CGM had helped patients for tighter control of globose specially on pts that are afraid of doing accuchecks at home
Also SGLt2 are great drugs for prevention of cardiovascular disease

This will significantly enhance patient outcomes by providing more precise glucose control and minimizing complications.

Integrating CGMs and AID systems into routine T2D care enables real-time glucose monitoring, improves time-in-range, and supports personalized treatment, especially for insulin-treated patients. SGLT2 inhibitors complement this approach by lowering glucose, aiding weight loss, and offering cardio-renal protection. Together, these technologies and therapies enhance outcomes when tailored to patient needs and supported by team-based care.

With the use of cgm and auto mated insulin delivers system random snack and meals will be given an appropriate dose of insulin

SGLT-2 HELP TO LOWER A1-C WITH BETTER GLUCOSE VASCULAR DISEASE LOWERING PROTEINURIA WHICH IMPROVES KIDNEY FUNCTION.ALSO IMPROVES CHF.

some strategies and considerations for seamless integration:
-Patient Education and Training: Educate patients on the use of CGM and AID systems, emphasizing their benefits in improving glycemic control and quality of life.
-Healthcare Provider Training: Ensure that healthcare providers are well-versed in the latest diabetes technologies. This includes understanding how to interpret CGM data and adjust treatment plans accordingly.
-Integration with Electronic Medical Records (EMR): Incorporate CGM and AID data into EMR systems to facilitate real-time monitoring and data sharing among healthcare providers.
-Personalized Treatment Plans: Use data from CGM and AID systems to tailor treatment plans to individual patient needs. This can include adjusting insulin dosages, dietary recommendations, and lifestyle modifications.
-Regular Monitoring and Follow-up: Schedule regular follow-ups to assess the effectiveness of CGM and AID systems in managing T2D. Use these sessions to make necessary adjustments and address any patient concerns.
-Collaboration with Multidisciplinary Teams: Involve a team of healthcare professionals, including endocrinologists, diabetes educators, and dietitians, to provide comprehensive care and support for patients using these technologies.
-Addressing Barriers to Access: Work to overcome barriers such as cost, insurance coverage, and patient reluctance to adopt new technologies.


Regarding the role of new drug classes like SGLT2 inhibitors (SGLT2i), they can complement the use of CGM and AID systems by:
-Improving Cardiovascular and Renal Outcomes: SGLT2i have been shown to provide cardiovascular and renal benefits, which are crucial for patients with T2D who are at higher risk for these complications.
-Enhancing Glycemic Control: SGLT2i can help reduce blood glucose levels, which, when combined with CGM and AID systems, can lead to more stable and optimal glycemic control.
-Weight Management: SGLT2i can aid in weight reduction, which is beneficial for many patients with T2D and can improve overall diabetes management

CGM help patient monitor their sugars and help lower sugar with instant feedback. Combined with AID you can have tighter glucose control much like pancreas functions. SGLT-1 have CV reduction benefits in addition to sugar lowering.

Utilization of CGMs and AIM have already been a major game changer for diabetes management. Real-time glucose monitoring and insulin administration has improved A1c of so many of my diabetic patients.

With CGM use, patients are more cognizant of their glucose readings and also the effect that eating certain foods have on their glucose. I think I would have better outcomes in my non-insulin treated type 2 diabetics if I were able to get them CGMs. SGLT2 medications and their benefits outside of glucose lowering make them a mainstay of diabetes treatment.

It has been much easier to get the approval of GLP-1 and SGLT2i because of guidelines. We routinely screen all pts for CV conditions and recommend GLP-1 therapy as first line therapy

I think CGMs have been the game changer for patients with diabetes in general - even those not on insulin. For diabetes patients on basal bolus insulin or are on a pump, and those who could meet criteria for being on a pump/ AID system - this is so much better, with hypoglycemia being prevented automatically and with overall better control. These systems are not fullproof and will be challenging to the patient who is used to having the ability to self correct multiple times on his/ her pump manually. The SGLT 2 inhibitors are excellent medications for DM - with benefits more mutliple organ systems, but I believe GLP and GLP1/GIP meds offer even more benefits. Luckily they are not mutually exclusive and can be used together

AID systems are game, changers for people on intensive insulin therapy. They should be required like statins for all patients, opting out only if there's good reason. For CGM, they should be available to all patients, because they can help educate what affects glycemic control, including life style and diet. SGLT2 inhibitors also revolutionized care and there should be no step edit therapy for these medications.

