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WHAT WE DO
consulting
strategic advice and comprehensive information for those interested in the diabetes industry
diabetes close up
our monthly newsletter
industry reports
periodically we take the long view on trends or on specific breakthroughs.
TEAM
Meeting with Dr. Irl B. Hirsch
Irl B. Hirsch, MD, is Professor of Medicine at the University of Washington School of Medicine and Medical Director of the Diabetes Care Center at the University of Washington Medical Center. Dr. Hirsch has authored ~ 100 original papers and over 40 abstracts as well as dozens of letters, editorials, and book chapters. In addition, he has published books on diabetes care geared toward both physicians and patients. He was named ADA Clinician of the Year in 2005, received AACEs Distinguished Endocrinologist award in 2006, and he has been repeatedly recognized for his clinical excellence. He sits on the Board of Directors for the ADA, JDRF, and the American Board of Internal Medicine. The former associate editor and editor-in-chief of Clinical Diabetes, Dr. Hirsch is currently the editor-in-chief of DOC News. He recently discussed with us his latest thoughts on continuous glucose monitoring and glycemic variability, incretins, inhaled insulin, and how diabetes care in America is in a relative state of crisis.
Kelly: Thanks so much for talking to us, Dr. Hirsch. Wed love to start off by getting your take on continuous glucose monitoring. Is it ready for prime time, in light of questions regarding quality and reliability and reimbursement? Is it too much information, too little, about right or is that a ridiculous question in light of patient heterogeneity?
Dr. Hirsch: Were in the early days. First of all, nobody really has ever taught health care professionalsmuch less patientswhat to do with the information. If you have a continuous graph, what do you do with the glycemic profiles, especially if you are a patient? That is, you may see your current blood glucose is 95 and you know that a half hour ago your glucose was 135, and now youre getting ready to eat, and now you would normally give 8 units for what youre eating, but your blood sugar is dropping quickly. How much less insulin do you take? How do you change the lag time? You know, usually you take your rapid-acting insulin, you wait a few minutes before eatingeating nothing may be dangerous in this case. Were going to teach patients how to interpretthats the goal. We have to recognize that some clinicians cant or dont even teach patients how to do the finger stick interpretation. First things firstbaby steps are required.
Kelly: For both the technology and for clinicians time, what sort of outcomes data would increase prospects for reimbursement?
Dr. Hirsch: It needs to be based on studies showing which data works best for large numbers of patients. It may be that we will need different types of software for different patient populations. In the world of SMBG, little attention was paid to data interpretation for lots of reasons, the main one being physicians saw this as being too labor intensive. I believe that one of the positive aspects of CGM is it will show both physicians and patients how powerful this tool can be, and it likely will increase use of downloading old-fashioned SMBG meters. The other good news is that the companies are putting more time into thinking about their software for downloading. Still, we need studies to guide us as to what is best.