Video Practical Aspects of Starting CGM in Your Primary Care Practice Play Pause Volume Quality 720P 720P 576P Fullscreen Captions Transcript Chapters Slides Practical Aspects of Starting CGM in Your Primary Care Practice Overview CONTINUE TO TEST Back to Symposium Thank you Dr Bergen stall for your presentation on beyond A one C. Using C. G. M. And ambulatory glucose profile to help in managing care. So we are going to move on to a little more real world topic practical aspects of using and starting continuous glucose monitoring in your office practice. This is to say how do we make this work in the real world? So I am dr tom martens. I am an internal medicine clinician. I have worked at parc Nicholas brookdale office for the last 27 years and I also serve as a medical director at the International diabetes center in Minneapolis Minnesota. I do have some relevant disclosures. Um I do diabetes research as part of my job at the International diabetes Center. I will say that all financial management for all these activities is done by my employer nonprofit HealthPartners institute. And I received no personal income from any of these activities. So here we go. Technology and type two diabetes in primary care settings. Historically diabetes technology has focused on type one diabetes. Why is that why? Because, well because type one diabetes has a high burden of care, there's a need for precise insulin management. Need for a lot of monitoring associated with insulin management technology carries with it the promise of beta cell replacement through technology trying to really decrease the burden of managing type one diabetes by using technology. So, in the world of type one diabetes, in the world of endocrinology. See gm insulin pumps hybrid closed loop insulin delivery systems are available to proven they're widely used. They have become the standard of care. If you look to the world of type two diabetes, advanced technology really is much newer. The benefits a little less clear. But we know from the world of primary care is that finger stick blood glucose monitoring either hasn't really been shown to be beneficial or perhaps is modestly beneficial for people using non insulin therapies to manage their diabetes. Question is can advance technology like C. G. M. Help them do that better. We know that Finger stick blood glucose monitoring is under used in type two diabetes for people who are managing their condition with insulin will advance see GM technology help them do that better. And we also know that advancement of therapy, titrate nation of therapies is often the missing step in primary care settings. And the open question is can continuous glucose monitoring help us do that better to help people optimize the diabetes care. Why is it important to think towards primary care? Well, if you think about the burden of diabetes in America, there are actually about 30 million people in the us who have diabetes. That's over 10% of our population, most of them 90-95% to have type two diabetes to help manage them. How many Are there in the us depends on where you get your numbers from. But it's 6,000 8000 endocrinologists. And so it becomes very clear that to help manage this huge burden of type two diabetes primary care is going to have to be the ones filling the gap and so that the task becomes identifying who in this larger population of people with diabetes will benefit from advanced technology. And the second task is creating ways to make the technology accessible to people with diabetes so that they have access to diabetes technology. Finding ways to make the data accessible to clinicians, the people managing the diabetes are helping to manage the diabetes and finally improving the skill of primary care clinicians and optimizing care based on C. G. M. Based data. Where do we stand as far as the database for using C. G. M. In Type two diabetes? Well, if you look to the literature this is sort of what we have as far as randomized control trials. If you look at the group with Type two diabetes using multiple daily dose inflict which is to say basil and bolus insulin, what we know is that C. G. M either improves hemoglobin a one C. Or it decreases time in hypoglycemia more than finger stick blood glucose monitoring. We know that from dr Roy Beck and colleagues diamond study in Type two diabetes. We know that from studies using flash glucose monitoring the hacks study. We know that in Type two diabetes for people using basil insulin without mealtime insulin. C. G. M. Used improves hemoglobin. A one C. More than finger stick blood glucose monitoring. We know that from the monitor study and we know that from work done by robert Gorski and Nicole Erhard prior to that. What we don't know is is C. G. M. More beneficial for people not on insulin therapies. There's emerging observational data, there's a lot of intriguing, smaller and older studies, lots of interest, but the level of evidence at least if we look to randomized control trials is suboptimal. Here's a question for you beyond insulin therapy. Are there other groups that may have a fairly clear benefit from using continuous glucose monitoring? And what I'm thinking about is other non insulin therapies? Perhaps