The Huddle: Conversations with the Diabetes Care Team

Kristine Batty, APN, BC-ADM, and CDCES talks about her experience both living with Type 1 diabetes and working with people with diabetes as a CDCES, and how understanding both sides of the desk can help to optimize health outcomes. 

Visit danatech here: Diabetes technology for healthcare professionals | Danatech (adces.org)

View Kristine's video series below:

Reducing Diabetes Technology Burnout (youtube.com)

Continuous Glucose Monitoring: Managing Expectations (youtube.com)

Breaking Down Diabetes Technology Barriers (youtube.com)

The Essentials of CGM Accuracy (youtube.com)

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

This episode is sponsored by Medtronic.

Painful diabetic peripheral neuropathy (DPN) can significantly impact a person with diabetes and their quality of life. Nalani Hunsaker PA-C, MCMSc, BC-ADM, a paid consultant for Medtronic, joins The Huddle to talk about Medtronic’s spinal cord stimulation therapy option, how the procedure works, and its success in relieving pain from DPN. Please reach out to http://www.medtronic.com/dpnconnect to connect with a Medtronic representative today. If you would like to share more information with your patients check out http://www.medtronic.com/dpnpain.

Learn more about DPN and DPN pain here on danatech: Diabetic Peripheral Neuropathy (adces.org)

References:

1. de Vos CC, Meier K, Zaalberg PB, et al. Spinal cord stimulation in patients with painful diabetic neuropathy: A multicentre randomized clinical trial. Pain. 2014;155(11):2426–2431. doi:10.1016/j.pain.2014.08.031 

2. Slangen R, Schaper NC, Faber CG, et al. Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: A prospective two-center randomized controlled trial. Diabetes Care. 2014;37(11):3016–3024. doi:10.2337/dc14-0684 

3. Medtronic Pain Therapy Clinical Summary M221494A016 Rev B. United States; 2022. 

4. van Beek M, Geurts JW, Slangen R, et al. Severity of neuropathy is associated with long-term spinal cord stimulation outcome in painful diabetic peripheral neuropathy: Five-year follow-up of a prospective two-center clinical trial. Diabetes Care. 2018;41(1):32–38. doi:10.2337/dc17-0983 

5. Zuidema X et al. Long-term Evaluation of Spinal Cord Stimulation in Patients With Painful Diabetic Polyneuropathy: An Eight-to-Ten-Year Prospective Cohort Study. Neuromodulation. 2022 Dec 30:S1094-7159(22)01403-9. 

6. Tarakji KG, Mittal S, Kennergren C, et al. Antibacterial Envelope to Prevent Cardiac Implantable Device Infection. N Engl J Med. 2019;380(20):1895-1905

7. Desai MJ, Hargens LM, Breitenfeldt MD, Doth AH, Ryan MP, Gunnarsson C, Safriel Y. The rate of magnetic resonance imaging in patients with spinal cord stimulation. Spine (Phila Pa 1976). 2015 1;40(9):E531-7.

8. Mullins CF, Harris S, Pang D. A retrospective review of elevated lead impedances in impedance-dependent magnetic resonance-conditional spinal cord stimulation devices. Pain Pract. 2023;00:1–8 https://creativecommons.org/licenses/by/4.0/.

9. Temel Y, Ackermans L, Celik H, et al. Management of hardware infections following deep brain stimulation. Acta Neurochir (Wien). April 2004;146(4):355-361.

10. Pepper J. Zrinzo L, Mirza B, Foltynie T, Limousin P, Hariz M. The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg. 2013;91(1):56-65.

11. Tolleson C, Stroh J, Ehrenfeld J, Neimat J, Konrad P, Phibbs F. The factors involved in deep brain stimulation infection: a large case series. Stereotact Funct Neurosurg. 2014;92(4): 227-233.

12. Thrane JF, Sunde NA, Bergholt B, Rosendal F. Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation. Stereotact Funct Neurosurg. 2014;92(6):360-364.

13. Deer TR, Provenzano DA, Hanes M, et al. The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management [published correction appears in Neuromodulation. July 2017;20(5):516]. Neuromodulation. January 2017;20(1):31-50.

14. Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain Pract. March-April 2011;11(2):148-153.

15. Falowski SM, Provenzano DA, XIa Y, Doth AH. Spinal Cord Stimulation Infection Rate and Risk Factors: Results From a United States Payer Database. Neuromodulation. February 2019;22(2):179-189.

16. Clifton M, Quirouet A, Pizarro-Berdichevsky J, et al. Infection rate after sacral neuromodulation surgery: a review of 1033 InterStim procedures. J Urol. April 2016;195(4S):851.

17. Bjerknes S, Skogseid IM, Sæhle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period. PLoS One. August 14, 2014;9(8):e105288.

18. Piacentino M, Pilleri M, Luigi Bartolomei L. Hardware-related infections after deep brain stimulation surgery: review of incidence, severity and management in 212 single-center procedures in the first year after implantation. Acta Neurochir (Wien). December 2011; 153(12):2337-2341.

19. Hamani C, Lozano AM. Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotact Funct Neurosurg. 2006;84(5-6):248-251.

