AGDT-AGPD Spectrum Group - Spectrum - Part 1 - Curriculum

are overwhelmed by the high volume of data and information, both for cognitive and psychological reasons,

react with strong, dysfunctional fear when dealing with CGM data and/or who might be at risk for trying to handle their fears by using excessive control strategies,

are affected by insufficiently controlled psychological problems, abnormalities and disorders (e.g. fear or obsessive-compulsive disorders, addiction or dependence disorders).

An information session („Module 0“) and a consultation with the diabetes team should precede the actual CGM training course so that patients are informed well enough to decide for or against using CGM. This module contains the basic information on CGM. Module 0 can be used as part of an MDI or insulin pump training or, for example, as part of an information evening as per the possibilities and plans of the diabetes center.

Modules 1 to 6 are intended for people with diabetes who have already decided to use CGM. This modules contain information for participants on the practical use of CGM and participants then practice using it in daily life. Any knowledge or skills already present are refreshed, brought up-to-date and delved into. The modules intend to convey information and skills on using CGM and also to exchange both the experience of daily life with diabetes as well as solutions for difficulties with CGM.

Module 0 conveys basic information on the topic of CGM in order to help patients make an informed decision for or against CGM.

Module 1 delves deeper into the most important CGM basics (e.g. CGM display, lag time, calibration).

In Module 2, the first sensor is inserted, the alarm settings are set and the start rules for the initial days are stipulated.

Module 3 deals with the interpretation of the CGM information on the display and with the further optimization of the alarm settings.

In Modules 4 and 5, the saved CGM data is evaluated together by all participants who then exchange their practical experience from the initial weeks of CGM use.

Module 6 assists patients in using CGM over a longer period of time and under special circumstances (e.g. physical activity or traveling).

Tab. 1: SPECTRUM modules (for adults) and main content

A time frame of approximately 8 weeks is intended for participation in the entire training and treatment program (4–12 weeks, see Table 2 for the time frame).

Module 0 can be presented at any point in time before beginning the course.

Patients who have decided to participate in SPECTRUM are first taught the basics of CGM in Module 1 before inserting the sensor and beginning with CGM one week later as part of Module 2.

To get off to a good start with CGM, patients should reflect upon the initial personal experience as part of Module 3 one week later. Any problems at the start should be addressed directly and solved as much as possible. Participants also quickly learn about the display and alarms.

Working on Modules 4, 5 and 6 happens at an interval of about 2 weeks (larger intervals due to circumstances such as vacations is possible). In this way, participants have the possibility to gather comprehensive experience with CGM, exchange this experience and profit from the group dynamic.

Tab. 2: Time frame for SPECTRUM for adults

SPECTRUM is best suited for use in group training. The group should be 2-4, maximum 5, patients. In groups with more than 5 participants, the risk exists that certain aspects might not be delved into enough, such as aspects which apply to individual participants, the individual evaluation of CGM data or characteristics of the different CGM systems. The training material is suitable for individual consultation although this then lacks the helpful effects of the synergy of the group.

The SPECTRUM AGDT author team offers regional training courses for physicians and qualified training personnel In Germany. For more information, visit www.diabetes-technologie.de.

Countless studies show unanimously that the only way that users can expect a benefit from CGM is if they use this technology continuously and correctly. In reality, this is often not the case. The main reason for this is often assumed to be the considerable costs associated with the use of CGM. However, incomplete use of CGM is also observed in patients who are able to use the CGM free of charge.

Two factors appear to be important for the successful use of CGM:

How do patients interpret the information obtained using CGM in the current situation and what are the therapeutic conclusions they draw?

How did patients treat their diabetes before using CGM and how well did the patients control their therapy using blood glucose self-monitoring?

This is why structured patient education is of vital importance. Only then are users capable of using CGM technology properly and continuously.

Patients often react unsure and overwhelmed when they first use CGM. The constant availability of real-time data makes it much clearer to patients just how much their glucose values fluctuate throughout the day. Conventional blood glucose measurements only deliver 4-10 measurement results per day as the basis for making therapy decisions. By contrast, CGM delivers 288 glucose values per day as well as trends and statistics. The volume of data often makes it difficult for users to make the right therapeutic conclusions at the right time for their diabetes treatment. At the beginning it can be very tempting to intervene too frequently on the glucose trend by administering correction insulin or consuming carbohydrates, which often further destabilizes the metabolic state. Practical experience has also shown that compulsive behavior in patients can be worsened by CGM.

SPECTRUM gives patients methods to identify personal „typical CGM patterns“ that influence the success of therapy in a similar way (e.g. CH amount consumed, insulin dose, injection-to-food interval, etc.). At the same time, SPECTRUM participants learn the proper and safe criteria for adjusting the insulin dose in specific situations such as the correction of increased glucose values. One of the important aims of SPECTRUM is to give the users experience and, with increasing practice, reduce the feeling of insecurity and worries; this then makes it easier to optimally control the glucose trend and experience the advantages of CGM.