Speaker 1:

Welcome to AACE Podcasts. Thanks for tuning in as we elevate clinical endocrinology by taking deep dives into trends and topics that can help us improve our patient care and global health. Find the latest episodes on aace.com/podcasts. And now let's meet the endocrine experts who will be talking with us today.

Dr. Cheryl Rosenfeld:

Hello and welcome to our AACE podcast. I'm Dr. Cheryl Rosenfeld. I'm an endocrinologist in private practice in Parsippany, New Jersey. I'm also an adjunct associate professor of medicine at Toro College of Osteopathic Medicine in New York, and core faculty in endocrinology for the New York Medical College Internal Medicine Residency Program at Clair's and St. Mary's Hospitals in New Jersey. I'm currently an AACE Board member and the liaison to the Patient journey program.

Today we'll be discussing the ACE patient journey of diabetes technology, an easy to understand guide designed to help patients and members of the care team navigate the world of diabetes technology. Before we begin, I'd like to thank our sponsors, Abbott, NovoNordisc, Medtronic, and Vertex, for supporting this engaging podcast. Joining me today are Dr. Madhuri Vasudevan, and Dr. Diana Isaacs, who have been instrumental in the development and continued content creation of the journey. So thank you both for being here.

Dr. Vasudevan, can you please introduce yourself and tell us about your area of expertise?

Dr. Madhuri Vasudevan:

Thank you so much. It's a pleasure to be here and to share in this exciting journey with all of you. My name is Madhuri Vasudevan. I'm an assistant professor at Baylor College of Medicine in the Department of Endocrinology. I am a full-time staff and faculty at the Michael E. DeBakey VA Medical Center in Houston, Texas. In my role as one of the endocrinologists at the VA, I started the first insulin pump and sensor program at the Houston VA. When I first started in 2012, there were about 10 patients on a Medtronic pump at the time, and now we have more than 400 patients that are currently utilizing a variety of insulin pump and sensor technologies.

I have been very excited to share my love of diabetes device care with many colleagues, including my new family at AACE. My clinical niche is specifically in diabetes devices, focusing on complex diabetes care, trying to address those most challenging cases of either extremist lung resistance or the highly sensitive patient with profound hypoglycemia, finding the benefits of the different devices that we have now at our disposal and really helping our patients succeed in the care of their diabetes.

Dr. Cheryl Rosenfeld:

Thank you. And Dr. Isaacs, can you please introduce yourself and tell us about your area of expertise?

Dr. Diana Isaacs:

Sure. Well, it's great to be here today, and it was a real honor to contribute to this resource. I am an endocrine clinical pharmacist. I'm also a certified diabetes care and education specialist at the Cleveland Clinic. In my role, I'm also director of education and training in diabetes technology. So my area of focus is diabetes technology, and I joined the Cleveland Clinic about nine years ago. Prior to that, I was in a primary care setting, but I came in in 2016 as this explosion of technology, and that was really where the need was. And we started off doing a lot of professional CGM, which then exploded into lots of personal CGM and increasing access for people. And then also it was 2017 when we got our first automated insulin delivery insulin pump. So it's been really exciting to be a part of that and bring this technology to more people and help them to optimize it.

Dr. Cheryl Rosenfeld:

Thank you, Dr. Isaacs. I agree. This is a very exciting time to work with diabetes. To start, Dr. Isaacs, can you provide a brief overview of the development of this patient journey?

Dr. Diana Isaacs:

Yeah. AACE is a leader in a lot of this clinical practice guidelines. This is a resource that really takes these guidelines and puts them into practice. And so where this really comes from is we have the 2023 AACE consensus statement on a comprehensive type two diabetes management algorithm. And then there was also the 2021 Clinical Practice Guideline for the use of advanced technology and the management of person with diabetes. And so these guidelines are great. They're really geared for healthcare providers, healthcare professionals, but then when we think about the implementation and the person living with diabetes and how they can translate all this information and use it in practice. So it was taken in a way to really get it to the person in need and help them determine, well, what questions do they need to ask? How do they learn more about this? What are the steps to delving into technology? And then Diabetes Sisters, which is an amazing organization that puts out so many person-centered diabetes materials, they reviewed everything to make sure it is designed for the person with diabetes in mind.

Dr. Cheryl Rosenfeld:

Thank you. Dr. Isaacs. I agree that we definitely needed to make sure that it was in a patient-friendly voice, and it certainly was plain language to be sure that it was easily understood.

Dr. Vasudevan, why do you think it's a valuable resource for managing diabetes?

