Below is the transcript from the Blindness and Diabetes: Continuous Glucose Monitoring Devices Webinar with Abbie Chesterson from the University of Pennsylvania Diabetes Education Center. This is an automatic transcription from the ZOOM platform and there may be some inaccuracies. To listen to the entire recording, go to: https://www.accessiblepharmacy.com/blindness-diabetes-webinar-dexcom-vs-freestyle-libre/
Hi everyone, and welcome to our blindness and diabetes webinar where we will be discussing the Dexcom and FreeStyle Libre continuous glucose monitoring devices.
We are so excited to be doing this in collaboration with Penn Medicine.
And so we first want to thank. Well thank everybody here for tuning in, and we also want to extend a huge, huge thank you to Penn Medicine and Abbie for putting this on with us.
We had close to a 1,000 Registrants which is absolutely incredible, and we're so so thankful, and it's just been incredible planning at all, especially with Abbie.
So thank you for those of you who are just now joining us for the first time.
We're just now hearing about us, we are accessible pharmacy services for the blind.
Excuse me, we are a home delivery pharmacy, and we specialize in the needs of the blind, low vision and DeafBlind
We are the only provider of its kind, and we are the largest blind own healthcare company in the country.
My name is Alexandra, and I am the senior director of Business development and communications with Accessible Pharmacy.
And once again, just thank you for being here. I have a couple of more.
Thank yous to give out. We owe a huge thank you to.
Marsha drench with the NFB. the National Federation of the Blind for her insight with this webinar topic, and we are also very grateful for our own pharmacy.
Team, especially Dr. Eric Wagman, and Dr. Jason Barrett, for their knowledge and their expertise in the diabetes space.
We wouldn't have been able to do this webinar without them.
And lastly, I want to thank everyone who submitted questions to be answered by Abbie during the webinar, so she'll be answering a lot of these questions, and we will also be reaching out to everybody after the webinar
that submitted these questions to further those conversations after we're done today. she won't be taking any live questions during the webinar.
So if you have any further questions that you would like, answered or discussed, please feel free to call us directly.
Our phone number is 1 8, 8, 8, 6 3 3 7 0 0 7.
That's 1, 8, 8, 8, 6 3 3 7 0 0 7. and we will also have Abbie's contact information available after the webinar.
And on our website page throughout this webinar holly is here to supply us with asl interpretation, since.
Thank you, Holly, and this webinar will also have live closed. captioning after the webinar is over.
In the next few days we will be sending out a follow-up email that follow up email will have links to the video and audio recordings of the webinar resources from the webinar and Abbie as well as a chance for you
to respond with feedback, which we really really encourage and appreciate, so that we know what we need to do for our next webinar.
And before we get started I just want to quickly run through some announcements.
We've got some really exciting things going on that I just want to tell you about really quickly, to start we are approaching conference season.
We're super excited to be virtually and physically attending several conferences this fall. So we'll be delighted to speak with many of you. Further, whether that be you know in a virtual format, or at an in-person conference in the next coming months.
And secondly, if you haven't heard we recently launched the news of our upcoming Blind Health Expo and we're absolutely thrilled with the feedback.
We've been getting our Blind Health Expo will be a completely virtual event.
On Friday, December second, from 10 Am. to 4 pm.
Eastern time it will be the largest virtual expo.
Healthcare information, healthcare products, services and medication for individuals who are blind, deaf, blind, or who have low vision.
It's absolutely free to attend it's free to exhibit. We are already approaching 75 exhibitors, and we already have thousands of attendees signed up our attendees range from consumers to patients to providers to nonprofits, government agencies. You name it.
And as I said before, we just can't believe the feedback we've gotten so far, so we're so so excited.
And whether you want to attend and just check out all those exhibitors for the day or if you would like to exhibit yourself we would add absolutely love to have you.
So please just come and check out our website page. So if you would like more information, you can visit the Blind Health Expo Tab on our website: https://www.accessiblepharmacy.com/blind-health-expo/
Also please feel free to share the blind health. expo information with as many people as possible.
As I said, it's free to attend free to exhibit It's a completely virtual event.
Okay, Now I will stop talking, and it is my absolute pleasure to introduce our speaker for today, and, as I mentioned before, we are doing this webinar in collaboration with pen medicine, and we are so thankful to have Abbie Chesterson, with us to speak today.
She is the director of the Diabetes Education Center at Penn Medicine which is in the University of Pennsylvania Health System.
Abbie is absolutely amazing. she is a diabetes education, champion. we're just so thankful that we get to work alongside of her.
So please take it away, Abbie.
Thanks so much Alex I’m gonna go ahead and share my screen here.
Let me see. so it's telling me that participant screen sharing is just to people.
I figured. Let me let let me change that now you should be good, alright, perfect, right, everybody.
So I’m just gonna get our stuff ourselves set up here?
Alright, Alex, can you see the sides purpose alright? so like Alex said, My name is Abbie Chesterson.
I am a registered dietitian by training and a certified diabetes.
