Integrating Continuous Glucose Monitoring Into Diabetes Care: Baseline Assessment

Launch Date:
June 16, 2022

Primary Audience:

Healthcare professionals who treat patients with diabetes, including endocrinologists, internists, primary care physicians, pediatricians, obstetricians, and advanced practice providers

Relevant Terms:

Diabetes, CGM, A1C, AGP report

Answer the following questions to assess your knowledge on the use and benefits of CGM.

Ananda Basu, MD, FRCP

Harrison Professor of Medicine
Clinician-Investigator
Division of Endocrinology 
Center for Diabetes Technology
Director, Diabetes Technology Program
University of Virginia, Charlottesville, VA

Dr. Ananda Basu, MBBS, MD, FRCP, is a Harrison Distinguished Professor of Medicine at the University of Virginia School of Medicine. His area of interest is integrated carbohydrate physiology and hormonal regulation of carbohydrate metabolism in type 1 and type 2 diabetes. He has worked in this field at Mayo Clinic, Rochester, MN since 1993 and continues to do so at the University of Virginia since he moved in 2017. In the last 25 years of independent federal funding, he has helped develop and applied state of the art research tools involving innovative isotope dilution methods to enhance our understanding of carbohydrate physiology in type 1 diabetes with the ultimate goal to inform, refine and help develop the next generation of artificial endocrine pancreas (AP) that re-creates, to the extent possible a truly artificial islet The triple tracer method that he helped develop, is currently the gold standard for in vivo assessment of postprandial carbohydrate turnover and β cell functions and forms the underpinnings of the FDA endorsed Type 1 diabetes simulator. Glucagon kinetics, α cell physiology and intra-islet network (β-α cell interplay) is insufficiently investigated in humans, especially in those with type 1 diabetes. In order to refine the next generation multi-hormonal closed loop control algorithms to restore normal insulin-glucagon hormonal milieu he has developed an innovative isotope dilution technique using stable-labeled glucagon isotope to measure parameters of glucagon kinetics in humans directly and in vivo.

He is particularly interested in the translational aspects of implementing diabetes technology in the outpatient clinic and is the Founder-Director of the Diabetes Technology Clinic at UVA that follows close to 1000 patients with Type 1 diabetes in the community. Dr. Basu attended medical school in India, trained in endocrinology in the UK before completing residency and fellowship training in Endocrinology at Mayo Clinic in Rochester, MN and joined the faculty there in 2000, before his move to UVA in 2017.

Rita Basu, MD

Professor of Medicine
Clinical Education Director of Center for Diabetes Technology 
Division of Endocrinology
Chair of IRB-Health Sciences Research
University of Virginia
Charlottesville, Virginia

Dr. Rita Basu, MD., is a tenured Professor in the Division of Endocrinology, department of Medicine at the University of Virginia (UVA) School Of Medicine. She received her medical degree from Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) in Pondicherry, India. In 1996, she joined the Mayo Clinic in Rochester, MN as a trainee investigator in integrative physiology of Diabetes and other metabolic disorders. Following completion of her fellowship in 1999 she continued her career in understanding the pathophysiology and mechanisms of insulin resistance in humans with metabolic disorders and rapidly rose through the ranks to a full Professor in the Division of Endocrinology at the Mayo Clinic in 2012. She was recruited to the UVA faculty (fall 2017) as part of a strategic initiative to develop Translational research for diabetes at UVA School of Medicine and Center for Diabetes Technology (CDT). She currently serves as the Clinical Education Director of the CDT.

Dr. Basu is currently the Principal Investigator on grants from NIH as well as industry. These include studies that probe the mechanisms of hepatic and peripheral insulin resistance in humans with type 2 diabetes and pre-diabetes. Dr. Basu is also a co-investigator on several NIH sponsored projects for the artificial pancreas for type 1 diabetes.

Dr. Basu has had a long and productive career as an expert in the Ethics of Research and Human subject protection for over a decade at Mayo Clinic where she served as Chair of the Mayo Clinic IRB for over 10 years. She is currently the Chair of the Health Sciences IRB at the University of Virginia.

At UVA, she has continued to develop state of the art physiology and interventional research to better phenotype people with type 2 diabetes, NAFLD/NASH and pre-diabetes such that therapy to treat these disorders could be more precise and personalized, targeting the specific physiological abnormalities in a person-specific manner to match the national and NIDDK call for ‘Precision Medicine’ initiative.

Her educational interests include teaching providers and patients to effectively manage and optimize glycemic control by using state of the art technological devices. Towards this, she Chairs CME/CNE credited “Diabetes technology symposiums” both at UVA and in national meetings. She has several grants related to educational initiatives for training primary care physicians, nurses, and diabetes nurse educators, pharmacists on use of diabetes technology to improve care of patients with diabetes both within and outside USA.

She served on the American Diabetes association scientific sessions committee for 4 years. Her knowledge of evolving strategies for management of fatty liver disease has not gone unrecognized. She recently represented the Endocrine Society at a Senate Capitol Hill briefing on NASH and serves on the NASH steering committee established by the Chronic Liver Disease Foundation. She is a member of the Global Liver institute. She is currently working with peers from AACE in drafting the practice committee guideline recommendations for NAFLD/NASH. Furthermore, she adds voice to a patient advocacy group task force for NASH (ICER).

Dr. Basu has authored > 200 peer-review publications in major journals including the New England Journal of Medicine, Diabetes Care and Diabetes. She is on the editorial board of Diabetes Care, American Journal of Physiology and past Associate editor of the Diabetes Technology and Therapeutics journal. She serves as reviewer on numerous scientific associations and journals. She serves on several study sections of the National Institute of Health and International review panels and DSMB’s. She has actively participated as a WHO fellow and Co-Director in a WHO collaborating center initiated 5-year international program that provided advanced training and education to several hundred promising diabetologists in China and Europe.
She continues her commitment to excellence in diabetes training, education and research in her current position at UVA.

