Video The Evolving Evidence for Sensor-Based Glucose Monitoring to Optimize Glycemic, Patient Health, and Safety Outcomes in Persons with Type 2 Diabetes Play Pause Volume Quality 1080P 720P 576P Fullscreen Captions Transcript Chapters Slides The Evolving Evidence for Sensor-Based Glucose Monitoring to Optimize Glycemic, Patient Health, and Safety Outcomes in Persons with Type 2 Diabetes Overview Continue to Test Back to Symposium we're now going to change gears a little bit and go into translating trial based evidence in rural world data for us to optimize our health metrics in person across the diabetes spectrum. We're going to take that sensor based glucose monitoring and really try and make it applicable of why we do it, what the patient gets from that, what the provider gets from it. And also as we move forward in the evolution of diabetes and technology, how it can be quite illuminating for all the participants in this. And so, um I am Doctor Eden Miller, I am a primary care provider. I'm also a diplomat of the american board of Obesity Medicine. I work as a diabetic ologists. It and today we will focus on those persons with Type two diabetes, on oral anti diabetic therapies with or without insulin. And we're going to explore this evolving evidence for how we can optimize the patient health their safety. Of course, we always say safety first, but there's also this glycemic illumination that occurs well for the patient and the provider. And we're going to explore all of that today. So here are my affiliations. I work out here in central Oregon in Bend, and I am the executive director of diabetes and obesity care and I'm the founder of the nonprofit diabetes nation. So let's start by looking at what we call the current challenges and outpatient management of type two diabetes. We really have a need for a progressive plan of treatment intensification with engage patients. You know, this is kind of, how shall I say that holy grail? We it's a marathon. It's not a sprint. And I get this all the time. How do I keep my patients engaged? How do I send a foundation for engagement? Because we have to keep pace with them. We have to continue to expand as a graduate through the different chapters of their disease. Now throw on top of that clinical inertia. You'll probably see me I'm very involved with the A. D. A. On Clinical Inertia and actually the co chair for the provider education piece of how we overcome therapeutic inertia, those barriers. It's those things that come to sabotage Us as providers patients, the payer the delivery system because it's so prevalent in the management of type two diabetes and probably in my opinion, is a disease state where we see inertia to be the greatest and we see these longest delays for initiation of insulin and titillation. But I would also go on to say that we see delays in overall intensification. It doesn't matter what therapy, we just sit and hope that somehow the magic diabetes fairy is going to come and change all of these things that were encountering. We really have this substantiated foundational fear of hypoglycemia. We all have it. The patient has it. They think by distancing themselves from control, we're going to avoid hypoglycemia. And then of course the provider being empathetic comes right alongside and says, you're right, I should raise your sugar to avoid hypoglycemia. But with a lot of the emerging data We're finding that really it's not the destination a one C that provides the hypoglycemic risk. It's how you get there and something we call glucose variability. So with all of this, of course we're under diabetes distress, we have that ongoing treatment and lifestyle non adherence and poor treatment persistence. This is what I call where diabetes distress turns into un engaged apparently apathetic patients. But in my opinion, high level of distress includes apathy. And it's not that these patients don't care, it's that they just are so frustrated they don't know what to do and layer on top of that. The resource utilization and healthcare costs through morbidity and mortality. Wouldn't that be lovely to work in a system where we would talk about interventional opportunities such as technology and see Gm and how it can save money, How it can limit comorbidities. I was astounded by having lunch with a friend of mine who runs the local VMS for our county area. She's the head dispatcher. She said the number two E. M. S. Ambulance requests for 911 is hypoglycemia. And I said, you've got to be kidding me. I didn't know that. I was even unaware as a health care provider that how pervasive this was. Of course we are very unaware of that silent or unawareness of hypoglycemia and we really don't appreciate the nocturnal hypoglycemic risk that our patients are experiencing hidden in the middle of the day. Okay, I'm going to advance my slides here. So the trials and tribulations of A one C. It really is a metric, right? We know that it's your average speed. It's actually retrospective. There's nothing prospective about it. It is the metric that I don't think it's going to go anywhere, but it really has been what we've called in the past. It's still that universally accepted standard of care. It's also diagnostically used. We use it in all of our day and day out kind of thing. But there's this ongoing debate of what the optimal way once he is. Because a one C. Doesn't tell the whole story. In my opinion, I've often tried to use this nomenclature of a standardized A. B. G. P. Added to a hemoglobin, A one C. So what do I mean by that? I I really call it a validated a one C. Where we look at C. G. M. We look at time and range. We look what the ambulatory glucose profile provides and we say, hey yes you have an A. One C. And that A one C. Is encompassed by these kinds of metrics. That agreement