Video Maximizing Patient Engagement, Satisfaction, and Clinical Outcomes with Sensor-Based Glucose Monitoring In Type 2 Diabetes Play Pause Volume Quality 900P 654P 524P Fullscreen Captions Transcript Chapters Slides Maximizing Patient Engagement, Satisfaction, and Clinical Outcomes with Sensor-Based Glucose Monitoring In Type 2 Diabetes Overview CONTINUE TO TEST Back to Symposium Thanks so much for having me today. I'm Doctor Eden Miller. I get the distinct pleasure of discussing moving beyond a one C new standards and target destinations for optimizing glycemic control with CGM systems. So we're going to be applying that new CGM technologies to optimize that glycaemic metrics in this real world diabetes practice. Uh I absolutely love integrating CGM. I work in Bend Oregon. I'm the founder of diabetes and obesity care. I am a primary care by training, but I'm a diabetologist and I really believe that incorporating sensor based glucose monitoring, really maximizes that patient engagement. We get massive satisfaction. We get dual satisfaction, we get satisfaction on the patient level, we get satisfaction on the prescribing uh uh facing it's really dual beneficial. And so we want to discuss some of this new real world data that confirms that we see this patient centric preference for CGM care. It really is how they prefer to engage in their diabetes as well as how we as diabetes specialists. In addition, those primary care providers in that setting because you know, for them diabetes is primary. So we're gonna make some distinct interventional efforts to help you feel comfortable with this and empowered yourself as a prescriber. So when we look at those individuals with diabetes, we, we talk about early control is important. And I'm gonna remind you because a lot of the diabetes complication trials, the UK P DS, we've looked at what's called this legacy effect. And if we took two individuals, person with diabetes, a person with diabetes b and they both had diabetes for the same amount of time, right? In this case, 20 years. But if we looked at that 10 year increment of person, a and let's say they had a mean A one C for those 1st 10 years of seven and then they drifted to an A one C of nine for the 2nd 10 years, they're gonna have a different set of outcomes than a person who maybe in the early time of their 1st 10 years were out of control and then finally got it in control in the last 10 years. And so when we look at this information, we actually see that that individual who, what we had that early intervention, early glycaemic control, that legacy effect translated into a 33% reduction in cardiovascular disease and an over 50% reduction in kidney related or reduction in EGFR, which is really that indicator of advancing kidney disease. And as a result of that, the earlier implementation of intensive therapy is associated with greater reduction of what we call those end states. Complication. So what matters by grabbing these individuals trying to fix their dis metabolism and not allow them to drift all over the place. What would be ideal is to keep them in that remissive state. But we know it's challenging, there is this percent risk reduction of diabetes related complications for every A one C we decrease, you know how you have an individual and you really want to get them to target, but we really got to have what we call those intermittent targets or those in between targets. Because as a result of that analysis of the 10 year follow up from the UK P DS and this legacy effect, we get that continued risk reduction for both microvascular as well as macrovascular complications. Even though macrovascular complications tend to be more tied to the therapy. You're doing not so much the destination, there's still reduction in that. And so if you lay out this scenario for your patients to say, hey, let's just try to get a 1% decrease, let's try to get it early, let's try to maintain it. But let's at least try to get that 1%. We have such significant impact in amputation and peripheral vascular disease, both eyes and kidneys, diabetes related morbidity and mortality. M I and then all causes mortality. So every percentage matters. And that's why I do a lot of close follow-up. I have this thing that I try to overcome inertia by saying if your A one C is greater than nine. I bring it back every six days, weeks. If your A one C is between eight and nine, it's every two months. If it's seven, it's every three months. If it's less than that consistently, I go six months. And so I keep hammering at that, keep trying to get them to that target and not let inertia establish itself. So, one of the things I've really been trying to encourage this new language is what we call this validation of A one C by time and range. You know, you can know your A one C of an individual, but that doesn't mean that you know their time and range. But if you know their time and range, you can know their A one C. And so why don't we move on? Why don't we go from this average retrospective past metric into this present metric by saying, OK, I know what you're a A one C is now, I'm going to check your time and range, right? 