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Robert Rapaport Part 3, CGMS Diabetes Treatment

In part 3 of this Exclusive Interview, Dr. Robert Rapaport talks with Diabetes in Control Publisher Steve Freed during the AACE 2017 convention in Austin, Texas about the use and concern about the CGM in managing pediatric diabetes.

Robert Rapaport, MD is Professor of Pediatrics, Chief of the Division of Pediatric Endocrinology and Diabetes and the Emma Elizabeth Sullivan Professor of Pediatric Endocrinology and Diabetes at Icahn School of Medicine at Mount Sinai, New York.

Transcript of this video segment:

Steve:  CGMS has come a long way, I remember the first glucowatch, I’m sure you do also.

Dr. Rapaport:  The glucowatch had a checkered career, it wasn’t used very much, it wasn’t a such good product.  But, the idea was there, and I think its next grandchild is this CGM.  CGM is very important.  You briefly mentioned taking care of adolescents, and certainly CGM sounds like a no-brainer.  Yet, many adolescents either wear it for a short time then they stop wearing it, or they don’t want to wear it at all.  Those are areas we need to look into.  Why is it? What are the barriers to them using all the technology that’s out there to do that?

Steve:  I would imagine that you would prefer to have most of your patients on the CGMs because we have seen a better control and they know if they are getting low.

Dr. Rapaport:  What we prefer and what happens in the real life are two different things, but sure.  So, when I see a patient who doesn’t want to be either on an insulin pump or CGM, I tell them, “Look, it is up to you whether you want to be on it or not. Nobody can force you to do things. All I want you to do is to be aware of what’s out there and then you can make a decision what you want to utilize and when.”  And I think that’s very mportant, educating them about what is out there.  Whether or not they will use it, whether or not they will use it for a short time, it’s a secondary question. But, the education of the patient and their family is absolutely crucial. That’s why teamwork with nurse educators, nutritionists, social workers, psychologists are all very important pieces of this healthcare team.

Steve:  Studies have shown that the use of a CGMS has basically, not so much improved the A1cs, but it’s really reduced the amount of hypoglycemia.  Do you find that in your practice?

Dr. Rapaport:  It probably has and it’s certainly beneficial to use it; the more information we get – it’s better.  Concerns that some patients have and some parents have, quite justifiably, is unrecognized hypoglycemia, and CGM certainly helps with that.  Yes, it is a marked improvement to have that.

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