older non insulin therapies. And so here's a question for you does self in Elyria therapy have a lower hypoglycemia risk than insulin in type two diabetes. Well, let's look at the data. If you look at the United Kingdom hypoglycemia study group data from 2007, it really does not. About 7% of individuals using cell phone Elyria therapy reported an episode of severe hypoglycemia over the previous, essentially year of the study. If you look at people in the first two years of using insulin and type two diabetes, it was about the same. They both had a pretty significant risk of developing severe hypoglycemia hypoglycemia requiring the assistance of somebody else to correct it. If you look at a more recent study, how about the grade study? So glitchy me a reduction and type two diabetes glycemic outcome study. This data was published in september of this year. 2022. And what they saw again the grade study was comparing for groups of patients huge randomized control trial. They were comparing self delivery therapy. Glimmer pride versus DPP four therapy versus GLP one therapy or clergy. So basil insulin. And what they saw severe hypoglycemia was generally uncommon. But it affected more participants assigned to the glimmer pride group, the cellphone Elyria group than to any of the other groups, including large in insulin. It's 2.2% in the glimmer pride group, 1.3% in the large in group. So clearly cellphone cellphone Elyria therapy is a risk for hypoglycemia. And those folks potentially benefit from continuous glucose monitoring in that hypoglycemia is easier to see, especially at night. So where do we stand as far as guidelines in directing us towards the patient populations who may benefit the most. This comes from the 2022 A. D. A. Standards of medical care and diabetes. What they do is they raped the literature leaning towards randomized control trials and their grading puts for individuals with type two diabetes on basal and bolus insulin. They give it a grade A If it's real time, see Gm grade B. If it's intermittently scanned, see Gm essentially because there's, you know, a little bit of disparity in the literature basal insulin only. They give real time C G. M. A. Grade A. Based on that mobile study. Grade C for intermittently scanned C. G. M. Just because we really don't have the strong randomized control trials for that system. Non insulin therapies grade three or observational studies. There are single arm studies but we really don't have strong randomized control trial data. Yet the american association of clinical endocrinology essentially the same. Um For people on intensive insulin therapy which is multiple daily dose therapy strongly recommended. They also recommended for people with problematic hypoglycemia no matter what the therapy is recommended for Children and adolescents with type one diabetes and recommended in pregnancy. Pretty much across the board and may be recommended for individuals with type two diabetes on less intensive insulin therapy. But again you sort of start to see that the groups that have better established benefits. Starting to settle out. This is the I. D. C. Type two diabetes guidance for C. G. M. Use again we if you're on multiple daily dose insulin you have a lot to gain. You need data. The data is helpful if you're having severe hypoglycemia. We know that C. G. M. Identifies that much better than finger stick blood glucose monitoring. So severe hypoglycemia, frequent mild to moderate hypoglycemia. You really need monitoring hemoglobin aapa these where A one C. Is not reliable. So this gets back to what dr berg install was discussing. It is beyond A one C. Talk is that if you're using his pony in C. As your marker for care. But you can't rely on the A. One C. Data really. See GM data is what we should be leading towards. Perhaps we should be leaning towards that anyway. But for that particular group see GM has high benefit beyond that. People using insulin cell. Finally area therapy regardless of A one C. Essentially because of hypoglycemia risk can see GM work in primary care practices. I think I'm here to say yes it can. I can tell you where we started. This is back in 2018 we actually did a quality improvement project using the first generation of C g. M. S that didn't require calibration. So professional C. G. M. First one to the market in 2018 and what we did is we did a quality improvement project to see sort of how it would work in a primary care setting. Especially looking towards workflows working towards was it even effective? And so what we did is we collected a group of individuals with type two diabetes a one CS between seven and 11. So not meeting their glycemic goals managed on any regimen. If you weren't meeting your glycemic goals. We were going to see if see GM could help you do it and they had to be willing to use professional C. G. M. What we did is they had a two week professional C. G. M ware had a visit after that with a clinician or a diabetes educator to review the data. You share decision making. Talk about impact of lifestyle impact of diet. Talk about whether they needed to be a change in therapy, advancement of therapy or intensification of therapy. And then they set up