Selected Podcast
The New “Pathway” For MedStar Physicians
Michelle Magee, MD, explains how an intensive diabetes "boot camp," combined with a new blood glucose monitoring system, is making dramatic strides in reducing patients' A1C levels. This new technology provides real-time results, allowing diabetes educators to contact patients and uncover why blood sugar spikes are occurring.
Featured Speaker:
Learn more about Michelle Magee, MD
Michelle Magee, MD
Michelle Magee, MD, MedStar Health Research Institute, is an endocrinologist at MedStar Washington Hospital Center (MWHC) and an associate professor of Medicine at Georgetown University School of Medicine in Washington, DC. She also serves as director of the MedStar Diabetes Institute (MDI). In this capacity she leads and supports diabetes clinical, educational and research programs, including diabetes outpatient and hospital services across MedStar Health and diabetes education programs in the community. Dr. Magee's community work focuses on minority and vulnerable populations.Learn more about Michelle Magee, MD
Transcription:
The New “Pathway” For MedStar Physicians
Melanie Cole (Host): A 12-week diabetes boot camp intervention offers learned centered survival skills education and algorithm driven DM medication titration by endocrinologists who provide certified diabetes educators. My guest today is Dr. Michelle Magee. She’s an endocrinologist and the director of the MedStar Diabetes Institute a MedStar Washington Hospital Center. Welcome to the show, Dr. Magee. Tell us about this 12-week diabetes boot camp intervention.
Dr. Michelle Magee (Guest): Well, we have noticed that there are many patients who are living with diabetes who have a hard time getting their arms around how to optimally control their blood sugar so they can live well with their diabetes. So, what our boot camp program is, is it’s a 12-week intensive program where they come in to see us two times on site; we give them an exciting new technology device that’s a blood glucose meter that sends us all of the sugars that they do. Then, they graduate to our virtual visit center where, for another 8-10 weeks, we speak with them frequently and make sure they’ve received what we call “survival skills education” and have had frequent adjustments to their diabetes medications so that by the time they’re done, their sugars are much improved from when they came into the program.
Melanie: Is there an issue with them taking their blood glucose and this monitor? Tell us about the monitoring system and how it works and the adherence issues you might run into.
Dr. Magee: Yes. So, the system we’re using is the Telcare blood glucose monitoring system. It’s a cellular enabled blood glucose meter which is exciting. It sends the sugars, not by Bluetooth with an expensive data plan, but by a cellular network so there’s no charge to the patient for data. Every sugar that they do, as long as they’re within the cellular network, is sent to us and appears on a dashboard that our diabetes educators look at. In the pilot study, we gave it to the patient and gave them enough strips to do two sugars a day and so that’s what we’re doing in the ongoing clinical study. It is covered by most insurance plans and we help the patient to do the paperwork that’s necessary to get supplies into their hands of the strips that they need for this meter.
Melanie: So, tell us about the review by the certified diabetes educators to review these blood glucose levels and what happens next.
Dr. Magee: So, each day, they go to their dashboard and each of the patients who is participating in the program appears there and they quickly scan through to see who’s having high sugars; who’s maybe having low sugars and even who is not checking any sugars and then we reach out to each individual based on what we’re seeing and talk to them about either their highs or their lows or encourage them to do the checking so that we can watch their sugars. We frequently find that this has really been a game changer both for the patients and the educators. It is quite a transformation to be able to see the sugars, to call the patient at a moment in time when they’re having a high or a low so that we can ask them why they might be high or low. One of my favorite stories is a patient has been doing quite well since he came into the program. His sugars were all down under 200 having come in with a high of 400. One day, we see a 400, the educator calls him. Turns out he’s in McDonald’s having a sweet tea. So, that was the big Eureka moment for him. He realized that he cannot do that and live well. So, the educators get the sugars. They don’t have to deal with sugars written in a log book, they can look at them when the patent’s here, when the patient’s not here. So, the patient, in a way, feels like someone’s looking over their shoulder and helping them along.
Melanie: And then, what do the patient’s do with that report? Do they return to their primary care practices with this progress report? What happens then?
