Joshi, Shashank R

Background: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. Methods: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low–glucose and low-glucose hypoglycemia; very high–glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. Results: The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. Conclusion: The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clinicians and researchers to determine the glycemic effects of prescribed and investigational treatments.

Burnout is a syndrome of emotional exhaustion, loss of meaning at work, feeling of ineffectiveness, and a tendency to view people as objects rather than as a human being. Physician burnout leads to dissatisfaction at work and suboptimal patient care. Various causes of burnout at the individual, work environment, and health system levels have been identified. In this review, we initially focus on the burden of burnout. Subsequently, we describe the determinants of this problem in India and the West, while drawing on relevant literature. Finally, we provide evidence based practical suggestions to deal with physician burnout. Strategies suggested to deal with burnout need to be implemented based on locally available resources. Repeated assessment of burnout constructs using validated questionnaires can evaluate the effectiveness of an intervention. Hospitals, educational institutions, and physician societies need to collaborate with practicing physicians to address burnout and invest in physician well-being to continue providing high-quality medical care in the future.