Childhood Uninterrupted: How Continuous Glucose Monitors (CGMs) Empower Kids and Caregivers

Video Transcript:

Robin Loveday: Hello and welcome, everyone. My name is Robin Loveday. I'm a nurse practitioner, CDCES. And today, we're going to discuss the role of continuous glucose monitoring, or CGM, with managing diabetes. We're going to review benefits, challenges associated with this type of device, barriers to adoption, but also the unique benefits of this device in different subpopulations of patients living with diabetes. If you'll start us off and introduce yourself.

David Doriguzzi: Thanks, Robin. I'm David Doriguzzi. I'm a physician assistant. I’ve been working as a diabetes specialty PA for about 23 years. I am with a large medical group in Northern Los Angeles County in Lancaster, California. And it's a pleasure to be here today.

Dr Anita Swamy: I'm Dr Anita Swamy. I'm a pediatric endocrinologist, and I specialize in diabetes. And I'm in the awesome city of Chicago, Illinois, and honored to be here today.

Dr Aaron King: My name is Dr Aaron King. I'm a family medicine physician in San Antonio. I've had an area of interest in diabetes now for about 20 years and enjoy taking care of full scope adults both with and without diabetes and also take care of type 1 diabetes.

Joy Ashby Cornthwaite: I'm Joy Ashby Cornthwaite, and I'm a registered dietitian and a certified diabetes care and education specialist. I lead a group of clinicians taking care of high-risk pregnancies in Houston, Texas.

Dr Anita Swamy: When you have a child that's in a classroom and has diabetes, it's already a burden, right? And so, they don't want to stick out. And yet, we work with them on accepting their diabetes. So, until we can attain that, it's really important to meet them where they are. And taking out a phone when no one else has access to a phone can be daunting for them. They might not do that. So, the ability to actually look at the watch and see what their values are, are amazing. And our children are much more involved. They're able to act on highs and lows a lot faster. And also, tell someone, tell an adult. Even the little ones that may have the ability to get these watches can tell a teacher, "I'm low now." So, that the diabetes is not just their diabetes, but everyone helps them manage it.

I feel like we should all know this by now, right? Like finger sticks stink. Nobody wants to do it. You don't want to do it. Don't expect someone else to do it. So, give them something that is easy, that's small, that doesn't get in the way and gives them tons more data. Again, 288 versus—at best, I got really two to three, not four, per day. And so, I think it's a win-win. There is zero downside, so I just don't get the lack of ability for people to see that.

Robin Loveday: So, let's shift topics again and discuss the potential impact of CGM use in pediatric patients with diabetes. Managing diabetes in pediatric patients, it's obviously very challenging due to just lack of awareness of hypoglycemia symptoms, behavioral changes, rapid growth spurts, and resistance to needle sticks.

Dr Swamy, I'm going to look to you for this one. Most people, younger people with diabetes, it's probably the most challenging group, right? Difficult to get those target glycemic levels. And because of that, the ADA recommends the use of CGM in pediatric patients with diabetes. So, in your practice, Dr Swamy, how has the use of CGM in this patient population with diabetes impacted their lives, but also the lives of their parents, their caregivers, their loved ones?

Dr Anita Swamy: So, peds diabetes is very challenging, but it's also really rewarding. I feel like we get to see these children grow up and become young adults and succeed, and that is my goal. So, I could not achieve it without CGM. Without the Dexcoms that I put on these patients, I don't think I'd have the same outcome. In fact, I know I wouldn't because years ago, our ADA criteria for pediatrics was A1C target under 8.5.

It is only because of the advent of CGM that we are now able to say that they match the adult targets of under 7% without hypoglycemia. We would not have been able to do that. So, I think the fear of hypoglycemia is real. And any parent here knows how much we cherish our kids and the minute they're away from us for a minute, we worry the entire time. So, if they have type 1 diabetes, that's just exacerbated a thousand fold. And so, you never want to let them out of your sight.So, that creates a lot of stress for the kid—they feel different—as well as for the parent. There's a lot of anxiety there—which parent watches? Which parent does the sugar checks? 

So, I think that it is critical to do things that make everything easier. And CGM Dexcom is definitely that tool. And when I give them this, it is something that enables the child to actually be more free, and people misperceive it as well. So, I think it's a whole new dynamic. We have to teach people how to be a good follower. So, we talked about that earlier. And there's some rules and contracts. But, actually, it gives them more liberty and freedom.

So, for the first time—I remember this, when a parent sent me a screenshot of her kid playing football for the first time in his life—she didn't let him play it before because she was at work. She sent me a screenshot of him playing football. And then, it was followed immediately by a screenshot of his Dexcom because she could see it on the Follow app and what his number was. And his face said it all. He was just so excited.

And so, I think now these kids can play football after school without someone being present like a parent. They can go on overnight camping trips, sleepovers, birthday parties. They can go abroad. I used to have parents ask me, "Which colleges should they apply to?" And I was like, "I don't know. What do they want to do?" And now, it's, "Well, I'm in London for a semester, Dr Swamy." I had a telehealth visit the other day with a kid in London. And she showed me all the sites, and that's the way it should be. And the reason she's there is because we can see her data.

