In part 1 of this Exclusive Interview, Dace Trence talks about her work, CGM and diabetes management and the positive effects of CGM.
Dace Trence MD, FACE is the Director of the Endocrine and Diabetes Care Center at the University of Washington in Seattle.
Transcript of this video segment Dace Trence Part 1, Introduction: CGM and Diabetes Management:
Freed: This is Steve Freed with Diabetes in Control and we’re here at AACE 2018 in Boston. And we have a special guest with us today. And that’s Dace, is it? [Freed to Trence]
Trence: Dace. Dace.
Freed: Trence. And kind of a unique person. I have a list of everything that you’re involved in. And I just — we’d be here all day if I had to list everything, so I’m just going to let you tell us a little bit about yourself and how you practice.
Trence: Well, I’m at the University of Washington in Seattle at this time. And I’m part of the Division of Metabolism, Endocrine, and Diabetes Nutrition and have a number of hats that I wear. I have the fellowship program, so I see a lot of trainees. I certainly see patients, so I’m a clinician. And do a bit of administrative work, so a couple of different hats.
Freed: And what caused you to become an endo out of all the choices that you have when you started out?
Trence: Oh, it’s a fascinating area. I mean, it’s an area of thinking. It’s an area that challenges one to really think literally outside the box to be able to address issues that patients have.
Freed: So, let me just start off with the question that’s changed diabetes probably more than anything else, and that’s CGMs. It’s a newer technology. How does the CGM impact diabetes per se?
Trence: I think it’s really a tool that has allowed people to see something evolve. It isn’t a point in time when we did urines, fortunately decades ago, it gave you the answer of what was happening, perhaps, four hours ago.
Trence: Very helpful, isn’t that? Four hours ago. And we all were just dramatically enthusiastic when finger-stick glucoses became available, because now suddenly you had at least something that was right there. But then if you think about it, that’s the result of one second, of one minute, of one hour, of one day. Does it tell you, are you going to have ups or downs on your blood sugar profile? Are you going to be staying stable? It doesn’t give you a sense of what’s happening over time. And that’s exactly what CGMs, Continuous Glucose Monitor Sensors, actually now do. And so, it gives people a sense of what is it that’s happening when I choose to do something. So, if I choose to eat this, what’s it going to do to my blood sugar in two or three hours? Or if I choose to go out and exercise, what’s going to happen to my blood sugar? What if I take only half of my medication, what’s going to happen? What if I delay my medication? So, it gives a lot of answers to individuals right away. You don’t have to wait until your next three months’ appointment to discuss what was happening. You know right away what’s happening.
Freed: And we learn a lot. And what do we do with that information if it’s just to look and see what that number is? It doesn’t improve our condition. So, how do we use that?
Trence: I think that’s a good point, because that’s a point that has been made with the finger-stick checks. That if you just tell someone, “Go ahead, check your blood sugar by doing a finger-stick,” and you get a value, you don’t know. Is this a good value? Is this a poor value? Should I be doing better? Should I not worry about it? I think those were questions that people had that weren’t always answered. And so, the literature really wasn’t very positive. The finger-sticks helped people really advance and better manage their diabetes. With the continuous sensors, it’s a little different because you can see immediately, “Well, I had two servings of spaghetti. Oh, that’s not such a good idea. Maybe I should just try one.” You don’t need to have a lot of sophistication to be able to kind of know that that’s a change I can make. There actually is a study that has looked at just that. Looking at individuals with type 2 diabetes and actually, looking — do you need to do a lot of education? It seemed that you really did not. But people could pick up very easily because they could see immediately the feedback of a choice that was made.