a visit in three months for a second. A. One C. So who did we collect when we look for people not meeting their glycemic goals in our care system? I think I'd like to think of our care system as a relatively high functioning care system when it comes to optimizing glycemic therapies. What we found was that most of these people not meeting their goals between seven and 11 for an A. One C. Were on insulin. And it's not a surprise if you really look at our system data I think you're about 20% less likely to meet your glycemic A. One C. Goals if you're using insulin. And so just this tough group. And again the group that C. G. M. Really shows benefit. But we saw and we published this data just in 2021. We actually initially presented it at the A. D. A. Scientific meeting in 2019 but a pretty robust decrease in a one C. 8.8 to 8 0.2% with a single cycle of um professional C. G. M. Where did see a little bit of increase in hypoglycemia which I guess is not a surprise. And I think to my mind is an argument for personal C. G. M. In this group but it worked. it taught us a lot about workflows and has allowed us to really move forward a lot more effectively in our care system. So having said all that, how do we close the gap so that everybody who could benefit from C. G. M. Really is benefiting but we know is that um there's accumulating evidence that C G M works a little bit better than finger stick, blood glucose monitoring and research settings. If you look at the randomized control trials, research success, it isn't always the same as real world success but we do know that initial data from real world looks is really promising. We know that from large observation all cohorts, we know that from work we've done internally. So what factors need to come together to improve the quality of care we deliver, improve the lives of individuals with type two diabetes if we are using C. G. M. So here are barriers and opportunities and I like to think of these three broad categories as categories that are necessary to really optimally use technology. So to facilitators for the use of technology and primary care to think about it, availability and access of devices that is C G M is not going to improve anybody's diabetes management if they don't have access to see GM. So we need to think towards um Medicare, we need to think towards care plans on the national level to help make technology available. Second broad category technology and support on a local level. So it's one thing for people to have C. G. M. And using C. G. M. It's another thing to actually get that data and use it to improve care. And I say that knowing that for finger stick blood glucose monitoring, it seems like one of the biggest barriers was people are checking their glucose but is the data accessible at the time of clinic visits often. Not. So we need the technology to make it available at the time of clinic visits for CGM. We need support on the local level cables, cloud based therapy. We need process support and workflows and ideally EMR based access for documentation. Last category if you've got the data, people have the devices you have the glycemic data. You have real time data. You have retrospective data. We need to help clinicians and people with diabetes know how to use the data. So pattern based management based on ambulatory glucose profile data, retrospective C. G. M. Data and metrics based medication selection needs to be a priority. So let's think first about access and availability and we know that real world research is needed to help clarify what populations benefit the most. The other issue with access and availability is we really need to take a long range view in evaluating the cost benefit in the total cost of care for diabetes technology because it's not cheap. And what we need to do is make this technology available to the whole population who would benefit that includes populations with barriers to care includes includes populations who are socio economically disadvantaged. And we need to figure out how to make that happen in the big picture at the national level. Here's another question for you. What aspect of the care of individuals with diabetes consumes most of the resources which is to say cost the most? Is it nursing and residential facility stays? Is it prescription medications to treat the complications of diabetes? How about diabetes medications, anti diabetic medications, diabetes supplies? We're bundling see GM into that group number see there, how about physician office visits, inpatient hospital stays? Let's take a look What we know is that diabetes care in America costs a lot of money. The direct medical cost is $237 billion US healthcare dollars is spent in trying to help with the management of people with diabetes. So this is a huge bucket has huge impact nationally. If we look at how that's divvied up are $237 billion dollar bill for direct medical costs. If you look at it, you look at those top two categories medications for complications of diabetes. This isn't medications to treat diabetes medications to treat the complications, largely in folks who didn't have optimized management upfront. Second big category in patient care, emergency room visits. What