The Dialogues – Episode 7

Board-certified in internal medicine, pediatrics, and adult endocrinology, our guest for this episode, Dr. Calvin Wu is currently the lead endocrinologist at Steady Health, a completely virtual full-service diabetes clinic. Dive in for an in-depth talk about the healthcare system and how the integration of technology can create a better experience for patients and providers alike.

 

Watch the entire video:

 

Hi, Calvin. Welcome to the dialogues. How are you? 

Hi Pete, I am doing good. How about you?. 

 

Yeah, same here. It’s really great to have you here today. I’m really excited. Actually, I think that this is one of the episodes that I have been most looking forward to. The reason I’m particularly excited is because you’re an endocrinologist and I think that it’s interesting that, you know, as being a diabetic, we talk a lot about it amongst ourselves. Therefore, it is amazing to hear from an endocrinologist and understand the perspective. So I’m really excited to have you today. If you don’t mind, can you give us a quick intro? Tell us about yourself and your background.

Sure. Yeah. Well, first of all, thanks for having me. I’m really excited to have a chat and share my perspectives and experiences with you today so let me share my background. My name is Dr. Calvin and I am an endocrinologist based in San Francisco, California and I’m currently the lead endocrinologist at “Steady Health”. Steady health is a completely virtual diabetes clinic that’s basically available on your smartphone. We’re currently in California and Washington State in the United States but I guess, most importantly, we are first and foremost a full-service endocrinology facility. So we see patients, we have telemedicine visits, we write prescriptions, manage labs, and do paperwork. What sets us apart,is that we go above and beyond. We are leveraging the power of continuous glucose monitors to provide us with a constant flow of data so we can troubleshoot and deal with issues as they arise. Additionally, we’re using software, video messaging, telemedicine etc. to deliver more data-driven, connected, and personalized diabetes care to our patients. 

I think we’re really doing problem-solving for a couple of issues like the lack of access to diabatic healthcare, diabetes care which is a 24/7 disease, lack of time to review the data and we really use that to personalize diabetes management. 

Yeah, that’s great,  I think steady health is such a fascinating organization and I am really keen to know about how Steady Health is addressing some of the issues that exist in the world of diabetes and endocrinology and also share with us about this new model of care that Steady Health has brought in the market. In addition to that, I would really love to hear a little bit about your journey as an endocrinologist so please tell us a little bit about how you started and why you got into endocrinology. 

Sure. Absolutely. I studied bioengineering at UC Berkeley. As I have always been fascinated with technology and particularly applications and health care. You know, I really enjoyed that. I would say, I was definitely drawn to human interaction and I really enjoyed working with people, pushing them on the path towards better health, and so forth. So that interest made my decision to go into medical school and I went to the University of Southern California. You know, medical schools actually take four years, which in some way sounds like a lot, but it’s also a lot of material deployment. Endocrinology is a topic that always interested me a little bit more than the rest and I think it has to do more with the functioning of hormones and their pathways that our body has and so forth. That’s just really nice that you can actually make sense of things so that really drew me to that field in particular. 

When you say ‘make sense of anything’, please tell us a little bit more about it in detail as I think I find this stuff fascinating and your listeners will also find it interesting as well because it’s easy to think about an endocrinologist as someone who helps you deal with your diabetes. So please give us a bit more detail on that. 

Yeah. I think that in terms of what’s really fascinating about it is that it’s really about communication, right? Your body’s different organs are basically communicating to each other and what’s really cool about endocrinology is that you understand those signals and what they were intended to do. So on the basis of that you can diagnose the problem from there, right? So maybe I would exemplify this as if you think of your thyroid as a hormone factory, right? It’s just making hormones i.e. thyroid hormone and there’s a part of your brain that’s controlling that. Sending signals to the hormones and if those levels rise, it basically says “thyroid gland, make more hormones for me” right? So if you’re diagnosing a problem, you then look at those hormone levels, the TSH in particular. You would say “No. If the TSH is high, it means my brain is really trying to push my thyroid gland to work harder.” This actually means that the problem then lies in your thyroid. Your thyroid factory is destroyed. But if those hormone levels are low, then maybe the problem is that your brain is not sending the right signals, so this often helps to make sense for where the problem is. 

