Step-Wise Approach to Education May Improve CGM Adherence

NEW ORLEANS — Adopting a tailored approach and going step-by-step when educating young users of continuous glucose monitoring (CGM) may improve sustained use and reduce the number of patients who abandon CGM, speakers said during a presentation at AADE 2015, the annual meeting of the American Association of Diabetes Educators.

When too many alerts and features are introduced at the initiation of therapy, the user can easily become overwhelmed and may not continue using CGM, according to Christine Richardson, RN, BScN, CDE, of Children’s Hospital of Eastern Ontario in Ottawa, Canada, and Alanna Landry, RN, CDE, of Markham Stouffville Hospital in Ontario, Canada.

To address this issue, they have implemented a step-wise approach to ongoing education and follow-up.

Both Richardson and Landry participated in the CGM TIME multicenter clinical trial that included 144 children aged 5 to 18 years with type 1 diabetes. Criteria for participation included diabetes duration of more than 1 year and being naïve to insulin pump therapy.

In the trial, patients were randomly assigned to simultaneous pump therapy plus CGM or standard pump therapy with addition of CGM at 6 months. Data are currently being analyzed.

The trial researchers developed the step-wise approach for consistency in education with all participants.

The success of this step-wise integration of alerts, features and integration of data uploads led to the adoption of this approach at Richardson’s and Landry’s respective clinical centers. During their presentation, both shared their experiences, with Richardson noting that CGM is an effective tool and needs to be personalized to the user’s needs through ongoing CGM education and regular support in order to improve CGM adherence.

“Historically, educators and clinicians have felt that CGM users should be aware of all of the features and alerts at initiation of CGM. When multiple features are introduced too soon, it was often overwhelming,” Richardson told Endocrinology Advisor. 

“It is better to use CGM with minimal alerts and only those the user sees as important and willing to respond to rather than having them become frustrated and abandon CGM. For example, frequent alerts annoy users, leading to alert fatigue, which results in them not responding to the alerts that are set.”

Landry outlined the step-wise approach to the integration of alerts and features, focusing on teaching what is important, minimizing alerts and the importance of utilizing uploaded data for ongoing management and education. 

A key message, according to Landry and Richardson, was focusing and tailoring the education to the user by staggering the introduction of new settings and features as the user is ready to integrate them and respond to the alerts.

“Not all features are needed by all users. Assess what is important to them and what is needed for safe and sustained use,” said Landry.

Richardson also outlined that there have been significant improvements in CGM technology since 2006 — one particular improvement being a new sensor released in Canada in January 2013. All CGM TIME Trial participants were able to utilize this sensor prior to its release in Canada under a protocol with Health Canada. With their experience in the trial, they recognized that the patients were no longer complaining about their sensor insertion and instead they were complaining about their infusion sets.

“So, the evolution of CGM has been significant, it is a 9-year-old technology and no longer considered new. However, we are continuing to learn how best to introduce this to our families and how to set them up for success with using this technology,” said Richardson.

Reference

1. Richardson C, Landry A. W23 – Initiating Continuous Glucose Monitoring (CGM): Utilizing a Step-Wise Approach. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.