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Elizabeth Buschur Part 4, Interpreting CGM Data

In this Exclusive Interview, Dr. Elizabeth Buschur talks with Diabetes in Control Publisher Steve Freed during the AACE meeting in Austin, Texas about the focus on understanding how to read CGMS data and explain it to patients.

Dr. Elizabeth Buschur, MD is an assistant professor at The Ohio State University in Columbus, Ohio. She has implemented and is the director of the Diabetes Transition Clinic at the Nationwide Children’s Hospital as well as the Endocrine Disorders in Pregnancy Clinic at The Ohio State University.

Transcript of this video segment:

Steve: So, obviously you have to interpret the results and you can talk for hours when you look at the results for example results for two weeks and they have a food plan that they have written out. How do you interpolate that? Do you sit down with them and go through every single meal? What do you do that preserves your time and you can get the results that you want using the information to interpret?

Dr. Buschur: That’s a great question. It can be overwhelming even for the clinician to know what to focus on. Usually I will try to find a couple of key areas to focus; maybe even looking at their post prandial glucose in one instance then their fasting glucoses and try to see the pattern and ask them questions like…. “Are you possibly snacking and missing boluses or is this rise physiologic?” That will mean changing insulin dosing. It’s a good question.

Steve: If you look at the report and you pick the areas where they are having issues and deal with those because where its normal there’s not much to talk about.

Dr. Buschur: It’s always nice to point out where things are working and where patients are doing well to keep the motivation going. Usually most of the reports have a patient-focused area and a physician-focused area so that patient-focused segment of the report might have just what the target glucose is as well as what percentage is in that range, what percentage is low and what percentage of the day is high. Also, they will have aggregate data of the two-week average on a graph instead of looking each day individually which can be cumbersome with the patient. It is helpful to say over these two weeks it looks like after dinner really is the troublesome time, what do you think is going on there? What do we do to fix that?

Steve: I can remember when we started to use computers and download blood glucose meters. I was working with Abbot at the time and this was when laptops first came out and they were expensive. Abbot gave me a laptop and I would download blood glucose monitors. I generated these beautiful 30page reports in 12 different colors, pie charts, graph charts and blood sugars from Mondays through Wednesdays, and Tuesdays through Saturdays. It was beautiful. I am a pharmacist and the doctor came to the pharmacy. I jumped over the counter and had this reports in a leather binder and showed them to the doctor. He looked at me and asked; “What! Are you, nuts? If you want to send me a report, do it on one page and give me a 2-sentence summary and I will look at it.” You are dealing with a lot of information and you have to consider what you are going to use to talk to the patient about because you can probably talk a lot with all this information. How do you determine what you are going to talk about with that patient?

Dr. Buschur: So, that’s a good question as well. I try to look at the overall average and see if there is a trend in terms of something that we can focus on rather than focusing, “Hey what happened Tuesday? You went up to 400” or 300 or something like. If it was an outlier, I try not to focus on that, but obviously it needs to be addressed somewhat, but focus really on the key areas that you think you can make a difference. And a lot of times the patient will be able to say; “You know, on Tuesdays I snack after dinner.” Or when they actually see the results of that, they can actually be able to pinpoint what they think is the cause.

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