that individual a 1C targets must be based on their age and their life expectancy and their comorbidities and risk of hypoglycemia. But just taking a person who is at risk and making them high actually may cause hypoglycemia unawareness. And so we're actually drifting into those comorbidities. And so when we look at the reports that continuous glucose monitoring provide and will explore that. One of the things that's becoming quite emergency. Me and Earl, we'll agree we both really agree on this concept is that glycemic variability drives these risks. It's not a one c. A one C is just kind of an average. But what you are around that A one C. You know what I mean? What you are high and low how high and hilal. What's your scope of your leukemia that supports us A one C. That's what we're looking for because as we have less variability we have more consistency and license management. And I'll show you of how this is eliminated. In addition, we know A one C. Has the inability to capture short term variations. It doesn't give us anything real time and it's so retrospective that it's not surprising we don't have patient engagement with it. So we know that not all agencies are created the same. We've we've talked about it. We kind of assume inpatient A. That we haven't even seen seven. That means all of their sugars are on target Between 70 and 180 because that's the time and range. Or T. I. R. That we would like. But in reality if you take that A one C. Of seven and you really look at all the different glucose is there visiting it could be like patient beat where 63% there in time and range and 8% there below 70 and 29% there above target. Or it could be Patients see which also has the same a. one c. But now we have what we call higher glucose variability around the mean. And we have 58% above goal and 25% on target but a dangerous 18% below target range. This is why we're talking about it and I understand it may feel daunting but I like in it to having like a speedometer in your car or a gps system. For years we were driving the diabetes vehicle not knowing how fast we were going, not knowing where we were going. You know, pushing on the accelerator, slamming on the brake and we had this conception that that was the way we could do it. And now we're here to tell you that you have a tool that is complementary to the disease. It's liberating for the patient. It's liberating for the provider. And so the question comes up, who should see GM or who should not see GM. And so we're going to give you some guidance of it. But let me start by saying this. I believe all persons who have diabetes could benefit by using C. G. M. Now that doesn't mean they're going to use it all the time. Maybe they do intermittently. Maybe they do it professionally. Maybe they do it personally. But it all has to do with that. C. G. M. Offers different benefits to different people. So if you go into the mindset of all you need to see GM or not see GM. Because patients on insulin and they're at risk for hypoglycemia. It's only one thing that C. G. M. Provides. And so when I look at an overall, I could argue that all persons could benefit it in some way. Whether it's engagement or illumination of exercise or lifestyle or therapies or safety, it's endless. But there are some what we call basics that you can do it in your day to day encounters and to say, hey, wait a minute. Anyone sees just an average. If something isn't making sense right? I look at anyone see of 71 and they're telling me, you know, they feel awful, they feel confused or they're having hyper or you're just not getting that full picture. That's when we consider C. G. M. And understanding that each A one C could have vastly different glucose ranges to it. Well we take diabetes out of the past if you want to go out from that retrospective well you should do better last three months you know and bring it into the present and then talking about the future. That's really who 60 Gm. It's also a lovely engagement tool. The other person is totally disengaged from their diabetes ideal candidate to do an intermittent C. G. M. To do a professional to bring them back in the office and analyze it together. And then of course what we call the low hanging fruit. All persons who are at risk for hypoglycemia, whether it's their morbidity, their cognition, their age, their treatment these must be a standard of care because it is a safety issue and that does provide that safety and so that C. G. M. Fills in the gaps. If we looked at a person that did anyone see on the left in this light blue this is just saying that All these different metrics over these 12 weeks is here is your number and that number has some meaning but it doesn't have direction. It has meaning in terms of metric but not direction. So then we have somebody in the middle do a point of care and we're like yeah we want you to really check your blood sugar. Wouldn't it be great to get these you know six points of care. We're lucky if we get one where we have one in the morning and it's called when their car has been overnight and they're sitting there in the parking lot so you can see what they're starting temperature is. You know nothing about the physiology of diabetes where postprandial, the highest peak plasma glucose. And so if you do these 46 points which is considered very high standard of control, you get more data. But their point of care. If we fill in what see GM provides on the right hand side, we've now taken these point of care data and we've shown you All the different sugars they visited in getting to those different areas. In fact, you missed the peak plasma glucose at 11 pm. Because you were just looking at this metric that was, you know, 12 hours earlier. And so this is an opportunity for this information to be meaningful and