ManagedCareCGM

Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

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Clinical and Technology Innovations With Interoperable Real-Time CGM

Free On-demand CE Activity

Intended Audience: This activity is intended for diabetologists/endocrinologists, primary care physicians, obstetricians and gynecologists, nurses, nurse practitioners, and pharmacists.

Credit Available: Up to 0.25 credit hours of AMA PRA Category 1 CreditsTM), ABIM MOC points, ANCC Contact Hour(s), and knowledge-based ACPE (0.025 CEUs).

EDUCATIONAL OBJECTIVES

  • Upon completion of this activity, participants will:

    • Have increased knowledge regarding the
      • Data supporting use of real-time CGM (rtCGM) in various patients/settings in diabetes practice
      • Role of rtCGM in various patient types and diabetes practice settings
    • Have greater competence related to
      • Clinical use of rtCGM to improve patient outcomes in various patients/settings

EXPERT FACULTY

Shivani Agarwal, MD, MPH
Director, Supporting Emerging Adults With Diabetes (SEAD) Program, Fleischer Institute for Diabetes and Metabolism
NY-Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine
Bronx, New York

Gregory P. Forlenza, MD
Assistant Professor
Barbara Davis Center for Diabetes
Aurora, Colorado

For complete CE information and to access the activity, please go to:
www.medscape.org/symposium/rtcgm-updates

Supported by an independent educational grant from Dexcom.


Real-Time CGM in the Hospital: Improving Management in the COVID-19 Pandemic

Free On-demand CE Activity

Intended Audience: Primary care physicians, diabetologists, endocrinologists, critical care specialists, and nurses.

Credit Available: Up to 0.5 credit hour available for Physicians (ACCME) and Nurses.

EDUCATIONAL OBJECTIVES

  • Need for enhanced glucose monitoring via continuous glucosemonitoring (CGM) in the hospital setting during coronavirus disease 2019 (COVID-19) pandemic
  • Strategies for effective use of real-time CGM (rtCGM) in the intensive care unit (ICU) and step-down settings during COVID-19

EXPERT FACULTY

Guillermo E. Umpierrez, MD
Professor of Medicine, Division of Endocrinology, Metabolism, Emory University School of Medicine
Chief, Diabetes and Endocrinology, Grady Memorial Hospital
Atlanta, Georgia

Shivani Agarwal, MD, MPH
Director, Supporting Emerging Adults With Diabetes (SEAD) Program, Fleischer Institute for Diabetes and Metabolism
NY-Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine
Bronx, New York

Carol J. Levy, MD, CDE
Associate Professor of Medicine & Obstetrics, Director, Mount Sinai Diabetes Center and T1D Clinical Research
Icahn School of Medicine at Mount Sinai
New York, New York

For complete CE information and to access the activity, please go to:
www.medscape.org/roundtable/covid-diabetes-cgm-hospital

Supported by an independent educational grant from Dexcom.


ADA COVID-19 Resources and Online Forum

Source: American Diabetes Association

Key Takeaway: The American Diabetes Association provides a wide array of resources including recorded webinars, live events, and podcasts for those managing patients with diabetes during the COVID-19 pandemic.

 


Diabetes and Technology in the COVID-19 Pandemic

Source: Journal of Diabetes Science and Technology

Key Takeaway: In the inpatient setting, the use of CGM devices will expand. In addition to reducing nursing or providers workload, which has been underscored during this healthcare crisis, CGM systems can have many other benefits: They can lead to intense glucose monitoring and therefore to early recognition and prevention of impending hypoglycemia. Glycemic trends could be identified easier leading to better insulin adjustments and improved glycemic control.

 


Implementing CGM for Hospitalized Patients With COVID-19 and Diabetes: Insights From One Medical Center

Source: EndocrinologyAdvisor

Key Takeaway: “First and foremost, our idea for using glucose sensors and remote glucose monitoring [at Rush University Medical Center] was to help the front-line nurses save time and PPE by not needing to go into the patients’ rooms to test the finger sticks. The second benefit of CGMs is that we feel the patients are safer. With forefinger sticks, you get a rough snapshot of diabetes control and it is easy to miss severe hyperglycemia and hypoglycemia. With the way we use remote glucose monitoring, we are able to detect and prevent most of these highs and lows [in glucose levels].”