Based on that, do you wanna even delve a bit deeper about the hormones in general and their significance because I suppose, an endocrinologist is basically a kind of your hormone doctor.

Yeah, you very rightly stated that an endocrinologist is basically a hormone doctor. And I think hormones truly are chemicals essentially, that help us coordinate our activities. So the sense is that your body is always trying to maintain homeostasis (balance) right? We don’t want too much of anything and we also do not want too low of everything. So in that regard, you’re always trying to stay in between so your body always tries to coordinate those things. For instance, your blood sugar doesn’t get too high, your body temperature doesn’t get too high and all those functions are driven essentially by hormones, so there’s probably a really long list of conditions that could arise in case of hormonal malfunctioning or imbalance right? 

I imagine that actually, you overlap and coordinate with other specialties quite a lot and that other specialties may even come to you for consults to help understand things when hormones are a play. We take diabetes as an example, as that’s one of the most prominent hormonal conditions. And I suppose we don’t always think about diabetes as a hormonal issue because we believe and we all the time work to manage our blood sugars so the mind does not think about the condition in the context of hormonal imbalance. Therefore I would like to hear about the relevance of hormones in the diabetes space. 

Yeah, I think this is a very relevant question because when we talk about diabetes we always take it as high blood sugars or low blood sugars. But it’s important to understand that actually, insulin is a hormone that regulates energy, right? It works for how our bodies actually make use of that energy properly. Let me give you an example to clarify this, when you eat something you absorb those nutrients including amino acids, glucose molecules etc. that circulate in your bloodstream right? So insulin is a hormone that basically opens up those doors, letting the sugar into your cells, using that sugar to make new cells, and otherwise storing some of that extra sugar for later use. When you’re fasting, those hormones are also constantly changing because if you’re eating you’re in a well-fed state, there are plenty of nutrients. That’s where insulin is active. Actually, it’s trying to put those into use and store them away versus if you’re hungry and you’re starving these insulin levels are at the lowest because you’re not trying to do that anymore. You’re trying to derive that energy source from elsewhere. 

So do you want to give us a little bit more detail around insulin itself?  Though you did explain it pretty well, and that’s a key that unlocks the cell and allows it to function so where do the things start going wrong. I suppose we can discuss more about type one, type two, and other types of diabetes as well. I know that there’s a growing list of different types of diabetes. We’re all quite fascinated, particularly with type ones so how do we get it? Like if I reflect on my diabetes journey,  I was 30 at the time when I got diagnosed with diabetes, at that time I was working really hard so I wondered if it was stress-related, but I always think if it’s a virus or stress that caused it. So would you relieve our curiosity about how we might have ended up with type one diabetes?

Yeah, I would say that the answer is quite complicated and so far we don’t even know all of the answers, actually. Mostly diabetes manifests through blood sugar imbalances and you’re absolutely right, by the way, that diabetes is a hodgepodge of different diseases but it’s really about insulin, actually. When you talk about type one diabetes, there is a true insulin deficiency, right? And in type two there is insulin resistance, which means you make insulin, but it’s not enough to meet the demand like supply doesn’t meet the demand. 

You can have people with type one who has elements of insulin resistance, for instance, they are relying on insulin, but they may require much higher doses then someone who doesn’t have the insulin resistance as well. But at its core, in either of the conditions, insulin isn’t there or it’s not working properly. 

So that’s interesting, actually, about type ones having insulin resistance as well. Does that mean that you have type ones who also have versions of type two? 

Not actually, let me clear it a bit that in type one, the reason they’re having those issues is that their pancreas isn’t producing enough insulin but in other words, they can have elements of insulin resistance too. You know, for instance, being overweight is one of the classic situations that counteracts the function of insulin, and therefore they require as much of it. 