actionable. Not overwhelming. You will find as you familiarize yourself with this, it will be very empowering. So let's unpack a little bit. One of my favorite real world analysis that laying produced on the association between the frequency of scanning using the freestyle library monitor. So it's a you know, flash freestyle system. They were in their engaging in it universities just looking, we were actually swiping your scanning and so we have these three different metrics and so we looked at hypo hyper and then T. IR remembers diamond range. So we looked at the daily scans at the bottom. The daily scan is all the way from zero, all the way to 50. You know, nobody was doing 50 but there were some forties out there, you know the scanner watchers. Right? So what was amazing about this data, which I think changed the trajectory in terms of looking at C. G. M. Rate of hypoglycemia and hyperglycemia. And we looked at the corresponding A one C. Right that estimated we see in blue, that's your little marker and blue. And then we looked at the hours above the target time and range is really very high sugars about 2 40. What we saw is that there was this relationship that the more you scan the more you interact with your C. G. M. The better your a. one c. And less hypoglycemia. It really threw itself in the face that we said if you get a low A. One C. You get more hypoglycemia. And what we found is that the A. One C. Associated with the highest hypoglycemia. Great was 8.2 which was so counter to what the recommendations were is raised the A. One C. In order to protect safety because it's really about variability. It's about not knowing where you're going. Now there was a sweet spot we got we got less diminishing return. We saw that the curve of hypo and hyper Was a steep downward curb. And when it got to, you know about 12, swipes interactions. You know, we started to see that tail out. You know, there were people like I said swiping at 40. Usually I have a conversation with them. Are you doing anything or is it just worry? So what we get from this data is the more you interact with your CG and the more you know where you currently are, where you came from, what got you to that destination and where you're heading and this improves patient engagement improves a one C all the while decreasing the risk of hypoglycemia. And many of us as experts knew that was the case because it's that data that's meaningful not data that is a meaningful. So there were some great studies and type one and type two diabetes in the Netherlands called the flare study. We looked at individuals in different age categories. Some had type one, the majority did. Some had type two. We were really trying to conceptualize that C. G. M. Is not just a type one metric. Rather I should tell you every person with type one diabetes should be on the C. G. M. But there are secondary benefits beyond those patients with Type one because Type twos are on sometimes type of icy make agents, they need more engagement. And we looked for the most part with those persons with based on A one C. Is greater than or equal to 8.6. And we looked at the most profound increase or rather I should say decrease uh in that A one C. What we do know for sure that every single study to date that has added A ones are added see GM onto a Type one or type two patients has shown improvement in A one C. But we also see secondary improvement as well. We see better engagement, better quality of life. This particular studies showed work absenteeism as well as diabetes related hospital admissions. This is a cost saver, went from 18.5 to 7.7 and respectively 13.7 to 2.3. This world world data demonstrates the use of this particular freestyle library system resulted in improved well being decreased disease burden. And we also got improved glycemic control all the while impacting morbidity mortality. Now one of the studies that was near and dear to my heart was one that we presented last year looking at A ONE C reductions after initiation of freestyle in persons with type two diabetes who are either on just basil insulin, no rapid acting or non insulin. Yes. GOP one's oral anti diabetic agents or what we call non insulin agents. And our aim was to look at that changes based on a one c. And so we looked at retrospective data. We did three different data stores linking together to look at that trifecta of the library view the quest diagnostic with the A. One C. As well as the DRG reported medications. So we knew we were getting those just on basal insulin or those on oral anti diabetic agents. We had baseline criteria WNBC greater than equal to 65 prior to the index of receiving continuous glucose monitoring and these two core hurts. And we wanted to look at the A. One C. At the 180 day mark right around there and then again at the 360 day mark. And this was what was so exciting for all of us who were participants. We knew that C. G. M. Impacted Type ones are people on based on bullets insulin with type two. But we didn't know what the impact would be if somebody was just on long acting insulin. Right? Something you can titrate just on a 24 hour basis. And what we saw is in that first six month index period. They had a name of production at 60.8 that continued at the 12 month 2.6. But look at the right hand side. Those are the individuals with type two diabetes who were not on insulin. They had an agency reduction of 20.9. In addition, they went on to continue to have that at 0.7. That's really talking about people who we used to say glucose testing didn't give you any benefit because you weren't using the metric to change the dose like insulin. Right? So what is happening here? I think we have a lot of thought with is it engagement in the disease? Isn't knowing how food and exercise and missed medications affect