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Pharmacy specialist emphasizes collaboration, CGM use in diabetes care
HOUSTON — As the saying goes, there is no “I” in team. Diana Isaacs, PharmD, BCPS, BC-ADM, CDE, clinical pharmacy specialist and CGM program coordinator in the department of endocrinology, diabetes and metabolism at the Cleveland Clinic Diabetes Center, knows this as well as anyone. Using lessons from her time in pharmacy school and her experiences working with a range of health care providers who treat patients with diabetes, Isaacs has found that collaboration is a more effective means of improving outcomes than more siloed approaches.
A cohesive diabetes team can also play a critical role in helping patients navigate the rapidly developing diabetes care space, which is increasingly influenced by technology. Isaacs is particularly focused on advances in continuous glucose monitoring technology and ensuring that as many people with diabetes as possible are offered the devices and receive appropriate education.
Isaacs, named Diabetes Educator of the Year by the American Association of Diabetes Educators, spoke with Endocrine Today about her successes in collaborative treatment, benefits of CGM and the future of diabetes care.
What was the defining moment that led you to your field?
Isaacs: As a pharmacy school student, I had the opportunity to volunteer at health fairs with faculty in underserved areas. We would provide glucose screenings and explain what the results mean to participants. I enjoyed providing these services and felt like I was making a real difference, which ultimately led to me pursuing this as a career path.
Why do you think a holistic approach is the most effective way for health care providers to support p eople with diabetes?
Isaacs: Diabetes takes a lot of time and energy to manage well. There are tons of things people with diabetes are asked to do related to their eating, physical activity, monitoring of glucose and taking medications. And then sometimes life events get in the way, such as sickness, death, financial struggles, etc. I had a patient with an HbA1c of 14% and providers continued to increase her insulin. When I sat down with her and asked her more directed questions, I learned that she takes only half the dose. She went on to tell me that her daughter also has diabetes and since insulin is expensive, she was only taking half the dose and giving the rest to her daughter. A holistic approach takes this whole situation into account instead of just increasing insulin to treat the high HbA1c.
I am fortunate to work with an amazing team of diabetes educators, dietitians, nurses, medical assistants, pharmacists, advanced practice nurses and endocrinologists. We each bring unique perspectives and the care we provide people with diabetes is so enhanced by all of us working together.
Can you tell me about your work with CGM and how you think it can be better implemented or made more accessible?
Isaacs: CGM has the potential to transcend diabetes management, and all people with diabetes should have access. My diabetes educator team and I created CGM shared medical appointments where we see four to six patients at a time for a combination of professional CGM and diabetes education. After a patient wears the device for 7 days, we download and interpret the reports together so that the person can see how different foods, medications and activities affected their glucose levels. We help transition patients to personal CGM and now offer a shared visit for personal CGM users as well. My goal is to help train other diabetes educators to maximize their use of this technology. CGM availability in pharmacies is growing and is one of the best mechanisms to make it more accessible, along with convincing insurance plans on the value of paying for it and making sure the whole health care team knows how to use it.
What area of research most interests you right now and why?
Isaacs: I am particularly interested in how CGM technology can be used to improve care in some of the less well-studied populations that I work with, such as post-kidney transplant, pregnancy and those following low-carbohydrate meal plans. As CGM becomes more widely available in pharmacies, I am interested in expanding the pharmacist’s role in CGM to help with device training, downloading and interpreting results, and then assessing the clinical outcomes of this type of program.
What do you think will have the greatest influence on your field in the next 10 years?
Isaacs: Technology is exploding. CGM use continues to rise, and we are getting closer to fully automated insulin pump technology. More services will be given remotely through virtual visits. As technology expands, it is essential that diabetes educators figure out how to best support the person with diabetes and stay up-to-date with all of the new information. – by Phil Neuffer
Disclosure: Isaacs reports no relevant financial disclosures.