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Elizabeth Buschur Part 6, New Technology and Pregnant Patients

Dr. Elizabeth Buschur talks with Diabetes in Control Publisher Steve Freed during the AACE meeting in Austin, Texas. In this Exclusive Interview, she gives her thoughts on the direction of technology in diabetes treatment.

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: Technology changes the way you practice medicine and if you go back 50 years, we had only oral drug for type 2 diabetes and now we have over 2 million combinations, plus we have CGMs which we didn’t have before and I know they are also working on a CGM that’s like a band aid, it’s noninvasive. Google has billions of dollars in Dexcom working on something like that where you just slap it on. There’s no reason to have a blood glucose monitor anymore that you’re checking once a week at 8 o’clock in the morning when you can get something that checks your blood sugars. So technology is really changing the way you practice your medicine. Where do you see technology going? I always ask when do you think there’s going to be a cure for type 1? Type 2 is a whole other disease, but for type 1, the research that I’m familiar with, that’s going on today…we’re so close it’s mindboggling.

Dr. Buschur: Those are wonderful questions, for sure. So, I think its a really exciting time to be treating diabetes. There’s so much new technology, like you said and each year, it’s seems like this past year, so many advances. So the FDA approved Dexcom that you can bolus off that value. That’s pretty amazing when for years it was not accurate enough. And now with the new Minimed pump coming out any day now, it’s very, very exciting. But patients will need to be trained, clinicians will need to be trained. I haven’t treated a patient that has a self-adjusting pump before, so it will be interesting, for sure. Those hybrid closed loop systems coming out is just the beginning of really exciting things  to come in the next several years.

Steve: When we do drug studies, we don’t include pregnant women. We don’t include infants and children for a lot of different reasons. They do not get the benefit of knowing what an SGL tube might do. How do we overcome those things? What are the only oral drugs that you can use for gestational diabetes or for any pregnancy right now?

Dr. Buschur: Right now, we use metformin and glyburide exclusively. There are concerns about glyburide as well. But it’s a lot of insulin for patients that are not diet controlled.

Steve: You have patients that are borderline and have A1Cs of 5.7 or 6.4 and they want to get pregnant. The first thing you do is physical activity and nutrition and then work from that. How much time do you usually give them? They come to you, they want to have a child, they are prediabetes, the doctor referred them to you. What’s the time frame before you even consider putting them on insulin if their blood sugars are at that border point?

Dr. Buschur: Usually 3-6 months. But, patients wanting to get pregnant, a great patient population, they are very eager, very motivated. If you tell them to come back in three months and try these things, most of them will do that. It’s very impressive.

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