Exploring the Role of Healthcare Providers in Continuous Glucose Monitoring Coaching, Education

Alivia Kaylor:

Hi and welcome to Healthcare Strategies. I'm Alivia Kaylor, senior editor of LifeScienceIntelligence and PharmaNewsIntelligence. Today, we are speaking with Tina Platania, director of clinical services at CCS, about the role of healthcare providers in continuous glucose monitoring coaching, and teaching. Tina, thank you so much for joining us today.

Tina Platania:

Oh, good morning, Alivia. Thank you for having me.

Alivia Kaylor:

Of course. Tina, just to start us off, if you could briefly explain a continuous glucose monitor and why it has become an essential tool in diabetes management, that'd be great.

Tina Platania:

I'd be excited to do that for you. So CGMs, or continuous glucose monitors, are small medical devices that continuously measure glucose levels in the body through a small sensor that sits on either the arm or the abdomen. And what it does, it measures the glucose in the interstitial fluid. So what it does is it gives us that 360 view of what's happening continuously throughout the body during the day for glucose.

And what happens with that data, it's then transmitted wirelessly to a smart device like a smartphone or an actual reader that the patient uses to monitor their blood sugar. So the data is transmitted and then it provides that immediate feedback to either the provider or to the patient.

Some of the benefits of the CGMs, in my opinion, they have revolutionized diabetes management. I think it's the next best thing to insulin....

So like I said earlier, now we have this great technology, we have these cameras and video recorders. When you go somewhere, you take these great videos of... You're in a botanical garden and you can take a 360 view of everything in that garden versus just taking one picture of a flower.

You have this whole view, and same thing with the CGMs. When you have this entire view, you can help your patients make informed decisions about optimizing their healthcare. So not only do you get that comprehensive view, [but] patients are able to look at trends and patterns in their data as well along with the healthcare providers.

One of the biggest things for patients nowadays is less finger sticking of the traditional blood glucose meters. So it improves their quality of life, per se. They still have the finger stick sometimes, but the amount of finger sticks is reduced.

So another good feature of the CGMs is they have these customizable alarms. So they're a great safety feature for patients. So in the middle of the night, if they're going low, their alarms go off. They know that they have to do something proactively to manage that during the night.

There's just so many great benefits altogether for CGMs, but most of just having that data at their fingertips to help them make informed decisions is one of the best features.

Alivia Kaylor:

For sure. I actually get to see this firsthand. My father has diabetes. I always joke, I never want to share a hotel room with him because in the middle of the night that alarm goes off.

Tina Platania:

The alarms go off.

Alivia Kaylor:

And it's loud.

Tina Platania:

They're loud. They're loud. Sometimes what happens is...they call it "alarm fatigue" because there's so many alarms that it works the opposite way, but then you can customize and could turn some of them off during the night anyway.

Alivia Kaylor:

I see. Okay, I'll tell my dad about that. Yeah, so can you explain how have healthcare providers traditionally been involved in diabetes care and how does CGM coaching and education change their role?

Tina Platania:

So traditionally, a patient managing diabetes, it used to be you would go to the office--before you go to that office visit, you would go and get lab work done. You'd come back in the office. The doctor would look at your logbook of all the numbers you were keeping track of, traditionally. They would adjust medications.

It's remote now, so you're saving the patient time from going into the offices. But whereas you're getting that A1C value that you get every three to six months when you go to the provider's office is not telling the whole story.

So you can have patients with an A1C of seven--which is actually the gold standard for that diabetes goal for A1C--but what's seven for one patient may not be seven for another patient looking at what's going on throughout the day. You can have someone who is totally enraged all day long and [has] an A1C of seven. And then someone next to you has an A1C of seven as well, but they're having lows during the middle of the night, or they're spiking right after breakfast. Traditionally, you're getting that one number that's not telling the whole story.

Now with the CGMs, you can look at that data, and you can see everything that's happened throughout the day: what's happening after they eat breakfast, what happens when they're taking their medication, what's happening when they're exercising or taking a walk in the afternoon. You can use all that information to create a more personalized plan for the patient and just [help] them being able to fit what they're doing into their daily life.

Alivia Kaylor:

For sure. Can you speak a little more about maybe some real-world examples of how the coaching and education [have] helped patients make more informed decisions about their diabetes management? For example, I know my father uses, I believe, the Libre 2. And with those, there is a delay, right? They get delayed information in their sugar because they're taking the reading from the interstitial fluid instead, right?

