Endocrine Abstracts

Background: In 2019, funding for continuous glucose monitoring (CGM) commenced for children and young people with diabetes (CYPD) in our region. However, there was no local established CGM structured education programme. We developed ‘the CGM Academy’ with continuous improvement using the Plan-Do-Study-Act (PDSA) cycle.

Objectives: To review the PDSA cycle of improvements to deliver structured education using CGM.

Methods: A CGM curriculum, using evidence-based structured education guidelines, was developed (January-February 2019). Dynamic glucose management (DynamicGM) using glucose values and trend arrows to maximise time in range (TIR, 3.9-10.0 mmol/l) was taught through 6 face-to-face (F2F) sessions. The COVID-19 pandemic necessitated virtual (V) adaptation and adoption of a “Flipped Learning” approach, truncated into three sessions, an interactive workbook with short videos, and personalised hypoglycaemia and exercise algorithms. The first 50 CYPD educated through F2F (April 2019-February 2020) and V (April 2020-February 2021) programmes were assessed for change at six months from baseline in time below range (TBR, <3.9 mmol/l), HbA1c, and TIR. Qualitative user feedback was gathered. Cost-analysis compared the F2F and V programmes. Combined data from the total cohort was analysed to identify the strongest predictors of TIR to teach the most effective strategies.

Results: The F2F cohort reduced TBR by 8.3% (p<.001) and HbA1c by 3.8mmol/mol (p<.001) and improved TIR by 9.6% (p<.001). User feedback indicated that the six-session programme was lengthy. The V cohort reduced TBR by 9.2% (p<.001) and HbA1c by 4.9mmol/mol (p<.001) and improved TIR by 8.9% (p<.001). Qualitative feedback suggested information overload from teaching too many DynamicGM strategies. There was an 18% cost-saving for every 50 CYPD educated by the V (£4,601) vs. the F2F (£5616) programme. In the combined cohort (n=100), the strongest predictors of TIR were: Short-bursts of exercise to stop highs, bolus timing to stay in target and a weight-based hypoglycaemia algorithm to prevent lows.

Conclusion: PDSA cycles ensured regular innovation of the CGM Academy resulting in a clinically effective cost-saving programme.