Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 1

1 - ESTABLISHMENT OF AN EVIDENCE-BASED THERAPEUTIC CONTINUOUS GLUCOSE MONITORING TRAINING PROGRAM IN A COMMUNITY SETTING

Saturday, Apr 27
11:00 AM – 11:30 AM

Objective :

To establish an evidence-based therapeutic continuous glucose monitoring (CGM) training program in a community setting, so that type 2 diabetics  on a multiple daily insulin (MDI) regimen can utilize all features of CGM, improve glycemic control, and reduce glucose variability. 


Methods :

Adult patients with type 2 diabetes mellitus on a MDI regimen who perform self-monitoring of blood glucose with a hemoglobin A1c (A1c) greater than 7.5% were referred to our training program. A diabetes team consisting of an endocrinologist, nurse practioner, dietitian, diabetes educator, and medical assistant saw patients every 1 to 3 weeks. Patients attended classes on diabetes education, nutrition, features of Dexcom G5 CGM, and how to adjust insulin doses based on glucose levels and the CGM trend arrows. Each patient wore Dexcom G5 for 12 to 16 weeks. Deficiencies in patient knowledge were identified using an initial assessment questionnaire and compared to a final questionnaire at the end of the training program. CGM metrics were compared during the pre-training and post-training periods using a paired t test. A baseline A1c prior to the training program was compared to the final A1c 12 to 16 weeks later. Upon completion of the program, patients received a certificate and their family physicians received recommendations for their ongoing diabetes care. 






Results : There were 31 participants with a mean age of 62 years. The mean duration of the program was 59.2 days. The average score was 84.2% on the initial questionnaire and 90.4% on the final questionnaire. CGM metrics for the pre-training and post-training periods were compared. The mean glucose decreased by 23.3 mg/dL, while the coefficient of variability decreased from 30.9% to 27.5% (p = 0.006) after the training program. The mean A1c decreased from 9.2% to 8.2 % at 3 months (p < 0.0001). The average time in target range (70-180 mg/dL) increased from 51.3% to 71% (p <0.0001). This improvement was from reduction in time spent in the hyperglycemic range (> 180 mg/dL) from 46.8% to 28.3% (p = 0.0002). Although not statistically significant, the percent of time in hypoglycemic range (< 70 mg/dL) also decreased.



Discussion : Our CGM program empowered patients to effectively use CGM to improve glycemic control and reduce glucose variability. Given the dearth of endocrinologists, community-based therapeutic CGM training programs should be established so that type 2 diabetics on a MDI regimen can reap all the benefits of CGM.


Conclusion :

A community-based therapeutic CGM training program for type 2 diabetics on a MDI regimen effectively teaches patients how to utilize all features of CGM, improve glycemic control, and reduce glucose variability. 






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Neelima Ghanta

Resident Physician
SOVAH Health Danville
Danville, Virginia

Dr. Neelima Ghanta is a PGY-3 resident physician at SOVAH Health in Danville, Virginia.

Sushma Reddy

Endocrinologist
Lake Huron Medical Center
Fort Gratiot, Michigan

EDUCATION
1972-1975 St. Teresa’s High School, Bombay, India.
1975-1977 Intermediate, Women’s College, A.P., India.
1977-1982 M.B., B.S. Kakatiya Medical College, A.P., India.
1977-1983 Rotating Internship, Mahatma Gandhi Memorial Hospital, A.P. India.
1984-1987 Residency in Internal Medicine at Wayne State University, Detroit, MI.
1987-1989 Fellowship in Endocrinology and Metabolism at Wayne State University, Detroit, MI.

HONORS AND AWARDS
People’s Choice Award for the 2017 Governors Fitness Award
Finalist, Directors Champion of Health for the 2017 Governors Fitness Award
Hometown Health Hero Award Michigan Dept of Community Health 2012
Michigan State Medical Society Community Service Award 2010
Medtronic Center of Excellence Award 2009
Patient Focused Physician Award, St. Joseph Mercy Hospital 2008
Michigan State Medical Society Community Service Award 2006
First Rank in University in final year of medical school (Final MBBS).
Best Outgoing Student Award in medical school
Gold Medals in medical school for securing highest marks in General
Medicine, General Surgery and ENT & Ophthalmology
HOSPITAL COMMITTEES
2005 – 2015 Director, Diabetes Excellence Team, Port Huron Hospital
Achieved Joint Commission Disease Specific Specialty Certification for Inpatient Diabetes Care, Nov 2012 (third hospital in Michigan)
Recertified in Oct 2014
2007 – present Director, Diabetes Excellence Team, Lake Huron Medical Center
Achieved Joint Commission Disease Specific Specialty Certification for Inpatient Diabetes Care, June 2016 (one of three hospitals in Michigan)
Recertified in 2018
1992 – 2015 Chair, Diabetes Advisory Committee, Port Huron Hospital
1993 – present Chair, Diabetes Advisory Committee, Lake Huron Medical Center
PUBLISHED ABSTRACTS
1. Standley PR, Zemel MB, Reddy S, Shehin S, Teklinski A, Sowers JR. Ca and Na
metabolism in Dahl-S rats as affected by dietary Ca and NaCl. FASEB J, 1988.
2. Reddy S, Shehin S, Sowers JR, Dardas G, Zemel MB. Aortic 45Ca Flux and blood
pressure regulation in streptozotocin-induced diabetic rats. FASEB J 3(3) : A233, 1989.
3. Shehin SE, Reddy S, Chiou C, Sowers JR, Zemel MB. Hypertension in the Zucker obese
rat: Role of altered calcium kinetics in vascular smooth muscle. FASEB J 3(3):A233, 1989.
4. Reddy M, Reddy S. Risk factors associated with the development of Type 2 diabetes mellitus in women with previous gestational diabetes mellitus. Diabetes May 2000
5. Reddy RB, Busdicker, Reddy S. Prevalence of Vitamin D deficiency in women age 45 and older in a small Michigan community and the effect of Vitamin D supplementation on myalgia.. JBMR 22(1): S342, 2007
6. Reddy M, Reddy PS, Reddy S. Physical Characteristics of Salt in the Treatment and Prevention of Hypertension. J Clin Hypertension 13(1) :A26, 2011