20. Hayek SM, Veizi E, Hanes M. Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database. Neuromodulation. October 2015;18(7):603-608. 

21. Bendel MA, O’Brien T, Hoelzer BC, et al. Spinal Cord Stimulator Related Infections: Findings From a Multicenter Retrospective Analysis of 2737 Implants. Neuromodulation. August 2017;20(6):553-557. 

22. Wexner SD, Hull T, Edden Y, et al. Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence. J Gastrointest Surg. July 2010;14(7):1081-1089.15 

23. Chen T, Mirzadeh Z, Lambert M, et al. Cost of Deep Brain Stimulation Infection Resulting in Explantation. Stereotact Funct Neurosurg. 2017;95(2):117-124.

24. Provenzano DA, Falowski SM, Xia Y, Doth AH. Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database. Neuromodulation. April 2019;22(3):302-310.

25. Medtronic data on file: Economic Impact of Infection Related to Neuro-Stimulator Implant. Study report prepared for Medtronic prepared by Optum, 2018/01/03.

26. Garrigos ZE, Farid S, Bendel MA, Sohail MR. Spinal Cord Stimulator Infection: Approach to Diagnosis, Management, and Prevention. Clin Infect Dis. June 10, 2020;70(12):2727-2735. 

27. Tarakji KG, Mittal S, Kennergren C, et al. Antibacterial Envelope to Prevent Cardiac Implantable Device Infection. N Engl J Med. May 16, 2019;380(20):1895-1905

28. Garrigos ZE, Farid S, Bendel MA, Sohail MR. Spinal Cord Stimulator Infection: Approach to Diagnosis, Management, and Prevention. Clin Infect Dis. June 10, 2020;70(12):2727-2735

29. Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial. JAMA Neurol. April 2021. doi:10.1001/jamaneurol.2021.0538

Spinal Cord Stimulation Brief Summary 

INDICATIONS Spinal cord stimulation (SCS) is indicated as an aid in the management of chronic, intractable pain of the trunk and/or limbs-including unilateral or bilateral pain. CONTRAINDICATIONS Diathermy - Energy from diathermy can be transferred through the implanted system and cause tissue damage resulting in severe injury or death. WARNINGS Sources of electromagnetic interference (e.g., defibrillation, electrocautery, MRI, RF ablation, and therapeutic ultrasound) can interact with the system, resulting in unexpected changes in stimulation, serious patient injury or death. An implanted cardiac device (e.g., pacemaker, defibrillator) may damage a neurostimulator, and electrical pulses from the neurostimulator may cause inappropriate response of the cardiac device. Patients with diabetes may have more frequent and severe complications with surgery. A preoperative assessment is advised for some patients with diabetes to confirm they are appropriate candidates for surgery. PRECAUTIONS Safety and effectiveness has not been established for pediatric use, pregnancy, unborn fetus, or delivery. Avoid activities that put stress on the implanted neurostimulation system components. Recharging a rechargeable neurostimulator may result in skin irritation or redness near the implant site. ADVERSE EVENTS May include: undesirable change in stimulation (uncomfortable, jolting or shocking); hematoma, epidural hemorrhage, paralysis, seroma, infection, erosion, device malfunction or migration, pain at implant site, loss of pain relief, and other surgical risks. Adverse events may result in fluctuations in blood glucose in patients with diabetes. Refer to www. medtronic.com for product manuals for complete indications, contraindications, warnings, precautions and potential adverse events. Rx only. Rev 0422

TYRX™ Neuro Absorbable Antibacterial Envelope Brief Statement 

The TYRX™ Neuro Absorbable Antibacterial Envelope is intended to hold a vagus nerve stimulator, a spinal cord neuromodulator, a deep brain stimulator or a sacral nerve stimulator securely in order to create a stable environment when implanted in the body. The Neuro Antibacterial Envelope contains the antimicrobial agents Minocycline and Rifampin which, have been shown to reduce infection in an in vivo model of bacterial challenge following surgical implantation of a pulse generator. The Neuro Antibacterial Envelope is NOT indicated for use in patients who have an allergy or history of allergies to tetracyclines, Rifampin, or absorbable sutures. The Neuro Antibacterial Envelope is also NOT indicated for use in patients with contaminated or infected wounds, or Systemic Lupus Erythematosus (SLE). This device is intended to be used in conjunction with vagus nerve stimulators or deep brain stimulators implanted in the infraclavicular fossa, or in conjunction with spinal cord neuromodulators or sacral nerve stimulators implanted laterally to the body midline and slightly superior to the gluteal region. The use of this product in patients with compromised hepatic and renal function, or in the presence of hepatotoxic or renal toxic medications, should be considered carefully, because Minocycline and Rifampin can cause additional stress on the hepatic and renal systems. Patients who receive the Neuro Antibacterial Envelope and who are also taking methoxyflurane should be monitored carefully for signs of renal toxicity.

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

Last year, ADCES received funding from the Centers for Disease Control and Prevention toward work aimed at advancing access to diabetes education and prevention resources for those in underserved communities. In anticipation of updates on progress made thus far at this year's upcoming annual meeting, we're resharing a previous episode of The Huddle in which Angela Forfia from ADCES and Sarah Ann Piper from Emory Centers explained how this will come to life over the next 5 years.