you? Is it awareness? Is that personal responsibility and awareness to say oh my gosh when I go for a walk this changes? Or is it also that giving the provider data to have what we call that actionable insight? I like to say that the ambulatory glucose profile is an actionable glucose profile because There are different touch points for intervention and so type two diabetes in the use of real time glucose monitoring. You know this development has had a profound impact on the field of diabetes. I really feel like we've gone from a 30,000 ft view to a microscopic view. But let's take it one more step further. It's personalizing it. We have for so long generalized diabetes control that C. G. M. Can be personalized whether even it's if it's pro or a personal use that data is uniquely them and so we can have impact on them uniquely. And there is this expanding evidence that there is utility for persons outside what we call the considered, you know, individual beyond type one beyond type to even on intensive insulin therapies but really available for all persons with type two diabetes. I've even done some work in prediabetes the forbidden diagnosis of Is there a way because you're aware of your glucose ranges to have impact And we're just there. I think we're just we're like archaeologists now with a new tool for the management of diabetes and we're peeling back the layers of how we can intervene in the different stages. And so I'm actually really excited because in these interventional opportunities it gives me more tools to have an impact because I would love to impact the disease earlier rather than later. And so if we look at a comparison of continuous glucose monitors and reducing A one C in Type one and type two diabetes using the freestyle liberate compared with the decks. Com. This is something that our previous presenter erlin, I actually are co presenting for the A. D. A. And poster. And that is we looked at the systems, it's like, okay, so if we look at dX. Com, we know it's used in Type one. It's also used in Type two. If we looked at the freestyle libre, the the original and the 14 day Systems. My contributing authors, we looked at the amount of reduction in the A. One C. We know they both improve. But if we if we separate the type one and type two and then get rid and eliminate all of those confounding variables and we've matched the groups. Do we see a difference between those using the decks calm and the lee brae? And what we found is that all recipients of CGM experienced a significant improvement of A one C. And the A one C. Improvement between the two devices was identical. And that it was this concept of C. G. M. Ng. And that one system was not superior over the other. There was no statistical differences between those devices. And so upcoming C. G. M. And type two diabetes studies. I think this is going to catapult us into this greater appreciation. Uh The decks com G six has a couple studies that are coming out right now. They're looking at the Vanderbilt diabetes center is 15 studies sites called the mobile trial which focuses on C. G. M. Use and type two diabetes in the basil insulin user. And they're being followed by a primary care physician who can utilize that data for intervention. You know we're looking at adult patients that randomized either to get self monitoring of blood glucose or they're getting the decks come G6 system. And we're looking at other what happens when they're empowered with this tool. But one of the things that's important is to understand that there is a benefit to the patient. But then the provider needs to pick up their benefit as well. And then the question is if we redrew them later do they migrate back to poorer control because they've lost their real time monitoring. And then of course the refer basil study which is actually something that I participated in um Through the UK. I was one of the sites in in the us looking at the efficacy of flash glucose monitoring the type two diabetes on basil insulin alone. It was a cohort out of the UK, United States and Canada and it is pending publication. Looking at that data, I actually know what, it is not surprising. Like I said, we see improvement in all persons and all cohorts using continuous glucose monitoring. So I'd like to transition a little bit to a case study because we got to put this in practice right. This is actually a real individual in my practice. And it really highlights kind of some of the key takeaways that we interact on a primary care level. So I have a 63 year old female type two diabetes for 3.5 years. She has a consultative appointment kind of the same criteria. Hypertension, hyper lymphedema. She's class to diabetes. And she comes in on metformin and she says to me you know I do the Metformin. I know I'm supposed to do it. My previous doctor told me I need to do it but I just I sometimes can take it. I sometimes don't. I get gi related issues. She comes in with the name and C. Of 84 Now you might say well we need to do a better job. Of course we do. That's why we bring her in. But often times in the United States the average A one C. Is a two. So this is not too far off the national average. So I discussed with her about different things, different options. We went you know we could all argue different therapeutic interventions and changing that's not the issue. Rather she kind of had this lack of engagement. She actually told me she had attention deficit disorder. And I said hey would you be willing to try a personal C. G. M. To really increase your engagement to get you aware of how the medication in your life and the different things impact your disease. And she was like I'm all over it. And so what we did is we placed her on the C. G. M. And I had to do a pretty quick interval follow up. That's the key. You