← Diabetes Core Update
Loading summary
Transcript59 lines
- [00:05]
A
Welcome to this three part series of Diabetes Core Update where we will discuss the cutting edge topic of automated insulin delivery for people with type 2 diabetes. I'm your host, Dr. Neal Skolnick, professor of Family and Community Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University. This special series of Diabetes Core Update is sponsored by Insulet. On the first podcast of this series, we discussed the benefits of automated insulin delivery, that is aid for people with type 2 diabetes who are on insulin. We are used to thinking of this for people with type 1 diabetes and now it is available for people with type 2. We'll review that prevention briefly in a few minutes with Davita Kruger, who joined us for the first episode, who I will introduce more in a moment. Even when new technology that brings benefits and the reason we're talking about this is we recognize that new technology is intimidating and it can be particularly intimidating not just for patients, but for us as clinicians because we're responsible for people using this correctly. So today we're going to discuss the practical aspects of of how to get started prescribing automated insulin delivery for people with type 2 diabetes. And joining us for today's episode are two clinicians who have a wealth of experience with managing and teaching people to manage aids. First, I'm going to introduce again, as I did on our first episode, Davita Kruger, who is a certified nurse practitioner in diabetes for, yes, more than 40 years at Henry Ford Health in Detroit, Michigan. Her roles there include both clinical practice and research. She is a past president, Healthcare and Education, the American Diabetes Association. She served over the years as an editor of both Diabetes Spectrum and Clinical Diabetes. And she has been an author on over 100 publications, including two different trials published just this year, one in JAMA Network Open and the other in the New England Journal of Medicine that looked at today's topic, automated Insulin delivery in type 2 diabetes. DaVita, welcome back.
- [02:28]
B
Well, it's a thrill to be back and I'm so excited to get to work with both you and Ashlyn today.
- [02:35]
A
And that leads to our second guest, Ashlyn Smith. Ashlyn Smith is a Board Certified Physician Associate. She is a Distinguished Fellow of the American Academy of pas, a Certified Diabetes Prevention Program, Lifestyle Coach, and founder of ELM Endocrinology and Lifestyle Medicine, pllc. She is past president of the American Society of Endocrine Physician Assistants, Adjunct faculty at Midwestern University, and a frequent lecturer at many Endocrinology CME events. Ashlyn, welcome to the ADA podcast.
- [03:14]
C
Thank you so much, Neil. I'm so excited to Work with both of you. I think we will just have such a great time and there'll be lots to learn.
- [03:22]
A
This is a good team to discuss this topic. Davida in our first episode, we discussed the rationale for considering aid and people with type 2. Today we're going to go into the details of patient selection and how to start aid. But first, can you just briefly review for our listeners the value proposition of aid for people with type 2. Why should we make an effort in primary care to learn about this technology?
- [03:52]
B
So, first of all, you know, in the United states is like 7.9 million people are on insulin and most likely more should be on insulin and some of them are just on basal insulin and need to be on basal bolus or they need to further what they're taking. But the thing that's alarming with the medications we have today is less than 50% of those individuals are at treatment goal. We could spend a lot of time talking about what the individualized treatment goal is, but the fact is we are not doing that. And we know that if people aren't at treatment goal, it does affect their long term outcome, complications of diabetes, cardiovascular disease. And I can go on and on. So when I think about delivering insulin, I think about the vehicles we have. And an insulin pump is a vehicle that we can offer people with type 2 diabetes. So you mentioned two very good studies that were published in the last two years and those were individuals with type 2 diabetes. And the big picture, we showed that upwards of 2.1% lowering of the A1C and when we looked at individuals who were on GLP1, and we know everybody gets to start or should start on GLP1, and most of us believe once we give GLP1, the job is done. Well, what we found is on stable GLP1, the A1C lowering was the same as for those individuals who were not on insulin. So and people just felt better and they had less diabetes distress. So I think the vehicle choice should be an insulin pump, an aid.
