Demanding Better Diabetes Care in Hospitals was written by Mike Hoskins for DiabetesMine.com, 19 April 2020. This has been a problem for a long time … that’s what prompted me to write The Savvy Diabetic: A Survival Guide several years ago. That’s why we are working so hard to get ourselves prepared and safe if we should end up in a hospital. Watch for my Wednesday blog on T1 and Being Prepared, with downloadable tools and suggestions.
Even before this pandemic began, many PWDs shared stories about inadequate care during hospital stays, with medical professionals not being familiar with even basic diabetes management know-how or diabetes tech, to incredible challenges in getting glucose checks or insulin as needed.
The latest data from the Centers for Disease Control and Prevention (CDC) shows that 50 percent of PWDs who contract COVID-19 are being hospitalized. That, combined with data showing diabetes is tied to worse outcomes for those with the virus, makes for a very scary situation.
Here is a ray of hope: On April 8, the FDA announced approval for both Dexcom and Abbott Diabetes Care to offer their systems to hospitals for frontline healthcare workers to better monitor patients with diabetes during inpatient care. Enthusiastic headlines announced that “CGMs Are Joining the COVID-19 Fight“!
The Food and Drug Administration (FDA) also just issued an FAQ about patients using their own fingerstick meters brought from home when hospitalized with coronavirus. The practice is encouraged, because again it limits hospital staff work and risk. But CGM is even more helpful because it provides constant tracking, even when the patient may not be alert.
The reality: What is Needed: a standard for hospital glucose control! Long before the COVID-19 pandemic, this was a pressing issue given the number of PWDs who land in the hospital for various reasons nationwide. Thankfully, a new measure has been in the works and is on the doorstep of being approved. Developed by Yale researchers and diabetes tech industry experts, it is dubbed “HypoCare” as it primarily addresses hypoglycemia (dangerous low blood sugar). The new measure would require hospitals to report severe hypo rates, and would tie the results to bonus pay for staff: If they don’t collect baseline data on tracking glucose management in patients, they will lose that additional money.
CMS would eventually establish a penalty for clinics, which could be up to 3 percent of their CMS-billable work. This can add up to multiple millions of dollars depending on the hospital and care system network.
Endocrinologists across the country are working closely with hospital systems to ensure that patients with diabetes get adequate care, according to Dr. Sandra Weber, current president of the American Association of Clinical Endocrinologists (AACE) and chief of endocrinology at the Greenville Health System in South Carolina. If a hospitalized PWD has the mental capacity to continue using their own diabetes device, Weber believes that person should be allowed to continue using it in order to complement their hospital care.
Dr. Anne Peters, professor of clinical medicine at the Keck School of Medicine at the University of Southern California and director of the USC Clinical Diabetes Programurges PWDs to prepare an emergency kit (Go Bag) that they bring along to the hospital, especially since family isn’t allowed in. The kit should include testing supplies, CGM and pump necessities, and any charging cords and cables needed for those diabetes devices and mobile app components … (my input) PLUS your own supply of glucose, a back up BG meter, and even your own insulin with syringe if you need additional insulin and the hospital staff is not expected to check in with you for several hours.
REMEMBER, check out my blog on Wednesday, 4/29/20 on T1 and Being Prepared!
Get to Know the Ambulatory Glucose Profile (AGP) was reported by Wil Dubois for DiabetesMine.com, 15 July 2019. Why isn’t there a standardized report for blood sugar data, as there is for EKGs? Actually, there is one. It’s been slow in coming, but is now gaining traction. You might even have seen one and not realized it. It’s called the Ambulatory Glucose Profile, or AGP.
Its origins date back to the late 1980s. It was developed by a team at the Albert Einstein College of Medicine headed by Dr. Roger S. Mazze. In its original incarnation, the AGP served as a way of graphically presenting multiple days of data from fingerstick meters — a huge improvement over traditional patient-kept checkbook-style paper logbooks. AGP is a one-page report with:
- A large graph with multiple days of overlaid and smoothed glucose data to help spot trends
- An EKG-like strip graph showing daily data
- Metrics such as average glucose, measures of variability, Time-in-Range, predicted A1C based on the aggregate data, plus percentage of time spent in hypoglycemic or hyperglycemic states
PWDs can download from their various devices (i.e. Dexcom Clarity has an AGP tab in its reports window.
The IDC’s Education Resources department recommends that patients look first at their Time-in-Range. The current goal is to be in target range 70% of the time, with less than 3% of the time below 70 mg/dL. Time-in-Range is a more actionable metric for patients using CGM than A1C. Patients can see an impact of changes in diabetes management within a week on TIR, whereas the changes take many weeks to be reflected in A1C.
Read more: Get to Know the Ambulatory Glucose Profile (AGP)
Important Things to Know about Beta Cell Transplants for Diabetes was written by Ginger Vieira for DiabetesMine.com, 16 April 2020.
If you are a relatively healthy individual who meets the eligibility criteria, it may be worth your while. Just know that it’s not an easy fix for type 1 diabetes. Instead, it may provide significantly more stable blood sugar levels but it also inevitably comes with other risks and medical issues. Here are seven important things to know about cell transplants for diabetes:
- You cannot transplant beta cells alone
- Islet cell transplants are not yet FDA approved
- Transplants are costly, but you can’t buy one yet
- Immune system suppression remains the biggest hurdle
- Islet cells are transplanted into the liver
- Measuring success is complicated
- Side effects range from mild to nasty
Read more: Important Things to Know about Beta Cell Transplants for Diabetes
I have been a transplant recipient in a Clinical Trial at City of Hope (Duarte, CA) for almost four years, and am totally insulin free after 35 years with Type-1, living my life as a “non-diabetic’ Type-1 Diabetic. I am taking immunosuppressant drugs, and will for the rest of my life. I found the article about the transplant quite accurate, but I have been quite lucky to avoid any of the complications listed. After years of increasing complications with Type-1, my transplant gave me a new life, with no hyperglycemia or hypoglycemia episodes since my transplant. We don’t know how long it may last, but so far it has been a life change experience, and City of Hope is working to make it last for the rest of my life. I would recommend it for anyone experiencing diabetic complications like insulin resistance, hypoglycemia unawareness, or brittleness. Contact City of Hope or ViaCyte. They may be able to change your life as they did mine.
Hi Roger Sparks,
Thank you for your story, and glad to hear you are still doing very well after transplant. Have you noticed that any of your prior complications have improved since the transplant? It’s great that your blood sugars are normal!
The most notable change was in my eyes – I was beginning to develop problems, and they completely disappeared 6 months after the transplant. My A1C has been a steady 5.3 – 5.5 since the transplant, and my fasting blood sugars in the AM always in the 90’s. I have had 0 blood sugars above 150 and 0 below 80. I still test 4-5 times a day as part of the clinical trial requirements.
All of those things combined, I believe, have reduced the strain on my kidneys, liver, etc., and in general I feel better than I have in many, many years.