Care and education specialist. I’ve been working with the diabetes population specifically for about 7 years.
Now. So I was really excited to approach this topic I learned quite a bit through the process, so that was really exciting for me as well.
So I’m really hopeful that you know if you guys have questions afterwards.
Please feel free to send them over to Accessible Pharmacy.
I am more than happy to delve in. Learn a little bit more.
See what I can find out, and get back to you if I don't know the questions.
Answer off the top of my head. So like alex's thing today's topic is gonna be continuous glucose monitor use, or the abbreviation that we'll use is CGM.
And we're going to be talking about the accessibility features of these monitors for the blind and low vision community.
So continuous glucose monitor or CGM technology.
Helps to monitor someone's blood sugar levels without having to poke a finger and get a blood sample.
So a CGM is a device that automatically tracks blood sugar levels for someone without again having to poke their finger for a blood sail.
This makes this piece of technology a huge help for the blind and low vision community, who, we all know, has a lot of difficulty with setting up a needle and a Lansing device getting that blood drop and getting that blood drop onto a test strip in just the right place. the gm technology really works with a tiny fiber that's inserted under the skin.
Each CGM that's out there does utilize an insertion device.
So someone is not gonna see a needle that's inserting this fiber.
It all happens really with the click of a button and so it's very easy to utilize these technologies.
The fiber itself that stays under the skin is going to measure the sugar level in the fluid.
In between our cells. So this is called interstitial fluid from a medical perspective.
These CGMs are gonna measure blood sugar levels about every few minutes we'll talk more specifically about each one independently The fluid or I’m sorry the sugar level on a CGM may vary slightly from the sugar level that we would get if we were to poke a finger to check a blood sugar level.
This is a simply just a reflection of the different type of fluid that we're measuring, and we do expect some difference.
If we're seeing large differences, if someone is doing a verification finger poke we would want to troubleshoot that with you to make sure that we are successfully getting accurate readings from your glucose sensor. CGMs. use a transmitter to send to, I should say wirelessly.
Send blood sugar information to a receiver device, so whether the transmitter is attached to a sensor site, or whether it's kind of an all in one sensor site, including the transmitter that's how the information is sent from your body to your receiver device. CGMs can send information to smartphones tablets.
Or we will touch on the devices that come with them from the manufacturer.
But we'll touch a bit on why the device from the manufacturer isn't gonna be the best for this population.
Great news is these technologies can be worn during bathing, showering, swimming.
The Libre itself doesn't recommend being submerged for longer than 30 min, or in water deeper than 3 feet, and the Dexcom doesn't actually has a much longer waterproof qualification I guess the Dexcom says, when properly placed, it can actually be under 8 feet of water, for up to 24 h.
Now I don't know of any person who will be under 8 feet of water for 24 h, but the device would still work in in that situation.
Alright CGMs are going to be able to provide 24 h a day of blood sugar information.
So they are going to tell us what our blood sugar currently is and it's going to be able to tell us trends in terms of where we're going and where our blood sugar has been CGMs.
Have special features, including alarms that will tell us when the blood sugar is too high or too low.
It also can tell us, or can provide us the opportunity to track things as well.
So not necessarily a feature that's going to be used too much with visually impaired clients.
But if someone wanted to they would be able to track and log their meals, their exercise, their medications.
CGMs. also allow for sharing of information or following So loved ones or diabetes, care teams, whether it be your diabetes.
Educator or your doctor can actually follow your information along. This has been a huge help with telemedicine being so big.
Since the pandemic and we are able to just log into our computer and see someone's blood sugars who may be, you know, 20 miles or more away. in theory.
If I had a client in California, I would be able to still see their blood sugar numbers, even though I’m here in Pennsylvania.
Now some CGMs do require calibration in which a blood sugar from the finger would be taken to verify against the sensor reading.
And so I’ll touch on that when we get to it and I’ll kind of explain why those sensors aren't going to be as accessible for visually imperative individuals so the first sensor that we'll spend
some time talking about today is going to be the Dexcom G 6. for those of you who are visually impaired.
The image that I have here on the screen is just the different pieces that come as part of this system.
So we have a picture of a phone that displays the blood sugar information, or we also have a picture of the receiver from the manufacturer that would display blood sugar information.
We also see the sensor applicator and the transmitter and sensor site that actually provides the blood sugar information.
The next time G 6 we're gonna start off just by talking a little bit about how it works.
So this sensor is one for 10 days so we'll put it on, and it will provide blood sugar information for attendee period.
This sensor system has a transmitter that is separate from the sensor site, that when we begin a sensor session we put onto that sensor site itself.
That transmitter. we're gonna use for a 90 day period or a 3 month period.
So this part can be a little bit tricky for people who are new to the Dexcom, because when we're changing the sensor site, we're not always changing that transmitter.
So it's something during a training that we really drive home to the individual to make sure that they understand.
Which piece of am I getting rid of? and which piece am I keeping next time?