- [05:34]
A
So Davita, let me just ask you a question there. You said there's an A1C drop of 2.1% and that's from entering the study until study end. Is that compared to how they were before or how does it compare to what we're used to doing, which is usually a titration algorithm with basal insulin, someone's new to insulin, you start them on a basal insulin, maybe at 10 units, you increase one unit a day. At the end of the month, they're never on what they should be on.
- [06:05]
B
So I would argue with you that that's apples to oranges and here's why. So if you take insulin, the A1C will come down. So many of these people's A1C, I would argue, should have been better. But on MDI, there's missing injections. The other issue on MDI, or just basal insulin, is hyper and hypoglycemia can't be accounted for. When I give you an aid insulin pump, it works with the sensor, talks directly to the sensor. When blood sugars are high, it compensates. When blood sugars trend down, it pauses or turns off the insulin, which you can't do on injections. And yes, it was 13 weeks, which is a very short period of time. And not everybody got 2.1. I will tell you that people whose A1Cs were 6.5 to 7, they maybe didn't go down as much. And we know they didn't go down as much. And some people stayed the same, but that's okay. They stayed the same with less hypoglycemia, without weight gain and with less distress. So to me, diabetes is so much work. If I can take some of that away, I think it's a win, win. And then your question about should primary care people get involved? Who is going to do this if we don't engage you? The majority of people with type 2 diabetes are in your practice, not mine. So I'm happy to partner with you. We need to get people who are in the primary care world engaged or we're not going to be able to accomplish this and we're not going to have a better outcome for our patients.
- [07:44]
A
That's a good point. So, Davita, first step for any therapy is selection of who gets it. The same thing for any device. Can you address patient selection here? Who should we think about automated insulin delivery in people with type 2 diabetes who are either beginning or on insulin? Who would be the good candidate?
- [08:06]
B
So from my perspective, when we think of continuous glucose monitoring, the person needs to be willing to wear continuous glucose monitoring. But that CGM is a right, not a privilege, and everybody should be afforded that. But when I think of who should be afforded an insulin pump, half the reason people aren't saying, you know, pick me, is nobody's asking them. But let's go back to the two research studies again. We took all comers. We didn't just say, I think, are you a good candidate? Are you a good candidate? Are you a good candidate? We took all comers. We took people on more than 100 units a day. We took people. The diversity was phenomenal. We went specifically out of our way to make sure we had cultural and ethnic diversity. We took different incomes, different educations, and we tried. We tried everybody and offered this opportunity. And at the end of the day, it didn't matter. Everyone did well. And so when you think about that, you know, back in the day when insulin pumps were brand new, in the 80s, when I first started, we kind of say, are you a candidate? Are you a candidate? Remember, back in the days, we even said you had a carb count. You don't have to carb count. We did not require these individuals to be carb counting. So. And, you know, and they did it. They did a marvelous job. So I think those individuals who wear a sensor and want a better way to deliver insulin and a better lifestyle because diabetes is a tough disease, those are the candidates we should be thinking about.
- [09:44]
A
Okay, that makes sense. So it's an individualized decision, but it can't be a shared decision unless someone knows about it and has the information with which to make a shared decision. So in your opinion, anyone who's on insulin, the main issues would be improvement in a 1C, decreased hypos, and increased ease of use compared to shots, whether it's daily or multi dose. And then it's a discussion. And that discussion doesn't happen if we don't bring it up, of course. Now, Ashlyn, let me turn to you now, and let's say we've talked to a patient. We've decided together that they want to try an automated insulin delivery system, because for all the reasons we discussed, they feel it would be a good idea. They might benefit. Many of us in primary care find the idea of starting what is, to us a new technology pretty intimidating. So at that point, we have two options. We've discussed it with the patient, and we can refer them to an endocrinologist. The other is we can learn how to do this ourself. The reality of referrals to endocrine right now, and particularly, we start referring a lot more people with type 2. Right now, it's about four months in the Philadelphia area. Four to six months to get into an endocrinologist, and that's in Philadelphia, where there are a lot, a lot of doctors. It is even longer. I've heard from friends in other geographic areas. So there's a real compelling reason for us to be able to manage this technology ourself. Is there any reason that we should be hesitant, though, to do that, Ashlyn?
