My First Time Using LibreView to Help Patients with T2D
Dr. Julia Blanchette, Ph.D., RN, CDCES, is a healthcare professional who works with people with diabetes. As a provider, she helps people with diabetes reach their self-management goals by identifying practical ways to make adjustments to their daily routine. Due to the coronavirus pandemic, Julia has learned to do that using virtual telehealth visits with LibreLink and LibreView. LibreLink allows friends, family, and caregivers of FreeStyle Libre users to get their glucose readings. LibreView is a cloud-based diabetes management system that provides patients and providers easy-to-understand reports from their continuous glucose monitor (CGM).
In the interview below, she discusses her first experiences using LibreLink and LibreView to help patients learn more about what impacts their diabetes, why CGM is valuable for people with Type 2 diabetes, and the benefits of virtual healthcare.
Thanks for chatting with us, Julia! Would you mind introducing yourself to our audience and how you help people in the diabetes space?
I’m Dr. Julia Blanchette and I am a nurse scientist and diabetes care and education specialist. I work right now at the Cleveland Clinic Diabetes Center in Cleveland, Ohio, which I love. I’m also starting a position as a post-doctoral research fellow at the University of Utah. But for clinical purposes, I work with patients in-person somewhat and virtually using telehealth. I work with people with all types of diabetes of all ages, but mainly adolescents, young adults, and adults.
When was the first time you came across the Freestyle Libre? What were your initial thoughts on it? And then how was it prescribing it to a patient for the first time?
Before I worked at the Cleveland Clinic Diabetes Center, I was not as familiar with the Freestyle Libre 14 day system and I believe it was already out when I started working there. This current position that I work in really exposed me to the Libre. We have a pretty big CGM program that Dr. Diana Isaacs, who’s a pharmacist, diabetes care and education specialist, oversees, and she has taught me a lot about the Libre. So the first time I saw it was at this job, and I remember thinking the first version, didn’t connect to the phone. And I remember thinking, wow, it’d be really awesome if it connected to the phone, like some of the other CGMs and that happened shortly after I was thinking that. And then I think pretty much as soon as it started connecting to the phone, we were able to sync patients up with our portal to remotely share their data with us.
Can you explain why CGM technology is important for people with Type 2 diabetes?
I think CGM is undervalued as a treatment for Type 2 diabetes. Not all people with Type 2 are using multiple daily injections (MDI) or multiple daily injection insulin therapy; some use long-acting basal insulin, but they’re not using mealtime (rapid-acting) insulin. So for people with insulin-dependent diabetes, CGM has the obvious benefits where you can see how your blood sugar is trending and understand how to make medication adjustments minute to minute throughout the day based on that. Also, people with Type 2 diabetes who are on oral medications can also benefit from using CGM technology, if affordable or covered by insurance, by seeing their blood glucose in real-time.
People with Type 2 often ask me “what is this going to do besides just show me my blood sugars?” and I think one thing that is so valuable is that you really learn a lot from your data. If I were to work with someone who was on oral medications, who was working on trying to eat more balanced and then trying an exercise regimen, we would be able to see the impact of different types of food and on more active days on their blood sugar, just by looking at that data. It helps people learn to make behavior changes and other self-management decisions outside of using it for insulin adjustments.
Due to the pandemic, there’s been a push for the usage of telehealth services, so patients don’t have to leave their homes to receive care. Can you explain what telehealth is and the benefits of using it with platforms such as LibreView?
I think depending on who you ask there are a few different definitions of telehealth, but from my standpoint, it is connecting with the patient virtually or on the telephone. So at my practice, the diabetes care and education specialists actually have to connect via video. We don’t do just telephone visits for telehealth. And I think that’s pretty standard, is that more people do video than just telephone. We do video visits, we can see the patient and we can communicate with eye contact, but also hear each other.
The benefit of having remote uploading capabilities like with LibreView is that we are able to see all of the data and go through it with the patient, and then we can share our screen and even use the cursor to kind of point out what we’re seeing and show the patient. You can go through the reports together and I think it’s still just as engaging as printing out a report and going through it in person.
Can you recall the first time you started using LibreView with a patient with Type 2 diabetes?