71 80. And it goes beyond just getting that average. It, it takes your glycemia out of the past and in the present, it captures variability, which is really what drives hypoglycemia and complications. But it also empowers the patient to live with their diabetes in real time and not live with their diabetes in a retrospective three month type of analysis. So there are factors that have big impacts on daily life with diabetes, you know, when we looked at all the different things you have to do in a given day for persons with diabetes, time matters, right? You gotta check your feet, you gotta make sure you go to your eye appointment. You know, food choices are so important. And so when we look at the individual types of diabetes with type one distinct with those with type two who are insulin and those with type two diabetes, not on insulin. We see if we look at food choices, everybody benefits from it. That's why I believe that CGM reveals the impact of what food happens. I tell patients when you're utilizing CGM, I don't care what kind of diabetes you have, whether you're on insulin or not or which type to be aware of how foods affect you. I I say find the fabulous five, find the five foods that you know, don't have a glycaemic impact. Then I talk about finding the forbidden five. Find the five. You just say to yourself, you know what uh it's not worth it. It's not carb worthy, it's not worth it. I'm gonna go to something else. When we look at time and range, we see benefits especially for type one. That's why type one diabetes CGM is standard of care. It's also why it's becoming standard of care for type two diabetes on insulin because their time and range vastly improved. But an area that many of you may or may not be familiar with. Is those persons with type two diabetes have a massive impact with their time and range. Well, how is that? They're not on insulin. It's because you're empowering them to carry the burden of their disease, to see how stress and lifestyle and different things impacts it, not necessarily that they're going to take a different med that day, but maybe about adherence. And so when we look at some of those expected numbers, all of the individuals with diabetes, irrespective of what kind they are, are gonna see. The revelation of the fact that I didn't know that I was that number. You know how they all say, oh, I can tell you who, what, where I'm at, I can feel it now it's pretty much hidden. And so a lot of this brings the numbers to the forefront, allows them to make more informed health decisions and dosing decisions as well as empowers them to dose insulin in a more uh concise manner and gives them that realization of what are my numbers. And then finally, hypoglycemia, we know it's imperative. We know it's imperative to impact hypoglycemia. We know it's imperative to be impact A one C and avoid complications as well as what we call symptoms of complications, right? When you have long term lack of glycaemic control. In other words, when I call diabetes metastasizing, so there are drivers of a positive mindset. One of the things I hear some is, oh, if I'm gonna be doing CGM, the patient's not gonna know what their numbers all are all the time. I actually disagree when you look at people who have diabetes related distress. Right. In fact, the most distressed are the most unengaged. So if you ever have a person that just doesn't engage in their diabetes, I always take the opportunity to say, why don't you feel important enough to take care of your diabetes? What happened to you when you were a kid? Because we're really talking about empowering. And I believe that if an individual with diabetes, you can see the different types here knows what their blood sugars are. They have a more positive feeling of empowerment. They feel like something else is monitoring their diabetes, right? They don't have to be so aware of it all the time. They can be alerted when they wanna be alerted, they could be aware of what occurs. And then in addition, they can take lifestyle interventions such as exercise, you know how hard it is with type one diabetes, I have it to be able to go to exercise. You're like, oh my gosh, I'm trying to get healthy, but I gotta make sure my blood sugar is right. So this is where this little guard dog, this little uh best friend in diabetes is there to help empower you to do lifestyle changes. And so I wanna turn CGM into that positive driver. And so with that when you introduce your, your patients to CGM, make sure you look at it as I wanna see all the journeys that you make. I wanna see how your diabetes is unique to you. And I wanna open your eyes to all the different things that occurs. So when you were coming back to see me, tell me what you've learned about yourself and tell me how this has empowered you. And so that a big impact on life. We've looked at this particular study that talked about this online survey, talking about source successes for current carers and what are the priorities for people with diabetes? You know, many differences between daily life and rank for individuals when you look at what's important to them. But time