G. 6 is approved by the FDA for use on the abdomen.
In practice technically off the label. I can tell you that individuals wear this sensor and other locations on their body as well.
So individuals may wear this on the back of their arm. They may wear it on like their backside, or kind of that, like love handle, hip area, or even on the outer part of the thigh.
Dexcom results can go to like we said, either their receiver or a smartphone or tablet.
The receiver that comes from Dexcom is not accessible to the low vision or blind
So in in this case we are talking about using an external to the company device.
The Dexcom come will provide a new blood sugar, reading as frequently as every 5 min, and again it will trend those numbers for you.
Dexcom can have alarms for a low blood, sugar, high blood, sugar.
If you get a loss of signal between the sensor and your reading device.
It can actually predict low blood sugars for you, or high blood sugars, and will alert at you up to 20 min before that blood sugar happens.
Which is great, because that can help you to treat a situation differently, because you have more information.
They're also customizable alert levels as There are ways there are with all of the sensors that are on the market.
Best thing about the next time. G. 6 is that there are no finger stick, blood, sugar readings required, so you do not have to poke your finger with this sensor.
It is approved to tell you it's bunch your blood sugar all on its own.
When it comes to the initial setup of Dexcom.
And this is going to be the same for Libre, or any of the other sensors that might be on the market, creating an account logging into the app setting up your alarm settings may be more difficult for the visually impaired. it's not going to be impossible but for example the Dexcom G 6 App the customizable alerts. and target blood sugar menus are scroll to select menus and depending on what features you're used to using on your phone.
It may be more difficult for a visual impairment.
I did play with it with the voiceover feature, and I was able to select and change those blood sugar levels, so it would just take a little bit of patience.
I would think Dexcom is a little bit different than FreeStyle in that there are 2 apps that someone would use with Dexcom.
So the decks come. G 6 app is going to be the one that's on the device that is going to tell you your blood sugar levels. The Dexcom clarity app is going to be on your device and that
allows you to share your information with your care. team in the clarity app again in the setup phase might be a little bit more challenging.
There's gonna be a navigating certain menus to generate a share code.
So, for example, you would go into the app you would go to your profile.
You're gonna click authorize sharing click generate code click for how long you want to generate that code.
And then there's going to be a 16 letter code that you would give to your provider all possible steps again.
Just might take some patience for someone with a visual impairment.
My biggest recommendation would be if you're gonna start on this sensor.
Same thing with the libre if you're able to get some assistance from maybe your diabetes educator, or a care manager, or a nurse in your prescriber’s office, that might make that setup just a little bit faster for you, and it might make you feel a little bit more comfortable getting started.
One of the things about the Dexcom g 6 that I think poses a bit of a let's say speed bump for someone with a visual impairment would be the fact that we need to end a sensor code
transmitter code into the app when we're getting started Now the good news is this: code can be entered through a picture on the phone.
Basically, it's gonna scan a QR code to get that information pulled into your system.
Fortunately the photo does not have to be hyper quality. so as long as you're able to get that code somewhere in the visual area of your camera, it should be able to capture that and get your sensor and your transmitter logged in again, if you're getting assistance the first time setting this up.
This would be something that someone could help you maybe place your hands in the right kind of positioning, so that you're able to feel what's the distance?
What's the kind of the proximity that I need to have my phone in these compared to these scans?
Now. I was thinking about it with my coworkers just yesterday.
How are we gonna get the transmitter? code scanned in Because it's on a box, and it's hard to tell when you're feeling a box?
What the different sides are gonna have, and so I figured it out for you guys.
So if we're looking at the decks come sensor, I’m sorry the transmitter box there's going to be a tab that opens the box when that tab is open your sensor code is going to be on the side of the box that's connected to that town and the sensor code is going to be in the upper left hand corner for someone to know that placement and know exactly what side of the box to find.
It. It's gonna make it a lot easier for you to scan that code into the system.
Now remember the transmitter code only gonna be entered once in 3 months.
So you're not gonna have to worry about that one as frequently, and that one was a little bit harder to take that picture of the transmitter once in 3 months.
The sensor itself every 10 days. but it's easier to find the sensor code.
It's gonna be on the applicator and that applicator is gonna fit in your hand.
There's going to be a flat side of the application and that flat sign is where that sensor cove lives.
So it's a lot easier to take a picture of the sensor code.
Now the next few slides. I have in here for both the Dexcom and the Libre.
Really, step by step, directions on how to go through how to insert the sensor, add the transmitter.
Get the app started I don't want to spend a ton of time on these slides at this point, cause I don't want to short the information at the end of the powerpoint.
Assuming we have time absolutely I’ll plan to come back and go through step by step, how to do each sensor insertion.
I’ll just kind of talk through the basics here when we're talking about the Dexcom G. 6.
The first step is going to be to get the sensor site onto your body.
So we're gonna use the application it has an insertion button.
It's one click and the sensor site goes onto your body The next step with the Dexcom is going to be to add a transmitter to that sensor site.