Dr. Madhuri Vasudevan:

Oh, thank you. I have so many positive points here to share about this tool. I think the first point to make is that when we see a patient in the clinic for a finite period of time, we are only able to provide so much education in that limited amount of time about the indications for different devices, the pros and cons of each device, the important icons that are present on each device. And yes, we do the very best we can in that limited amount of time, but education is empowerment. And by providing this beautiful tool to patients that they can take their time and explore at the pace that they feel comfortable with, it gives them a greater level of control over the amount of knowledge that they're clasping or grasping at any given time.

I also really appreciate the fact that it follows the whole course of a patient's diabetes care through the journey that they're taking with the management of their diabetes. It gives them the guidance at the beginning through the course of it. For example, if there's difficulty with managing a device, what are the contact numbers? How do they navigate that? Where do they go? What questions should they ask? When is a device not trustworthy? What should prompt the patient to then reach out to the provider for more guidance? So I think on many levels, this tool has provided patients with a lot of knowledge in a manner that's user-friendly. And diabetes is a journey that it's not a sprint, it's a marathon. So we want to make sure that we give patients the space and the time that they need to digest so much information that is readily available in this phenomenal tool.

Dr. Cheryl Rosenfeld:

I agree that after we see them, we run through our office hours. So they have to have the availability of another resource when they get home and they need to be able to take their time to go through it. So I agree 100%.

Dr. Isaacs, how have your patients been engaging with and benefiting from this resource?

Dr. Diana Isaacs:

Yeah, I think to add on, it really is about the journey. And a lot of times when we think about technology, we get so focused on insulin delivery and insulin pumps and automated insulin delivery, but for most people with diabetes, they're starting their journey. They're not on insulin at diagnosis, right? Most people are actually diagnosed with type two diabetes. They're going to be started on oral or non-insulin injectables, but still, technology is available. There are mobile apps. There's still glucose monitoring, whether that's BGM or that's delving into CGM and wearing CGM all the time or wearing professional CGM.

So I think it raises this awareness of, hey, it's not like, oh, you get to here and then you think of technology because then... No, it's like it's a part of all of diabetes management. So this is a tool that I am using from the beginning. It's just that the questions that the person may ask may be different depending on their therapies and how long they've been living with the condition. And that's one of the huge strengths of this tool is that it's for all with diabetes. Wherever someone is, whatever medications they are, whatever comorbidities that they have, there is a place for them in this tool on this journey. And so when I am working with a person, I'm helping them figure out, "Okay, where are you now and what things can you consider?" And then later on, there are other questions to consider. I think it's such a great way to get this engagement and bring about this awareness.

Dr. Cheryl Rosenfeld:

I agree. I've had patients where they're further along in their journey, but they've started at the very beginning of looking at the patient journey and found out some things that they may not have known. So they could be already on a continuous glucose monitor, but sometimes even starting from the beginning, there's aha moments that the patients can glean from this, and it's amazing when they come in with a new set of questions that are derived from this tool.

Dr. Vasudevan, I'm going to ask you how you are incorporating the diabetes technology patient journey into your practice. So can you share an example of how we can use this effectively?

Dr. Madhuri Vasudevan:

Sure, absolutely. I think the first step... As a representative of AACE and as one of the co-creators of this tool, we understand the content and we appreciate the volume of content that's been put into it, but I think the very first step in order to apply it in the clinic setting and to share with our patients is to educate our colleagues. So what I've done is I shared this link with all of my colleagues and I asked them to review every one of the icons and make sure that they understand the content first, because I think the first step to incorporating this wonderful tool is to ensure that all of our diabetes healthcare professionals understand the information that's embedded within.

And once they have that appreciation for the breadth and depth of the tool, then I think the best approach then is to share in the ambulatory clinic setting. Since this is an easily accessible platform, it can be accessed on any website. What I've tried to do in clinic is open it up on the screen and say, "You're here today for your first visit," or, "Your 10th year of follow-up," whatever the time course may be. "Let's take a look at this tool and see where you are on your journey and what we can glean from it together, what you can take from it."

The other thing which I've specifically done is created a QR code and printed that on a flyer with a screenshot of the homepage of our tool. And that way I have printed it and give it to patients as they are in the clinic with me. I believe as we shared before, knowledge is power. So the more information we can provide to them at their fingertips, It is key. Additionally, I think hard copy flyers or things that patients can take in hand with them. I always counsel my patients, "Put it on your fridge. Every time you pass, you're going to see that flyer and think, oh, I can access this. I can take a look at it," and it helps reiterate the fantastic education that's provided.