OTHER PUBLICATIONS
Reddy S and Sowers JR. Pheochromocytoma. In: Schwartz GR (ed): Schwartz’s
Principles and Practices of Emergency Medicine. Philadelphia, Lea & Febiger. 54:2120-
2125, 1992.
Reddy S and Schiebinger RJ. Hypoadrenalism/Adrenal Disorders in: Carlson RW and
Geheb MA (eds): Principles and Practices of Medical Intensive Care. Philadelphia, W.B.
Saunders. 112:1310-1317, 1993



INVITED PRESENTATIONS
1. Prevention of Type 2 Diabetes – An intervention by high school students to influence the eating habits and lifestyles of seventh-grade students. Oral presentation at the National Diabetes Education Program Partnership Network Meeting, Atlanta, GA, December 2004
2. Prevalence of Vitamin D deficiency in women age 45 and older in a small Michigan
community and the effect of Vitamin D supplementation on myalgia. Poster Presentation at
the Annual Meeting of the American Society for Bone and Mineral Research, Honolulu,
HI, September 2007
3. Current Trends in Professional Continuous Glucose Monitoring. Roundtable discussion at
Keck School of Medicine at the University of Southern California, Los Angeles, CA, November 2009
4. Diabetes Boot Camp: An Intensive Team Based Approach to Glucose Control and Patient
Empowerment in Type 2 Diabetes. Poster Presentation at the 77th Scientific Session of the American Diabetes Association, San Diego, CA, June 2017

COMMUNITY AND VOLUNTEER ACTIVITIES

HONORS AND AWARDS
2001 John R Hogan Humanitarian Award
1999 Women of Distinction Award, Michigan Waterways Council of Girl Scouts
1995 Spirit of Port Huron Award Cultural category.
2016 Blue Water Woman of the Year


COMMITTEE APPOINTMENTS
2016 – present Board Member, Blue Water YMCA
2011 – present Trustee, St. Clair County Medical Society Foundation
2010 – present Trustee, Community Foundation of St. Clair County
2011 – 2012 Chair, Education Task Force, Community Foundation of St.Clair County
2010 – 2012 Member, Activate America Committee, Blue Water YMCA, Port Huron
2003 - 2012 Physician Member, Port Huron Area School Health Advisory Committee
2007-2010 Vice-Chair, Education Task Force, Community Foundation of St. Clair
2005 – 2007 Member, Diversity Assuance Committee, Michigan Waterways Council of Girl Scouts Inc.
1994 – 2008 Member, Port Huron Area School District Gifted & Talented Parent
Advisory Committee
1999 –2001 Co-Chairperson Port Huron Area School District Gifted &
Talented Parent Advisory Committee.
1996 –1999 Member, School Improvement Team, Keewahdin School
1994 – 1998 Member, Steering Committee Comprehensive Community Health
Models of St. Clair County (CCHMS)
1995 – 1998 Trustee, Port Huron Museum



OTHER VOLUNTEER ACTIVITIES

2015 – present Blue Water Walking Club – A project that encourages physical activity by establishment of walking clubs in our county
2009 – present Walk for Summer Reading – A project that encourages physical activity
and improves literacy skills in disadvantaged elementary school students.
The students walk to “earn” books for summer reading.
2012 – present Co-Chairperson, St. Clair County Community Services Coordinating Body
Healthy Lifestyles Workgroup
1999 – 2015 Endocrinologist, Sweet Touch Program – Diabetes care and management for uninsured/underinsured as part of Peoples Clinic for Better Health, a collaborative effort by St. Clair County Medical Society and St. Joseph Mercy Hospital, Port Huron, Michigan
2008 Teen Health Center Lifestyles
2008 Holland Woods Middle School Science Club
2004 Y Knot Club – a youth program to initiate health and fitness habits for life. Initiated and sponsored this program through the YMCA of the Blue Water Area.
2003 Promoted and participated in the Educational Awareness Program on the Prevention of Type 2 DM in adults and children
1993 –2007 Festival of International Cultures – Chair person and participant











Gaurav Bhalla

Endocrinologist
Lake Huron Medical Center

Dr. Gaurav Bhalla is an endocrinologist in Port Huron, Michigan.

Kristin Elliott

Nurse Practitioner
Lake Huron Medical Center

Kristin Elliott is an advanced care nurse practitioner associated with Lake Huron Medical Center.

Kristin Ryan

Nurse Practitioner
Lake Huron Medical Center

Kristin Ryan is a nurse practitioner associated with Lake Huron Medical Center.

Kate May

Registered Nurse
Lake Huron Medical Center

Kate May is a registered nurse affiliated with Lake Huron Medical Center.

Shreya Ravula

Research Assistant
Lake Huron Medical Center

Shreya Ravula is a medical student and research assistant.

Teresa O’ Donnell


Michigan