The transmitter has one side that's very smooth and flat has one side that's actually kind of 2 levels.
That's gonna be how we can feel around to feel where that's gonna go into the sensor site on your abdomen once the transmitter is into that sensor site.
We're gonna go ahead and we're gonna be able to start the censor session and by doing so we're gonna be able to start seeing our blood sugar readings.
Once everything is on your body. we're gonna go back into our app it's very easy to get into the app really, what from an accessibility feature, you can simply just say you know, hey siri, or whomever your phones manager would be and you're gonna be able to say open decks.
Come, G 6 makes it super simple for you. The transmitter should pair automatically with your phone.
Usually there's a pop-up, notification with an audible, alert, as well, that, says Bluetooth, pairing request, and you can click the except for the pair button actually on the bottom right portion of that notification right in the middle of the screen there's a start sensor Button.
You'll click that and then I’ll initiate the 2 h warm-up period that we have for the Dexcom G 6 when it's in that warm up period you will not receive blood, sugar numbers.
So in that 2 h, if you were to have a need to check your blood sugar.
Unfortunately, we would be talking about a finger poke, blood sugar if you were able to do that.
Once your sensor session is started you need to stay within 20 feet of your body where the transmitter is, and you're receiving device.
If you go too far like, let's say your phone is upstairs in your bedroom, and you have to run to take the trash out, or something.
Once you come back together, they will resume but you wouldn't get any information in terms of alerts or blood sugar information.
While you were too far away after the 10 days is up, and our sensor session has ended.
That app will notify you that your sensor has ended. And actually Dexcom gives you quite a few reminders.
It tells you at 24 h that have 24 h left I’m.
Remind you again at 8 h, 2 h, and 30 min and those are pop up alarm kind of pop up notifications on your phone.
So if you're using for example speak screen or voiceover you'd be able to read.
Quote unquote Those alarms you'll pull the entire sensor site off of your body just like you would if you were removing a bandage.
You'll loosen if it hasn't already loosened part of the adhesive on your body.
Get your fingernail under there and just pull it off just like a bandy.
Now remember we've said that the transmitter for Dexcom is used for 3 months, so you're able to kind of put the hand on.
I either side of that sensor site and bends your hands down towards the floor.
This actually breaks the sensor holder, and that allows you to slide the transmitter out of that sensor holder.
So you can use it again for your next sensor so again.
That means you're only entering the transmitter photo once every 3 months.
It's the sensor code phoneo that you'll be doing every 10 days
Next we're going to spend some time talking about the FreeStyle libre, too.
So, freesyle Libre. you may have seen the 14 day sensor as well.
That was their original one. We are now in the United States on free style.
Liberate 2 free sally by 3 has been approved.
I believe in that Europe so hopefully. it'll be coming here soon. on this slide here.
I do have a picture of the FreeStyle Libre system.
Few less devices here. So in this picture we have a photo of us screen of a phone that has the blood sugar information on it.
We have a picture of the receiver from the company that has the blood, sugar information, and a picture of the sensor itself.
The sensor site I should say it's all print the brief side Libre is approved for a 14 day, where so we've got 2 full weeks here from this one.
And it isn't all in one device so that does make it a little bit easier for sensor insertion being that once it's inserted, we're only inserting one piece presale libre is approved for use on
the back of the arm, and unlike the Dexcom that people wear in other locations of their body.
Yeah, I really only see being used on the arm.
Big difference here between Dexcom and Libre is that Libre requires interaction with your device and the sensor in order to receive blood sugar information So, unlike the dexter which automatically pushes information from your sensor to
your phone libre requires you to interact with your phone and then interact with the sensor in order to see blood sugar information.
Now the receiver that comes from the company again is not an accessible device.
So we are gonna again Want to use a phone, a tablet, something along those sorts.
The libre also will provide your current blood sugar information as well as trends regarding where you're going, and where you've been.
Interestingly the Libre in my my experience here.
The directional arrows or the trends in your blood.
Sugar orange is accessible from a voice over or speak screen perspective as the directional information is from Dexcom.
But we'll get to that in another couple of minutes just like the Dexcom does provide alarms for low or high blood sugar.
Loss of signal between the sensor and the reading devices as well.
Now, interestingly, the leap, hey may recommend that someone complete a finger. stick blood, sugar.
It is not required, meaning if you don't check your blood sugar by a finger.
Stick It's not gonna stop giving you blood sugar information but it may recommend that we do a finger. stick.
It will recommend that more frequently in like the first 12 h that you're wearing the sensor and I found out through practice here that the notification that is recommending a finger stick doesn't come from on accessibility features
so using voice over, Speak, screen. speak to our text to speech it's not gonna tell you that it's recommending a blood sugar reading.
It is simply an image on the screen for our cited individuals.
We would see a small magnifying glass with a small blood drop next to it, and that's them, and indicating hey, might be worth checking your blood.
Sugar with a finger stick might not know you enough yet, but unfortunately, from an accessibility feature that's not going to come through.