I like the new recs and emphasizing weight loss and individual care is right on. No mention in the question about GLP-1s but they play even bigger role than SGLT-2 probably but they make a powerful combo. CGMs also a big advancement

CGM’s help tremendously
Better hbA1c control and compliance
AID s help in appropriate patients

Seamless Integration of CGMs and AID Systems into Routine Care
**1. Empowering Patient Self-Management and Engagement:

Patient Education: Incorporating CGM and AID systems into routine care starts with educating patients about how these tools work and how they can improve their day-to-day management of diabetes. This includes teaching patients to interpret glucose trends, use the data for adjusting their lifestyle, and integrate feedback into daily routines (e.g., adjusting meals, physical activity, and insulin dosages).

Remote Monitoring and Support: CGMs can provide real-time glucose data, which can be shared with healthcare providers. This allows for more frequent check-ins and timely interventions, even outside of traditional in-person visits. AID systems can also adjust insulin delivery based on real-time glucose levels, enhancing patient care and reducing the burden of daily management.

**2. Integrating Into Electronic Health Records (EHR):

Automated Data Syncing: To make CGM and AID systems part of the routine care workflow, healthcare providers should have access to integrated platforms that sync patient data directly from devices to the EHR system. This enables clinicians to have up-to-date information about glucose patterns, insulin delivery, and patient responses without having to manually enter data, reducing the administrative burden.

Decision Support Systems: AI-driven systems can integrate with EHRs to offer insights and decision support. These systems can analyze CGM data to identify patterns, predict future glucose trends, and suggest interventions (such as adjustments to insulin or diet), helping clinicians make data-driven decisions and personalize care for each patient.

**3. Personalizing Treatment Plans:

Data-Driven Adjustments: CGMs and AID systems allow clinicians to observe how lifestyle factors (e.g., diet, exercise, stress) and medications influence glucose control in real time. This information allows for more personalized treatment plans, enabling healthcare providers to adjust medications and treatment strategies more effectively.

Improved Clinical Outcomes: Real-time glucose data from CGMs can help prevent both hypoglycemic and hyperglycemic episodes, which are significant risk factors for diabetes-related complications. This proactive approach reduces the need for reactive care (e.g., emergency visits or hospitalizations) and helps patients maintain better overall control of their condition.

Role of New Drug Classes like SGLT2 Inhibitors (SGLT2i) in T2D Management
SGLT2 inhibitors, such as empagliflozin, dapagliflozin, and canagliflozin, are a newer class of diabetes medications that target the sodium-glucose co-transporter 2 (SGLT2) in the kidneys. These drugs help lower blood glucose levels by promoting glucose excretion in the urine. Here's how they can enhance T2D management:

**1. Improved Glucose Control and Cardiovascular Benefits:

Lowering Blood Glucose: SGLT2 inhibitors have been shown to lower HbA1c and reduce the risk of hyperglycemic episodes. When combined with other therapies like insulin or metformin, SGLT2 inhibitors offer an additional mechanism for blood glucose control.

Cardiovascular and Renal Protection: These drugs also provide cardiovascular and renal benefits, which are particularly important for patients with T2D who are at high risk for cardiovascular disease and kidney complications. SGLT2 inhibitors reduce the risk of heart failure, stroke, and chronic kidney disease (CKD), improving overall patient outcomes.

Weight Loss and Blood Pressure Reduction: SGLT2 inhibitors promote weight loss and lower blood pressure, both of which are beneficial in the management of T2D. Weight loss can improve insulin sensitivity, and lowering blood pressure can reduce the risk of diabetic complications like retinopathy and nephropathy.

**2. Addressing Key Challenges in T2D Management:

Insulin Resistance and Beta-Cell Function: SGLT2 inhibitors offer a complementary mechanism to drugs that focus on improving insulin sensitivity or beta-cell function. By promoting glucose excretion through the kidneys, these medications reduce the overall glucose load on the body, improving the effectiveness of other medications like metformin and GLP-1 agonists.

