Dr. Gogineni introduces way to improve Diabetes management.
Our Medical Director, Dr. Jyothi Gogineni, is already transforming the way we provide care at the clinic.
After finishing medical school in 2001, followed by an Internal Medicine residency and fellowship in Endocrinology, she joined Centegra Physician Care where she heard about the great work done at the clinic from Dr. Pasquale Bernardi. She began volunteering and continued even as her own practice grew. Dr. Gogineni has been volunteering with the clinic for the past seven years, and became the Medical Director in summer of 2017. “It is especially rewarding to care for patients with complex medical and social conditions using minimal resources. And I work with a wonderful clinic staff, that’s definitely a plus”, she said.
When asked for a story that stood out, Dr. Gogineni spoke of one of her first patients, Adrianna H. Adrianna had consistently uncontrolled diabetes. “We worked together, and tried different medications and patient management techniques to achieve optimal glucose for her. She worked hard. Her hemoglobin A1C (a measure of glucose control) was at an average above 10 consistently when I first began to care for her, but it has been brought down to 7, which is ideal”, she notes.
Dr. Gogineni recognized that home testing with finger sticks was not always enough to get an accurate gauge of what was happening with a patient’s blood sugar. Many patients come regularly for follow-up, bringing their glucose logs because they are trying to get their diabetes under control, but their A1C is not improving. At times, there is a big discrepancy between home testing logs and their hemoglobin A1C result.
One option to overcome this discrepancy is a continuous glucose monitoring systems (CGM). Continuous glucose monitoring systems place a small sensor under the patient’s skin to help measure their blood sugar 24 hours a day, so that spikes and drops can be accurately recorded. This allows the physician to determine whether there are other factors that may be at work in failing to get the A1c under control. CGM, however, can be extremely expensive, and can be time consuming for medical professionals to calibrate and teach patients how to handle them.
…this dream became a reality.
Dr. Gogineni wanted to include CGM in our clinic’s care, and found a cost effective model. With Dr. Gogineni providing the test interpretation, this dream became reality. In summer of 2017, staff received training and the clinic began providing this diagnostic tool to patients who needed it. The Libre CGM is a round device worn on the arm, and it has a filament that senses the glucose under the skin. The CGM takes readings every few minutes. Throughout the two weeks of a patient wearing it, approximately 1300 readings are recorded. That information is then downloaded, giving the provider an accurate report with graphs. This allows the provider to see trends and patterns in relation to the food and activity charts the patient keeps. This allows for more precise medication changes and accurate management of a patient’s diabetes.
She is confident that diabetic management will have improved considerably for clinic patients.
Since fall 2017, CGM has been used on four patients, all of whom had uncontrolled A1c levels. With the critical information provided, Dr. Gogineni made changes in medication and education for each individual patient based on those 1300 readings. In the next six months, Dr. Gogineni will be able to measure the effectiveness of this diagnostic, and perhaps broaden its use. She is confident that diabetic management will have improved considerably for clinic patients.
Dr. Gogineni is grateful to Pat Montemurro for helping launch this initiative, as well as Stephany Rico, our Wellness Coordinator, who was instrumental in helping operationalize this program.