So again, you don't have to provide a finger like blood sugar to this sensor, for it to continue to work. It's just something that is there that accessibility wise may not translate as I said with the
Dexcom logging in setting up an account in the liberty to app may be slightly more difficult for someone with a visual impairment.
Again, it does have those customizable alerts and target blood sugars that are the scroll to select menus.
So it is possible it just might take a little bit of patience to get that setup.
If you have the ability to set that account, and that app up with a cited individual, it might make your life a little bit smoother transitioning to the sensor.
The good news is from the libre to perspective once your app is set up.
There's no updating so unlike with the Dexcom where you have to update your sensor code every 10 days.
Once you're up and running with the libre to app it's a little more straightforward to transition from one sensor to another.
Again the next couple of slides that I had written out I’m more than happy to come back to if we have time walking through the different steps in in inserting a libre sensor.
We have 2 pieces here for the libre sensor as well.
We have a sensor pack that is kind of around package.
Honestly. it reminds me of a k cup so for those of you who can feel and mid visualize in your mind.
I can that's kind of what we're looking at when we're looking at the sensor pack round on the bottom a little tab for the lid on top we also have this sensor applicator which is going
to look slightly different than the Dexcom does. It has a cover on the bottom that one would twist off in order to expose the application itself.
We then have to line up the applicator over the sensor pack just right in order to get that sensor loaded into the application.
So Dexcom had the benefit that the sensor site was already loaded in the application with FreeStyle.
We have to load it in now. they make it pretty full proof.
The application in the sensor pack only fit together in a very specific way. So as long as we're able to line up those 2 spots, it's pretty straightforward in terms of loading them together.
If you put the 2 pieces together. and they aren't connecting you can just rotate that sensor application on the top of the sensor. pack until the 2 click together.
Once we have the sensor loaded into the application, we take that application.
It has kind of like a hollow tube almost on the bottom part of it that the sensor pack locates into and loads together, and we take that hollow tube.
Our head is on the top of the applicator, which is hard, solid, plastic.
We put that tube on the back of the arm and we'll push that solid plastic part into the arm, which actually does the insertion of the sensor for us.
We'll hear a click when that that push happens and that click indicates that the sensors going into your arm.
We then remove the application, and that sensor is inserted for us again.
Final steps. we'd be going back to our application to go ahead and start the sensor.
So you can ask your phones assistant to help get you there.
Now in the Libre App, I found that the voice over feature tended to be more straightforward than the speak screen.
So while we're starting, the sensor middle of the screen we're gonna locate the scan sensor button once we've clicked that it'll let us go ahead and scan that sensor Now to scan
the center. I think I mentioned already. but we're gonna take the top of the back of our phone usually where the camera is, and we're gonna take that area of the phone and we're gonna hold it just over the sensor.
Doesn't have to touch the sensor and it actually can read right through your clothing.
Once you're holding it over there your phone will vibrate, and that'll indicate that it has actually done the reading for you next.
Then on the screen, you'll see that you have a sensor countdown, basically.
So it'll say sensor ready at and then whatever time this libre has a 1 h warm up time so slightly less of a warm-up than our dexter does on the screen.
It'll also indicate how many minutes are left remaining before that sensor is going to be fully functional just like the Dexcom sensor.
We will not get information in terms of what our blood sugar is.
During that 1 h. warm up time. this speaks screen reads out the entire kind of hidden menu on this sensor, ready at whatever time screen before it tells you how much time you have until your remain until your sensor is active so for
example on my screen. It says, You know, FreeStyle Libre.
It, says Abigail Chesterson. It says log Book.
It goes through all of a menu that you don't even see on the screen before it.
Then tells you what is on your screen so it's and it's not gonna not work. it's just gonna take you maybe an extra minute to hear what time your sensor will be ready, and how much time remains until then, now Libre recommends staying within 33 feet of the sensor in order to get those alarms and alerts to scan the center.
As I mentioned, we do need to interact with the app on the phone and the sensor in order to get the information.
So every time you want to see your blood sugar, you have to open the app again.
Your phone assistant. can help you'll then find the check glucose button on the screen which tends to live at the bottom of the screen.
You'll check that button that says chat glucose it'll show a ready to scan screen on your phone, and then you'll complete that screen or I’m Sorry you'll complete that scan again with
your phone touching next to the sensor itself if we have voice over on that ready to scan screen will read out for you, so you'll know exactly when to go ahead and complete the scan to check your blood sugar once. this sensor has scanned you'll feel a vibrate on your phone which is gonna indicate that the sensor has been read.
A scan complete window will show, and then will go away again.
If you have the voiceover feature on your phone, it will read out that scan complete, and then you're able to have it read out your blood sugar as well.
The blood sugar reading will display at the top middle portion of your screen so you can hold your phone.
I’m sorry. Hold your finger over that area in order to read out your number with the free size Libre.
The way their algorithm is programmed from A. you know, computer perspective, the directional arrow of where your blood sugar is going will not read out.