- [11:37]
C
Well, I completely agree. Especially with delays in care. And where I practice in Arizona, there are huge cancer care gaps where even if an endocrine provider is available, they may have to drive three or four hours one way to get to them. So there are definitely gaps that we need to really get the collaboration with our primary care clinician colleagues to help fill that need. And I see a shift happening with aid, much like we saw with cgm. It used to be that CGM was only in endocrine practices. It was seen as too complicated and only for a very narrow subset of patients. And that really has changed. Right? We see CGM so much more ubiquitous, and I love that. I agree, Davita. I think CGMs for anybody who wants them, and we're seeing that a similar parallel now with aid that we're seeing now. The studies are supporting use in type 2 and broader patient populations than we had originally thought and then getting indications for type 2. And now we're even seeing our standard of care of 2026 expand the recommendations for aid. So this shift is happening so much like CGM came to primary care. I think we're seeing that aid is coming to primary care.
- [13:00]
A
So, Ashlyn, can you tell us more about the standards of care, the American Diabetes Association's new update, and what it says about aid?
- [13:09]
C
Yes, that was a huge change and it was really exc and quite timely, I would say, for this podcast. The couple of things that are really important, a couple of things that I think are really important. And I'll actually, I'll see you if there's anything you want to add there, davita, but some things that I took out were increased use of automated insulin delivery devices. And specifically what we saw with that is that they had removal of some of those barriers that we would have previously thought about, meaning recommending removal of a C peptide level, removal of getting antibody levels or certain duration of insulin treatment before starting pump therapy. So we're really seeing an expanded use and removing some of those barriers that we previously had.
- [14:01]
A
So, Ashlyn, just to clarify for our listeners, when you say removal of those, you mean removal of the requirement from some insurance companies to require that before being able to prescribe it?
- [14:13]
C
Well, it's the ADA recommendation to remove those. So we'll see payers that hopefully catch up with that. We know there's always a lag behind that, but that at least, you know, if we have that guideline directed therapy supporting that, then we can advocate for that for our patients, which helps to move that needle.
- [14:34]
A
So, davita, so similar to what you were saying. The standards of care now support a very broad opportunity to initiate aid as a vehicle for insulin.
- [14:49]
B
Well, it kind of blew me away. I was so excited. I was actually at a technology meeting, and we were all passing it around and doing our happy dances. Because the ADA has always supported the use of insulin pumps in type 1 diabetes, and now it is absolutely saying that in 2026, the new standards of care say that aid systems for those individuals, whether they have type 1 or type 2, and they include adolescents and children who have type 2 diabetes, should be offered, which is, I think, amazing for those individuals. And you need to individualize the care and the glycemic goals.
- [15:32]
A
Davita, that addition to the standards of care is critically important. And it's so critically important. Let me actually quote directly from the standards of care, and if anyone's interested, they can look at section 9.27. And it says as follows, quote, automated insulin delivery systems should be offered to all adults with type 1 and type 2 diabetes on insulin, depending on the person's or caregiver's needs and preferences. And that is a grade A recommendation.
- [16:15]
B
But I'd also remind our viewers that some of our newer insulin pumps do not require the use of a durable medical equipment store. So for our patients who have type 2 diabetes, if we send a prescription to a pharmacy for a pump that can be obtained at a pharmacy, we don't have to worry about the C peptide, but it's still a direction that we're going.
- [16:38]
A
So that's a perfect segue into the details. And, Ashlyn, we decide ADA now recommends to offer an aid as an option. A patient decides that they want this, and now we're saying, okay, let's do it ourselves. Because there's a long wait to get into an endocrinologist. What are the steps? How do we approach this? How do we learn about this?