Tina Platania:

Correct. So there is a slight delay between taking a traditional finger stick in the blood versus interstitial fluid. So there is a slight delay, but it all evens out. And we always tell patients with CGMs that, if your symptoms don't match what you're experiencing, if your CGM is telling you one thing, but you're feeling something totally different, we always tell patients, "You need to go ahead and finger stick and check your blood sugar," to get that immediate feedback so then you know what's going on.

Because every time they evolutionize a new CGM and they come out with a new iteration of something, there [are] always advanced technologies. They're getting more and more accurate. But sometimes certain things can interfere with those readings, whether it's some adhesion that's on the arm or the patient is sweating or a medication they've taken or even a vitamin that they've consumed. Those can interfere with the readings as well.

But some of the other examples for patients is you got the dinner and you have a big meal, and then you can see what happens with the CGMs is they have arrows. They have trend arrows, so they trend up or they trend down. So if you have a big meal and you notice, oh, I'm trending up a little bit, then you can actually fine-tune what you need to do. Do I need to maybe take another unit or two of insulin? Do I need to go for a walk after dinner? Same thing with the nighttime.

If you see you're trending downwards before you go to bed, maybe I need to have a snack before I go to bed so I don't have that alarm waking me up at 2:00 in the morning saying, "your sugar is low."

Alivia Kaylor:

So it's almost like it's tailoring the care almost to the individual.

Tina Platania:

Correct.

Alivia Kaylor:

That's a great benefit. However, I feel like the ease of the device and the capabilities of what it can do is obviously very innovative for diabetes management, but what are some common misconceptions or challenges that health providers may face when they're integrating these devices into their practice?

Tina Platania:

Some of the challenges [are] training the staff to read the reports. Along with training the staff is the time that it takes for the healthcare providers to actually sit with a patient and go over their data with them. That's a real big thing.

And so part of what I do and what my team does as educators is we take some of that off of the provider's plate. As diabetes educators, we have the time to spend with the patients to help them understand their data.

Another challenge is the insurance, trying to maneuver through insurance, whether you're a commercial insurance or Medicare. Can you get a CGM through the pharmacy? Can you get it through durable medical equipment? The providers, their time is precious as well, and for them...having to fight with insurance companies and submitting prior authorizations for these devices can get a little hairy for them.

Other challenges, [from] the patient perspective, is cost, of course, "how will I be able to afford a device like this every month?"

Some of them are just overwhelmed by the technology. We talk to patients that don't have a smartphone. They don't have a computer, so they don't benefit from that because they don't have the capabilities to be able to utilize that technology. As well as some of them are just resistant to technology. They're happy pricking their finger four times a day and you can't sway them any other way.

For the most part, once you start a patient on a CGM, they never look back.

Alivia Kaylor:

Yeah, they don't get tired of... Or I guess they're tired of sore fingers and they never want to go back to that, right?

Tina Platania:

That's right. Exactly.

Alivia Kaylor:

Great. Okay. Does the coaching or education differ at all between patients who have Type 1 versus Type 2?

Tina Platania:

Originally, CGMs were more geared towards the Type 1 because you can fine-tune their insulin and make those [medication] adjustments.

The coaching and the education share the same common themes. What differs slightly is the focus. But with the Type 1s, we try to manage more of their insulin and we focus on carb counting with these patients, as well as making sure they understand how to prevent the hypoglycemia and going low. With Type 2, the emphasis is more on those lifestyle modifications.

How can we help them incorporate more of those to bring down their A1C and to make sure they're in the time and range? So we work on the nutrition planning and physical activity and help them develop meal plans and make sure they're getting enough sleep. Because as we know, all these different factors are capable of disrupting your blood glucose. If you have a terrible night's sleep, you're going to have effects the next day. Physical activity can lower your blood glucose for up to 24 hours after the physical activity.

So there's a lot of different factors involved. But in general, the common principles are the same. You're focusing on all these healthy habits and just being able to get that optimal control of their blood sugar.

Alivia Kaylor:

Great. Are there any specific guidelines or best practices that healthcare providers should follow when providing coaching and education?

For example, I know my father, he showed me you have the app that you can track your history of your sugar levels. And I know his are just so crazy. I could never find a trend or a pattern to me, which is crazy, but I don't have diabetes luckily.

Are there any best practices or guidelines that you would suggest for patients come in asking, "okay, we have this data, but what do I do with it?"

Tina Platania:

What do I do with it? Yeah, that's a great question. Like you said, so basically being able to understand that... They call it AGP report. So that's the report that incorporates all that data into this great format that will show you, "here's your time and range. Here are these patterns and trends."