and range is number one for all, we'd all agree, right? Every person with diabetes, irrespective of who they are or what they do, they always ask me, what should my blood sugars be? How do I keep it there? And so that's number one, type ones might say that I wanna make sure that I don't have a sugar that I just didn't know where it came from. Type twos are more a one C centric, right? Because we built glucose control on the A one C. But we're now going to be changing that we're having a different message. We're having that A one C that is validated. That's on that foundation of time and range. We know that individuals on insulin, both type one and type two really are worried about what kind of dose should I do. And hypoglycemia is really on everybody's mind. But you can see that the rank changes a bit when you're a person with type two because maybe you have different types of targets for them. And so that's why I say every person with diabetes, every person could benefit from CGM, they might have different benefits, but they're all going to benefit in some way in their own disease state, which is a perfect segue to say who really benefits from CGM. I know we talk about affordability and accessibility or what we call coverage. But let's be allegiance to the disease. When you look at A one C as an average, we've already reviewed how it doesn't tell the whole glycaemic story. It's just an average, it's in the past and individuals can have the same A one C but vastly different glucose ranges. In fact, as we're going further into the complications and control of diabetes, we're discovering that variability, you know, the highs and lows, the peaks and valleys, those are probably more of a driver of complications as well as more of a driver of the risk for hypoglycemia than the destination A one C. It's not the A one C that confers hypoglycemia. It's how you get there. And so I remind the prescriber to open your eyes as well as the patient's eyes. It's also very beneficial when you have somebody who, it just doesn't make sense. Maybe you get an A ONE C and you're like, well, the patients telling me they're checking their blood sugar in the morning and it's this, but their A one C doesn't congruent with that self monitoring. Or when the patient says I've been trying so hard and yet my A one C hasn't budged. There's also a utility of CGM for what I call the unengaged patient. Remember how I told you the highly distressed patient is unengaged. It's not because they have a death wish. It's because they're so overwhelmed, they cannot control it. They don't know what to do. And so that's an ideal time where you identify that individual to say, hey, would you like to wear something that's gonna monitor you? You when you wanna forget, but it's gonna remind you to look up when you need to. And at the same time, maybe you could just kind of observe your life. Don't try to change anything, don't try to be different, but just observe your life. So you see where you're at. So I unblind you and then I'll show you how you can start intervening with things that can really make a difference. I love when prescribers download those A GPS. It's so important. Don't just have the patient benefit from it. Have you as a clinician benefit from it, from the engagement and patient discussion, overcoming barriers, intensifying treatment plan. That's one of the biggest things we have here with the AD A and its committee on overcoming inertia, our inertia and fear of hypoglycemia. Right? How we are reticent to advance therapy because we always have that big looming fear of the low. But rather you have this low detector, you have this device that is going to remember that you have diabetes. In addition, if you need more insight, if you need to find out the effects of food and activity stress, I had an amazing case. The other day of an individual who was wearing AC GM always seemed to be pretty much time and range. But on 2 to 3 days out of the week, the blood sugars were over 300 and it was like two or three o'clock in the morning. And I kind of teased the individual saying what is happening on Monday, Wednesday, you know, Tuesday, Wednesday and Thursday. And she goes, what do you mean? I'm like, are you ready in the fridge in the middle of the night? Because your blood sugar is so high. And she said, what days are those? And I said it's this day and she said, oh my goodness. It's when I care for my mother in hospice and she wakes up in the middle of the night has to go to the bathroom and I'm afraid she's gonna fall. I was like, I cannot believe it. I didn't really need to talk about intensifying therapy. In that time, I needed to talk about stress reduction or how she was dealing with that. So you can see that CGM uncovers all the causes of the glycemia and empowers you as a prescriber to intervene in that glycemia that up until then you and the patient weren't even aware of. And so when we look at kind of the association of CGM uses and treatment satisfaction, that's important. So you take persons both with type one and type two diabetes, we look at their what we call their satisfaction score, right? Diabetes