What Top Hospitals Say About Diabetes Care in 2019

Every day here at DiabetesSelfManagement.com, we cover topics related to a particular aspect of diabetes or its treatment — a new study, a food trend or a device that can make your life easier.

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But every now and then, it can be useful to step back and take a look at the bigger picture of diabetes treatment and management. The innovations and changes in the treatment landscape in just the last few years have been mind-boggling, and even many health professionals are struggling to figure out the best way to use the latest drug and device offerings.

To get a sense of where we are right now and where we’re headed in diabetes care, we asked experts from some of the top-rated hospitals in the United States the same five questions. Their responses (condensed and edited for clarity) appear below.

Diabetes Self-Management: There are more tools available for monitoring blood glucose levels than ever before. What developments do you see as most promising, and how do you decide what to recommend to patients?

Clare Jung Eun Lee, MDClare Jung Eun Lee, MD, endocrinologist and assistant professor of medicine, Johns Hopkins Medicine: In terms of blood glucose monitoring, we’re able to offer options the are less painful. Some of the latest editions of continuous glucose monitors (CGMs) do not require that you calibrate their systems with a fingerstick glucometer. Theoretically, if your blood sugar is behaving, you shouldn’t have to prick your fingers at all. And that’s been a big boon to patients who had to prick their fingers 5 to 7 times a day. We’re talking about quality of life.

Even on the cost front, [traditional glucometers and CGMs] may be neck and neck. CGMs are not necessarily cheap, but test strips are not cheap, either. And the fact that you can see not only where your blood sugar is at the moment, but where it’s going, has implications for how patients can prepare and maintain their levels. It’s an exciting development, and these systems are only going to get better and better.

David Matthew Nathan, MDDavid Matthew Nathan, MD, endocrinologist and director of Diabetes Center, Massachusetts General Hospital: CGM has been the major development for Type 1 diabetes and is of great importance to patients at particularly high risk for severe hypoglycemia. Its benefit in other patients with Type 1 diabetes is a little less clear, and depends on the individual patient’s ability and willingness to adjust their insulin regimen.

Pump-treated patients can respond to CGM data often and more easily than [those treated with] multiple daily injections, but studies have demonstrated a benefit for the latter group as well. Individualizing monitoring remains important. CGM is a critical element in creating true artificial pancreases. Whether CGM will provide a benefit for some patients with Type 2 diabetes remains to be established.

Adrian Vella, MDAdrian Vella, MD, endocrinologist and diabetes researcher, Mayo Clinic: I think the ease of monitoring that comes with CGMs or flash monitors is a positive thing, provided it is used appropriately to motivate patients towards better glycemic control and to decrease the risk of hypoglycemia.

If someone is on a regimen that requires frequent testing — for example, more than three times a day — it is increasingly becoming my practice to recommend a flash meter, since the cost is beginning to approach that of standard self-testing. I tend to reserve CGMs for patients who are using an insulin pump. Not every patient needs this, but from a personal point of view, if I had Type 1 diabetes, I probably would want the ability to check my blood sugars as frequently as necessary.

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