So whether you are using voiceover, whether you are using speak screen.
It will only tell you what your blood Sugar is It will not tell you where you're going.
Both the dexter and the free style. also cannot read out your trend graph from where you have been so Dexcom will tell you where you're going. FreeStyle.
Unfortunately, the readout at this point does not. If your phone is unable to scan your leave right sensor for any reason, it will vibrate, and then display an error message that can be read out again with voiceover not with speak screen, the error will say, Scan error.
Your skin was unsuccessful. Tap the scan button and scan again.
You can click, Okay, to clear the error and then find the check glucose button at the bottom of the screen and try again.
I honestly don't know why sometimes it doesn't scan correctly.
It happens to me and I don't exactly understand what the rhyme or reason is, I just don't know if it's a phone timeout, or what it may be so just because you get a scan error doesn't mean
there is something wrong with your sensor. Just clear the error by clicking.
Okay. find the check glucose button again at the bottom of the screen and scan again at the end of the 14 day period.
Again. the app will notify you that the sensor session has ended.
You'll pull the entire site off of your body just like you would, if you were removing a band-aid, and you'll dispose of the sensor in accordance to your local guidance for disposing of materials
exposed to body fluids. you don't have to keep any part of the libre to sensor The whole thing just goes right in the trash, and if you were gonna place, another sensor you would follow the same insertion steps you would put it in. You would click to scan new sensor, and it's gonna start a new sensor session for you.
Very briefly, I’m gonna touch on the Medtronic Guardian, connect sensor.
It's not one that most people are familiar with It is one that more commonly goes with an insulin pump. less commonly is a stand alone.
Glucose sensor. Again, the image that's on this screen is a picture of the phone that is displaying the blood sugar number.
A picture of the sensor site itself. the sensor is a small half moon, shaped white transmitter, a sensor insertion site applicator and charger. Excuse me, I then a charger for the transmitter itself. so I would say, if I had to say system like pieces wise, I would say the Medtronic has more similar number of pieces, as the dexter the free cell is slightly more simplified. Now the Medtronic guardian connect is only worn for 7 days.
So we're talking about a once a week transition here. It is fully approved for use on the stomach.
The backside or the back of the arm, so it is fully approved for more wearable areas.
It connects to a smartphone app the Guardian. connect smartphone app to receive your readings.
It tells you a new blood sugar level every 5 min, so similar to the Dexcom
And it again also provides both high blood, sugar alerts, low blood, sugar alerts, loss of signal gonna tell you your current blood sugar, and it also does have directional information available.
The Medtronic army and connect can provide predictive alarms up to 60 min before a high or a low blood sugar, so it can give you a little bit more for warning that something is changing.
But the difficult insertion and the difficult starting of a sensor, in my opinion, really significantly limits its use in a visual, impaired patient, and biggest thing is that the dexter I’m sorry the Medtronic requires at least twice daily finger, stick, calibration, blood sugars.
So twice a day at least, it will alert at the user to poke your finger and check your blood sugar.
Enter that blood sugar into the system, so that it can verify the sensor.
So in my opinion, that makes it completely not applicable to someone who has a visual impairment, because we have to use a regular traditional glucometer.
If we're using this sensor that's all we're gonna say about that one.
There are few things I just want to review here that are going to talk about making CGM's accessible, and then we're going to touch briefly on eligibility and coverage.
So Alexa works with Dexcom G 6 through a sugar mate.
Skill so enabling the sugar made scale on your Alexa device.
And I apologize if through this we are getting your Alexis all riled up
But we're gonna enable that sugar meat scale on your Amazon device.
And you'll be able to hear glucose readings from your CGM.
You Don't need to be a sugar mate user through the app on your smartphone in order in order to enable the scale on your Amazon device.
You would basically say, Alexa, ask sugar meat for my latest reading, and she'll read out an example would be.
It's a 153 and rising last checked about 5 min ago.
It's 5 higher than your previous reading. So the Sugar-made skill really gives you a lot of information, and it again will also tell you where you're going, which is great.
Siri in Dexcom are also very user friendly together.
Some features of the scary with Dexcoms are a little more straightforward for older iPhones, although I was able to make it accessible on my I think I have an iphone 13 so within the Dexcom
app, you are able to set up series shortcuts and customize a phrase.
So in the Dexcom app you are able to say Hey, siri!
What's my blood sugar and then anytime you wanna know you can ask siri.
So, for example, let's see if mine will work hey?
Siri, what's my blood sugar Okay, viewing you're 107, and steady, So my theory tells me my blood sugar is 107 and steady.
And that's exactly how this theory would work you don't have to open your phone.
You don't have to open the app Now with Dexcom if you're relying on alerts that will tell you if you're going high or low siri won't read those out on her own you wouldn't have
to be alerted, and then ask what your sugar level is.
You can sure I understand she's still trying to talk to me Sorry about that.
You can also ask her to open the decks.
Com. g. 6 app, and then from there you can use, speak, screen, or voice over to read out the blood, sugar, and the direction.