treatment satisfaction among CGM. What we looked at was a prospective multi center trial at adults who had diabetes. It didn't matter what kind they had. And we looked at their six months baseline pre period and then during the six month follow up period with using CGM, we had almost 1000 individuals, we had a different mix of type one and type two. And we also looked at what we call the perceived frequency of hypoglycemia. And what we saw is there were significant improvement in the overall feeling empowerment or that satisfaction with utilizing CGM. We saw that the daily frequency scan correlated to a decrease in A one C. This was using a scan system and with each additional scan, it was the reduction of an A one C of 0.04%. That by just knowing the blood sugar things improved and there was this kind of minimum time we actually saw that between about 18 to 13 times per day of viewing or engaging in the glucose really allowed for that improvement. And we saw that those individuals who are now more engaged in their glycemia, they felt better about using CGM as well. And so if we look at the overall breakdown of the scores, so what we looked at BGM is in the kind of the aqua blue and in the salmon color of the freestyle Libre system. Well, type one on the top and type two. And we saw that the treatment satisfaction was significantly higher in the use of this FS cell system. And it had a statistical p value associated with that. If we looked at some of the other scores about convenience and flexibility and satisfaction, you can see that they all were in the positive towards looking and effectively intervening what I found to be interesting of the perceived frequency of hyper hypoglycemia. Even though I do believe patients are not fully aware of it. I do think that when you see people with CGM use, it says the perceived frequency of hypoglycemia is less. I think that's because they're empowered to know it. And so they're experiencing hypoglycemia less as well. So this is where the patients benefit on so many levels, uh it on their convenience, their flexibility, I call it uh uh it unburdens some of the day in and day out part of diabetes. I think that's why what we call lack of engagement, uh predominates because we really don't have things that actually help save the patient time and ease the burden. And that's why I think CGM really intervenes with that. Now, let's talk about CGM and patients who are older. This is one area that I've been quite interested in. I've been working with a lot of different agencies from hospital to extended care facilities, especially even workflow with people who are elderly or of advanced age in utilizing CGM because many of them hadn't ever engaged with their diabetes that much. And so there were studies also looking at diabetes treatment satisfaction of CGM in adults with type two diabetes who were older than 65. Again, we looked at that six month lead in and then that six months of utilizing it around 267 individuals. And what we saw is that utilizing CGM was associated with significant improvement in diabetes treatment satisfaction, kind of that unb it. And the more you scanned, the improvement of the A one C was seen in that population as well. And here is that graphic showing that overall score, significant improvement even for individuals who are advanced age. We talk about technology in this group, right? We say, well, I don't think they'll do it. I don't think they'll like it. But we can see here that this particular demographic also had a high treatment satisfaction score. In fact, their overall treatment and flexibility even exceeded that of the younger population. So you're never too old uh to stay current with some of the ways to intervene with glycaemic control. And this allows them to have their disease. And I always say, does diabetes have you or do you have it? And so this is a, a scenario where we're going from the old conventional way of blood glucose monitoring, the old way of retrospective A one C to a present day real time monitoring of glucose. And I love this particular study that was done by Marion. This was looking at individuals who um had CGM and kind of the metrics, right? When they report having an improved understanding of their glu fluctuations of 95%. That's big. That's a big number. I, I don't think we could get 95% of the people to agree uh that they like their phone, right? And 92% of the individuals found it easier to manage their blood sugars with their meal. 92 that's a great number. 