On this episode of danatech Talks, a special series from The Huddle: Conversations with the Diabetes Care Team, Dana Moreau is joined by Caitlin Nass, NP, to discuss the fundamentals of integrating diabetes technology—especially continuous glucose monitoring (CGM)—into primary care workflows. Caitlin shares practical insights on building team-based processes, educating patients, leveraging data for better decision-making, and partnering with diabetes care and education specialists to support successful technology adoption and improved patient outcomes. This episode was supported by an educational grant from Abbott.
Explore the latest in diabetes technology as well as trainings and resources on danatech: danatech l Diabetes Technology Education for Healthcare Professionals Listen to the first episode of our danatech Talks diabetes technology series.
Dana Moreau
Welcome to Dana Tech Talks, a special series from ADCS's The Huddle, conversations with the diabetes care team powered by ADCES. I'm Dana Moreau of Dana Tech, and in this series, we dive into the very latest in diabetes technology, bring you expert insights, clinical strategies, and the innovations that are shaping patient care today. Whether you're brand new to diabetes technology or looking for the next level of expertise, Dana Tech Talks is your source for real world knowledge.
Today's podcast is funded thanks to an educational grant from Abbott. We're joined by Caitlin Nass, adult NP, who's going to be talking to us about the fundamentals of integrating diabetes technology into the primary care workflow. Caitlin, welcome to the huddle. Happy to have you. And happy that you're joining us to talk about our topic today, which is something that's quickly becoming non-optional in primary care, diabetes technology.
Caitlin Nass
Thank you so much for inviting me.
Dana Moreau
So we're talking today about CGMs, connected pens, insulin delivery systems. These really are no longer specialty only tools. So before we dive in, Caitlin, tell us a little bit about who you are, what you do, and how you view diabetes technology.
Caitlin Nass
So I am an adult nurse practitioner. been working in diabetes care within endocrinology since about 2012. And diabetes technology is always a challenge in any setting because it's changing and because we have to make sure our systems are up to date and working to support patients. But it was in 2021 when I started working on a grant from within the endocrine practice to support diabetes care and education specialists in primary care. And that's really when I got a full appreciation for how hard the job is that they're doing and how limited their access at that time was to diabetes tech. So it gave me a real appreciation for the work that we need to do. And I've since transitioned into working in population health and primary care. So I'm working on diabetes tech from the other side of the street at this point.
Dana Moreau
So before we kind of zoom in, we're gonna get a little more tactical. Primary care is already, from my understanding, pretty overwhelmed by everything else that's on their plate these days. So why is diabetes technology kind of become something we're talking a lot more about and something that really can't be ignored or referred out these days?
Caitlin Nass
Well, I think we all appreciate how challenging it is to support patients with diabetes, what a time intensive specialty it is with education. And then we're really data dependent. So one of the things that really struck me back in 2021 was not how few patients were on CGM, but how few patients were even using glucometers. So primary care providers in short visits were trying to make sense of their patients' needs with very limited data you can't practice that way and nobody wants to practice that way. So with PCPs giving the majority of diabetes care, they need the tools to allow them to do their job more effectively. And I tell people, once you start using CGMs, you're going to fall in love with diabetes care again, because it is wonderful when you have the right data and the right support for your patients.
Dana Moreau
And as you are, I mean, starting to talk about this, recommend it, feel more confident in just discussing it with patients and monitoring their care, are you at this point already starting to see any better outcomes or any kind of different inpatient engagement than you may have seen when you first started in this area?
Caitlin Nass
I would say absolutely. So I've just been with this new practice about two and a half years and the number of patients who are using CGMs, that's the primary tool that we're using in our primary care practice. It has really increased and I'm working in that setting. There's another diabetes nurse practitioner in that setting, but many, many of the PCPs are prescribing as well and reaching out for help or just innovating on their own with getting patients launched and using CGMs.
Dana Moreau
So if we all agree and it seems like we do that this is becoming essential for those who haven't really dove into this now, how does a primary busy care practice realistically start?
Caitlin Nass
Well, there are great tools out there and Dana, you probably wrote some of them. Dana Tech being one of them. But I mean, I think it's really important to do an inventory of who on the care team is going to be a champion, who has a baseline knowledge and a real motivation to get involved. And then figuring out who are your resources going to be. And I definitely have to lean heavily on our vendors, the representatives who can train us and support us with downloading software in place and also getting in with IT and with billing and compliance early so that you can work through any headaches there if you're starting a process and starting to bill for things that have never been done in that particular setting. So learning if you're affiliated with an endocrine practice, learning from them, adopting their strategies, and making sure everybody in the primary care space is comfortable with the practice as it evolves.
Dana Moreau
And you mentioned the idea of identifying a champion. Is this something that you found to be physician led? Is this someone else on the team or is it really truly team based?
Caitlin Nass
It's really truly team-based. For certain types of politics or headaches, sometimes it really does help to have a physician credential to be a champion, but they're definitely never gonna do it on their own. So it's really just the members of the team who are really gonna be passionate about it and stay current with it and be willing to collaborate and train and retrain as new team members join the practice.