And the other thing I would say is that I think people with diabetes were really lonely in this journey. Whether it's type 1 or type 2, it was their diabetes, right? You saw the numbers and maybe that's why you didn't check, because it was depressing. And now, it is really nice to have a whole support system. And so, not only does it open it up so you don't have to carry that burden yourself, but it also opens it up so all of these people in your life can see that it's not just about you. A fever can impact it. Stress can impact it. What you eat, what you exercise, what you get on a test that day or having a test that day. So, people learn to appreciate, "God, this is really hard for you." And the judgment goes away, and the understanding begins. So, I think that is a huge benefit for parents and patients.

And then, I also think the ability for the school system to get involved. We used to have these kids on two shots a day, so that they had no involvement with school while they were there for eight hours. It just made it a lot easier. But what do we have for outcomes? Really poor outcomes. So now, we do national school nurse training programs, so nurses can be involved in the care of these children. They spend a third of their day there. So, it just really empowers everybody to step in and help.

And then, finally, for families, for caregivers, I sometimes will write a prescription for them to have a date. So, for parents to go on dates. I mean, these parents have so much stress and anxiety, valid. And I really need to work on that too, because I want that parent there 20 and 30 years from now, right? I don't want them to burn themselves out.
So, we say, "Go on a date. You can see your kid's data in the Dexcom Follow app." So, I think that's really empowering. And they look at me kind of funny and they say, "Actually, yeah, we haven't had a date in about a year." So, I think in so many innumerable ways, it has benefited everybody in the diabetes world and the team that is around that kid—and adults. So, again, I can't emphasize enough, I can't do diabetes without a Dexcom.

Joy Ashby Cornthwaite: I love that you added that it supports the supporters, because sometimes, the supporters are forgotten. Right? And so, I had this really great diabetes seminar that I went to a year and a half ago. And one of the speakers opened up with—she wanted to find a way to connect us, and she was certain that this next question would. And so, we're all looking at her because it's a different way for a speaker to start. And she says, "If you have the lived diabetes experience, stand up. If you have the learned diabetes experience, stand up. If you have the labor diabetes experience, stand up. And if you have the loved diabetes experience, stand up."

Dr Anita Swamy: I love that.

Joy Ashby Cornthwaite: And the entire room was standing. And I think we forget that to support the person takes a lot. And so, as the child of two parents who lived with diabetes—my dad has passed, but he told me—because I, like you, started my diabetes education journey because of my family members and because I wanted to fix the system. And he said, "I live this journey, so through you, no one else has to."
And I think Dexcom has allowed, through the very intentional application of a Follow app, to include the caregivers in the space that is also protective of their mental health and all the fears that we carry for—is our family member going to be okay out of our circle? And support the relationship that you can maintain by not nagging.

Dr Aaron King: If I could, I want to just share a quick story that's very personal. So, not on the physician side. My kids all competitively swim. And just a couple years ago, one of their swim mates was practicing early in the morning, about 6:00 in the morning. And he's about 13 years old, and he's in the pool swimming laps back and forth. There's about 20 kids in the pool all being watched by the coach. Everything seemed to be fine.

Well, the parent of that child got an alert on the Dexcom Follow app, of course, that this kid was having a hypoglycemic event. And it's somewhat hard to get in touch with a coach on the fly. But she was very persistent, as you might expect, and actually was able to get in touch with his coach. They pulled this kid out of the water. He was still swimming. His glucose was well under 55. He was not coherent. He actually needed glucagon in order to come back. EMS was called, of course.
And so, we talk a lot about Follow, and we talk about families and caregivers being—but when you have an experience like that and you see a child and their life is saved because of this technology, it becomes so much more real. And I know all of us take care of people with diabetes, and we have those stories, and it's just powerful. And it shows you that, at the end of the day, we should all have access to this technology.

Robin Loveday: So, Dr Swamy, how do you approach concerns with pediatric patients and their parents? Can you talk us through that, how you envision CGM shifting? How caregivers can manage pediatric diabetes?

Dr Anita Swamy: Sure. I think these are real concerns. So, I think validating those concerns, not brushing them off and saying, "Tell me what it is that you're worried about." But I also think addressing this as standard of care is critical. So, it is no longer something that I approach as optional. I don't know if it ever was. So, it is something where I say, "This is what we do today. This is not my dad's diabetes. It is not your grandparent's diabetes. We are so much better. And so, this is what we're going to do." So, having confidence as a health care provider myself, I think is really important for them to perceive that this is something they've got to do.

And then, secondly saying, "What are the hesitations? If you think that you can't do this, I will show you. I will walk you through it. This is what these arrows mean." So, you can't just put technology on someone without education. Education has to follow, but it doesn't have to be esoteric. It is basic education that is available everywhere. So, even if they're not at any of our practices, they can get that online, even guiding them to say, "Look at this website."

So, Dexcom has some wonderful resources online to understand what trend arrows are, what these alerts are, what the benefits are, and how to use them. There's five million websites that I follow, Instagrammers that I follow who show all this. So, I think it's really important to share those with them and dispel the myth that you can't do it.

I wear a Stelo for prediabetes. So, I'm often able to show them that it's not painful. But what I tend to do is actually have them meet somebody else in another room. So, I have a very busy clinic with lots of patients in the rooms, so I'll often have a model. So, I'll ask another patient to come in. And I will tell you that speaks way more volumes than I ever can. I feel like when I'm talking, they hear, "Wah-wah-wah-wah." And then, another kid comes in and they're like, "Whoa." And so, I have that child talk about their journey with CGM and a pump. And in our practice, you walk out of the hospital on CGM, and that is the standard of care.

Robin Loveday: Thank you all so much for your time and your expertise. This has been an absolute pleasure, and thank you so much for joining us.