- [17:03]
C
Well, first, I really just want to build upon what we've been talking about, about. I think having the right mindset when we're approaching aid is so important. And what I have seen that's really valuable is really reframing what we as providers think about aid. So we have previously thought, oh, I'm, you know, I'm so frustrated that my patients aren't meeting their goals. You know, the A1Cs aren't coming down, whatever the frustrations might be. And then that often gets pushed back to the patient. Right. The patient must be. You use these words. Non adherent. I don't use those words, but that's. That's what some providers say and they get frustrated with the patients for not meeting the goals. But really what we are seeing with this data that DaVita was explaining was that we're taking those what we previously thought were patients that would not be good candidates. So people that are on really high doses of insulin, we thought too much for a pump or not taking their medications consistently, or not carb counting, you know, there's a whole litany of reasons why they might not have been, quote, unquote, a good candidate for pump therapy. And now we can reframe those maybe frustrating cases into these potential situations where we get more consistent insulin delivery, we get less burden, which often translates to more of that patient engagement, more of that patient adherence, if you will, taking their medication patients more consistently. And plus it's attached to that they're going to be taking their insulin consistently. So it really helps as providers that we reframe how we think about aid, that it's no longer this frustrating patient and then this obtuse technology. Now it's a tool that we can use to help bridge that gap. And that what we really have seen is that thankfully the path to getting to a pump and actually starting at the logistics of it are simpler than they used to be. Because perhaps one of the most intimidating aspects of pump therapy was actually just starting it. So sitting down to that pump therapy order form and having to do all the calculations and figure out all the settings that, I'll be honest, even in endocrinology, I would make sure I sat down and was not doing, not multitasking anything. I was focused just on that pump therapy order form because it was involved. And actually the majority of the aid systems now have these automated or kind of pre filled forms. So for some of them you only have to put in the total daily dose of insulin in a patient's weight and it fills the rest of it out for you. So it's no longer your entire lunch break trying to calculate all this out. It actually pre fills it with that information.
- [19:57]
A
So I'm going to slow you down there for a second. Where do you obtain a form?
- [20:01]
C
They are easily available online.
- [20:05]
A
So you look under the brand and then you can get the form for starting.
- [20:09]
C
Oh, you don't even have to go that specific. Go ahead, Davida.
- [20:13]
B
I was gonna say it's easier than that, Neil, because when you prescribe a pump, the pump arrives, that company sends you the form through whatever method you have agreed, an email or wherever you want it to arrive. You fill it out, get it back to the pump trainer and then the pump trainer. And I highly recommend, especially in primary care, that you use the pump trainer from the companies, which we do. Even in an endo practice, they take the form, they schedule the time and the appointment with the patient. They meet. We have a meet in our office because I think that should be done face to face. And then they tell you how the patient did and you can do a follow up visit.
- [21:00]
A
So stop right there for a second because that I think answers so many questions that cause a jam up at a primary care level so that you're not sitting there explaining something you just try to figure out. But there's a certified trainer who's going over the details of how to use this. What you need to do as the clinician is say what your daily dose of insulin is. I'm going to pause there for a second. Daily dose of insulin. How do we come up with that? Someone's on whatever their total dose is. Do we go to a lower dose?
- [21:37]
C
That's a good question. So as we know, sometimes what people are prescribed is not what they're taking. That's why we have that as well as the weight to put in. And then typically what happens is there's kind of an average of the two, and that leads to what the, the actual pump settings are. But typically, yes, if we were just going off of total daily dose, we would, we would subtract that. We would give about 3/4 of it for pump therapy. But we, we know the realities of insulin therapy, so that's why we put those two, two inputs in there and it gets a more approximate dose.
- [22:12]
A
So for new starts, it's a weight, calculated dosage, and for people who are already on insulin, it's roughly three quarters. And the weight is there as well. To make sure that's correct, you don't.
- [22:26]
C
Even have to do that math. You just put in their total daily dose and their weight.
- [22:30]
A
So this is a lot easier than many of us have thought it is from a distance. So we send in the prescription. Now, there are a few companies out there, and we don't want to endorse any one company over another. But I will say as a primary care doctor, that often, whether we're talking about insulin delivery systems or simply medicines, where there are a lot in a class, we tend to learn one that we can then learn the details of and prescribe enough so that we have a safe sense of how it works and what the system is. Does that make sense, Ashlyn, to you?