Dana Moreau
Okay, and when you're thinking about the workflow involved with, again, talking about prescribing, recommending, are there any workflow best practices or even mistakes that you might see from time and time again?
Caitlin Nass
So this may only be relevant for some teams, but when I was at an academic practice that had multiple settings, for whatever reason over time, it had evolved that each office had its own account with the different device download systems. It was hugely inefficient and confusing, and the patients didn't think we were credible because they can download me downtown. And so that was a real work around to marry those databases. It was not elegant. It was time consuming. So that's the kind of thing I would encourage people to think about, you know, right out of the gate. And it's a mistake that we didn't make in my current practice just because I had suffered through it the last time.
Dana Moreau
Well, that sounds like fun, but it's a game. We're always looking to, you know, anyone who's been through this, tell us what you can potentially avoid in the future by learning from our own cautionary tales. So again, thinking about the workflow again, and if you have one in place, and let's just say we're already moving to when a device is prescribed. One of the additional hurdles aside from prescription is making sure that there is adequate patient education. Clearly primary care, you don't have 45 minutes to train with somebody. So how should primary care be thinking about setup and education?
Caitlin Nass
So people are going to do it different ways. In my role, in my current practice, I have longer visits, and that's by design. So if a patient and a provider want to just hand off to me so that I can start that process or finish it, that works, and I have the time and expertise to do that. Very tech savvy patients may feel comfortable getting started on their own. I still want everyone to get education, so that's really my strong bias is wanting to get a hook so that they get time with an educator of some type just specifically to focus on the technology and then looking at the results. But I can tell you at my current practice, we don't have a great infrastructure for support for downloading devices. So the providers are doing it themselves. boy. Yep. And they're very motivated, and they really appreciate the data, and it's worth it to them.
Dana Moreau
there's so much to cover and especially again if you're looking at the different types of tools. So CGM might be a little easier, AID if you are moving into that area might be a little more complicated. But if we're thinking about this, let's just do an easier one which is CGM. In that first visit, like what absolutely would you want to make sure is covered with your patient from an educational perspective and what maybe can wait till like a secondary appointment or a tertiary appointment?
Caitlin Nass
It's really important for them to understand how they're going to be viewing the data, how to understand the data, the fact that I'll be able to see their data, but that I'm not supervising them. I'm not getting their high and low alarms. So we have an ability to talk and share the data, but this is not like surveillance, basically. Making sure that they understand the difference between a finger stick reading and a CGM value and when to test finger stick readings.
going over the alarms so that they understand what to expect and that we can adjust them in advance. I always tell people, if you don't love your CGM, then I'm concerned it's because we didn't go over something in this visit to help you succeed with it. If it's waking you up all night, if you're testing your fingers, sticks compulsively because you didn't understand why there's a 10 degree discrepancy between two readings, then I didn't do my job to help you really learn and kind of flourish with this.
Dana Moreau
That's a great perspective. There is sometimes a concern that patients can become overwhelmed by the data and that may make or break their use of that tool. What do you talk to them about? Like, what recommendations do you give?
Caitlin Nass
Fortunately, in my experience, people are not often overwhelmed by CGM data in general. So that is really the minority of patients who really struggle feeling like they have to respond to all this data in real time and have to make sense of it. People absolutely get overwhelmed by alarms, which I kind of alluded to. The thing that's important for folks to understand is, and they'll come up with, what sugar is too high and what sugar is too low? Well, the too low question is an easy one to answer and then going over how to treat a low sugar. But the too high one is a little more complicated. And so talking to folks about patterns and this first week, I don't want you to do anything differently with your medicines. I want you to see how you're responding. I want to see how you respond to food and to physical activity and then we'll adjust your medicines together.
That's the message that I try to send for those early days because I don't want people feeling like I have a sugar of 250, I need to do something right now because they might not have the medicine that's appropriate to use that way and we may never have talked about how to do it safely. So we're gathering information, we're learning, this is the early stage, your dosing may evolve, but for right now, don't get nuts.
Dana Moreau
I think that's good advice, in life in general to be honest, not just here, so many places. And so like a CGM, as we mentioned, is a little bit easier, but then we can get into AIDs and some of the other devices. And in primary care, we don't always have all the expertise that's available. So this might be a good time for us to talk about when is it important to bring in additional outside expertise. So, when do you think like a primary care professional might want to bring in the diabetes care and education specialist or send them elsewhere and how should they think about that partnership?
Caitlin Nass
Again, I'd like to use technology as a way to get people with diabetes educators if they've ever turned it down in the past. With CGM, certainly clinicians can do that as part of their provider role. But when you're talking about starting something like the linked insulin pen or thinking about pumps, those patients have to be working with the diabetes educator. That's non-negotiable for me, just because we need to know that somebody took all the time that that individual patient needed to get to their questions and figure out the gaps that the prescriber didn't recognize in their knowledge or their readiness. And so I'm a big proponent of that, as I said. And in my current setting, we do not have diabetes educators within primary care. So I will send them to our endocrinology practice for education.