77. So more than two thirds felt they had reduced hypoglycaemic events, whether they were aware of how to deal with them and whether they actually had less of them. Now, exercise is hard to get people to do. But 37% improvement in exercise. It's one of the hardest metrics. In fact, it's one of the biggest barriers that is reported when we look at diabetes, that ability to engage in regular physical activity and using applications matter. I know that Medicare requires that we have readers in order to level the playing field for those of advance age or different incomes that cannot access smartphones. But if we look at an app based platform of CGM, we actually see that that app base has more time and range 1.2 hours of time and range less variability which equates less complication, lower average glucose and less hyperglycemia. Just because they were using the App based system. I think it's because our phone is now an additional appendage that we have and having it with you having as a part of you as you're engaging in this world of technology. And I think that's why having this application really has kind of broken into that everyday life. And we see that benefit. This is one of my favorite studies because yes, I actually helped complete it and this really goes to the economics and I know we've been talking about the patient, their satisfaction, how we're trying to go from that A one C to that time and range. But I think when we see the impact of lack of glucose monitoring on cost, it becomes quite apparent. And so the flare study looked at both patients with type one and type two diabetes around 1300 or so. And we looked at the rate of absenteeism, you know, I've seen it even in my clinical practice of employees that suffer with diabetes where they couldn't show up to work or they're having issues of feeling high or low, just feeling lousy. And we saw a 50% 58% reduction in absenteeism. That's very important metrics for those of human resources, those who deal with large employer based systems. But I think the one I'm most impressed by is the reduction in hospitalization admissions. Can you imagine the cost savings of using CGM in this population with a 66% reduction in hospital admissions in my neighboring county where I live, my very close friend runs the dispatch for Ems. She's the head of that and we were having lunch together. She asked me what I was doing. I talked with her about CGM and she said, do you know that in our county phone calls 911 calls for hypoglycemia are the number one thing we get called for. I was like, you gotta be kidding me. I don't think anybody knows that. Yeah. In fact, they said we often deal with it there and our number two purchase Met is Glucagon. I said, can you imagine if every person who phoned you at 911 where you were able to give them a sense? She said, oh, our amount of calls would drastically decrease. We also know that hospitals whether they were readmitted or rese by the emergency room for both hypo and hyperglycemia are significant. We see that in fact they get dinged, right. At least here in the United States, they get dinged for having what we call those repeat offenders. So this is how that economics of CGM goes a long way in re in reducing these acute related events. At the lower bullet here, six months after getting CGM patients, not on bolus insulin, not on bolus insulin, right. Just that one shot a day had a 30% reduction in acute related events. And here in the states, our Medicare or beyond 65 system now covers CGM for those who are on one shot a day or more or who experience acute related events. So make sure that you document these occurrences so you can have accessibility for the CGM. Here's another study that I was proud to be a part of and it was looking at the a one C reduction after the initiation of the freestyle libre two system in type two diabetics patient who are on long acting insulin on the left and noninsulin therapy on the right. And so if we looked at those individuals on the left, these were the one time injectors, right? And those individuals, if we grouped them as a whole, those with type two on one insulin. And on all, we saw a 0.8% reduction in that first six months, didn't matter what you were on and that still had durability at 0.6% a one C reduction. Now, if we were to pull out the cohort in this combined group of those who weren't on insulin. I'm talking oral antibe agents, those on maybe injectable GOP ones, but no insulin, no rapid, no long acting. They had a 0.9% a one C reduction that still was durable at 12 months. These are people that are not doing shots. In fact, these are the people that for years, we have kind of disenfranchised that they can't even benefit from knowing what their glucose is. But I hope that you have seen up until this point how much both for the prescriber and the person utilizing CGM is gonna benefit their life now reduced time and hypoglycemia like this one as well. We've got the type one is of the impact trial. The type twos with the replace trial, the gray are those who are the control and the blue are those that are sensor based. This was the reduction in hypoglycemia, OK? For both cohorts one and two, reduction in hypoglycemia in minutes per day, per day. And they didn't have a significant increase in A one C. It's there to blow this concept out of the water that in order to protect against hypoglycemia, you gotta increase the A one C. No. In fact, it doesn't, you have to decrease variability. In order to prevent hypoglycemia, you need to implement CGM because that empowers the patient living with the pa with this disease to reduce those acute related events Now, if we go over the 10 year cumulative incidence of developing diabetes complications after improving time and range, right? We wanna know