you come to realize is that the cost of office visits, diabetes supplies, which includes C. G. M. S. And B G. M. And diabetes medications. Both insulin and non non insulin medications is only about 30% of the total cost. The other 70% is spent on treating complications is spent on hospital stays. So there's this huge potential win for re diverting some of the huge expense we spend on managing diabetes towards treating people earlier with better therapies, including C. G. M. To reduce the complications, reduce the hospital stay, reduce the inpatient stays. So C. G. M. In the real world, what do we know about trying to get? See GM for our patients for people with, with commercial payers, it's it's a little bit tough. There's a lack of transparency and coverage even with within a given plan. People are on high deductible plans coverage and deductibles varies. What we know is that high risk and disadvantaged groups tend to be less well insured and under insured. So it's a challenge. Medicare and Medicaid can be especially difficult. We're fortunate here in Minnesota and that our Medicaid coverage for C. G. M. Uses quite liberal. Lovett Medicare is a challenge. Um, high risk groups tend to be again, disproportionately impacted by Medicaid coverage on a state basis. DME DME based billing for Medicare folks can be a barrier DME suppliers not necessarily willing to jump through all the Medicare hoops very easily. So it creates a lot of prior authorizations and a lot of paperwork. We also know that Medicare has been pretty strict in who they will provide C. G. M. For. They recently liberalized a little bit. You no longer need the four finger stick blood glucose values per day to be documented. They are still limited and yet to people who are using three or more injections of insulin per day but that's likely to change to. It sounds like they are going to move to covering people on any type of insulin regimen probably early next year. So looking forward to that. What we know is that coverage for C. G. M. Is lacking behind the data of benefit in type two diabetes. And so that is a point of advocacy and hopefully we can move it forward if the devices aren't available or they're unaffordable. Nobody really benefits. Let's think about bucket number two and this is technology and support for C. G. M. Use on a local level. And we know that without access to data, the impact of even the best technology isn't very big data access. What are the barriers? Well you got to be able to get the data from the device which is a smartphone, it's a reader to a computer computer. Hopefully a computer screen in front of you in an exam room is what we're working for. We know there are barriers institutional firewalls, there are hipAA concerns regarding confidentiality with obtaining the data. Um There's a lack of availability to directly import data into the electronic medical record. Um As you think about data management, you either have to manage things locally or via the cloud locally means people bringing in their devices, you hooking up a cable and uploading it to your local computer. Cloud based management means people being connected to industry based clouds typically via smartphone so that the data is transferred automatically and can then be accessed in clinic settings. What we know is that cloud based data management it's accessible more broadly to your team and ultimately it's a lot more feasible and usable than uploading individual devices in a clinic basis. When we think about data let's think about two different times the types of C. G. M. Data. So real time data we know that these can be used as a as a very fancy glucose monitor. You get a flash glucose community reading you get a trend arrow that shows whether your glucose is rising or falling glucose trend line. Pretty much the same view across manufacturers and that's real time data. That's what patients with diabetes people with diabetes are seeing. The other type of data is retrospective data and that's the C. G. M. Based ambulatory glucose profile that Dr Bergen stall was discussing last program we know retrospective data during clinic visits is tremendously powerful. We know that it allows us to know if we need to take an action we can review our time and ranges data. We know that it can helpful. It can be helpful in telling us what action we actually need to take. We have a model debut or a G. P. Profile view that shows us patterns is the key to pattern based management using C G. M. And finally retrospective CGM data allows us to know what adjustments are tight rations and therapy are needed to really optimize care. So retrospective data is what we're after for our clinic visits. How do we get it? Workflows, workflows are everything data only helps if it's available and you use it and so we need access to retrospective data for clinic visits. Again, cloud based access is the best case scenario if people don't have a smartphone that can be an issue, especially with folks who are a little older um downloading data from devices and clinics definitely feasible. It takes a little more time. It's helpful if there's a nursing process, people with diabetes can upload a reader device from their home computer. Again