Type twos typically need much higher doses of insulin so how do we start getting type one diabetes? And what are the potential reasons that we get it?

Well, we have mapped out that it’s likely an autoimmune process, right? So we know your immune system is not functioning properly and It recognizes your own pancreas essentially as the enemy and gradually destroys it. So, you know, if those factory cells are destroyed, you cannot make insulin. There are many causes like stress, infections etc. that really turn on the immune system and are really thought to be a possible culprit. Unfortunately, we can’t give you a straight answer about how it happens to you as we are still looking into that. There are clinical trials going on that are trying to understand this part but right now unfortunately we don’t know exactly about it. There is a lot of conjecture here, but we do know that there are certain things that seem to precipitate it such as environmental factors, stressful situations, etc. But at the end of the day. How it manifests is an autoimmune attack. 

So, let’s assume that stress is a cause then how does stress per se initiate the autoimmune response?

Technically, we wouldn’t call it type one. It might be something else. So there’s actually a class called secondary diabetes, which means it’s due to a different disease. Let’s say, for instance, you have cystic fibrosis, right? where all the secretions clog up the pancreas and end up kind of digesting itself. That’s a different situation because the pancreas itself is damaged, right? So it’s not an autoimmune attack. Alternatively,  let’s say you have pancreatic cancer and you have undergone pancreatic surgery. You don’t have those cells anymore, but it’s not that you have type one, However functionally speaking, you have the same problem, which is to say that you still need to treat with insulin because your body doesn’t have that capacity. 

So I suppose that’s probably a similar answer to viral-related or any other factors that trigger autoimmune responses?  In terms of the research that you would have seen as a student, where do you think we are at in terms of getting closer to preventing type one? Did I hear something about potential vaccines or potential treatment to avoid it? 

There are research studies done in that area. You know, that we’re basically trying to temper that immune response and to make it so that our immune system doesn’t attack our own body and so forth. There may be some small encouraging results but it’s still under research.

What are you seeing in the world of diabetes research that is encouraging at the moment?

I think if you’re trying to address it from a biological standpoint then one of the interesting avenues is islet cell transplants.  For instance, the idea here is that you could extract these islet cells actually infused into the liver and those transplanted cells can essentially produce insulin appropriately and normally in the body of the receiver. But the question, of course, is about the long-term benefit like what is the outcome for longer term  right? You know, whether insulin independence will also persist or not? so that’s the challenge, 

I agree with what you said and it’s still experimental at this stage. So you’re saying that currently there are type one diabetics out there who have received islet cells (injected islet cells) and they are functioning and producing insulin. After that, do they not need any insulin injections anymore?

That is correct to some extent, but then again I have seen people who after one or two years, get back to insulin injections. So the question here is to prolong the longevity of those cells and to get these cells is also very hard, most of the time it is taken from a cadaver (Someone who has passed away). So taking those cells immediately and those whole protocols are very complicated and they are still in development. But that’s promising, right? That would be kind of like the “Holy Grail” will say, 

Yeah, I think that’s a fascinating topic and potentially exciting as well because it looks like a real practical way to solve a short term problem anyway. Who are the patients getting those transplants at the moment?

It’s very selective and these are clinical trials to be clear. So it’s not that any center is saying that we are open up for this treatment modality and everyone with type one diabetes should come to us. Rather in medicine, there’s a lot about risk versus benefit, which is to tell the patients that going through this procedure involves risks. Also, we need to talk about the benefits. Like someone who is having a lot of lows, and he might be pretty sensitive to tiny amounts of insulin so they might benefit tremendously from this. For someone who is younger and has more years to live then this treatment may be more helpful for them to prevent these outcomes again. 

This is really exciting. What other areas of research that you think is worth mentioning today for our listeners? 

Yeah, previously we discussed the research from biological perspectives, and now we will share some of them through a bionic angle Right? So basically trying to use technology that mimics the pancreas and hopefully, we will also create the artificial pancreas. Which is something that literally plugs into a machine essentially. I mean, there’s been a lot of progress in the last  5 to 10 years and so forth. Its results are quite promising. 

