by getting access to the data, by knowing what to do with the data, and by helping folks with diabetes use the data in real time.”
The data from CGM devices can help patients make more informed decisions on lifestyle modifications, insulin dosing, and meal planning. Dana Gershenoff, MS, RD, CDCES, Program Manager at IDC, likens the insights provided by CGM to a fog being lifted. The patient and the health care team are able to clearly see how nutrition choices, medication, and physical activity directly impact glucose levels.
Gershenoff will address the potential for CGM to guide effective and sustainable dietary changes in the primary care setting and also how clinicians can maximize their time with patients.
“They only have a 15-minute visit with a patient, so how can they quickly access the data and then, in less than five minutes, look at the data to help the patient facilitate behavior change that is sustainable long term to optimize glucose levels?” she said. “It’s a pretty tall order.”
An IDC handout titled “Know, Observe and Learn” offers some solutions, as Gershenoff will explain.
Smart insulin pens are another technology that can be paired with CGM. These devices help people with diabetes determine how much insulin they need to take and record the doses, making it easier for the primary care team to know what the patient is doing and, as a result, to better recommend adjustments.
“There’s a lot of innovation in this area,” said Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP. “A second smart pen was recently FDA approved, and there’s several in the pipeline that are likely going to be available in the near future.”
Smart insulin pens amplify the utility of CGM because there is even more data to work with.
“When you combine with CGM, you have that exact timing of the insulin dose and what’s happening with the CGM levels,” said Dr. Isaacs, Endocrine Clinical Pharmacy Specialist and CGM and Remote Monitoring Program Coordinator, Cleveland Clinic Endocrinology & Metabolism Institute. “It makes it easier for the primary care practice to make adjustments, and the person who has diabetes learns from this information and they’re able to make self-management changes.”
The first smart insulin pen came on the market in late 2017.
“New technology sometimes seems intimidating, but these make everyone’s life easier,” Dr. Isaacs said. “We shouldn’t be afraid. We should embrace it.”
The session’s final speaker, Revital Nimri, MD, Senior Physician at Schneider Children’s Medical Center of Israel, will analyze the benefits of CGM-guided clinical decision-making in primary care.
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