The Revolution in Continuous Glucose Monitoring for Diabetes

Continuous glucose monitoring represents not only a game-changing intervention for diabetes, but also a model for more continuous digital monitoring of various person-generated data. Diabetologist and informaticist Aaron Neinstein will discuss the advances in CGM and their implications for the care of people with diabetes and for patients with other chronic diseases.

Speaker:
Aaron Neinstein, MD, is Associate Professor in the UCSF Health Division of Endocrinology, Vice President of Digital Health for UCSF Health, and Senior Director at the UCSF Center for Digital Health Innovation (CHDI). He helped lead UCSF’s ambulatory Epic EHR implementation; helped develop and deploy numerous digital health solutions transforming digital patient experience and virtual care delivery across UCSF; contributed research and advocacy to advance US federal health policy in interoperability and patient data access; and co-founded Tidepool, a nonprofit that created open-source software to empower people with diabetes. His multidisciplinary team at CDHI focuses on advancing patient experience and digital transformation of care delivery, including the use of telehealth and remote monitoring technologies to deliver more connected care. His clinical practice is focused on the care of people with diabetes.

Note: Closed captions will be available within 48-72 hours after posting.

Program
Bob Wachter: Introduction
00:03:15-00:40:14 – Aaron Neinstein (Associate Professor in the UCSF Health Division of Endocrinology, Vice President of Digital Health for UCSF Health, and Senior Director at the UCSF Center for Digital Health Innovation (CHDI))
00:40:14-00:58:56 – Q&A
Bob Wachter: Closing

See previous Medical Grand Rounds:
• January 13: The Omicron Whirlwind: A Conversation with Eric Topol - The Current and Future State of the Pandemic
• January 6: Confronting Racism Denial: Naming Racism and Moving to Action
• December 16: Omicron in Mid-December: What Have We Learned and What Does It Mean?
• December 9: Our Emerging Understanding of the Gut Microbiome in Health and Disease

[fiskie]

I have had T1D for 59 years and was able to obtain a Dexcom CGM 3 years ago. My feeling is, NO! this is not data overload for me. I am absolutely thrilled to know my (interstitial) glucose level many times a day, whenever I want, multiple times. I monitor how different foods affect glucose level, how different types of exercise affect glucose, how stress and infections affect my glucose level, and so on. Bring on the data!!! I used to have serious hypoglycemia during the night several times a month, a fear that has now gone the way of the typewriter. I began with one injection/day in 1963 and constant hypo- and hyperglycemia because the Benedict's test we had was useless. I can still remember when I had a fasting blood draw one morning at the student health service, then received a frantic call fro the lab director that afternoon because my BG level was 21. Scary. So, the first diabetes revolution for me was in 1980 when I was able to use home glucose monitoring with the analog Ames reader. I couldn't believe I could know my BG level without having a venous blood draw. Since then technology has steadily improved, and now we have CGM. Onward and upward!

[myggggeneration]

T1D for 30+ years. 71 yrs old now, I received my CGM (Dexcom) 3 months ago and I love it. It's a game-changer. I wish I had figured this out before my eyesight suffered.

[ex-nerd]

As someone with T1 (one of the 3-in-4 of us who get it as adults!), CGM is definitely life-changing, especially when combined with dynamic management techniques like Sugar Surfing that bring diabetes care from the 1970s into the 21st century. And for "alert fatigue", my biggest complaint is that I can't always silence them. Dynamic management and following trends means I've usually corrected my highs/lows at least 15 minutes before they happen, so the alarm isn't a surprise, just an annoyance. But I'll trade that for the piece of mind of knowing where my blood sugar is "going" -- that 2 hour warmup time every 10 days on my Dexcom feels a bit like being blind.

[Timmiehere]

I love my cgm. I believe knowing and seeing the data let’s you see how different foods and activities affect glucose levels. You can see what is safe and not safe. Modify your food combination and maybe add or remove foods to keep numbers in range. It is a no brainer! ❤️❤️❤️

[aeromodeller]

One thing I have observed that was not mentioned in any of the books or classes is the synergic effect of insulin and exercise. If I have a high glucose and take a shot, it will go down a little. If I only exercise, it may go down a little. If I exercise vigorously, even with a shot, it will go up. I take it that this is a reaction of the liver to stress. But if I take a shot and go walk for an hour, the glucose comes down where I want it. I assume this is because the moderate exercise moves blood around, distributing the insulin. If the insulin stays in one place, it decays rapidly without getting to most of the cells that need it. I expect insulin decay is related to concentration. When it is widely distributed, it is less concentrated, so decays more slowly, and more of it is where it is needed.

When I started the finger stick monitoring I learned a great deal about my glucose dynamics. I was able to adjust my insulin dosing and this led to a major improvement in control. We are taught a linear model, diabetes is not linear. When the CGMs first came out I took a class, but was told the devices were available only to people who had very poor control. My control is good, but could be better. Being able to examine those curves will give a much better understanding of glucose dynamics. Maybe the attitude has changed. I will ask again about getting a CGM.

[charliemoore]

Insightfull!1 i am type2 diabetic since 3-4 years, using freestyle libre 2 sensor currently with blucon transmitter, I like Blucon as a pocket-friendly CGM, Blucon has helped me with remote monitoring of glucose levels and adding my daily notes in the Linkblucon app to manage my eating habits too.

[floradean]

Nice video, I diagnosed with T1 and use the FreeStyle Libre sensor with Blucon transmitter, I track blood glucose readings on watch and phone constantly and the phone beeps at night when the glucose is out of range.

[abbasmukhtar]

This has been a challenging time, and I appreciate you so much Dr Igudia, you have created a life that I thought was lost, thank you so much for curing my Type 2 Diabetes

[chinbabyogbonna]

God Bless you dr odija on YouTube keep on the good work you have been doing and thanks also for curing me off this disease you are truly a God sent towards humanity I appreciate you sir dr odija!!!!

[iqbalahmad]

THE MODERN MEDICINE IS PROGRESSING WITH REVOLUTIONARY TREATMENT OPTIONS BUT THE BEHAVIOUR OF THE PEOPLE IS GOING IN AN OPPOSITE DIRECTION.

[secondtalk]

New studies from Italy, New Zealand and even China show that type 2 diabetes and pre-diabetes can be managed (or possibly reversed) if you know how.