We would like to share excerpts from our recent interview with a Nationally Acclaimed Diabetes Educator and prolific author on diabetes, Gary Scheiner, Owner and Clinical Director at Integrated Diabetes Services.
Owner and Clinical Director
Integrated Diabetes Services, LLC
Integrated Diabetes Services is comprised of a multidisciplinary team of expert coaches that help educate and empower individuals and their families to intensify the management of diabetes.
How would you describe your practice?
Our organization has counseled over 5,000 patients, from over 30 countries, with Type I and Type II diabetes on intensive insulin therapy since starting the practice back in 1995. We work closely with our clients using new technologies to fine tune daily needs, and understand the nuances that food, emotions, and physical activity have on the management of diabetes.
How would you characterize your patient population?
Because 1/3 of our patients are pediatric, we work with both individuals and families. 80-90% of our patients are on pumps. 50-60% are using continuous glucose monitoring (CGM). In 20% of our Type 1 patients, we are making use of alternative treatments, such as metformin and SGLT2 inhibitors, in addition to insulin.
In which patients do you obtain a GlycoMark test result?
We place a lot of stress on managing postprandial glucose – the sticking point is postprandial testing. I recommend the GlycoMark test in any patient relying on fingerstick data alone. Its nearly impossible to obtain the postprandial data needed in anyone not using CGM.
How do you currently use the GlycoMark test?
After we gain control of premeal glucose levels, we focus on postprandial control. Unfortunately, you reach a glass ceiling just looking at fasting and premeal glucose. A low GlycoMark test lets us know we need to address postmeal issues.
Most patients with Type 2 diabetes lose first-phase insulin release, and that’s going to result in abnormal postprandial glucose. If the GlycoMark is unusually low, then I will likely intensify therapy.
Even if someone wears a professional CGM for a week and shows good control between meals, it’s worth doing the GlycoMark test a few times per year to gain more data, which can then be used to help determine if the chosen therapy is still working.
What led you to using the GlycoMark test in clinical care?
We began using the test because we didn’t have good tools to assess postmeal control. Many patients with decent A1Cs had issues with glycemic control, especially after meals. Diabetes is not a static condition; it’s continuously progressing and evolving. As diet and meal patterns change, we never know if a postmeal fingerstick reading was at the peak.
What impact has the GlycoMark test had on your practice and your patients?
With one lab test, the GlycoMark helps me to identify and teach patients when a postmeal problem exists. I have an arsenal of techniques, treatment strategies and lifestyle changes available to address this condition. As CGM has evolved, we have increased our use of that technology, however, the GlycoMark test remains an important indicator of postmeal glycemic control in nearly half of our patients, and provides important information to better utilize our monitoring and treatment tools.
How do you educate patients on the test and test results?
When we first discuss the importance of postmeal control, we discuss the importance of measuring glucose. I inform patients that with one lab test, we have a good indication if glucose is peaking. Since a low GlycoMark test is abnormal, opposite to how patients view A1C, I explain that the 1,5-AG molecule is lost in the urine any time glucose exceeds 180. A low test result indicates a lot of peaking above 180.
Gary Scheiner, MS, CDE is owner and Clinical Director of Integrated Diabetes Services, a practice located just outside of Philadelphia specializing in intensive insulin therapy and advanced education for children and adults.
Gary has had Type-1 diabetes for 33 years, and been a Certified Diabetes Educator for 22 years. He was named 2014 Diabetes Educator of the Year by the American Association of Diabetes Educators and has written six books, including the best-selling “Think Like A Pancreas-A Practical Guide to Managing Diabetes With Insulin.” He lectures nationally and internationally for people with diabetes and professionals in the healthcare industry. In addition to serving on the faculty of Children With Diabetes and the Board of Directors for JDRF, Gary volunteers for the American Diabetes Association, Diabetes Sisters, and Setebaid Diabetes Camps.
Subsequent to incorporating the GlycoMark test into clinical practice, the physician became a paid clinical consultant of GlycoMark.
For full GlycoMark prescribing information please see our package insert.