While at the Value-Based Medicine Institute® (IVBM) event held in Cleveland, Ohio; American Managed Care Journal® (AJMC®) We sat down with two experts to discuss new diabetes technology.

  • Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES, Endocrinology Nurse at University Hospitals
  • Kevin Malloy, PharmD, BCPS, Pharmacy Materials Coordinator, Cleveland Clinic Akron General Medical Center

New technologies such as continuous glucose monitoring (CGM) are revolutionizing diabetes treatment and benefiting patients beyond those requiring intensive insulin therapy. These technologies provide actionable insights into blood glucose patterns and facilitate individualized treatment decisions, even for patients on lower-intensity insulin therapy or those not receiving insulin at all.

According to Bellini and Malloy, successful implementation of diabetes technology requires a collaborative approach between healthcare teams, focusing on the patient's unique needs and configuring the device accordingly. Ultimately, it can strengthen patient-provider relationships and improve outcomes.

AJMC: How will the new technology benefit all people with diabetes, not just those taking multiple insulin injections?

Natalie Bellini, DNP – LinkedIn

Bellini: Thanks to new technology, many people with diabetes can now identify patterns in which their blood sugar levels rise or fall. If you have someone on metformin and you put a continuous blood glucose sensor on them, you can't just tell them what foods affect their blood sugar, but also how exercise affects their blood sugar. You'll also know if it's time to add more medicines or medicines. do not have.When we first started, the pump was [was seen as] This intensive technology. Other technologies are now available to most people with diabetes. If your insurance doesn't cover it, you can still use something called a diagnostic CGM. This device is actually owned by the clinic and the diabetic patient wears it for 2 weeks or 10 days depending on his diabetes symptoms. You can check the pattern together by returning it using

Malloy: As the literature expanded and grew over the years, individual CGM data initially focused on populations using more intensive insulin delivery devices. [such as] Pump and multiple daily insulin injections. As time passes and CGM becomes almost standard of care for all patients on insulin, there is increasing data supporting that CGM can be used to improve glycemic control in patients on lower-intensity insulin therapy. Masu. And between the time research begins and the time it's already published, new technologies have emerged and standards of care have changed. I think we will soon be able to show significant efficacy in patients who are not receiving any insulin treatment, which will reflect real-world practice standards. Clinical outcomes aside, we don't have the same health care system as he did three years ago. We live in an environment that relies heavily on remote technology, and we believe many of these technologies are enabling the ability to provide remote care to patients with diabetes. This now fits pretty well into our medical model, particularly improving diabetes care, but also allowing patients to be treated in the way that works best for them.

AJMC: One of the concerns with technology and data collection is whether the data is good and actionable. Have you overcome it or are there still problems?

Bellini: Continuous glucose sensors measure glucose every 1 to 5 minutes, potentially resulting in 1,000 readings per day. But instead of coming in an Excel spreadsheet that you have to decipher later, it comes in a report that you can easily learn to read. When I talk to medical students or people who have never injected before, I say this. “Do you remember how you learned how to administer NPH insulin?” In the old days, we used to administer insulin based on finger pricks several times a day without any problems. This is just a different way of looking at the report, and you're actually looking for patterns. What you're looking at is not what happened at 2:00, 2:02, 2:07, but did this person wake up after lunch? Does this person wake up after lunch most days? Do you change their medication? Offer to change it? Do you watch what they eat? And how do we make those decisions?

Kevin Malloy, PharmD – Cleveland Clinic

Malloy: Healthcare technology, of course diabetes technology applies, but I think it's rarely really useful in and of itself. Rather than just basically throwing a device at a patient and letting them learn it themselves, we need to work with great clinicians who are familiar with the device itself and how it can be used to impact healthcare. there is. So I think that's very important. Many payers combine some level of coverage with demonstrating benefits for the use of these devices. Regardless of the payers, I think we should really take on the challenge in healthcare. If we're going to bring these technologies to our patients, that means we need to work with them, not just the patients, to realize the most benefit from them. It's not just about getting started and training, it's about the follow-up process to ensure the user gets the most benefit from the device, no matter what it means to them.

AJMC: How can care teams ensure successful implementation of diabetes technology?

Bellini: Each care team works a little differently. Roles should be defined for different members of the team so that people don't get lost. This is the most important thing. As a prescriber, I typically prescribe a CGM and a diabetic patient begins wearing her CGM. In fact, we also have a pharmacist on staff at our clinic who follows the patient for her two to four weeks, checks the continuous blood glucose sensor, and makes treatment decisions based on that data. And if other needs are identified, we'll send someone to the dietitian or diabetes educator, but every interaction downloads glucose so everyone is involved in treatment decisions together. It will be.

Malloy: The Association of Diabetes Care Educators, a working group of the Association of Diabetes Care Educators, published a paper several years ago that laid out a framework for implementing diabetes technology in practice. It's called the Identify, Configure, Collaborate Framework (ICC Framework). The first part is to identify. That means being knowledgeable about the diabetic patients you're working with and highlighting whatever their specific problem is. Because just as no two diabetics are the same, no two diabetics are the same. Therefore, it is about understanding what is the barrier to achieving optimal health and optimal diabetes outcomes. And if we can pair that patient's problem with a device or technology that might help them overcome it, that's kind of step one.

And you also need to make sure that you're configuring that specific device for that patient. This also applies to the follow-up mentioned earlier. As such, we must ensure that the device and some of its benefits are tailored to the individual patient's needs, beliefs, and ideal healthcare delivery. Finally, we need to work together to ensure data from devices is used to drive better outcomes, increase transparency, and drive data-driven conversations. I think this is just a buzzword that we like, but ultimately this is very helpful in improving the patient-clinician relationship and making the interview less of an interrogation and more of a conversation about objective data. Masu. I always think this is a good piece of work. This really simplifies the workflow of patient visits and helps improve the patient-provider relationship.

AJMC:In your previous answer, you used the word interrogation. Do patients sometimes feel like they are being interrogated?

Malloy: surely.i do my best every day [to avoid that feeling], but then when I leave the hospital room, I sometimes feel like I've subconsciously interrogated them. By putting that aside and actually presenting that information up front, it becomes less of an interrogation and more of a conversation. It sounds like a cliché, but it's very true. We have to spend a lot of time in this area. It's a very numbers-driven field. Whether you're a healthcare provider or a medication assistant, this is a very data-driven field and that's a lot of the metrics that we accomplish. We don't work with numbers, we work with people, and part of that is working with numbers. And with technology that can collect and store that data, you can take that part out, and in many cases, when you put clinical decision support tools in there, you can take that part of that interview and actually have a heart-to-heart with that individual. You will be able to open and speak. Then, make sure you use those numbers to help everyone reach their goals.

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