it takes a little bit of technology savvy have to connect the micro USB cord, you have to have the right drivers and operating system or else it can get hung up. What we do know is that if the data is available it is really powerful. So the question I think with workflows is who's going to retrieve the data at the time of clinic visits and beyond that is going to help set up smartphones, cloud based access up front so that the data is easily available at the time of clinic visits. And so what you really need is a diabetes technology champion. I guess in our clinic that tends to be the diabetes educators. But this could be a nurse who's taken on this role who really sort of owns see GM technology, diabetes technology who can help to make sure that you have the data available when you're seeing a person with diabetes and clinic. So let's think a little bit about cloud based access Again, this is really the best way to capture retrospective C. G. M. Data. So this would be the optimum case scenario. Every manufacturer has a cloud based system for collecting C. G. M. Data for the the Abbott diabetes care system, its library view for dex calm, it's the calm clarity view the other two. C. G. M. Manufacturers, Medtronic has care link and ever since, has he? Ever since diabetes management system and they all function somewhat similarly. There are other systems. Type pool is is freeware, multi device software that is an aggregator of diabetes data and global care subscription. Multi device software system I guess in our system we are using the manufacturer cloud based websites. They actually worked pretty well. The manufacturers have a big interest in providing sites that are easy to use and so here's how they use if you if you are on the Abbot G. Six system you have a patient who establishes a review account or a desk calm clarity account and then they have the data from their their sensor yet a transmitter flow to their cell phone which then can directly transmit it to the cloud based repository. If you want to access that data most easily in clinic, what you need to do is have that person with diabetes except and emailed invitation granting the clinic access to the glycemic data. And once you have that it's really easy. You've got cloud based access to glycemic data for clinic visits, for remote visits, for interactions anytime you need them. You can also upload from a reader. You're using a micro USB cord. You can either create a one time report or link it to a patient um requires a little more but if you have a workflow created in your system so that your support staff, your nursing staff is helping you do that. That can work okay to best case scenario they're linked to the cloud via their cell phone. Few more thoughts about introducing technology naive individuals to technology. So this these are folks with type two diabetes. Folks with type two diabetes tend to be a little older than a lot of the individuals you work with with type one diabetes. They tend to be less technology savvy. They really haven't had much exposure to technology. C. G. M. S. Not much technology beyond B. G. M. management. So it is worth spending some extra time to make sure that devices are being used correctly and what do I mean by that? It starts with setting up the device the right time, the right language making it work. Um People need a little bit of coaching as far as sensor placement, coaching regarding adhesion and retention issues if they're using an intermittently scan, see GM like the freestyle libre two system, they need to be swiping their sensor multiple times per day, at least three times per day. But the more the better to capture all the data. And finally they need some education regarding how to use the data that they get on their reader on their smartphone to actually optimize care. How do you look at that data to see the impact of lifestyle choices, see the impact of diet. Don't assume that they have any familiarity at all with connected technology. And so a lot of these folks are going to need help connecting to the cloud if they're using a smartphone. Um don't assume that they're going to be uploading a reader to the cloud without prompting. You know, it just takes a little coaching. The payoff is huge. One quick caveat for cloud based see GM access, don't forget that this is personal health data, health data. So HIPPA rules do apply. Um all of these websites have password complexity rules, Two factor authentication is rapidly becoming an industry standard. So you have to get past passwords and two factor authentication just like you do when you're banking and everywhere else in the world. Make sure respecting patient privacy protected health information integrity. So keep in mind this is patient data. Use it appropriately. So what's viewable once you get to a cloud based website, Well if you look at the H. T. L. M. View, you essentially can look at the ambulatory glucose profile view from there. There are other metrics provided varies depending on the manufacturer. You can actually download PDFs of the ambulatory glucose profile which when I'm seeing somebody with diabetes and clinic is what I do because I like to have a sheet of paper sitting