Now I found very user friendly. the voiceover feature or the talk back feature on the smartphone to work very well with both of these devices.
It'll allow you to hear your current blood sugar reading within any of the CGM.
Apps. The voiceover will read the blood sugar result when it is selected on the screen.
As I mentioned in Libre. it doesn't read out the direction, but in Dexter it does, and would indicate whether you were steady rising, or following speak screen works really well, as well. I felt like it. was a little more user friendly
within the Dexcom app compared to the FreeStyle Libre app.
But it allows you to hear the information that's displayed on the app screen, including for the warm up time that you're in the warm up phase.
And how long? until your sensor is active again. Speak, screen
For the leave right is not gonna indicate which direction your blood sugar is going.
Speak selection. I really didn't find super user friendly with the CGMs.
In theory, this speak selection would allow your user to hear the information so selected on the screen within an app.
Really what sugar information within these apps isn't really set up to be.
Quote unquote like selected, which meant that it was more difficult to select it, to have the phone read it out so that could be more difficult from a visual impairment perspective.
So in my experience here. the voice over our talk back feature or the speak screen feature.
We're much more accessible for these CGMs now, the text to speech function on some phones ran into an issue with the FreeStyle we brave.
Recently. we actually got a message from Lee Bray. tell us that apple devices that have been upgraded to Ios 16 may run into problems with the text to speech feature.
So they were really recommending don't update if that's the feature that you rely on for reading out your lead right.
They found during pre-release testing of the new operating system, that the text to speech feature was acting incorrectly.
If you've already upgraded and you can't call back like we said fixes for the interim would be the voice over or this speak screen. Last couple of slides here like I said are good beyond the cost and eligibility for CGM: So commercial insurance coverage varies.
But typically commercial insurance is, I would say more likely to cover a CGM with flexibility.
And that'll make sense here in just a second So Medicare is pretty strict with coverage for CGM.
So to qualify. under a Medicare plan, you have to have either type, one or type 2 diabetes.
You must use an insulin pump, or take 3 or more insulin injections per day, and your provider has to document that your insulin treatment works frequent adjustment based on your blood sugar readings They also have some guidelines in terms of how frequent Usually you are seeing your provider and I’m not sure if these 2 requirements adjusted at all for the pandemic.
But I’m gonna read them as stated currently on the website So within 6 months prior to ordering the CGM.
And individual had to have an in-person visit with your treating practitioner to Evaluate.
Your diabetes control and determine that you meet the criteria.
From then, every 6 months after the initial prescription of the CGM.
The individual has an in-person visit with the training practitioner to assess adherence to the CGM and your diabetes plan.
They're saying it, at least prior to the Pandemic that you needed to have an In-person visit with your provider at least every 6 months, in order to continue to CGM.
Use now for those of you out there with diabetes typically, you're probably seeing your provider in person, and or virtually at least every 3 to 6 months.
So these 2 requirements aren't the hard ones to qualify under. I would love if Medicare would cover for more conditions than individuals who are taking 3 or more insulin injections per day from a diabetes educator perspective We know that there are plenty of other medications that are regularly prescribed for diabetes.
That would be equal as beneficial using a CGM.
Also, CGM is going to provide us more usable information than just a finger stick of blood.
Sugar does so I cannot wait until CGMs are the norm and finger stick.
Blood sugars are less common. So I’m gonna do everything I can to try to make that happen because CGMs I believe in so much with Medicaid plans.
Unfortunately, some States will only cover CGM for Medicaid patients who have type.
One diabetes. So even if a Medicaid patient has type 2 and takes 3 or more insulin injections per day, some States will see, not cover that CGM.
Under a Medicaid plan. I have a hyperlink there, for providers really took a look at a great resource for a guide to state Medicaid coverage for CGM and we'll make sure that gets provided
out to you guys as well. CGM may be covered as a pharmacy benefit.
So you might be able to pick it up at your local pharmacy, or depending on your insurance.
It also may be covered as a durable medical equipment supply.
So if it's denied at the pharmacy you're likely going to be able to get it since to your house basically through a mail order, Third party company pricing really varies so Dexter is more expensive out of pocket. if you will compare to the Lebron through commercial insurance.
Though Dexcom coverage really is going to vary from a minimal cost to a high cost, depending on your co pay or your deductible Medicare patients are going to have the same Co. pay for tax-com as they
would for other CGMs and for a minute here patient if they have a secondary issue. That secondary insurance is typically gonna cover that co-pay. so they may not have any out of pocket cost in practice.
Medicaid would cover fully. But again, whether or not you're state is going to cover that may vary in my opinion, Dexcom self pay, meaning, if your insurance doesn't cover really Dexcom is cost prohibitive it may cost $550 to $860 per transmitter, and again, that's every 3 months, and then it could cause an additional $330 for a one month supply of sensors.
So that's 3 10 day sensors I don't know of anybody really who would want to just go ahead and shell out, you know.
Well over about $1,200 or so at the high end on your sensors.
