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William Polonsky Part 2, CGM Effects on a Diabetic’s Mentality

In part 2 of this Exclusive Interview, Dr. William Polonsky talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about the impact CGM can have on the effort to make diabetes visible by showing the effects of small behaviors on blood glucose.

William Polonsky, PhD, is President and Founder of the Behavioral Diabetes Institute. He is also Associate Clinical Professor in Psychiatry at the University of California, San Diego.

Transcript of this video segment:

Steve Freed: In your presentation, I can see now why you’re giving that particular presentation about CGMS because now you just mentioned you have to have a way to show them because they can’t feel it, but they can see it now. How important is that number 1 for type 2’s who are not on insulin, who basically… let’s start with prediabetes, how important is that in preventing diabetes in a prediabetic. It’s certainly not approved for that at this point.

William Polonsky: Prediabetes, I don’t know about, to me that’s too difficult, we’ve played with that and I find that too challenging. But if we’re talking about people with diabetes who aren’t insulin, for example, that’s different. As you know, just to back up CGM for a moment, we had this long running battle about is blood glucose monitoring you know, SMGB, is that useful for folks not on insulin? And if you look across studies, you have to say well it looks like it’s not so useful and that’s why we’ve seen insurance companies and countries beginning to cut back on reimbursement because the conclusion is really there isn’t much of an impact on glycemic control. I find that the study to be convincing and completely wrong because what they basically shown is that SMBG done poorly, has no impact. So if you give someone a meter and you don’t tell them what the numbers mean, or help them to figure out what to do with it and their physician doesn’t know what to do with it and even make sure that those physician never even see those numbers, it’s just a waste of time. In fact it is a demotivational thing to do, but it doesn’t have to be. If we show people how to make use of these data, and we have a couple good studies showing that people, even newly diagnosed, you can have an enormous impact on their engagement with their disease, on self-care behavior changes, on A1c over the course of time. When you support people that understand their data, when you ask them to be checking blood glucoses in a way that makes sense using structured testing, or paired testing so people can see how meals affect them, how exercise affects them, then everything changes. But oddly enough, people don’t seem to be appreciating it that much. And to me that’s the promise of CGM, now we can do it in an amazing way, where people aren’t sticking their fingers so much, where you’re getting data every 5 minutes, where you can show people trends and people can see with support, with guidance that, “wow my actions really do make a difference, positively or negatively. And with small changes I can really show an impact on that.” and that can be lifestyle but it can really help people see “Gee, maybe those medications my doctor’s been telling me to take and maybe they can make a difference too.” But it isn’t just use berating people, it’s sharing with them, helping them to see that let’s look together at how you can see if it’s working or not working. It’s making the invisible visible. This is the opportunity.

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