Thank you, Vivian for that wonderful overview. I'm gonna pivot a little bit now and talk about incorporating CGM based glucose patterns, insight reports commonly referred to as the GP IR and treatment prompts in type two diabetes with a focus on refining and simplifying clinical decision making based on CGM. So what is the most important pattern that you see here? If you have the labs? As noted over here on the left, the labs are fine. The A one C is 7.5. You can see the regimen that the patient is on to include maximum dose of Metformin, maximum dose of AD LP one receptor agonists glipiZIDE before breakfast and dinner. And you have this A GP report. I wanna challenge you to ask what is the most important pattern that you see? And once you've identified that what is the therapy change that you would recommend? And I've listed about 12 or 13 potentials here. And as you go through your clinical decision making, when you look at this pattern on the A GP report, here are your some of your choices that you would make mindful that you want to be, make one change only. So what is the best decision that you can make after you've identified the most important pattern? Well, so let's go ahead and talk a little bit about the A GP report. The A GP report is a standardized report that's developed by the International Diabetes Center or I DC. And it shows a standard set of information and graphs. You can see them here. The timing range target values, the subjects, timing range values the A GP figure in the middle section and in the daily glucose uh profiles. It's important to note that the focus of this was designed by indos and intended primarily for indos and diabetologists. It's not really a tool for the nonspecialists. Uh And as Libre has expanded, the care providers that are subscri sub subscribing and prescribing are no longer diabetes specialists. Hence, there's a need for a new report for a nonspecialist care provider to be able to easily interpret glucose data. Now we see the GP IR or, or the glucose patterns insight report. The intended user is a non diabetes specialist but a person who treats patients with diabetes. The cash strategy is outlined here is to identify and work on one pattern at a time doing so by simplifying the assessment and therapy change process, by focusing on what we call the most important pattern in the hierarchical structure of lows eyes with some lows and then high glucose patterns. With the goal to address the low glucose patterns first. And if a low pattern is mitigated at the next visit, address the other patterns in the order that we've listed them and the high patterns when the low glucose patterns are mitigated, that is the time that you want to address the highs, taking care not to make the lows worse. And the high variability of this up and down the roller coaster so to speak may prevent from addressing highs without making lows worse. And in that situation, you want to discuss lifestyle changes or lifestyle behaviors that may be contributing or consider different therapies. The elements of this A GP report are represented in the glucose patterson insight report, but they're simplified less busy. So why do we need this report? Well, as we've already indicated, uh many primary care clinicians are not diabetes specialists but treat patients with diabetes. Primary care clinicians are very busy and have limited time to address the patient's needs and health care needs. Uh And to review excessive amounts of data, there's a discordance between the quantity and kinds of new therapies for type two diabetes and improved outcomes which highlights an unmet need for tools to help the clinician make appropriate therapeutic adjustments. So a primary care physician would benefit from a way to make it easier, faster, safer, to make a better clinical decision for their patients living with diabetes. So we proposed a useful performance improvement tool would permit the non expert primary care physician to make a better clinical decision with minimal disruption to the workflow, easier, taking no more or less time faster and without adding additional risk for adverse events such as hypoglycemia safer. So you see the old A GP report here on the far left, same data, the same information in the glucose patterns insight report, which is right here in the middle panel. So need to understand that this is not one or the other, but you actually have both at your disposal. The glucose patterns Insight report updates from the A GP report, but it removes the time and range consensus targets that are in the upper left hand corner of the old A GP report. It has a different A GP figure design with color coordinated with the glucose patterns Insight report and it shows the critical A GP patterns down in the bottom. You can see it highlighted in the red box there. It also suggests medication or lifestyle considerations and it's removed some of the daily glucose profiles and removed the glucose variability. But understand that this is still available in the A GP report. So we wanted to do a problem assessment to see if this glucose patterns insight report improved primary care physicians or primary care clinicians decision making. So we designed this study and the study we had inpatient cases from clinical data. We had an indo uh or a panel of three of us assess this and arrived at what we felt was the most appropriate decision to make for a first and only one change we generated from that A GP reports and 10 glucose patterns insight reports. We enlisted, we had 20 reports from 10 cases to review and we generated these reports to allow a head to head comparison. So we had 35 primary care clinicians and you can see the mixture or the uh diversity of the group here. Over on the right, there were 20 physicians and 15 non physicians representing nurse practitioners, physicians, assistants, and clinical pharmacists. You can see that uh most of them had been in practice greater than equal to 10 years. But there was a significant number who had been practicing less than 10 years. All cases were presented with a report of the laboratory results. The A ONE C and the current therapy and the clinicians were given a maximum of 60 seconds and they were asked to make their first best therapy change, not allowing simultaneous changes. So we generated 10 A GP reports, we generated 10 GP IR reports. If you got in the first round, the A GP report, you were switched over and these were interspersed in your second report. You got the GP IR. If you got uh reports of the GP IR in the first time in the second round, you got the A GP and this allowed for a head to head comparison and to see how people changed. So here's an example of a case with overnight loads. You can see the labs here. Uh We're all fine. A one C was 7.5%. And the medication, this is the score card or the card that they are evaluation card they were given and they would check off. What change would they recommend? This is with the A GP the same patient data, same patient profile with the glucose patterns, insight report. The case breakdown. We had five low glucose cases, five hypoglycemic cases that were interspersed throughout the tin three were high glucose, one was high with some lows and one had no discernible pattern. It was actually in pretty good control. The reason we weighted this toward hypoglycemia was because it's rarely reported by patients, but it's prevalent in greater than 