Dr. Cheryl Rosenfeld:

Thank you. I have a habit of keeping it open in the background on my computer behind my electronic health record, and I have the patients access it right there. I'm like, "Here, give me your phone." And there's a QR code on the image and I blow the QR code up and I say, "Give me your phone," and I access it for them so they can take it home with them. This way they can review it at their leisure.

Why is it important for them to have that access to this resource? You mentioned, Dr. Vasudevan, that you give them a handout. So why is it important to have this resources outside of the office, outside of the clinical setting, and how has it helped them empower them in their diabetes management?

Dr. Madhuri Vasudevan:

Sure. I think that as we've alluded to, we are only with them for a short period of time, but why it's important to have this tool is that people, as they care for their own diabetes or caregivers that may be involved in the person's diabetes care, will have questions along the way. They may have a question when they leave the clinic and they go home. They may have a question about, is this the right next step for the care of my loved one's diabetes? Or the patient themselves may have that question. And having an access to this particular, fantastic and comprehensive educational tool provides that to them seamlessly, and it allows them the freedom of reviewing it again and again.

I also believe that repetition is the key to success. Consistency is the key to success. And having access to this tool, being able to access it or review it numerous times over the course of a patient's journey with diabetes is also going to optimize their chances of getting their blood sugars under control, not letting diabetes be the condition that controls their life, rather learning from this tool will give them the guidance to be in control. It makes it so that they can have a fulfilling life to thrive and manage their diabetes without it being a burden.

I think our goals as endocrine providers, as diabetes healthcare professionals, is to bridge that gap between knowledge and implementation, to empower our patients through education. And this is just, again, another wonderful tool that will make that possible.

Dr. Cheryl Rosenfeld:

Thank you. Dr. Isaacs, how can different members of the endocrine care team utilize the journey to stay up-to-date with the latest diabetes technology?

Dr. Diana Isaacs:

Yeah, I mean, I think this is a great resource for people with diabetes and for healthcare team members. Going back even to people with diabetes, we try our best. We educate in the office, but the reality is that they only spend so much time with us. And even if they are fortunate to get additional diabetes education sessions, it's hard to remember everything. And it's hard to really go through everything. A lot of my patients will ask, where can they go for good quality information? And unfortunately, online, it's very hard to differentiate what is a quality source and what is maybe not, especially if someone doesn't have a healthcare background. So I think that's where people are very happy that, "Okay, there's a tool. We know it's updated. We know the information's accurate. It's coming from a trusted source. It is fantastic."

And so going now to the healthcare team members, it's hard for everyone to keep up in this space. It is changing so rapidly. There are constantly new devices coming out and there are updates with these devices. And so it's hard even for healthcare team members to know, "Hey, did something new come out?" And so this is a source that is updated so regularly that it is a great starting point. Now, granted, it is geared for people with diabetes, but it's such a fantastic way to stay up-to-date and then it can guide the person, okay, oh wow, there's this new category of CGMs or of mobile apps, and then they can go and learn more about it. So it's great to spread the awareness across the healthcare team, and then other healthcare team members can also share that with their patients as well.

Dr. Cheryl Rosenfeld:

Yeah, I agree. I've been forwarding it to my colleagues in primary care and internal medicine, and actually, I forwarded it to a pediatrician as well because we forget that they also have patients who utilize diabetes technology. You mentioned that it's updated because things happen every single day. There's always something new that's coming out. Dr. Isaacs, can you discuss how the content is reviewed and updated to reflect new treatments and advancements in diabetes technology?

Dr. Diana Isaacs:

Yeah, absolutely. It is updated very regularly. In fact, there were just recently updates added related to hypoglycemia and DKA. And as we get feedback and we hear from others like, "Oh, it'd be nice to include this," those types of topics are added. But also, if there's new guidelines, any new guidance, at least every year, there's going to be a big update, but even rolling as smaller things come along. So it's a very top-notch, accurate, up-to-date tool, which is necessary in this space because it is so quickly changing. It's really got to make sure it reflects everything that is available and that's out there.

Dr. Cheryl Rosenfeld:

I completely agree. Sometimes I worry that I'm having trouble keeping up with something that happens brand new every single day. So you can imagine how overwhelming it could be for our patients.

Dr. Vasudevan, Dr. Isaacs, I want to thank you both again for joining me today for this discussion of our AACE patient journey of diabetes technology.

To learn more about the AACE patient journey of diabetes technology visit aace.com/diabetesjourney. Thank you.

Speaker 1:

Thanks for listening to another great AACE podcast. Join us for another episode at aace.com/podcasts and help us in our mission to elevate clinical endocrinology. Together we are AACE.