in front of me that we can look at together. Talk about patterns, Talk about daily views. Talk about what's going on. What's not yet readily available is a view in the electronic medical record for most of us. Um So importation into the electronic medical record takes a little bit of extra work and I will tell you it's not that much extra work. This is what I do in my practice. I use the snipping tool so you go down to Windows accessories click on the snipping tool, what you get is a pop up box. You want to click on new snip and then you drag the boundaries around your ambulatory glucose profile, which you have from the club based website. You can cut, you can paste it right into the medical record and their next time you see that patient you will have access to their ambulatory glucose profile report. That's what I do in clinic works actually very quickly. Once you've done it a few times a few seconds honestly. How about a third circle So we have people with diabetes who have access to the technology they're wearing C. G. M. We've worked on our workflows to make sure that the data from that C. G. M. Device is actually available at the time of clinic visits. What's the last circle I as a clinician and the person in front of me, I need to know how to use the data to actually improve care. And so from the standpoint of the patient is mostly real time management but they can see the pattern based data also on their on their smartphone or their reader. From the standpoint of the clinician, we are really thinking about how do we use the retrospective data for pattern based management especially if they're on insulin. And how do we use glycemic metrics the time and ranges to optimize their medication selection in our system. We've done lots and lots of work with this. We are working hard at the International diabetes center to create tools for patients to be able to better use um they're C. G. M. Data to make diet choices, lifestyle choices, physical activity choices and understand what they're seeing on their their smartphone or reader. And we have also done presentations both within our care system and outside our care system to help clinicians use CGM data better. Let's think a little bit about the practical aspects of using C. G. M. So this is on an individual patient patient basis. How do we really pick the right device and help people to use device as best they can If you're thinking about which device to send an order for choose your device based on features, cost patient specific factors. There are a few out there that do not require calibration with PGM Soon it will be all of them but not quite yet. We know that the Abbot systems and the discount system G six soon to be G seven do not require calibration with finger stick blood glucose testing. How about simplicity Really. This is the simplest out there is the Abbott, freestyle race system of which. There are few versions. How about you have somebody who's having frequent hypoglycemia for that person. What you really want is alarms. And so you may benefit from one of the more sophisticated systems like the decks. Com system. The newest freestyle libre system library three has alarms so that's available but when you're picking a system certainly keep that in mind, most of the currently available systems are less affected by Tylenol use acetaminophen use it's one of them that's not but the big ones are um not so much affected by Tylenol. There's the one system, the intermittently scanned system on the market, which is the freestyle libre two system requires swiping of the sensor to capture the data. Yet if you look at the literature, the more swipes per day, the better people do so encourage them to swipe early and often and finally cost of devices. There's some pretty significant differences in cost depending on manufacturer, depending on insurance coverage and these devices are expensive enough that we always want to be mindful of that. So using C. G. M. On an individual basis, two big issues you can run up against sensor adhesion, which is to say these sensors, they stick on your skin for 10 days to 14 days ideally. And that's a challenge. You know, if you think about trying to develop an adhesive that will keep something in place on your body for 10 to 14 days, it is a challenge. There are some approaches that can improve adhesion, things like barrier wipes and sprays, skin tax skin prep. There are others can be helpful if you can try to leave a barrier area at the center of the application for the sensor adhesive overlays. So these are like big old band aids and bandages that go over the top of the sensor to help hold it in place. They can be really useful in improving the longevity of adhesion and my biggest tip. If you're prepping this site by washing it with water if you're prepping it by wiping it with alcohol, make sure it is dry. I can tell you from personal experience if that alcohol is not evaporated off the skin before you put the sensor on it's gonna fall right off. Ask me how I know that. So make sure that whatever you're using it is 100% completely dry before you apply the sensor. How about skin irritation and adhesive reactions? So this does come up, it's not that common but