put it on him whether you do a professional which is what I would suggest you do at the very minimum. These are easy to apply, they're easy to build their easy to interpret and it's a way for you to wade into the sea GM pool. She happened to have a personal because I wanted her to see her numbers and get engaged. I brought her back within 3-4 weeks and what I saw was this heads up ambulatory glucose profile. Like I turned the actionable glucose plan right? How we're going to interact And so what we were able to do is you can see all the different components and you're going to be experiencing a lot of this. But understand this is a report card, don't say that to the patient. They feel like they're being graded. But it really is the it's like when you take your car to the mechanic and you hear your computer print out, this is your computer, print out your actionable plan. It gives you this visual representation, it gives you this time and range. It gives you the standard and it gives you these metrics on the left hand side that says if all things were considered the same going forward in this two week 14 day predictive period that this person's glucose management indicator, A k a a one C metric for two weeks would be 7.4 if things stayed the same. And so when a person comes in and it's only been a month and we haven't washed out there. Anyone see, I can say, hey look, we have improvement in your metrics and this is what you're able to see would be right now. We would also be able to look at the safety first. Like in a day one c we would look at the glucose variability, We would look at the time and range and it gives me these actionable insights. In addition, each med has its own signature that when you add on that format, it has, you know, a bit of this postprandial effect, a little bit of this fasting effect. And each med, many of my colleagues don't realize have its own fingerprint. And so that's what we're going to be seeing going forward. That you'll be able to plug in meds based on what, you know they do and how they impact with the bisi mia. So what I did as a result of getting this metric from her is I said, you know what, you're not taking your Metformin, you wrote in your little logbook, how you're doing it, you can see what happens when you don't and what she reported is that she had the significant increased awareness of food. She goes, I certain foods really bother me. I learned that about myself. That's something you can't tell them within a one c stress and activity levels, medication adherence or lack of adherence had a big impact. So, by looking at her egg up looking at her postprandial excursions, knowing Metformin doesn't have a robust postprandial effect. Knowing what a one c I was at, I suggested a GLP one receptor agonist for her discontinuing the Metformin work on something that's weekly with better adherence. And she said she wanted to continue her particular freestyle liberate because she called it her diabetes accountability partner. So 14 months after baseline. Yes I saw the patient previous to this because we tie traded doses. We worked on engagement, we worked on things. But this was her report after she had been initiated in our clinic. She had been currently using the medication. We had really improved on our overall engagement. She had a lot of issues mental health wise, she did have attention deficit. She also had a concomitant diagnosis of bipolar disease. And so what we get is this a G. P. On this particular one that shows her target range was 90%. Oh my gosh it's amazing. And look at how we didn't get that because we were getting hypo, she had zero less than 70 and zero in the severe range and only 10% in the 1 81 to 2 50. And we call that the cloud or that's the outliers that 5% around the mean. You know, the darker is the 25 to 75% around the around the line of congruity of the mean. The lighter is the 5% and 95th around the mean. And so then I could go from each day because in this profile you can look at each day and I said what happened here? Oh my gosh, I went in the head birthday cake or that kind of thing. And it's not that you're judging them, you're engaging them how their day to day life impacts or glossy mia. Now her particular point of care A one C. was 71 But if you look at her glucose management indicator on the left where she's at over the last two weeks, look at where she's at and target and we have a very narrow glucose or glycemic variability play scenic, very building needs consistency. The narrow where the data is, the more consistent. Then you can look at where the data spreads out and say what happens here and her greatest glucose variability is around lunch. So you ask, what about timing of food? What about the amount of food? What about you? What are you doing where you walking? Are you not? You know, dinner tends to be a high area of variability. So I know this is kind of a bit of a cursory introduction, but every single data point here is an opportunity for action. We don't want you to say, hey, here's a c G. M. I'm glad you as the patient are benefiting from this and I feel better because you're safer. No, it's your report to walk through the patient to build with the cpt modifiers to sit there and customize and this is what you're doing and what about here and looking at the effects and becoming familiar. There's so many plants, there's so many teaching opportunities out there that we have online help. You deconstructing the A. G. P. The other thing is very few of us are even downloading it. It's like less than 15% or even downloaded. So make sure you download it even if you're not perfect. Even if you print it off and say let's look at it together. And even if you say things like, what do you think happened here? And they go what it was that that was saturday. Do