There’s a concept of a closed-loop system which is to say that you have a CGM and have some source data, in other words, right. This continuous data is then analyzed through an algorithm that helps us understand where things are going on. And then you have a pump basically delivering insulin and maybe other hormones to actually keep you balanced. If everything works appropriately and coordinating well, then we believe that maybe someday we would have something that could be very responsive, managing sugars when they go high or low. 

In that realm, right now, at least in the United States, there are four major CGM brands. So I think in the coming years, hopefully, many of those will come out to be real products and that’s very exciting. Similarly, there are multiple insulin pumps as well that are in development. Now as I mentioned about different hormones like there’s one that actually will include insulin and glucagon. Until now, traditional pumps actually only did insulin so you can only lower blood sugars, but if you give too much then you can’t really do anything about it because it’s irreversible. Imagine if you could reverse your insulin dose one administered, just to raise your blood sugars so that’s very cool, right?

 

This makes a lot of sense actually, just in practical terms that you would have a device that actually is able to go both ways

Exactly. Right now we only have a brake pedal system and we can only go down and so to be able to have control in both directions would be incredibly exciting. 

How do pumps manage hypos at the moment? Because I have not heard that hypos are a problem. What’s the kind of general messaging from the pump companies as to why hypos aren’t an issue. 

I think it’s because of the predictive algorithms which basically know and understand the trajectory of your most recent blood sugar readings. As it gets more data, it’s gonna update its algorithm to say, “Yeah, my prediction is changing over time, right? And so that then allows your pump to be preemptive. 

Is there any evidence around the number of hypos for people with pumps versus people without pumps? I mean, what do you expect there? What does the data say? 

Now that we have CGM so you need to try to keep your blood sugar in range. But the idea is to keep people in the safe zone and how much we can maximize that. Also, avoid the low blood sugars right? A lot of these trials say that there’s a reduction because of these advanced algorithms and it can hopefully prevent those situations.  If you look at some of these trials, for instance, you’ll see some encouraging data in that direction. 

I’m quite curious and keen to start to explore models of care and the system in general that we’re using in this health care system and endocrinology in general and the sort of dynamics that influence patient care and experience to kick off that. Do you wanna discuss a little bit? So please tell us a little bit about what you’ve seen or how you’ve seen the system? The health care delivery system’s evolution over the last couple of years and how many years it has been since you started this profession?

Well, it’s a long path of rust so I did four years of residency, I did four years because I did actually internal medicine and pediatrics. After that, I completed 2 years of fellowship. So we’ll say 10 years and then I came outspent  4-5 years in practice.

Give us a little bit of insight into your perspective as a doctor to the system, and what has it changed over the last few years? And what sort of changes have you seen? 

So in short, not much. And I think a lot of us come into medicine in kind of an ideal way. We know what and where we’re getting into? But we don’t really know that day in and day out, the nuts and bolts of all of it. I think when we come out we don’t really get trained on how the health care system works so far? So in some ways, I think we’re all in for a rude awakening. We start practicing and seeing patients because the reality is, unfortunately, a lot of medical professionals actually spent most of their time on paperwork so they do not have enough time because you’re scrunched in to see lots of patients, especially if you’re in a large organization, where it feels like you’re just a cog in the wheel and seeing tons of patients. Then on top of that, you have to also worry about reimbursement. I know it sounds sad, but the truth is, it’s a business as well, and you have to kind of keep things going right? So, you know, you have to kind of look at how much you are getting paid for this. And I think a lot of people have this misconception that doctors are paid well separately, and there’s no doubt that there are some who are paid adequately, but I will say that the system actually is much more complicated than people realize it. 