- [23:09]
C
I agree. And that would be A recommendation I would have, too, is really, you don't have to be a master of every pump. You start with one. Start with one that, you know, helps with easing the burden of patients that live with type two. And my tip would be to use a form and a setup and the support that helps you as a provider. And that's kind of the best of both worlds, and then we can always learn more. But that's a good starting place to get comfortable with using aid systems and then really see for yourself the benefit that it can have.
- [23:43]
A
So the trainer comes into the office, goes over things with the patient. When do you typically follow up with a patient?
- [23:48]
C
I follow up with people pretty closely. I want to see them usually within a month, because you want to have enough data on there to see what's going on, but you don't want to leave them off, you know, without any support after they've been onboarded. Davita, how quickly do you see them back?
- [24:04]
B
I want to also bring back in the trainer because the companies are very, very supportive, and the trainer actually does follow up phone calls and making sure that the patient is safe, making sure that they could do a change on the day, usually it's three days, that they're comfortable with it and that they were safe, successful. And they usually report back to us. And depending on which company it is, they may have a couple of phone calls, or at least everyone has at least one to two phone calls. And then we try to do the same as Ashlyn. We try to have someone follow up in a visit in two to four weeks. And, of course, the patient can certainly contact us sooner if they're having questions or they're having problems and. Or that the trainer will get in touch with us and say, hey, you know, I think you need to see this patient sooner than later, or you want to take a look, see at the data. And the other thing that I think is magnificent, at least from my perspective, having seen, you know, 40 years of iterations of insulin pumps, is because these pumps have a brain, meaning that they do correct on the high end and they do pause on the low end. I'm not as concerned about my choice in the beginning of what the insulin is. And I know that the pump is going to correct even me if I gave a little too much or not enough. So I think that I think we need to get people to take a deep breath and give it a try. And I think I usually say, try two to three patients, and that's where you're going. Comfort level will come from even if you're only going to pick one pump to start with and then you can branch out from there, I think the ease of how these pumps function will really surprise the person who's not had the ability or the opportunity to utilize them in their practice.
- [26:03]
A
That makes a lot of sense. So you, you do you put in a low end goal, like we do with basal insulin. We have someone checking their AM sugars or on their cgm.
- [26:14]
B
Well, let me just touch that, because one of the, one of the things we saw in one of the studies that we did was we looked at the goal of 1101-201301-40150. Actually, it was quite afterwards, but. And if we used a goal of 110 versus 150, if we took the patient from a goal of 150 down to 110, they spent 10% more time in range without any more hypoglycemia. And so I think as a new person, two pumps, you're probably going to go on the higher end, but I'm telling you the data is there that the lower end of the goal is not going to cause hypoglycemia because again, the pumps are really smart.
- [27:07]
A
So the devices are really good at protecting against what was most scary to us, which is the hypoglycemia. And then over the time someone's on it, the pump titrates. That's the automatic part, titrates insulin up so that when you see someone back at that one month visit, what are the details, what you usually go over, Obviously you're going over their CGM readings. What. But Ashlyn, can you walk me through?
- [27:30]
C
Absolutely. So one key piece that relates to this, we want to make sure is when you've had your patient onboarded with their pump so that you've used the trainer. An important piece of that is making sure that they've been connected to the platform that relates to that pump. And the reason that that's very important is that's how we're going to access the data. So that's how, how much like you would pull CGM data, you're going to pull the pump data from that. So really important to make sure that that expectation is clear. I would say almost 100% of the time it happens, but every once in a while it doesn't. So we want to make sure that when somebody's been onboarded, we, you know, make sure that they're on the platform and connected to our clinic, which is a Whole different process, but that's an important piece.
- [28:19]
A
Now, Ashlyn, I'm going to again, pause there because I know many primary care are going over their CGM data not through the cloud, but when the patient comes in, it's on their phone because they might not have chosen to have that organized in their office. Is it essential to be connected with the company's cloud based downloads?
- [28:45]
C
I would say it's about as close, as essential as it could be.
- [28:49]
A
And that's important to know.