“The reduced pricing options are really reasonable. There is still cost, but according to our economic analysis, the saving of PPE and of nurses’ time outweighs the cost of the sensor systems currently.”

 – Rasa Kazlauskaite, MD, MS, director of the diabetes technology program at Rush University and associate professor in the department of internal medicine at Rush Medical College in Chicago, Illinois.

 


Managing New-Onset Type 1 Diabetes During the COVID-19 Pandemic: Challenges and Opportunities

Source: Diabetes Technology & Therapeutics

Key Takeaway: The present case reports illustrate how telemedicine can be used safely and effectively for new-onset T1D training and education for both pediatric and adult patients and their families. The COVID-19 pandemic has acutely stimulated the expansion of the use of telemedicine and digital medicine. We conclude that telemedicine is an effective approach for the management of patients with new-onset T1D.

 


The Silver Lining to COVID-19: Avoiding Diabetic Ketoacidosis Admissions with Telehealth

Source: Diabetes Technology & Therapeutics

Key Takeaway: Acute diabetes complication like DKA increases morbidity and mortality in addition to adding cost to the health care system. The current pandemic of COVID-19 has allowed newer ways (with the help of newer technologies) to manage high-risk patients with T1D and DKA through telehealth and may result in lasting benefits to people with T1D.

 


Implementation of Continuous Glucose Monitoring in the Hospital: Emergent Considerations for Remote Glucose Monitoring During the COVID-19 Pandemic

Source: Journal of Diabetes Science and Technology

Key Takeaway: Given the importance of treating diabetes and uncontrolled hyperglycemia in every unit of the hospital, and the improvements in performance of current-generation CGM systems, we say why not continuously measure glucose in the hospital as well? The appropriate implementation of this technology may significantly decrease the burden of glucose monitoring for patients and providers. A systematic analysis of the experience gained during these unprecedented times will likely help transform inpatient diabetes care for the better.

 


ADA Town Hall: Real World Cases – Inpatient Care for People with Diabetes and COVID-19

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Source: American Diabetes Association

About the Webinar: During the webinar on 5/14, Drs. Carol Levy (Mount Sinai Diabetes Center) and Jing Chao (University WA) shared their real world experiences and perspectives on CGM use in the hospital.

 


Glucose Monitoring and Diabetes Management in the Time of Coronavirus Disease 2019

Source: Journal of Diabetes Science and Technology

Key Takeaway: We have learned that the coronavirus disease 2019 (COVID-19) pandemic is presenting the field of diabetes technology with challenges and opportunities. The challenges are difficult to overstate: in the United States, about 34% of patients hospitalized for COVID-19 have pre-existing diabetes, and patients with diabetes do far worse with COVID-19 than those without. The opportunities for diabetes technology are taking the form of stronger and better relationships within the diabetes community, expanded use of continuous glucose monitoring (CGM) and remote monitoring, a greater understanding of the disease as it relates to endocrine and metabolic disruption, and insights that may apply to the next public health crisis.

 


COVID-19 in People with Diabetes: Urgently Needed Lessons From Early Reports

Source: Diabetes Care

Key Takeaway: Digital technologies are providing remote access to educational and research meetings and, of course, to loved ones and friends who may be otherwise inaccessible. Until a proven vaccine and highly effective pharmacotherapy are developed, we need widespread testing of apparently well individuals to determine who has immunity from prior infection, who is at risk, and who is unknowingly infected. As the peak of COVID-19 begins to pass and we work to obtain better testing, pharmacotherapy, and ultimately a vaccine, we will enter a longer interval in which we must continue to support the most vulnerable populations, especially older people, those with diabetes or obesity, and those who lack the resources to limit day-today exposure to infection. We hope a growing sense of community will help in this task.

 


Remote Glucose Monitoring of Hospitalized, Quarantined Patients with Diabetes and COVID-19

Source: Diabetes Care

Key Takeaway: In summary, converting a personal CGM system originally designed for diabetes self-management to team-based, real-time remote glucose monitoring offers a novel tool for inpatient diabetes control in COVID-19 isolation facilities. Such a solution in addition to ongoing remotely monitored clinical parameters (such as pulse rate, electrocardiogram, and oxygen saturation) adds to quality of diabetes care while minimizing risk of staff exposure and burden.