Absolutely. I don’t know where I was listening to about the business of healthcare, and we could probably do an entire podcast on it. Actually,  it’s certainly an area of interest of mine as being in Australia, having lived in the UK and in the US and having been exposed to systems and having awareness as I have worked previously in the space of healthcare delivery and being aware of efficiencies and inefficiencies in the systems so looking at the US, for example, not just that, it’s inefficient, it’s also one of the most expensive. On one hand, you’ve got the US-based system, which is expensive, but the outcomes aren’t really better. And in fact, you’ve got the most expensive system, which actually isn’t delivering the best outcomes, which must be really frustrating. And then you can understand how frustrating it is for a doctor and their patients as well. Then you’ve got all the businesses around it, the insurance, and just the private hospitals that have these executives that are getting paid pretty well. This way we’re not going to solve the problem, but I think it’s good for everyone to be aware because sometimes I certainly hear patients, and I’ve probably seen one of those patients that complain about visiting an endocrinologist who didn’t give him what he wanted or expected through that interaction. So what are your thoughts on the inefficiencies of the system and its outcomes? 

Yeah, well, I couldn’t agree more to what you just said. I think at its core, healthcare should just be based on the provider and the patient, right? The problem is that there are a lot of people in between that kind of, put themselves into the place and involved in that interaction of sorts so that’s what’s probably most frustrating is that you know, like I’m very much familiar with the patient side as well. I’ve seen my family members kind of go through it. It just feels sometimes, like you’re being nickel and dime and so forth. Maybe, since that is probably a common experience. Now I’ll shed more light on the provider side. I think health care is one of the very few industries where you get a product and you don’t get paid for months on that by the way, So, for instance, when I bill insurance companies for a visit actually I don’t get paid for 2-3 months sometimes. That’s true with Medicare and other health insurance companies too. And on top of it, then they’ll come back and say, Oh, you didn’t document this so we’re gonna deduct some money from this as it didn’t qualify for this visit. Thus, it is really frustrating from both ends, as the systems are definitely broken in many ways. And again, I would say that there is so much stuff crammed in the middle that should not be there like in terms of price transparency which is a huge issue like I don’t know when I prescribe a medication how much my patient will pay for it. I can’t even compare the options. It’s very hard to do so. But even then there are pharmacy managers making deals on the back end. So the problem is again that there’s a lot of things intervening, however, we don’t see it at the end of the day. All we see is this interaction being poor, and then we blame each other. 

I think it is, as I said, a fascinating topic, and we could spend quite a while on it. Out of my pure curiosity, I would like to ask you how did the US healthcare system end up? do you have any insight into or any kind of knowledge as to how it ended up?

Well, I have some sense. You have to understand how we got here before we could try to fix this mess. I mean, for one thing, health insurance is often tied to jobs, right? So if you lose your job, you lose your health care especially in COVID right now, where people are losing jobs just because things aren’t working out for people anymore and that’s certainly a big issue here. Which is to say that, you know, things are tied to the wrong. There’s no incentive there, really, right? Like I never want to lose my health insurance, right.

I’m not sure how we got to all these hidden prices but there’s certainly too much bureaucracy in the system. Insurance companies, for instance, should be something you only use when there is an emergency but here health insurance is something ironically, that’s applied. Whenever you see a doctor etc., and there’s this whole business out of pocket which is super complicated. The issue is still that there are so many different players involved without any true transparency that we’re having in the United States. 

Well, yeah, we know what’s going on. I mean, there’s a cash incentive to deliver health care, and if someone does not have it,  they won’t deliver it so that’s the beginning of a massive problem for people who are suffering. 

The point is that we, doctors,  are not allowed to know how much someone else has paid on that contract, it’s illegal. Apparently. So for prices, we can’t even say how much they charge for a patient and if I try to ask about it that is against the law. 

Is there any reason to be optimistic about the US healthcare system? Is it possible that we may see in the next 50 years the system gets fairer? 

I truly do hope so. I mean, the truth is, in healthcare, things happen very slowly. And I think it’s because there are stakeholders involved in it.  But I think that pandemics released some of the flaws in the system, especially when people are losing coverage and have no place to turn to. I think it is to say that when we have tons of people who can’t manage on their own and  when we’re seeing bad outcomes, the lawmakers should work on this by involving everyone to find a solution. I’m hoping for that but I haven’t been very impressed with the progress so far. Fingers crossed for some better leadership, 

I think steady health is probably battling on a number of fronts. It is trying to deliver better health care for diabetics so do you want to talk a little bit about the improvements that steady health is looking to bring to diabetics through this new model of care? 