So the first time actually wasn’t a virtual appointment; we just started doing more virtual visits during the pandemic. So the first time we used it, I showed the patient how to connect to it from the office. And then we pulled up their data and it was exciting because I then showed the patient how they could go in and view their own data without having to connect their device to the computer. It can be tedious or frustrating for some people to have to plug something into the computer just to view all of your data. My patients thought that was really awesome and I was really excited that I could pull everything up and see it in a simpler way than having to connect to the device to a computer to download data.
What were some of the reactions that you and your patients had when you were able to see all that data just in aggregate? What were some of the reactions your patients had?
Personally, I get really excited when I go through data. The first few times that I see there that I have a patient and we’re looking at the data together, or the first time I’m using a new data platform, those are all really exciting moments for me because I think the data is so valuable. It’s also meaningful for the patient. The first time I went through a report with a patient, they were pretty amazed by the differences. You can see your blood sugar peak higher from having a higher carbohydrate, a lower protein type meal versus having a meal that’s more balanced with some proteins and carbohydrates and fiber. Seeing the difference in the peaks helps me make recommendations to the person I’m helping. They also find it very insightful and valuable since they could apply it to their lives.
How has the pandemic impacted your use of LibreLink and LibreView?
I started doing virtual visits during the pandemic. I’d been trying to do it before, but the coronavirus expedited that process. I’m working closely with a patient and I want to check in or follow up with them in-between visits, I was using it to view the data in-between visits and check in with them to talk about how the progress was going. It’s a good way to check in with the patient, with their goals, and help them refocus if they needed that support before their next visit.
As a provider, do you find that patients are more empowered and likely to work towards their health goals because they’re able to see you virtually and get their glucose data from LibreView?
I do; empowered is a great word. I think when people can see their data and when they feel like there’s a change that they can make and you can show it to them, they are more likely to continue to press forward, not only they’re applying it to their life, but they’re able to see an impact and they can make a difference. Also, not having to come into the office just to download your data from your device is so convenient to the patient. I also think that coming into the office to do that can be intimidating. But, if you’re able to check in with your patients to see how they’re doing and how you can support them, they’re more likely to make positive changes.
Were the questions during your first virtual visits food or medication-based? What were some of their primary concerns?
A lot of people come in with this sense of shame and guilt. They come in thinking or saying, “Hey, my blood sugars have been really bad,” and they use the word “bad.” I reassure them that we’re here to learn and we’ll find a way to reach their management goals.
When I explain it like that, a lot of their questions come up after. So, topics like food or medications come up after we’re done explaining everything. Because I think when you take the time to break everything down and explain where you’re having highs or where you can make those changes, they’re less anxious about managing their diabetes.
They can focus on one or two things as opposed to worrying about diving into different diets or resorting to insulin. A lot of times they come in feeling like they’re not doing well. A lot of times I’m able to point out, you’re working hard, here are some things that are positive for you. And then here’s a small thing maybe here that you can work on to lower your blood sugars after lunch, for example.
That’s what I strive for because I think numbers themselves can be really intimidating and a lot of times we use numbers to assess performance. Another thing I emphasize too, that just came to mind is, sometimes they do come in with pretty high blood sugars. I’ll point out to them how consistently high their sugars are running, and a solution to that means changing their long-acting insulin dose. Other scenarios are their blood sugars are really actually steady overnight and then they rise after eating. Maybe we need to add a new medication with food or a new medication that’ll lower some of those peaks after eating. I’m able to point these out using their data.
Do you have patients who are more likely to see you because of the convenience of LibreLink and telehealth, in general, or do you find patients still experience issues with access to a provider, even virtually?
The clinic I worked at spans a pretty large geographic area, so there were always questions about costs. But there are financial counselors that help clear the patients before they’re put on our schedule. But honestly, virtual care is not really that much more expensive across the board than in-person care. And the services are so much more convenient. You save time, you save money on gas, and save money on parking. When it comes down to it, it ends up being more convenient and more affordable in other ways. Plus, the visits are shorter. So I think a lot of my patients love virtual and some even prefer virtual because it saves them resources and other ways. Even if they have to pay a fee for it, which they don’t for me, out of pocket, but I know some institutions do have virtual out of pocket fees. It depends on where you’re seeking care. But also, I think the pandemic has pushed some of my patients to try new things like telehealth.
This content was sponsored by Abbott, the makers of FreeStyle Libre 2, — a Founding Partner of Beyond Type 2.