- [28:51]
C
Yeah, very hard to read that data off of a phone. And the benefit of having it beforehand too is for a number of reasons. One, let's say they don't have an appointment, but they call you and say, I've been having X, Y or Z happen. We can pull that data. I think it's important to always have some sort of disclaimer that we're not constantly monitoring people's data. That's important to know, but we can pull that data ad hoc, if you will, if there's a concern. And the other piece of it is how my workflow goes is I have somebody who's coming in on a pump while they're being, in my case, virtually roomed. I'm looking at their data before I even have a conversation with them. So I go into the appointment with a running head start. So that does help quite a bit.
- [29:43]
B
Yeah. The other thing, Neil, to your point, is that the trainers will connect the patient to your cloud and then it's just app based. You put your password in and mine's already set up, put the patient's name in and all the data is there. And what you want to look at is are they having any hypoglycemia, are they taking any mealtime boluses, you know, what has changed and then all the settings are there if you want to make a change in the goals. And I also want to go back to make sure we talk about the patient who we don't know whether they were taking all their insulin. When we looked at the SECURE study, 31% of the patients who entered that study were on 100 or more units a day. At the end of the study, 13 weeks, they were. Only 10% of those individuals were on greater than 100 units. So the question is, were they taking it? I don't know. Does it matter? Their A1Cs came down, they did well. They were using less insulin, they were not having hypoglycemia. So at the end of the day, it's the outcome I'm looking for. That I think is really, really important. And then the other comment I would make is primary care people, well, prescribe insulin. Most of you prescribe insulin. That's the scary part, because you're prescribing insulin. And once a person takes an injection, there's a risk of hypoglycemia. And we all know the rate limiting factor treatment goal, we saw it in the DCCT a gazillion years ago, was hypoglycemia. If I give somebody an insulin pump, that pump manages the hypoglycemia. So I think if a primary care person is going to be afraid, it's by mdi, not the pump. And expanding their knowledge base will enhance their practice. The patient will have a better outcome, and both the patient and the provider will have more satisfaction. At the end of the day, that.
- [31:47]
A
Makes a lot of sense. Before I get to troubleshooting, I just want to recap so steps. Sign up with the company so that you can access the patient's individual data, prescribe the device, then you will get a form to fill out. When the patient picks that up to put in the amount of daily insulin, the trainer will call the patient, and then you bring the patient back for follow up troubleshooting. Where are the kind of challenges and things for people to at least be aware of where someone might say something not working quite right? Are there issues around that?
- [32:30]
B
Well, if a patient's chosen a pump that has an infusion set, an infusion line, so the infusion lines in their body, the patient puts it in every three days to the cassette or the actual pump. Sometimes there's a problem at the infusion set site. There can be clogging, there can be bending of the catheter. So you want to troubleshoot. If a patient has hyperglycemia that is not resolving, they may need to change it. If they're using just a pod, that's, you know, that's not going to happen, which is also a benefit to the patient that's going to use a pod. So I think the troubleshooting is hyperglycemia. Let's backtrack and see. Is it a fusion set site more than anything else? Ashlyn, what else can you think of.
- [33:23]
C
That'S a good chunk of it? I mean, it's still mechanical technology at some point, so there are issues there. Another thing that comes up is that it's essential for the aid and the CGM to kind of work in conjunction with each other. So we work on kind of placing these sites in kind of a line of sight because we want to have them communicate with each other. So let's say somebody has an infusion or their pump on one side of their body and their sensor on the back side of their body, they're not going to communicate very well. So we want those two devices to have kind of a line of sight to each other other to ensure good Bluetooth communication between the two. Although I would say that is, it is getting better. But the smaller devices can sometimes have a harder time just with the technology. But that I'm sure will improve as time goes on. And I will say that even just working through kind of the common issues we see with pump therapy, because the aid is adjusting that basal, we're not going to be adjusting basal patterns, we're not going to be adjusting basal rates on follow ups or doing anything like that. What we're going to primarily be looking at is what's happening around the bolus. So are they getting good bolus coverage, meaning when they bolus for a meal, are they getting a big spike or is it staying nice in range? So we do still have control over that. The bolus settings like the carb ratio and the correction factor, but we don't need to be tinkering around with the basal rate because when the system is in the automated mode, the systems are in automated mode, then it's taking over the basil. We don't have to worry about that. And I would say in my mind that has a lot more reassurance than, you know, an injection of basal doesn't account for hypoglycemia. We can't uninject somebody. So that is nice to have that extra safety.