Absolutely. My motivation for joining steady health was actually twofold. I think the patient experience needs to improve, but I actually believe that the provider’s experience needs to be improved too, so that was really one of my main motivations to join steady health.

Do you know what I love about the study? I think I really love the deeper connections I’m building with my members. Steady health models foster the continuation of care which means that it does not last just for an hour rather we can continue this conversation over messaging and I can spend time on mental health too.  The fact is that we could spend the whole hour talking about data which is unheard of in a traditional healthcare experience, so that’s very fulfilling for both of us. 

I think as doctors, we’re a part-time adviser and translator because we wanted to translate and distill it down to its core elements to present to a patient. Medicine took a very paternalistic approach as compared to the previous one where you see a doctor, you get you medications, and leave. However, now I’m very happy to see that there’s a movement towards shared decision making, Which is to say that we want to help patients understand what’s going on because that’s how we move forward together as, at the end of the day, diabetes is a disease that the patient manages 24/7. So, we want those interactions to be meaningful. Being able to spend time with data has let me figure out better solutions to the patient’s problems. It’s not just the ratio, rather it’s like the colonial composition and we can identify when things are not going and when to change the course. there’s no way I could have done this in the traditional approach. 

So what is the model that you’ve created that allows the time?

This is where I come back to that reimbursing process. The fact is that we charged a membership fee, but that then allows us to spend more time to focus on things that don’t get billed at a face-to-face visit. Whereas in traditional health care, you don’t get paid until you see someone. So in providing a solution Steady health works as if charging a nominal fee that lets us focus our time on the areas that are important. 

Is the system allowing reimbursement for non-physical or non-face to face visits?

There’s a whole movement towards remote patient monitoring which is to say that as we get this data, we don’t have to be face to face with the patient, but you’re looking at the data making decisions. In fact,  COVID has also kind of forced changes in that realm as well. 

I think the care model design has again enabled us to take our sales away from that face to face visit, being that way helps us to move forward and we can continue the conversation over messaging which makes it a continuing process. I can look at the data when things arise. So if you have an issue next Tuesday, we can simply chat over it by looking at your data. Hence you don’t have to wait three months to see your endocrinologist anymore. So overall, it makes for a much more fulfilling experience. Understanding and involving in the shared decision making make patients super motivated to making tremendous progress. 

Wouldn’t it be great if somehow reimbursement or payment was attached to patient experience or patient outcomes? 

This is what we call value-based care but I think there are certain limitations there as well. You have to figure out the right metric and in medicine,  it’s often complicated. It’s not a simple number you can measure.  You need to keep other factors in mind as well. 

One of the challenges is that the outcomes are going to be seen in the next few decades.

The system is the US. Is a little bit short-sighted and that short-sightedness actually is just going to compound, so people are not getting what they need in the short term. They’ll end up admitted in the ICU that will create more burden on it. 

Now coming back to Steady health, please tell us for how long have you been working with Steady Health? 

I started back in January of 2019 so it’s been almost two years now. Fortunately, I have the freedom to focus on the intentions that I think are most important. We actually have a lot of members who are doing really well. For instance, they have HBA1C levels of 12% or 14% but they have no education about it because their providers have never taught them about it. So we could do a tremendous amount of work for them and we’ve seen that the outcomes are very good. It speaks to the fact that these people are highly motivated. We have shifted our resources to those people to really help them and so forth. 

Is it all remote at the moment? 