Reduced Hypoglycemia Risk: Since SGLT2 inhibitors work independently of insulin, they do not increase the risk of hypoglycemia, a common concern with insulin therapy or sulfonylureas. This makes them a safer option, particularly for patients who are concerned about low blood sugar episodes.

**3. Synergy with CGMs and AID Systems:

Optimizing Glucose Monitoring: SGLT2 inhibitors can be monitored more effectively with CGMs. By providing real-time glucose data, CGMs can track how these medications influence glucose levels, helping clinicians adjust the treatment plan as needed.

AID Systems Adjustment: AID systems can adjust insulin delivery based on the glucose data from CGMs, allowing for more precise control when a patient is on an SGLT2 inhibitor. For instance, if glucose levels are effectively managed through both insulin and SGLT2 inhibitors, AID systems may reduce insulin dosages to prevent hypoglycemia.

Key Considerations for Integration:
Cost and Accessibility: While CGMs, AID systems, and SGLT2 inhibitors provide significant clinical benefits, cost can be a barrier to access for many patients. Work is being done to increase accessibility through insurance coverage, subsidies, or lower-cost alternatives.

Patient-Adherence and Support: To ensure the successful integration of these technologies and medications into routine care, patient adherence is crucial. Clinicians should provide consistent support, regular follow-ups, and education to ensure patients are using these tools effectively.

Collaborative Care: Successful integration of CGMs, AID systems, and SGLT2 inhibitors requires a collaborative approach between patients, clinicians, and diabetes care teams. A multidisciplinary team approach ensures that the patient receives the full benefit of these advanced technologies and therapies.

AID help is progressing nicely and with time should be able to monitor CGM activity close to the bodies ability

cgm havAtients immensely, as they can better see what they eat can negatively impact there glucose levels and aid devices take away the quests work of how much insulin to use when coupled with a cgm.

CGM's have helped us so much in our insulin requiring patients but need it in all diabetics to train them to control their diets if they are willing to see what is driving their sugars up.

Need better coverage insurance wish to help use cgm on top of sglt meds. The injections are game changes if pts could afford them except here in Cali all the medicad plans cover them.

The addition of CGM has led to create a data collection for all patient specifically type one diabetics and elucidating times when they might be hypoglycemic another times they may be hypoglycemic, which is not shown by the typical hemoglobin A1c, which is attained every three months these patients can use the CGM in order to track their meals, diets and result of their blood sugar secondary to the use of CGM. They just need greater coverage by all the insurance companies not just type one diabetics and not just patient we were taking insulin knows on oral therapy‘s benefit as well

CGM's need to be covered by insurance companies in all patients with diabetes

Guidelines are making it easier for PCPs to manage diabetes and prescribe SGLt-2i and GLP-1 analogs as first lines when treating pts with obesity, CKD and/or CVD. rate of insurance approval have also improved significantly based on current guidelines. More and more pts are getting access to GLP-1 and SGLt-2i and we see significant drop in insulin use, therefore, less referral to Endocrinology. These medications are extremely safe and easy to use and can be used by all specialties that are involved in management of diabetes related complications

CGMs and AID both are great assistive devices that help improve outcome. CGMs are particularly helpful in improving compliance for both type 1 and typ2 diabetics.
SGLT2 s have simplified and improvized management of diabetes and preventing complications.

Both CGM and AIDS has helped in achieving better glycemic control in patients and more involvement in the implementing dietary changes. Challenges lie in cost and insurance coverages

CGM alone has proven to lower blood glucoses and A1c's just because patients can be aware of how different choices affect their blood glucose in real time. Using AID along with CGM further reduces blood glucose which makes sense given that it takes much of the guess work and inconvenience of multiple injections out of the equation. I utilize SGLT-2 in most of my diabetic patients because I understand that they are at increased risk of both cardiac and renal disease. This seems like a very easy way to mitigate risk and decrease blood glucose.