Rodolfo J. Galindo, MD, FACE

Associate Professor of Medicine
Investigator, Center for Diabetes & Metabolism Research
Emory University Hospital Midtown
Medical Chair, Hospital Diabetes Taskforce 
Emory Healthcare System

Dr. Rodolfo J. Galindo graduated with Summa Cum Laude from the Institute of Medical Sciences of the University of Havana, Cuba. He completed his Internal Medicine and Endocrinology fellowship at the Albert Einstein College of Medicine and North Shore University Hospital, in New York. After graduating from his fellowship, he joined the faculty of the Mount Sinai School of Medicine and served as the Director of the Hospital Diabetes. Dr. Galindo joined the faculty of Emory University in 2017, as a clinical researcher on diabetes and obesity.

Dr. Galindo’s areas of clinical and research interest include management of diabetes with complications, including those with obesity, with advanced renal failure, and in hospitalized patients. He is interested in using diabetes technology and has several ongoing research projects on the use of CGM technology in these populations. His clinical research program is currently funded by the NIH- NIDDK, NIDDK-sponsored Georgia Center for Diabetes Translational Research, foundations and investigator-initiated studies.

Elyse Marriner BSN, RN, CDCES

Registered Nurse
Endocrinology Pantops
University Physicians Group
Charlottesville, Virginia

Elyse Marriner grew up in West Chester, Pennsylvania, and graduated from the University of Virginia with a Bachelor of Science in Nursing. She then moved to Charlottesville, Virginia permanently to start her nursing career on the Acute Care floor at UVA Children’s hospital.

In 2018, she helped lay the foundation for the Advanced Diabetes Management clinic at UVA, a clinic designed specifically to help patients with diabetes utilize and access technology such as insulin pumps and continuous glucose monitors. Here, she gained the knowledge and experience to become a Care and Diabetes Education Specialist and insulin pump trainer. She is always looking for opportunities for professional development and has participated in many different educational programs, ranging from local lectures to students to presentations to providers regarding the role of technology in diabetes management.

She recently returned to UVA Children’s hospital, and can be found doing what she loves best: teaching coping skills to families of children newly diagnosed with diabetes.

Elyse is associated with the University of Virginia Medical Center.

Roger Mazze PhD

Director, AGP Clinical Academy, Portsmouth University Hospitals, NHST, UK 
Visiting Professorship, Nanjing Medical University, 
Nanjing, China

Professor Mazze is currently the director of the AGP Clinical Academy at Portsmouth University Hospitals, NHST, Portsmouth UK. He was formerly Head of the WHO Collaborating Centre for Diabetes Translation, a joint program of the International Diabetes Center (IDC) and Mayo Clinic as well as professor at the University of Minnesota Medical School. He is also visiting professor at Nanjing Medical University where he helped to develop a new research and training center devoted to diabetes modeled after the IDC. Previously he served as Professor and Executive Director of the Diabetes Research and Training Center at the Albert Einstein College of Medicine. There he developed the first WHO designated center for technology in diabetes. After moving to the IDC, Dr. Mazze initiated training programs in more than 40 countries based on a systematic evidence-based approach known as Staged Diabetes Management (SDM). The author of more than 100 original articles and several books, he is recognized as the the creator of the Ambulatory Glucose Profile (AGP) analytic program for continuous glucose monitoring and as the developer of the first memory-based reflectance meters. In recognition of these accomplishments, in 2017 the American Diabetes Association presented Dr. Mazze with the Harold Rifkin Award for Distinguished International Service in the Cause of Diabetes. He is also the recipient of the 2021 DMDEA Gold Medal Oration Award, India.

Viral Shah, MD

Associate Professor of Medicine and Pediatrics
Barbara Davis Center for Diabetes
University of Colorado
Aurora, Colorado

Dr. Shah is an Associate Professor at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus. His research is focused on improving glycemic control and reducing complications, with special interest in fracture prevention, in people with type 1 diabetes.

Dr. Shah has been the PI for many clinical trials of diabetes technologies and therapeutics. He has been a part of landmark research such as REPLACE-BG, WISDM, Artificial pancreas Cambridge (ApCam), Omnipod 5 HCL, and Dexcom G6 pivotal that led to FDA approval of newer devices and changed the type 1 diabetes management. Moreover, his interest in understanding the effect of diabetes on bone fragility had led to two NIH-funded studies investigating effect of long-standing T1D on bone tissue material properties and factors affecting bone density, bone mechanical properties in adults with type 1 diabetes.

Dr. Shah has served on many leadership positions such as steering committee member for T1D Exchange Clinic Registry (2016-2017), Communication director for diabetes technology interest group at the American Diabetes Association (2019-2020), Ad hoc member of 79th AD annual meeting planning subcommittee for Diabetes Technology (2019), and American College of Endocrinology Self-Assessment Program writing committee member (2020-2022). He is a recipient of prestigious AACE Rising Start in Endocrinology award (2021).

He serves as the Editor-in-Chief for Clinical Diabetology and Senior Editor for the Endocrine Connections. He is well published with over 100 research publications including original article, invited reviews, editorials, and book chapters.
1.
Describe guideline recommendations for incorporating CGM in persons with diabetes on oral agents as well as injectables
2.
Summarize the benefits of CGM regarding reducing postprandial hyperglycemia, increasing time in range, improving A1C, and reducing hypoglycemia risk
3.
Explore strategies to overcome clinician/patient barriers and, through multiprofessional small group interactions, improve adoption of CGM devices in community practices