Endocrine Abstracts

Background: Continuous Glucose Monitoring (CGM) is now becoming the standard of care for children and young people with diabetes (CYPD). Due to a lack of validated education programmes, we created ‘The CGM Academy’ delivering evidence-based structured education. The results of the first 50 CYPD graduating from the academy demonstrated statistically significant improvement in time in range (TIR, 3.9-10.0 mmol/l) by 8.3% (P<0.001) and HbA1c by 3.8 mmol/mol (P<0.001) when dynamic glucose management (dynamic GM) strategies were implemented. The subsequent analysis enabled the determination of the most effective strategies for the first 100 graduates and presentation in a user-friendly format avoiding fatigue.

Methods: Step 1) The first 100 CYPD CGM Academy graduates completed a questionnaire at six months documenting their use of the seven dynamic GM strategies:(1) Prevent hypos (2) Trend Arrow Adjustment Tool (TATT), (3) Bolus timing (4) Exercise checks (5) Regular CGM report review (6) Short bursts of exercise and (7) Insulin corrections. Step 2) Factors predicting TIR were identified after adjusting for variables, using multiple linear regression. Step 3) using the strongest predictors of TIR, an infographic was co-created by the diabetes team and CYPD.

Results: The best predictors for TIR were: Short bursts of exercise (β=3.261, P<0.001), Bolus timing (β=2.651, P=0.006), and Prevent hypos (β=2.52, P=0.015). These three strategies were condensed into a mnemonic facilitating ease of teaching and memory retention: GAME (Stop highs)-SET (stay in target) -MATCH (Prevent lows). GAME: G = Glucose percentage TIR desired, A =Alert on high set accordingly, M = Mode of exercise, E = Exercise time. SET: S = Start insulin before eating, E = Eat three balanced meals, T = Ten minutes of moderate activity. MATCH: M = Measure weight in kilograms, A = Always use glucose, T = Try to prevent hypoglycaemia, C = Change glucose amount, H = Have patience and wait 20 minutes.

Conclusion: Teaching the most effective dynamic GM strategies avoids user overload and fatigue. The use of an infographic has eased the reiteration of taught strategies in the busy clinic setting. The retention of taught strategies will be further evaluated on an ongoing basis.