- [35:21]
A
That makes sense. So we're getting toward our allocated time for our podcast and this has been a great discussion. Ashlyn, is there any one of the systems that is simpler for a primary care clinician to start out using? Some have tubes, some are pods. Is there anyone that is particularly more straightforward with less troubleshooting?
- [35:48]
C
I think picking a system that has good data about lowering burden for patients and has a simplified onboarding process, especially that pump therapy order form, having both of those is really important. And when we're talking about prescribing, I would agree to kind of what you mentioned earlier, Davita. If we're not worrying about tubing, we're also not worrying about prescribing tubing and prescribing infusion sets. We're just prescribing the tubeless portion, which is a bit of a simpler process. So that's in my in my opinion, that is a simpler process to go for.
- [36:27]
A
That's helpful because I think simplicity is very important. When you're not doing a lot, you all spend your life. David, as you said, your life for the last 30 years or more has been all about pumps. For people who are doing this as a part of a larger practice where they also see people with asthma, copd, obesity, depression, you name it. Simplicity is important. Ashlyn, can you just remind us of the different systems by name that are currently approved for use with type 2 so that our listeners can look those systems up and evaluate for themselves?
- [37:08]
C
Yes. So we have three that are currently approved for type two that may change here in the near future, but we have three that are currently approved. So we have the Omnipod 5 system that is approved for type 2. We have the T Slim X2 system, and then. Then we have our Medtronic 780G that are currently approved. And I know others are being studied as well, so that will likely change.
- [37:36]
A
So helpful. So we're about out of time. Davita, do you have any final thoughts to share with our listeners?
- [37:43]
B
Yeah, I don't want to be remiss in being sensitive to the needs of people in primary care, but I also recognize that that's where all the patients are, are that potentially could benefit by the use of aid. And so we need to figure out how do we move that forward and support the primary care world and having them understand that there really is some simplicity by picking a pump, working with the team to support you getting used to it, even if you just pick one, but offering it to a couple of your patients to get started. Because I think that the next step, the big step, has to be offering insulin pumps to our primary care colleagues.
- [38:31]
A
Excellent. Ashlyn, your final thoughts to our listeners.
- [38:35]
C
I echo what Davita said, and I also want to underscore that you are not alone in managing this. As we mentioned, the trainers are very helpful. We also have wonderful diabetes educators, diabetes care and education specialists in the community who are brilliant. They are more brilliant than I am with doing a pump, for sure. So utilize those colleagues. And it's really important to understand that you, as a sole provider, are not responsible for doing every piece of it. And I would also encourage you to have an aid champion in your own office. It could be one. It could be a medical assistant, an lpn, an rn. It could be anybody who is passionate about it, and that can be the go to person for aid. And that way we're not having to do it all ourselves. But we're not also not having to find a way to make sure everybody's 100% up to date. We have our champion who's really pushing that forward and staying on top of it with us. And I think that just helps remind you that diabetes is not managed alone. That patient is not managing it alone. We're part of that team. But you have wonderful teammates that can be extremely beneficial as well.
- [39:51]
A
Those are really excellent suggestions. Davita Krueger, thank you so much for joining us. Ashlyn Smith, thank you.
- [39:58]
C
Thank you both so much.
- [40:00]
A
And most of all, as always, thanks to our listeners. Thank you for joining us in this second of a three part series on automated insulin delivery for people with type 2 diabetes. I think we heard a lot of details today about how to select patients and the details about how to initiate patients and follow up with patients. Don't miss our third episode where we'll have a case based discussion focusing on overcoming therapeutic inertia as well as real life challenges that occur with practical solutions. This special series of Diabetes Core Update is sponsored by Insulet. We thank you for listening and for the American diabetes association, I'm Dr. Neal Skolnick. Till next time, stay safe and keep learning. Sa.