Dr. Magee: Well, this is being done in full collaboration with MedStar’s internal medicine providers. They actually order the past pathways for the patient and at points along the way, if we need to make major changes, we let the primary care provider know what we have done medication-wise. At the end, we send them a report with what the patient’s values were when they came in, what they are at the end and any further ongoing recommendations for diabetes management or education.
Melanie: Did the majority of your patients use the smart meters successfully and report increased adherence with their blood glucose testing and do you think, in your opinion, that this was because they knew they were being monitored?
Dr. Magee: All of the patients could use to learn the meter. We were really pleased by that. We were worrying about some of the elderly patients—whether they could do it. But, really, it works just like any other blood glucose meter and if you spend a little time with a patient, they can use it. Then, yes, I think certainly told us that having them watched was a good motivator for doing the values so that we wouldn’t be calling them to ask them where they were.
Melanie: Makes a lot of sense. So, tell us about 6 months down the line.
Dr. Magee: So, six months down the line, of course, is the billion dollar question in terms of health economics and it’s one thing to get the A1C down and another to keep it down. I don’t yet have six months data for the patients who were in the pilot in an on-going fashion but what I do have is information on how they’re having less frequent visits to the emergency room and to the hospital. So, we were very pleased to see that at 30 days, we had a 27% reduction in risk for hospital visits and emergency room visits and at 3 months, that reduction was 63%. Then, to answer your 6 months question, a small tweak upwards in the tail at 6 months to about 45%. So, we do need and we’re just beginning to address support strategies for ongoing maintenance of glycemic control and we’re looking at such things as the dashboard being taken back in by the internal medicine providers and residents as devices that actually look at blood sugars and insulin doses and generate recommendations for adjustments and for web-based coaching programs that can assist the patient in an ongoing fashion and track along with their sugars and reach out to them when they appear to be falling off the rails again.
Melanie: Dr. McGee, tell us about the evidence and what it demonstrates and then wrap it up for us as where you see this particular pathway taking patients down the line.
Dr. Magee: I think this shows us clearly that patients need a certain amount of core survival skills education in order to manage their diabetes medications and the multiple variables that impact their blood sugars on a daily basis; that if we can assist the primary care provider in making frequent adjustments to medication rather than having them done every quarter when they come in for their standard diabetes care visit, then we can get patients to their goal blood glucose levels. We’re very excited about this and we are now working on rolling it out and spread throughout the system to other hospitals and to other primary care practices so the providers can avail of the boot camp and offer it to their patients with uncontrolled diabetes.
Melanie: Thank you so much, Dr. McGee, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That’s www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.
The New “Pathway” For MedStar Physicians
Melanie Cole (Host): A 12-week diabetes boot camp intervention offers learned centered survival skills education and algorithm driven DM medication titration by endocrinologists who provide certified diabetes educators. My guest today is Dr. Michelle Magee. She’s an endocrinologist and the director of the MedStar Diabetes Institute a MedStar Washington Hospital Center. Welcome to the show, Dr. Magee. Tell us about this 12-week diabetes boot camp intervention.
Dr. Michelle Magee (Guest): Well, we have noticed that there are many patients who are living with diabetes who have a hard time getting their arms around how to optimally control their blood sugar so they can live well with their diabetes. So, what our boot camp program is, is it’s a 12-week intensive program where they come in to see us two times on site; we give them an exciting new technology device that’s a blood glucose meter that sends us all of the sugars that they do. Then, they graduate to our virtual visit center where, for another 8-10 weeks, we speak with them frequently and make sure they’ve received what we call “survival skills education” and have had frequent adjustments to their diabetes medications so that by the time they’re done, their sugars are much improved from when they came into the program.
Melanie: Is there an issue with them taking their blood glucose and this monitor? Tell us about the monitoring system and how it works and the adherence issues you might run into.
Dr. Magee: Yes. So, the system we’re using is the Telcare blood glucose monitoring system. It’s a cellular enabled blood glucose meter which is exciting. It sends the sugars, not by Bluetooth with an expensive data plan, but by a cellular network so there’s no charge to the patient for data. Every sugar that they do, as long as they’re within the cellular network, is sent to us and appears on a dashboard that our diabetes educators look at. In the pilot study, we gave it to the patient and gave them enough strips to do two sugars a day and so that’s what we’re doing in the ongoing clinical study. It is covered by most insurance plans and we help the patient to do the paperwork that’s necessary to get supplies into their hands of the strips that they need for this meter.