because we've looked at the Honolulu heart study before that says those why glycaemic excursions? We've even looked at some of the newer studies of cardiovascular disease, even in prediabetics, what we call that glycemic excursion, we want better time and range. If we looked at type one in the first column compared with type two, and we looked at three incremental types of time and range, whether it was 50% 8% time and range 70 or 80. Remember that 70 to 1 80 we looked at what we call the hazard ratio of myocardial infarction, whether it was M I type one and type two end stage renal disease, severe vision loss and amputation. Look at the effects, look at that incremental improvement or rather reduction based on time and range. Look at how it affects the type ones and types twos. We often forget that those with type one diabetes can have metastatic diabetes as well. And so time and range matters, glucose variability matters. And now you have a tool that will allow you to both monitor and impact. I had a patient one time that said to me, you know, Doctor Miller, you cannot manage what you do not monitor. And I said you're absolutely right. And that's why CGM has revolutionized the impact of diabetes. And as a result of that we are going to reduce costs. And by investing making the investment of BGM, we will have a cost reduction of billions from 70 to 80%. Look at this improvement from time and range of cost reduction from 58. So if we see that first target of 70% that's that cost reduction. If we see the second target of 80% that's gonna pay for itself over and over and over again. And we know that those various agencies that deal with reimbursement and payment are seeing this because you only save money by allowing individuals to manage their disease to get to that target. If we look at cost reduction in those with type one, we know that type one standard of care is using continuous glucose monitoring. Even impacting hypoglycemia has an over a billion dollar improvement. If we get a 20% reduction in hypoglycaemic events, it's 1.7 billion, only a 10% reduction is over a billion. If we get 30% it's 2 billion. If we get a 40% reduction in hypoglycemia, it's near $3 billion it's definitely gonna pay for itself. And so the standards of care in 2023 of the ad a have gone a long way to help clarify based on the data, based on the data that's coming out, more and more each month, each year to go through. The use of CGM devices should be considered at the very outset of the diagnosis of diabetes that requires insulin management. I think we've only just begun. In fact, I think that we'll be able to show that all persons with diabetes will benefit. Whether CGM is a risk identification and risk reduction tool, whether it empowers the person to see the effects of their glycemia in early stages of diabetes. I know we're not quite there yet, but I believe we will go there, we will get there because we're on a destination of glycaemic control. We have a tool that opens our eyes to all the different glucose levels that we do and we see and we visit, but we need to make it individualized and educate. We need to match the device to the person. Here's where I like to dictate when I make recommendations for CGM that it really is ideal for people who've had maybe acute related events. They're at risk for hypoglycemia. They have secondary issues such as chronic diseases, they have caregivers that need to help intervene with them such as young Children who have family members or caregivers. What about individuals with DEX? Right? Some people that can't really poke their finger as well or they have cognitive impairment and don't recognize hypoglycemia. These are all the consideration, the considerations you're gonna need to have as you think of CGM for that person. And when you prescribe that device, make sure that they have follow up, make sure that they have support, make sure that both the caregiver and the wearer, know how to use that and make sure you're matching that CGM and the different features to that individual. There is broad application for those in type two diabetes on and off oral therapy. We know through the different recommendations that if you want better engagement, how physical activity and medications are affected, how the risk of hypoglycemia, even in the oral realm or the injectable realm, how those individuals with multiple daily injections. They guys you should be on AC GM if you're on a insulin delivery device and you're type two, you should be on that. That's the standard of care. And now with that basal insulin recommendation, as you saw the data I showed you previously, I think, like I said, we've only just begun for those people with type two diabetes. It is standard of care with type one. It's still exceedingly beneficial in type two. And I think we will see those care recommendations continue to grow with the data as it's presented youth for type one and type two. I hate to say how much type two we're seeing in youth. I run the camp in Oregon now and I'll tell you having CGM for type one diabetes has been a game changer. We don't have to wake up and poke these kids fingers. We