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Stuart Weiss Part 5, CGM for Diabetes

In this Exclusive Interview, Dr. Stuart Weiss talks with Diabetes in Control Publisher Steve Freed during the AACE meeting in Austin, Texas about the good and challenges with CGMs.

Dr. Stuart Weiss, is currently an Assistant Clinical Professor of Endocrinology at NYU Langone Medical Center. He has a long history of clinical practice in the management of patients in the field of diabetes, endocrinology and metabolism.

Transcript of this video segment:

Steve: So when it comes to CGM, there’s a couple of different things out there. Which one do you like to use?

Dr. Weiss: Well, I love the Dexcom and I download at least a couple a day and I find it very accurate and a nice tool. Some of the programs that they have come up with in newer software is not as good as I would like it to be. The CareLink for Medtronic is great but the sensor isn’t necessarily as good – maybe the new sensor will be, but I don’t really know at this point in time. I do the Libre quite a lot now, so the Libre is the Abbott, I put it on the back of the arm, the patient wears it for two weeks and they doesn’t see what’s going on. And then we look at their diet records and see how they match up to their glucose profile. And that’s great. The good thing about the first go around with sensing and avoiding the patients seeing the numbers is often patients overreact when they see the numbers. So often I am anxious about a new Dexcom patient because they’re going to see their numbers trending up and they’re not going to realize that the insulin is slow and lagging behind or they’re going to get a low and the Dexcom isn’t going to respond to the treatment of the low, they are going to get another alarm and they are going to overreact and over-treat the lows. Often, it’s better for them not to see the results in the beginning so we can talk later on about “when did you dose the insulin.” I give them sheets that are fairly specific for record keeping, so I know that when they dose their insulin, I download their pump. “When did you dose the insulin, how long did you wait and what did you eat?” And that’s how we look at matching insulin up to food, and it’s not easy, not by any stretch of the imagination, but it’s the way to go because you want to limit the excursions in glycemic control.

Steve: Are you able to get reimbursement for using the blinded CGM from Libre?

Dr. Weiss: Yeah, the reimbursement is not great. I’m not going to buy a new house from it. It’s not great, it’s good – it’s okay, it’s better than not getting paid.

Steve: Do you also get reimbursed from the Dexcom? Same thing?

Dr. Weiss: Same thing. Same billing codes.

Steve: If you had a senior citizen, someone in their late 60s or older, you would prefer the blinded?

 Dr. Weiss: For anybody I prefer blinded for the first go-around. So that they can make the mistakes they’ve been making up until the time I see them and intervene, then when I can intervene then I put the Dexcom on them or the Medtronic hopefully as that gets better..then I can put that on them so patients can deal in real time. Real time is hard because everybody expects things to be instant and insulin is slow and food is slow. And that’s trying for the patients because they want to fix that low right away and they want to fix that high right away. With inhaled insulin, we are getting some interesting results on that, but that’s a whole other story.

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