you do see it. People just like when you wear a band aid on your skin will sometimes develop irritation from that, it's usually irritation. Occasionally it's a true allergy. How can you try to minimize that? Always have people rotate the sites of application between sensor wears always encourage them to apply it to dry skin. Don't put on moisturizer on there beforehand because it's a gonna affect adhesion and be going to not necessarily help with the likelihood of reaction barrier wipes and sprays. They can help with this also. Um people have special tricks. I know when I run into somebody where I'm really struggling, I lean to my diabetes educators sometimes you can use things like transparent films um and with a hole cut in the middle and sensor on top of that. I know people have tried things like nasal steroid sprays sprayed on the site of application and allowed to dry. But there are there are tricks to this and your diabetes educators off are the people with the most experience so definitely lean to them if you're struggling with this C. G. M. Interpretation is a billable service and here's how to do it. There there are three cpt codes that are primarily used. You can build for um putting on a professional C. G. M. And training people in that you can build for training people and using a personal C. G. M. One time building code is 95249 and 95 to 5 50. The biggest code that we use is 95251. And that is a billing code for C. G. M. Analysis, interpretation and generating a report. This can be billed monthly on an ongoing basis. It can be build in conjunction with with a medical visit. Um One thing to keep in mind is that any of these codes if you're going to build them you need to have a minimum of 72 hours of C. G. M. Data which is to say if you're using professional C. G. M. And your billing for that application, you can't really drop that bill until you have your 72 hours of data. You can build this C. G. M. Interpretation code along with the problem visit code. Um If you build it as a separately identifiable identifiable service, 25 modifier code I tend personally to roll the C. G. M. Interpretation time into the length of the visit. Now that the problem based visit is more billable based on on visit length and but it's definitely a billable service. This is a service we're providing. It's not necessarily labor free so we should be able to get paid for the work we're doing. If you are building for C. G. M. Code here is guidance from the American Association of Clinical Endocrinology regarding what data elements should be captured. To help support that building code. I can tell you if you're cutting and pasting the ambulatory glucose profile into the chart. You're capturing most of this data automatically in your progress note. You do want to make sure you're documenting an analysis of the data and an interpretation of the data and most of this can be captured fairly easily if you're including an ambulatory glucose profile in your medical record. Where are we headed? Well ideally it would be phenomenal if the C. G. M. Based data could be directly imported into the electronic medical record without having to go to a cloud based repository in our system. We're actually working on the systems to do that. So we are using our electronic medical record can pull CGM data into the lab portion of the chart. You can click on the view image tab and the ambulatory glucose profile will pop up. We also have the ability to import C. G. M. Based metrics into our electronic medical record which allows you to track time and range measures over time. Very powerful potentially might allow you to use time and range measures as a quality measure going forward. So that's where we stand. We have have our three categories of facilitators to help us use technology optimally. And and really the goal here is not just to get people using C. G. M. But to get people using C. G. M. And optimize use if we can work on these three broad categories and optimize all three categories. We actually have a point of conversions where in the real world we have potential for care model innovation and what I'm referring to is team based care team based management. Because everybody in your team is gonna have access to data remote tight rations, virtual visits. We can decrease the burden to people with diabetes yet be tight trading their insulin be tight trading their non insulin therapies much more quickly than we do now. And so there is potential for two true quality improvement on both an individual and a population basis. So that's what I've got for you today. I think we really are on the cusp of a new era in managing diabetes in primary care. And I thank you for joining me to hear a little bit about the journey. Next presentation will be by terra estate and Greg Simonson who will discuss some C. G. M. Based cases using C. G. M. And the ambulatory glucose profile report to optimize diabetes care and they will be using case studies that should be a very fun presentation. So I invite you to join us for that. Published January 4, 2023 Created by Related Presenters Thomas Martens, MD Medical DirectorInternational Diabetes Center and Internal MedicinePark Nicollet ClinicBloomington, MN