just have to look at their technology, look and see where they at because type ones have a lot of variability. We see a lot of pumping in those individuals. We start to see that kids with type two diabetes are exceedingly insulin resistance. There aren't a lot of medications approved for the intervention of type two. So many of these Children are requiring injectable insulin, whether it's through multiple daily doses or through insulin infusion pumps. And so this is where the two of them become the standard for that. So what do we get? What do you get as a person? What do you get as a clinician or a prescriber with CGM to the person? CGM brings diabetes out of the past, into the present. It helps the person anticipate the future through arrows and trends and notification. It is individually driven. It is the most patient centered glycaemic journey tool we have out there. We want to orient the patient to the trend arrows what to do, how to be aware of it, how to set the appropriate alarms, whether they need alarms or not. We want them to be mindful. Like I said, the Fabulous five foods, the forbidden five. How stress activity, engagement and medications impacts our glucose. Not only that we are giving the patient as well as the family and the caregivers. A peace of mind. Don't forget the clinician, make sure and download these reports. You have an opportunity for that increased individual engagement that frees you up because they're gonna engage with their disease. Now, what you get the opportunity to do is to reveal the therapeutic impacts. You know, this system is gonna monitor for hypo so it can take it off your plate, right? It allows you to then accelerate or advance or de intensify therapeutic impacts. Depending on what you saw. Maybe you did see hypoglycemia, maybe you need to de intensify. Maybe you need to shift therapy from one part of the glycaemic day to the other. Don't neglect printing out, downloading PDF and showing intervening, discussing talking, engaging all those adjectives of what to do with CGM. You can also bill for this in many scenarios. Make it a part, make it a part of your shared decision making, make it a part of your visit with your patients. And there are some essentials for effectively incorporating CGM. The patient needs to understand that this allows them to feel in control. This is not a continuous glucose score or acceptance meter. It's a data set. It's feeling a part of that shared decision matching that CGM its features to the patient, what kind of needs they have and how they can benefit from it. I always say what we're gonna try to do with it. I say, what do you want to learn while you're doing your CGM? Let's journal the effects. I don't want a novel. Just write down some of those things. Then me as an AC P when I pull it back, I go what happened here? Oh, that's when I went out to dinner for my birthday. What happened here? Well, this is when I had this particular food, I had no idea it would affect me. Make sure you're downloading it. You have that workflow in your office to be able to identify the patients, to get the data, to incorporate it in the chart note. And then you'll have those in essential components so you can maintain that dialogue, maintain its utilization. It might take you a half of the day or an extended lunch to do this, but be purposeful about it because if you put the time in now, you'll definitely get that time on the other end. And so I hope it's been compelling because I still ask myself, what are you guys waiting for? What are you waiting for? This can only help you. Yeah, you gotta pause for a moment. You gotta start the job, but you're going to see early benefits to this. You're going to establish a precedent early on in somebody's life. Not only that, even if they're older, you're gonna bring them back out of the dredges of diabetes. I don't care what type you have. I don't care what you're doing for that intervention. You're going to improve that quality of life. You're going to reduce the cost of admissions to the hospital complications, work, absenteeism, you're gonna improve their time and rangers is gonna help their complications. We now have a metric. We can go beyond just the A one c the standard of care for the AD A backs you up. So dictate that document that this is what I'm doing. I'm following the standards of care. This is how uh this is the standard of care for type one. These are the emerging benefits for type two us as health care providers are in that key position. I don't like to defer it to other people, but I know some of you do but please embrace this. This tool is for you. This tool is for the patient and it brings you together to try and help intervene and, and be impactful in this lifelong type of condition. So as you know, we're moving beyond that A one C, we got new standards and targets and we're gonna optimize that control. We're gonna validate that A one C by that continuous glucose monitoring data. Thank you for joining me uh in this presentation. Published June 21, 2023 Created by Related Presenters Eden Miller, DO FounderDiabetes and Obesity Care LLCSt. Charles Hospital Bend, OR