25% of insulin using patients with type two. And it may can be showing severe hypoglycemia. We know that there's a growing link between hypoglycaemia and cardiovascular disorders in type two. So the we analyze each patient pattern subset separately. And for each case, we classified the therapy decisions based on whether or not they address the most important pattern. Whether or not they made a decision that worsened the most important pattern or whether or not they made a decision that prolonged the most important pattern. And we tracked the primary care clinicians deliberation time for each case. So we wanted to see if this was actually faster to be able to do this Well, what did we learn for the low glucose patterns, which is heavily weighted toward low glucose patterns. The therapy decisions using the glucose patterns, insight report improved versus the A GP report. And the time to arrive at these decisions also improved or high glucose patterns highs with some lows or a good control of the the therapy decisions. And the time was about the same. Let's show you this graphically what we learned. We learned that there were, the clinicians were three times more likely to identify and treat hypoglycemia using the glucose patterns insight report. They were 50% less likely to make a treatment decision that would worsen hypoglycemia using the glucose patterns inside report. And they were about 50% less likely to make a treatment decision that would prolong hypoglycemia using the glucose patterns report. Also, we learned that they actually did this faster using the glucose patterns insight report as opposed to the A GP. Now we looked at the preference for the two reports. And again, remember you have both reports available. The glucose patterns insight report was preferred 2 to 1 over the A GP report. Some of the reasons why it was less busy than the A GP report, they felt that it was cleaner and easier to interpret. They preferred the color coded A GP to match the time in range metrics. So it allowed to make an association of what they were seeing and they liked the boxes that highlighted the most important patterns for them to actually direct their eye to make sure they didn't miss something that was important. Now, for those clinicians who chose the A GP report, they like the daily glucose traces. Six of 12 noted that and they preferred the blue color, blue color palette. But again, I want to emphasize it's not one or the other. Both reports are available to the clinician. So let's look at some of the individual case results. And I'm gonna show you a couple of the low glucose pattern cases that we had and how the clinicians performed on. This is the old A GP report on the left in the middle panel, we have the glucose patterns insight report at the bottom. We have the patient uh laboratory A one C and medication. Given this particular profile, only three of the clinicians addressed the hypoglycaemic pattern using the A GP report that number increased sixfold to 18 using the glucose patterns Insight report. Conversely, 17 would have made a decision to worsen the hypoglycemia using the A GP report. Whereas only seven did so using the glucose patterns insight report and 15 would have prolonged hypoglycemia or versus 10 using the glucose patterns insight report. And this really sticks out in my mind as a learning uh lesson that we see is that people are drawn to hyperglycemia often at the expense of hypoglycemia. Another case case three, you the same set up, we have the old A GP report, the glucose patterns Insight report, laboratories, medications at the bottom here, seven, only seven identified and addressed hypoglycemia using the A GP versus 19. Of using the glucose patterns Insight report, 16 would have made a clinical decision or a therapy change to worsen hypoglycemia using the A GP versus only seven with the glucose patterns Insight report. So I think you can get the drift here and remember they did this faster using the glucose patterns insight report. So let's talk a little bit now, just in summary about what is the effect of this report designed on changes to a primary care clinicians decision making. This novel CGM based glucose patterns insight report or GP IR that identifies patterns of suboptimal glycaemic control highlights the clinically most important pattern and offers therapy considerations to address this most important pattern to assess the utility of the glucose patterns. Insight report in clinical decision making. This reading study was conducted comparing it against the standard glucose report or the uh A GP clinical data from 10 subjects uh were used to generate complementary glucose patterns, insight report and a GPS, nonspecialist primary care clinicians, 35 of them evaluate each case in each report designed alongside the A one C and medication regimen to make a therapy change. Only one therapy change recommendation and the the therapy change recommendations were categorized as to whether or not they address the most important uh pattern present with a priority on treating hypoglycemia if it occurs a coincident with other patterns in a given case. So how did they do primary care clinicians address the most important pattern equally well. With each report in cases presenting in patterns other than hypoglycemia across all cases and all subjects therapy change categorizations were different in 79 instances with 67 of these instances presenting as hypoglycemia. What this means is that the primary care physician recommendation using one report addressed hypoglycemia. While that using the other report did not within this subset in all. But one instance, 99% primary care clinicians correctly identified low glucose with the glucose patterns. Insight report. When they did not for the same case, using the ambulatory glucose profile or A GP. These findings indicate that the glucose patterns insight report aids in identification and treatment of hypoglycemia that would otherwise be missed using the current standardized reports. So let's go back to that first case again. What would you see see as the most important pattern here with the, you can see here if we give you that uh the A GP and the glucose patterns insight report. Of course, we would agree that to remove or decrease the glipiZIDE at dinner would be the most important single therapy change that we would make in this case. Now, one of the things that we've learned is that many people can't, haven't figured out where to find the glucose patterns in inside report. So I wanna just give you a quick 123. If you're using Libra view, as soon as you land on the landing page for a given patient, you'll come up with this. It says the glucose reports. If you press or tab in on that glucose reports in the upper right, you'll go to this report, this report suite and you'll see the A GP report is the landing page for that right underneath that. And if you scroll down or if you just tab on the glucose patterns in type report, you come up with the glucose patterns insight report. And then this patient allowed us to use uh his materials here for this one. But I think that you will find that this is a very easy tool to access and a very easy tool to use to speed up your the clinical decision making when looking at these reports. I'd like to thank you for your time and attention uh and hope that you have a great rest of your meeting.
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