CGMs and AID systems have significantly improved glycemic control in my diabetic patients. The patients are more aware of glucose levels and, in turn, this promotes compliance with diet. So many of my patients who check glucose by fingerstick forget their logs, so I am not able to review readings at their visits. With CGMs, patients can show me readings from their apps. SGLT2 and GLP1 medications have been game changers in the treatment of type 2 diabetes. They have many additional benefits besides glycemic control, and I quickly integrated them into my treatment arsenals.

SGLT2 amazong and becoming standard of care for CAD AND CKD. CGMs and Automtic insulin delivery systems have been incredibly successful for my patients. Significant improvements in diabetes control .

CGMs and AID systems into routine care, along with the use of SGLT2 inhibitors, can significantly enhance outcomes for patients with T2D by improving glycemic control, reducing complications, and providing cardiovascular and renal benefits. This is both by improving awareness of glucose responses to foods and beverages as well as improved weight loss and A1c from SGLT2.

To seamlessly integrate Continuous Glucose Monitors (CGMs) and Automated Insulin Delivery (AID) systems into routine care for enhancing patient outcomes in type 2 diabetes (T2D) management, several strategies can be employed:
-Personalized Care Plans: Tailor the use of CGMs and AID systems to individual patient needs, considering factors such as lifestyle, glycemic targets, and comorbidities. This personalization can help optimize glycemic control and improve quality of life.
-Education and Training: Provide comprehensive education and training for both patients and healthcare providers on the use of these technologies. This includes understanding how to interpret CGM data and adjust AID system settings appropriately.
-Integration with Electronic Medical Records (EMRs): Ensure that data from CGMs and AID systems are seamlessly integrated into EMRs. This integration facilitates real-time monitoring and data-driven decision-making, allowing for timely interventions. Collaborative Care Models: Implement collaborative care models that involve endocrinologists, diabetes educators, and primary care providers. This team-based approach can enhance the management of T2D by leveraging the expertise of various healthcare professionals.
Utilization of Decision Support Systems: Employ decision support systems that analyze CGM data to provide actionable insights and recommendations for insulin dosing and lifestyle modifications.
Regarding new drug classes like SGLT2 inhibitors, they can complement the use of CGMs and AID systems by providing additional benefits such as:
Cardiovascular and Renal Protection: SGLT2 inhibitors offer cardiovascular and renal benefits, which are crucial for patients with T2D who are at higher risk for these complications.
Weight Management: These drugs can aid in weight loss, which is beneficial for glycemic control and overall health
Reduction in Hypoglycemia Risk: By providing a non-insulin mechanism of action, SGLT2 inhibitors can reduce the risk of hypoglycemia, making them a valuable addition to the therapeutic regimen.

CGM are very good tools to follow patients progress, see how the keep diabetes control in range , SGLT inhibitors with the multiple indications help patients with the cv risk reductions, prevent ckd progression, management of heart failure .

These enhance the expanded use of SGLT2 and GLP-1 to provide tighter control and reduce events

sglts and glp-1 drugs are game changers and gcms offer lots of great feedback for motivated patients. Its a good time to be a diabetic if I may say that

CGMS have been the game changer since a few years ago - Even without adding meds or adjustments of insulin, just wearing a CGM can sometimes help patients improve their glycemic control. Starting SGLT2s in patients with the comorbidities which have been proven to benefit with SGLT2 use (CHF, CKD, CAD) - I think most endos are already doing this. But the ADA guidelines have a wider reach, so hopefully non-endocrine clinicians can do the same

CGM makes it easier for patients to get more involved in their DM care. CGM can help lower sugars and help patients become more compliant with DM care. AID helps patients get sugar down faster in my experience. SGLT-2 with their ability to help lower sugars and help with weight have several other indications including DM.