For healthcare providers, what I recommend for them to stay up-to-date is making sure they are in constant contact with the manufacturers so they get that latest technology, making sure they understand there's always software updates coming out, making sure they have those, leaning on and leveraging all the professional organizations, the ADA and the ADCES, those standards of care for the patients. So those are the guidelines that I think that are great resources for providers to stay up to date.

And the best practices, I think you hinted on it earlier, [are] basically that patient-centered approach, making sure we're tailoring the needs of our patients to meeting them where they're at basically, because you have to factor in their level of understanding, their needs, their priorities in order to optimize their healthcare.

It used to be where you would go into a doctor's office and they would say, "You need to do this and this." Now I think patients and providers are working together. They're collaborating more to develop that plan. And I think if you work with a patient, it's a motivator. They're motivated because they've actually had say in their healthcare plan, but it motivates them to make those choices. And then it just takes one or two little nuggets of information to motivate them and get them on the right track.

Alivia Kaylor:

Yeah, it sounds like it's a great device for empowering individuals to take control of their own healthcare.

Tina Platania:

That's right. That's right.

Alivia Kaylor:

Great. Awesome. I can say just from, it's anecdotal, of course, but just my dad, I can tell he's healthier just by using it and having that data and that information so quickly and up in your face and in your ears, if you will, that alarm. I can tell it's helping.

Tina Platania:

Yeah, and it just improves the overall quality of life as well.

Alivia Kaylor:

Yes. And I hope that this device gives my father many more years because I feel like he is healthier. So it's great.

Tina Platania:

That's great.

Alivia Kaylor:

Yeah. This is such a great conversation. I love this.

So we've talked about how great this technology is. So what role does technology play in coaching and how can health providers stay up-to-date with the latest advancements? You talked about this a little bit.

Tina Platania:

I did. I did. So I think, [it] piggybacks on that previous question,...it's just that more effective tailored diabetes management, because overall the technology is there to optimize that glucose control, and you just have so much information at your fingertips. It's just going to get better and better every year. So just utilizing that to make... You're able to get that data, make those informed decisions, as well as just making those timely adjustments to anything that the patient may need, whether it's for medication.

Sometimes if [the] patient's under the weather, you got to make some temporary adjustments to something. And like I said earlier, just staying on top of the latest and greatest that's out there with the organizations and manufacturer websites and just even collaborating with other provider offices to see what they're doing and how they're incorporating things into their flows as well.

Alivia Kaylor:

And to finish off our conversation, how do you envision the future of CGM coaching and its role in diabetes management evolving in the coming years?

Tina Platania:

In the coming years.... So, it's funny, so I took this question and asked my team. I was like, "where do you envision all this technology and where it's going to go?" The consensus was that these devices are going to become the standard of care for all diabetics because it is such a great tool for the motivational component, as well as optimizing those great health outcomes, keeping the patients out of the hospitals, out of the ERs and urgent cares, and keeping those costs to a minimum. As well as I think that we focus on Type 1 and Type 2 diabetes as well.

There's also that component of pre-diabetes. And so right now, there's not enough information out there to say that CGMs are helpful for that component, but I think that'll change eventually because you're able to get them to a good place. It's all about preventing long-term complications, improving your overall health. Because not only do the CGMs help with controlling our blood sugar, but as patients make those modifications to their diet, to their activity, you're going to see decreases in cholesterol. You're going to see the effects on their blood pressure as well, and just making those overall great health choices, which you're improving overall health altogether.

I think eventually we'll get to a place where we have so many different apps for everything. You've got food apps and activity apps and everything talks to each other. One of the clinicians on my team said, "It'd be great one day if you have a CGM and you can take pictures with another app of the food and it goes right to the CGM."

So then you can see that, so you don't have to manually enter information into that. But so you can take a picture and that food and the nutritional components of that get incorporated right into the actual app of the CGM.

Alivia Kaylor:

Yeah, that's really smart.

Tina Platania:

Yeah, isn't it?

Alivia Kaylor:

I love that idea. Awesome. I could talk about this all day, but unfortunately, we have to wrap up. Tina, this has been an amazing conversation. Thank you so much for setting aside the time to speak with us today.

Tina Platania:

Anytime. I'd be more than happy to come back if you need some more time.

Alivia Kaylor:

Great. Thank you so much. You take care. As for our listeners, we'd love to hear from you. Feel free to contact me with any healthcare-related questions or subjects you think we should cover by emailing me at akaylor@techtarget.com. And if you like this episode, please consider reading or reviewing us on Spotify, Apple Podcasts, or wherever you're listening. Thanks for tuning in. We'll be back soon.

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