Dana Moreau
Have you found any other way to make referrals to like a DCES? I know some people have been challenged by it. Like they think they should, but they're not even necessarily sure where to go to find them.
Caitlin Nass
One thing that I've started to take advantage of is actually an organization that has a national presence that does telemedicine care exclusively. And they do have diabetes educators who are part of their team. And one of the things that's great is they offer diabetes education in multiple languages, which I think is really important and which it would be very, very difficult for me to find locally.
Dana Moreau
Okay, now let's move on and assume our patient is up and running. But let's look at what happens next essentially. So once devices are in use, what do you think is the most efficient way for a primary care professionals to monitor that progress? What is their role amongst the giant team that they might be involved with?
Cailtin Nass
I think it's important for the patient and the provider to have a defined check-in point, and whether that's a message through the electronic medicine portal or early telemedicine follow-up visit for a check-in and potential med-titeration. I think for patients who are stable and their sugars have been doing well and now they just have another form of technology to support them, that need for early follow-up is not important.
CGM is part of a plan or another tool is part of a plan because someone's really struggling then those early frequent touch points are really key for people to start experiencing success and building confidence and So I send you know timed my chart messages. You'll get this in two weeks reply back to me That'll be my cue to give you a call if you're struggling If you're having a lot of lows call the office right away. Don't wait but yeah putting those signposts in place and the idea that our next visit is in three months because that's the standard interval doesn't meet the needs of someone who is struggling with their diabetes care. So we have to see them sooner.
Dana Moreau
Exactly. And what are some of those kind of early signs that a patient might be struggling a little bit and could use a little bit of a deeper dive on the training front?
Caitlin Nass
You know, people complaining about the device, I don't like it. I don't think I want to stay on it. People complaining about device failures, I've wasted three CGMs already. Whatever's happening, that patient needed support. I wish I had heard about it sooner, but we need to get on a call or get into the office so we can turn the tide here that you're feeling discouraged, not feeling supported by the tool that we just intentionally started you on.
Dana Moreau
Okay. And so what exactly, from your perspective, does a high-functioning diabetes technology ecosystem look like in primary care? It doesn't have to be how it exists for you today, but if you had all the resources and all the time at your disposal, what would that look like?
Caitlin Nass
So I would want everybody on the team to know about the technology that's in use. So when a patient calls with a question, whoever is answering the phone has an appreciation for what's going on or how urgent it might be and can kind of reassure the patient. There has to be a system for launching patients successfully on devices, what that education is going to look like, what's our minimum time and detail that we go over with each patient, how is that documented, how are we billing for it? And then what's the process for reviewing the data, having data ready for those clinical encounters. So in my current role, that involves me downloading the reports the day before the visit. In my previous role in a diabetes center, that was all just handed to me as I walked into the room. So it can happen many ways and mercifully the systems keep getting better and keep getting easier to use. But you have to think about all those things and then making sure the patient gets to stay on their equipment.
So we know how to order it, we know how to refill it, we know whether to send it to pharmacy or to a medical equipment company. There's a lot of details with this. I wish it could be simpler. So somebody has to own all that knowledge and then recreate it and have a work plan that gets revised as needed.
Dana Moreau
I know there's a lot of tools coming out to kind of help streamline these things, but it almost feels like every tool that comes out just adds another layer of complexity lately. So that's my own personal opinion. Doesn't need to be yours. But I'm hearing this from a few people.
Caitlin Nass
Yes, no, because I'll have the vendors tell me about the latest feature on their device. Like, actually, I haven't heard about that yet from my patients. And thank you for reminding me that I need to tell them that that feature is there because it's constantly evolving.
Dana Moreau
Last question here, what are you excited about in terms of where diabetes technology and patient care and outcomes are heading?
Caitlin Nass
I have really been impressed by some of the research coming out of these large data sets where they've been able to demonstrate a relationship between someone getting a prescription for a CGM and patients being less likely to be rehospitalized or use the ER. So being able to make the case to every level of the healthcare infrastructure that supporting patients with this technology is transformative at every step of care and that we're getting closer and closer to it being the standard of care. So offer it early and often and I will use it for people even if it's just a one-time kind of sample trial just so they can learn and we can learn about their patterns or something that they know they're going to use and never live without.
Dana Moreau
Any final thoughts for anyone listening?
Caitlin Nass
We're in better shape now. If you're just starting, there are so many fantastic tools and partners that you can work with. You do not have to reinvent the wheel. You just need to assemble the team and find the time to be able to integrate it into your care. And there is no better reward than the satisfaction that you get from seeing patients succeed. I'm focusing on CGMs in my mind because of my current setting, but it never gets old. It never gets old seeing people improve their self-management and their confidence.
Dana Moreau
Love that. Thank you so much for joining us and honestly for all the work you do. I'm sure everyone tells you thank you, but we're going to say thank you again. that will conclude this episode of Dana Tech Talks from the Hull. Thanks again to Abbott for supporting this episode. To explore more resources and guides that have been mentioned in today's discussion, visit danatech.org. And until next time, thanks for tuning in.
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