1. Routine Integration into Diabetes Care:
Education and Training: Healthcare providers need to educate patients about the benefits and proper use of CGMs and AID systems. In clinical settings, staff should be trained to interpret data from these devices to help inform treatment decisions.
Data-Driven Care Plans: Routine follow-up appointments should involve reviewing CGM data and adjusting insulin delivery settings accordingly. AID systems can adjust basal insulin rates and bolus doses based on real-time glucose data, minimizing the need for frequent fingerstick tests.
Telemedicine and Remote Monitoring: These technologies could be integrated into telehealth platforms, allowing healthcare teams to remotely monitor glucose levels and insulin delivery. This improves patient engagement and allows for more timely interventions.
Coordination Between Providers: A collaborative approach between endocrinologists, diabetes educators, dietitians, and primary care providers can ensure the devices are used effectively and that any necessary adjustments to medications or lifestyle are made.
2. Impact on Patient Outcomes:
Better Glycemic Control: With continuous glucose data, CGMs help patients understand the impact of food, exercise, and stress on their blood sugar, leading to improved glycemic control. AID systems further enhance this by automatically adjusting insulin delivery, reducing the likelihood of hyperglycemia and hypoglycemia.
Reduction in Complications: By improving glycemic control, patients may experience a reduction in the risk of long-term complications such as cardiovascular disease, neuropathy, and kidney issues.
3. Role of SGLT2 Inhibitors in Diabetes Management:
Dual Benefits: SGLT2 inhibitors (e.g., empagliflozin, canagliflozin) have demonstrated benefits in both glycemic control and cardiovascular risk reduction, making them a valuable addition to diabetes management. They work by preventing glucose reabsorption in the kidneys, leading to lower blood sugar and reducing the risk of diabetic kidney disease.
Synergistic Effect with AID and CGMs: SGLT2 inhibitors could work synergistically with CGMs and AID systems. As these drugs help lower blood glucose levels, CGMs can provide feedback to ensure levels remain stable. AID systems could adjust insulin doses based on the lower glucose levels, further optimizing care.
Weight Loss and Cardiovascular Protection: SGLT2 inhibitors also help with weight loss, which is beneficial in T2D, and they provide cardiovascular protection—an important consideration given the increased cardiovascular risk in T2D patients. This can improve overall health outcomes, especially when combined with the glucose control provided by CGMs and AID systems.
4. Personalized Diabetes Management:
Tailored Insulin Dosing: With AID systems, insulin delivery can be fine-tuned to an individual's needs. These systems can automatically adjust basal insulin rates based on CGM readings, providing more precise control without requiring frequent intervention from the patient or clinician.
Lifestyle Adjustments: CGMs help individuals understand how different factors (e.g., diet, exercise, stress) affect their blood glucose. This data can be used to educate patients on making better lifestyle choices, ultimately leading to better long-term outcomes.
Challenges to Integration:
Cost and Access: The cost of CGMs and AID systems may limit their widespread adoption, particularly in lower-income settings. Expanding insurance coverage and reducing out-of-pocket costs could help overcome this barrier.
Technological Barriers: Some patients, especially older adults, may face challenges with adopting these technologies. Ensuring that systems are user-friendly and providing adequate support for patients to learn how to use them will be key.
Data Overload: While CGMs provide a wealth of data, patients and healthcare providers may be overwhelmed by too much information. Developing intuitive systems that highlight actionable insights will be crucial for improving care without overloading patients.

SGLT2i's are a core treatment in type 2 diabetes and if afforable should be in the regimen of most patients with type 2 diabetes. CGMs and even AIDs are options for patients with type 2 diabetes on MDI with more nuances including formularity and number of insulin units per days. CGM are very helpful for the MDI patients and very embraced by patients.

CGMs and Automtic insulin delivery systems have been incredibly successful for my patients. Significant improvements in diabetes control . SGLT2 inhibitors are becoming standard of care for CKD and CAD.

CGMs have been helpful in those who take the time to let them and SGLT2 medication is becoming more standard of care in diabetes mellitus and heart disease

CGMs have been a game changer in the management of diabetes simply by giving the real time bio feedback real time and all the time and as it helps greatly with the dose adjustment of the insulin to prevent Hyper and Hypoglycemia but also helps to pt acknkowledge the caloric value of the food intake and effects of the exercise on glucose level for the pt on diet and oral medications and leads to behavior modifications for better diabetic control so CGMs are a must in optimal diabetic control ! What can you say about SGLT-2 inhibitors they are super meds and have gone beyond the realm of diabetes management in to the CVD and CKD management with overwhelming positive outcomes and real time experience ! With these advents in management of diabetes it has made it much easier for the Primary Care Physicians to manage diabetes and minimized the referrals to the endocrinologist and over all a golden era to practice diabetology !!