Melanie: So, tell us about the review by the certified diabetes educators to review these blood glucose levels and what happens next.
Dr. Magee: So, each day, they go to their dashboard and each of the patients who is participating in the program appears there and they quickly scan through to see who’s having high sugars; who’s maybe having low sugars and even who is not checking any sugars and then we reach out to each individual based on what we’re seeing and talk to them about either their highs or their lows or encourage them to do the checking so that we can watch their sugars. We frequently find that this has really been a game changer both for the patients and the educators. It is quite a transformation to be able to see the sugars, to call the patient at a moment in time when they’re having a high or a low so that we can ask them why they might be high or low. One of my favorite stories is a patient has been doing quite well since he came into the program. His sugars were all down under 200 having come in with a high of 400. One day, we see a 400, the educator calls him. Turns out he’s in McDonald’s having a sweet tea. So, that was the big Eureka moment for him. He realized that he cannot do that and live well. So, the educators get the sugars. They don’t have to deal with sugars written in a log book, they can look at them when the patent’s here, when the patient’s not here. So, the patient, in a way, feels like someone’s looking over their shoulder and helping them along.
Melanie: And then, what do the patient’s do with that report? Do they return to their primary care practices with this progress report? What happens then?
Dr. Magee: Well, this is being done in full collaboration with MedStar’s internal medicine providers. They actually order the past pathways for the patient and at points along the way, if we need to make major changes, we let the primary care provider know what we have done medication-wise. At the end, we send them a report with what the patient’s values were when they came in, what they are at the end and any further ongoing recommendations for diabetes management or education.
Melanie: Did the majority of your patients use the smart meters successfully and report increased adherence with their blood glucose testing and do you think, in your opinion, that this was because they knew they were being monitored?
Dr. Magee: All of the patients could use to learn the meter. We were really pleased by that. We were worrying about some of the elderly patients—whether they could do it. But, really, it works just like any other blood glucose meter and if you spend a little time with a patient, they can use it. Then, yes, I think certainly told us that having them watched was a good motivator for doing the values so that we wouldn’t be calling them to ask them where they were.
Melanie: Makes a lot of sense. So, tell us about 6 months down the line.
Dr. Magee: So, six months down the line, of course, is the billion dollar question in terms of health economics and it’s one thing to get the A1C down and another to keep it down. I don’t yet have six months data for the patients who were in the pilot in an on-going fashion but what I do have is information on how they’re having less frequent visits to the emergency room and to the hospital. So, we were very pleased to see that at 30 days, we had a 27% reduction in risk for hospital visits and emergency room visits and at 3 months, that reduction was 63%. Then, to answer your 6 months question, a small tweak upwards in the tail at 6 months to about 45%. So, we do need and we’re just beginning to address support strategies for ongoing maintenance of glycemic control and we’re looking at such things as the dashboard being taken back in by the internal medicine providers and residents as devices that actually look at blood sugars and insulin doses and generate recommendations for adjustments and for web-based coaching programs that can assist the patient in an ongoing fashion and track along with their sugars and reach out to them when they appear to be falling off the rails again.
Melanie: Dr. McGee, tell us about the evidence and what it demonstrates and then wrap it up for us as where you see this particular pathway taking patients down the line.
Dr. Magee: I think this shows us clearly that patients need a certain amount of core survival skills education in order to manage their diabetes medications and the multiple variables that impact their blood sugars on a daily basis; that if we can assist the primary care provider in making frequent adjustments to medication rather than having them done every quarter when they come in for their standard diabetes care visit, then we can get patients to their goal blood glucose levels. We’re very excited about this and we are now working on rolling it out and spread throughout the system to other hospitals and to other primary care practices so the providers can avail of the boot camp and offer it to their patients with uncontrolled diabetes.
Melanie: Thank you so much, Dr. McGee, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That’s www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.