We actually made a decision back in January during the initial phase of COVID to actually go completely virtual so, yeah, it’s all remote at this stage. Before that, we did have a physical clinic, but we were trying to figure out what our members were using and it was mostly telemedicine. I think our strengths are certainly that we’re so dead of data-driven care and support. So in that regard, you know, it was natural to opt for telemedicine. One thing that I was personally hesitant about was that I’ve always worked for face to face visits so losing the chance to see someone and examining their feet, their confusion sides, and all these other things that you can pick up in person, you lose that. But then we can reach people all over California and Washington, there are awesome conscious decisions we made and we decided that primary care can hopefully take the load off there. For instance, if someone has any sort of kidney issues and needs specialist consultation then we refer them.

So we will start to wrap up this whole discussion. We would like to hear your insight regarding CGM, I mean the endocrinologists’ perspective for CGM?

Yeah. I’m personally a huge proponent of CGMs. Obviously, I think when you’re looking at a couple of finger sticks’ readings and it will just give you a  scatter plot of data, right? Like you have a couple of finger stick readings per day. So, after three months, there is no pattern, whereas, with CGM, you can actually start to unlock the insights on a more personal basis. You can actually dive into the day to day activities and understand the patterns. 

I think the quantity of data is definitely a big advantage. The fact that you see trends and can reach real-time feedback. The users themselves can see what’s going to be incredibly valuable. Endocrinology, very strongly, is in favor of this in general, so we’re making a push for that. 

What percentage of type ones on CGM’s might be in the US?

Yeah, I remember seeing a chart, and I know it was dated a couple of years back in summer. There’s a jump up in recent years and it’s something around 38% or so. Don’t quote me on that, but it is rising. Maybe not as high as some other countries.  

There are four major brands of CGMs that are common like freestyle libre, Dexcom, Medtronic, Eversence so would you give us some insight about which brands have you seen as most effective and preferred by your patients?

I’ve seen Freestyle-Libre as the most effective CGM and  I love that it’s the most cost-effective. I mean, it is actually amazing,  especially for those who are new to CGM so it doesn’t cost a lot. It is also convenient as it does not have a big applicator so it’s very easy to use. Its accuracy is one of the biggest advantages. 

Dexcom is also an efficient tool as it’s continuously feeding the data, right, so the fact that they can see it automatically every five minutes, but for Libre, you have to scan it so sometimes people forget to scan overnight, and that makes them miss their data that could be critical at times. Therefore Dexcom has that advantage and obviously, it’s accurate too. 

Medtronic has its own pros and cons like unfortunately it still requires finger sticks which is a its drawback. However, just like Dexcom it is also accurate and gathers data every five minutes and also has options for trend analysis. 

Eversense is also an amazing CGM, because it is implantable.  Right now in the US it’s only for three months. I know in Europe they have it for six months, maybe trying out for a year at some point but getting people to insert it is actually a harder problem at the moment. 

I don’t know that much about the Eversense, do you have patients at Steady Health who are on Eversense CGM?

Very few of the patients are on Eversense CGM . Ironically, the endocrinologists are hesitant because it requires a mini surgery to put it in and then to remove it. 

The last question that I want to ask is basically that I heard from patients in the community how we can adjust our perspective better to have a little bit more understanding of the job that an endocrinologist does? What we (the patients) can do to help you better do your job? 

Sure, It would be simply understanding and empathizing with us for what we’re doing. A lot of times we want to spend more time but unfortunately, schedules are very constraining so it’s not our fault. Most of the time I’ve been blamed so just not blaming pointing fingers on us rather saying that this is what happened and I’m curious what you’ve done to help me with this, so I think that would be really, I would also say that you need to be honest with your provider, right, just being honest with what you feel and acknowledging those feelings can be helpful in good decision making. I think that these are incredibly fruitful for all, so I would encourage you all to do that. 

I think these are the great pieces of advice that you just shared for all those diabetics out there and I can’t thank you enough for your time. I really feel like we touched over a number of interesting subjects and I’m sure the listeners really appreciated it as well. 

Definitely, I think I’ve enjoyed the opportunity to talk to you today and I am happy to share my perspectives with you and our listeners. So I hope this was mutually beneficial overall. 

Thank you so much for your time. And have a nice day. Thanks Again.

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