Turn 'Patients Into Experts' on Their Diabetes With CGM Use

Eden Miller, DO; Mark Harmel, MPH, CDCES


July 15, 2022

This transcript has been edited for clarity.

Continuous glucose monitoring (CGM) is revolutionizing the way we look at diabetes. We've gone from a 30,000-foot view in diabetes to an individualized, patient-centric glucose- or diabetes-related journey. There's been much talk about utility and the science behind it, but I'm passionate about going from knowing CGM to actually doing CGM in clinical practice.

What we see in between is this large therapeutic inertia barrier. One of the things I want those in clinical practice to feel comfortable with is taking that science, that knowledge of technology, and incorporating it into clinical practice. This will provide much-needed insight. It will be illuminating to clinicians as to how to intensify therapy, or in some cases, deintensify therapy.

It will increase patient engagement in their own disease. I often say my goal is to turn patients into experts on their own disease. This new technology tool gives you your present glycemia then goes back in the past to tell you how you got to your destination and also predicts the future. I urge you to embrace this new science, to embrace this new technology. It will equip you and your patients to have a life well lived, taking diabetes along for the ride.

Understanding CGM and its technology can be sometimes overwhelming. We all have this great scientific background but getting that knowing into doing has a few steps. This clinician thinks all persons with diabetes can benefit from CGM.

It's not just merely glucose testing in a fancy way. This is really that retrospective, current, and prospective type of data that, as you identify persons with diabetes, as you look at those individuals and think, What could they benefit from CGM?... It's not just hypoglycemic protection. It's not just meant to be tagged along with those on insulin pumps or multiple daily injections — even though I believe those people should all have CGM.

CGM does more than just tell you what your glucose is. It's an opportunity for patients to engage in their disease at a level that they've never had before. Maybe they don't know the effects of food. Maybe they don't know the effects of stress, sleep, or occupation or the effects of their therapeutic adherence with their medications or all the different things they do in their life. It has a glycemic footprint, a signature. The first thing you should do in your practice is to look at that person in front of you and say, "What do they need from me in management of their disease?"

When you think of continuous glucose monitoring, you may put different reasons for CGM. You identify the person. You talk about how it may help illuminate their disease. Oftentimes, you choose a CGM that might be easier to use. The very first CGM that is probably the low-hanging fruit is to do that blinded professional CGM. All the different carriers and payers cover this.

It's something you can start with that has the least amount of therapeutic inertia. You can provide them those data; bring them back in 2-3 weeks; make sure that they keep a narrative of what they do in their life so you can overlay that ambulatory glucose profile, write their report, and be able to take their lifestyle and adherence and make meaning out of it.

As a clinician, you can use those data to help make therapeutic decisions. Oftentimes, we don't need necessarily intensification. We need deintensification. It goes both ways in advancing their therapy because, as we know, therapeutic inertia is massive. Why not have a piece of technology that can fill in those gaps and really give us that time that we're trying to get back from?

From there, if you want to start identifying those people with personal CGM, the ones that need that real-time engagement ongoing as a part of their daily life, you can help them obtain that, oftentimes through pharmacy benefit or durable medical equipment. Remember to empower them so they know their time in range, what's their target, how to avoid hypoglycemia, and how to do a few tasks over time. You don't need to do it all in one sitting. It's really a journey.

As you keep pace with them, you're their diabetes Sherpa and you've given them this GPS for their life that they can see directionally. You can see a better engagement. As you go on through this journey, bring them back in, download these things, make sure and go put the software on the desktop, and make sure to identify a diabetes champion in your office to help share that workflow. Create a workflow.

Don't just let time be the thing that pulls you back and forth. Pause. Take a moment to figure out how you're going to integrate this. How are you going to bring the patient in? How are you going to download the data? Where are you going to put it in the chart? How are you going to interface with your patients, whether it's in person during the visit to review the ambulatory glucose profile or whether maybe you have them through a televisit?

What an amazing way to virtually reach out to people for visits but also have their glycemic data. Remember, you can bill for these. These are your time. Beyond just that, you're really giving the patient a tool to help personally manage their disease, and it's giving you a tool as a provider to go down and distill for them that interventional glycemic pathway that they have. It's really for both the patient and the provider.

I urge you to take the time to create that workflow, to identify those patients who could benefit from it, to utilize it in your practice, to help guide your clinical decision making, and to empower your patients for their own individualized journey.

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