 


Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients with Diabetes in Wuhan, China: A Two-Center, Retrospective Study

Source: Diabetes Care

Key Takeaway: In summary, the findings of our study suggested that COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Diabetes was not independently associated with in-hospital death, while hypertension, cardiovascular disease, and chronic pulmonary disease played more important roles in contributing to the mortality of COVID19 patients. In-hospital death among COVID-19 patients with diabetes was associated with hypertension and advanced age, whereas only older age was independently associated with death among matched patients without diabetes. The need for early monitoring and supportive care should be addressed in these patients at high risks.

 


ADA Webinar: Answering Your Questions: COVID-19 and Inpatient Care for People with Diabetes

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Source: American Diabetes Association

About the Webinar: Drs. Robert Eckel (ADA President, Medicine & Science), Mary Korytkowski (University of Pittsburgh), and Irl Hirsh (University of Washington) answer questions about inpatient diabetes care during COVID-19. Topics include subcutaneous insulin infusions, CGM use in the inpatient setting, insulin infusion pumps in the inpatient setting, recommendations for inpatient glycemic control, oral medications, hydroxychloroquine and adverse effects in persons with diabetes

 


ADA Webinar: COVID-19 and Inpatient Care for People with Diabetes

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Source: American Diabetes Association

About the Webinar: Distinguished faculty answer questions about inpatient management of patients who have diabetes, during COVID-19.

 


Collaborative Open-Access Virtual Database for COVID-19 In Diabetes

Source: https://www.covidindiabetes.org/

About the Site: The Goal of COVID-IN-DIABETES is to Achieve Glycemic Control with a Community-Centered Perspective: Care for our patients, preserve PPE, reduce the risk of infection of our healthcare workers with SARS-CoV-2, and decrease the spread to the community.

Key Takeaway: This resource provides a large database of information regarding diabetes management during the current COVID-19 pandemic.


Interview with Carol Levy, MD, Clinical Director of the Mount Sinai Diabetes Center regarding Mount Sinai’s effort to make glucose management safer during COVID-19

Source: Endocrinetoday

Key Takeaway: “The advantages of [inpatient] CGM are less fingerstick testing and…more remote monitoring.” – Carol Levy, MD

 


Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes

Source: Cell Metabolism

Key Takeaway: Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.


Practical Recommendations for the Management of Diabetes in Patients with COVID-19

Source: The Lancet Diabetes & Endocrinology

Key Takeaway: Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus 2. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20–50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. We aim to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.

 


Individualizing Inpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic

Source: Journal of Diabetes Science and Technology

Key Takeaway: Effective inpatient diabetes treatment approaches that can reduce the effort of medical staff resulting from multiple insulin injections and fingerstick testing, the waste of invaluable PPE, and patient discomfort during this pandemic are paramount. Not optimizing glycemic control due to clinical inertia driven by fear or lack of supplies may lead to poor outcomes in patients with diabetes and COVID-19. An individualized approach, as opposed to standardized regimens, may reduce these barriers during this pandemic. However, systematic evaluation of these changes in care is necessary to evaluate both patient- and community-centered outcomes.

 


Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States

Source: Journal of Diabetes Science and Technology

Key Takeaway: Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer length of stay and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate.

 


A Pilot Study of the Feasibility and Accuracy of Inpatient Continuous Glucose Monitoring

Source: Diabetes Care

Key Takeaway: While there are limitations to these data including a small sample size, lack of blood glucose laboratory confirmation, and non–ICU admissions, we feel confident that the Dexcom G6 can be used safely in the hospital for patients infected with SARS-CoV-2. Now that the U.S. Food and Drug Administration has emergently approved CGM for use in the hospital, it will be easier to test all CGM devices in the hospital setting. This could potentially have major implications for inpatient glycemic management after the pandemic, and cost-to-benefit ratios will be important to consider. In our current situation, use of CGM could reduce the number of health care provider contacts and the need for personal protective equipment.