you see how they're going to help illuminate? And then you, as you get more familiar with looking at these, you're going to see how the different foods and the different stressors and actually how the different meds really impact. So kind of the overall summary, what does the individual get with glucose monitoring? Real time? Glucose monitoring brings diabetes from the past into the present and it actually helps predict the future. We have those trend arrows that show up or down or stable or going down. We have this individually driven patient engagement tool. You've empowered them. You actually will increase their engagement because you've given them a tool that just you scan and see you give them the personal effects that diabetes and their own life have their effects of food, their effects of time of day activity level illness engagement and you get this ease of mind for the loved ones there so they feel so safe that person who may be not be attending to it that they now you can yell across the room, why not just wipe and see what you are? Or have some family members who actually swipe they actually swiped their loved one whether they're a young individual or an older individual. But remember we as providers get something too and I really want to encourage you to spend a little bit of time. And some of this time you're spending here is educating yourself and don't neglect asking for help or doing other resources. This is not rocket science as as one of my friends dr nick are Gento said it's not like we're trying to fly the space shuttle. This is at 1/5 grade level. We, many of us who are involved in the building of the A. G. P. Made it with primary care in mind. We want this opportunity to reveal the therapeutic impacts that that different things you choose to get them to go and how they have that impact. We want to actually educate you. That is more than just a one C. Or what it does that that each drug either is an anti hyperglycemia occasion. In other words prevents about Children going up. Uh We know insulin drops the sugar. But that's all it does. There are other agents beyond insulin in the oral, anti diabetic or non insulin injectable realm that do more than one dimension. They impact the cardiovascular, they impact weight, they impact food choices, they impact the glucose from going up. They cause the glucose to go down. And many of these other therapies in that realm are what we call multidimensional or two or three dimensional. They go beyond just lowering the sugar, lowering the sugar. Yes. See GM needs to be there. If you are on an agent that lowers the sugar that can cause hypoglycemia. Risk that safety first. But beyond that, it it increases that individual engagement. It equips us with tools to be that compiled printable data. But yes, reveals hyperglycemia because it is about safety. But it's more about like scenic excursion variability, engagement, high and low time and range. Looking and peering into their personal profile to say, hey, where do I need to intervene? Don't feel like you have to know all the answers. Bring them in. Say what happened here? What did you notice here? What is this food? Is this activity? What about this new med? We tried What have we seen compare the prior one to the current one. You see all the opportunities for that interaction. So what are our summary and key takeaways? Yes. Managing type two diabetic patients on insulin. Is that next level challenge? I would say that C G. M. Provides an essential tool to eliminate and to illuminate and engage it. You don't have to be on insulin. That's just niche ng. Just one benefit of C. G. M. For hypoglycemia. It has a whole host of benefits for both the provider and the patient to really lessen the burden and to give you this completely scenic picture. It's supporting you and our patients. To me more informed. Like I mentioned earlier, it is the GPS for diabetes management. There are clinical benefits that we have seen in the realm of research. We have all cause hospitalization and mortality reduction. I'm here to tell you there isn't a single C. G. M. Study that hasn't shown improvement in agency for those with Type two diabetes. And it's independent of whether they're on insulin or not. And really prescribers should think about continuous glucose monitoring beyond real time glucose meters. They're more than just a fancy meter. There are retrospective and predictive tool that provides compile herbal printable data that are actionable for us in order to drive and overcome that inertia that the field of diabetes had had, mainly because we were practicing blindfold. And now by utilizing technology, we really can catch up with the disease and I believe that we're going to go more beyond managing. We're going to illuminate all of its secrets. We're going to look at the different stages. We're gonna be able to see with a more complete picture of how this dis metabolic system that is represented by hyperglycemia occurs. And so for me, you can catch my enthusiasm. I want to bring you along. I want to make you feel competent and comfortable with us. I don't want you to feel daunted by it, but rather liberated because as you take a little bit of moment to familiarize yourself, to go through them too, practice them, you're going to find how much of a time saver it is and how much benefit you'll see in that clinical scenario. And so we just thank you so much for spending your time with us right now revealing that sensor based glucose monitoring and how we translate the trial evidence into practical real world so that we, as providers, can empower our patients to be experts on their own disease. Thank you so much. Published June 10, 2021 Created by Related Presenters Eden Miller, DO FounderDiabetes and Obesity Care LLCSt. Charles Hospital Bend, OR