Pretty regularly, so commercial insurance, I’m sorry insurance in general is really going to be the best way to go about getting a Dexter now.
The FreeStyle Libre 2 through insurance. Again, most privately insured patients or patients with Medicare or Medicaid will pay anything between $0 and $60 per month for the sensors.
Self pay if you really wanted to Do It you could get 2 sensors.
That's a one month supply for only a $130.
So I absolutely have worked with patients in the past who would spend the $130, maybe, wear a sensor for 2 weeks Now, work on a couple of things.
Wait a couple of weeks or a couple of months where that second sensor, simply because the amount of information they're gonna get from the sensor was still beneficial, and it helped spread that cost out.
Both companies do also have patient assistance programs so this is where we're gonna wrap up today.
Dexcom and Libre are gonna require application and supporting documentation.
Biggest things to note for Dexcom. You must live in the United States in order to qualify for their patient assistance program, though you do have to have type one d diabetes.
You can have no insurance or you can't be enrolled in Medicare or Medicaid.
So limitation there being, do you have insurance? If you do, you may not qualify.
There is an age limit. You have to be 2 years or an age minimum.
I should say you have to be 2 years or older, and your household income has to be below 400% of the Federal poverty line.
Libre has a free sensor trial program, so it's not really a patient assistance program long term.
But you could start out on your free trial type. One or type.
2 diabetes must be 18 years or older but again, You're not eligible.
If you have Medicare Medicaid, or another State or Federal healthcare program.
Interestingly. if you live in Massachusetts Puerto Rico, or other Us territories again, you're also not eligible for this free trial program.
So there are options out there where you could get some.
Maybe experience with the sensor. if you're insurance didn't cover potentially.
But unfortunately there are some hoops you have to jump through, or requirements you have to mean.
So the preparation material that I have for you guys.
As I mentioned. Please please reach out to accessible pharmacy with any questions that you've come up through today's presentation.
As I talked with Alex previously, I’m more than willing to share the resources that I put into today's presentation.
I really through this like, I said learned a lot and I’m. really motivated to do what we can to get CGM.
Approved for individuals with a visual impairment.
That alone, I think, should qualify somebody to use the CGM. So I know my team and I are really kind of passionate about this.
Now. because we believe in it so much. so again. I wanna thank everyone so much for coming out today.
I’m gonna go ahead and stop sharing my screen but I really appreciate. turn out, and I’m helpful to this has helped you guys
Out a year awesome. I I cannot say and like enough things about you You're absolutely amazing, and we're just so thankful.
That you would do this with everybody, and just be here with us today.
You were just absolutely fantastic. thank you, everybody for coming today and listening, tuning in registering. I’m sharing the news about this webinar, and thank you.
Thank you. Thank you again, Abbie, for doing this with us.
As I said earlier, Abbie is a star and diabetes education, and we're just so thankful that she's just part of our team your experience in the space coupled with like your ability to Talk to patients talk to us talk to providers. and just discuss solutions and plans. it's so important.
And yeah, we absolutely love it. and you're a rock star thank you for being here and discussing all this with us, and like once again, Thank you, everyone for attending, and I hope this was a helpful experience and helpful webinar and
Thank you, Holly. I think we just want to extend a lot of gratitude for you for helping, you know, with the accessibility of this webinar.
As I mentioned earlier, and as Abbie said, we will be sending up a follow-up email in the next few days that follow up.
Email we'll have a few things first this webinar has been recorded. there will be a video and an audio link in that follow-up email as well as on our website.
So that you can go back and have access to this webinar in the future. other than that, like, I said that it will be available on our website and on our Youtube page: https://www.youtube.com/channel/UCJXHDYCnwi9Q9v-hNplWHFw
Also in that follow-up email in our and on our website will be a copy of Abbie's presentation with links and resources to everything that she discussed.
Also, when you get that email, please go ahead and respond to it and let us know your feedback on the accessibility of this webinar, and how we can continue to make programs like this more accessible in the future.
And I would just like to say, before we leave, that if you are not a patient of ours here at Accessible Pharmacy, we would absolutely love for you to join us.
We learn about how to support more patients by listening to our current ones, so we would absolutely love to have your feedback as a patient, so that we can learn from you about how to be more accessible of what other services.
We should be providing you can also speak with us to the determine if you're eligible for a Dexcom or a FreeStyle Libre device, or please reach out if you have any diabetes related
questions. The easiest way to work with us is simply to just give us a phone call.
Our phone number is 1 8, 8, 8, 6 3 3 7 0 0 7.
That's 1 8, 8, 8, 6 3 3 7 0 0, 7 other than that, we would just like to say thank you for attending our blindness and diabetes.
Webinar. we were so happy to put it together with pen medicine.
Have you all attend? please check out our information on our website for our upcoming Blind Health Expo and other than that.
Penn Medicine's Diabetes Education Center: https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/endocrinology-diabetes-and-metabolism/pennsylvania-hospital-diabetes-education-center