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

On this episode of The Huddle, Miguel Johns, Co-Founder & CEO of mmnt and creator of Milton, discusses how the use of artificial intelligence (AI) can benefit health care professionals across the diabetes space and how this technology is growing and changing. Topics include addressing some of the current opportunities and challenges associated with AI in health care, how AI can provide improved clinical decision support, and where this technology may be headed in the future.

Explore danatech here: Diabetes technology for healthcare professionals | Danatech (adces.org)

For more information on Miguel or mmnt, visit Milton | Powered by MMNT (getmilton.com)

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

The decision on whether to screen yourself or loved ones for Type 1 diabetes risk can be a very personal one. In the last episode of a three-part series, we're joined by Laura Smith PhD, CDCES and Holly O’Donnell, PhD as they discuss the psychosocial factors to consider when talking about T1D screening—including the reasons why a person may or may not want to be screened and how to talk to children and their families about what a potential diagnosis means for them.

Learn more about the Autoimmune Screening Study in Kids here: ASK Research Program / Autoimmunity Screening for Kids / Denver, CO (askhealth.org)

Learn more about the Environmental Determinants of Diabetes in the Young study here: The Environmental Determinants of Diabetes in the Young (TEDDY) Web Site (usf.edu)

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

Registration for ADCES24 is now open! Each year, ADCES' annual conference brings together thousands of professionals in the diabetes care space, and this year's event is not one to miss! Conference chair Lisa Hodgson, RD, CDN, CDCES, FADCES joins The Huddle to share all of the exciting sessions and events to look forward to this year in New Orleans.  

Learn more and register at ADCES24 (adcesmeeting.org)

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

Screening for Type 1 diabetes is crucial for earlier detection and management of the disease, but many people don’t know that they should be screened or how to access that screening.  In the 2nd episode in our three-part series on T1D screening, University Hospital’s Chief of Staff - Office of President & CEO, Franklin Hickey, PhD, RN, NEA, BC, Executive Director of Community and Population Health, Colette Barrow Adams, PhD, MPA, MDiv, and JDRF Patient Navigator, Courtney Harris joined The Huddle to talk about a partnership with JDRF that has allowed more than 1,000 people to be screened for early T1D in the underserved Newark, New Jersey area. They also discuss the importance of meeting people where they are and understanding barriers to access when looking to increase screening rates. 

Educational grant support for this episode is provided by Sanofi.

Learn more about University Hospital here: Hospital Administration - University Hospital (uhnj.org)

Lean more about JDRF here: JDRF - Diabetes - Type 1 Diabetes Research, Advocacy, and Support

Learn more about the partnership between University Hospitals and JDRF here: Inclusive Health: Creating Access to Type 1 Diabetes Screening in Underserved Communities (beyondtype1.org)

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

Chief Scientific and Medical Officer for the American Diabetes Association, Dr. Bob Gabbay, joined The Huddle live at ADCES' 2023 annual meeting in August. He touched on the challenges of addressing diabetes in primary care and the value of a DCES in this area, as well as the importance of active listening, perceived value, and engaging teaching styles when working with people with diabetes.

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

Advanced practice dietitian Amy Hess Fischl MS, RD, LDN, BC-ADM, CDE joined The Huddle to talk about the various food factors that can impact glucose levels, how to help people with diabetes address and understand the factors that impact them most, and how people with diabetes may adjust their insulin doses based on these various factors.

This podcast is being produced in collaboration with JDRF. JDRF works to improve the lives of individuals living with T1D by providing meaningful educational resources for health care professionals and community members. 

See a full list of factors that can impact glucose levels on Diatribe here: 42 Factors That Affect Blood Glucose?! A Surprising Update (diatribe.org)

Learn more about JDRF here: JDRF - Diabetes - Type 1 Diabetes Research, Advocacy, and Support

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.

Addressing the inequities that exist in diabetes care relies on each and every one of us in the diabetes space. On this episode of The Huddle, we spoke with Dr. Osagie Ebekozien, Chief Medical Officer at the T1D Exchange and award-winning researcher. Dr. Ebekozien talked about T1D Exchange’s Health Equity Advancement Lab (HEAL) and it's work in advancing health equity for underserved populations. He also outlines actionable steps, no matter how big or small, that DCES across the country can take to advance this work in their practices.

Please note, this podcast was originally recorded in 2023, and host Sacha Uelmen has since moved on from ADCES to pursue another professional opportunity.

Learn more about T1D Exchange here: T1D Exchange Homepage - T1D Exchange and learn more about the Health Equity Advancement Lab specifically here: HEAL - T1D Exchange

Stay up to date on diabetes advocacy initiatives here: Diabetes Advocacy (adces.org)

Dive deeper into health equity research at the links below:

Addressing type 1 diabetes health inequities in the United States: Approaches from the T1D Exchange QI Collaborative

Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools

Equitable Post-COVID-19 Care: A Practical Framework to Integrate Health Equity in Diabetes Management

Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.

Learn more about ADCES and the many benefits of membership at adces.org/join.