Objectives: Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). Design and methods: Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award-winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9-10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T-test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. Results: Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR. Conclusion: Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.
Bibliographical noteFunding Information:
We are extremely grateful to the ten families who piloted the CGM Academy and would like to thank all patients and families for their participation. We would like to gratefully acknowledge the contribution of; the CGM Co-ordinator, Danielle Alcock, the diabetes dietitians and nurses, Hilary McCoubrey, Catarina Leal, and Susan Gleeson, the CGM Committee members; Lesley Drummond, Louise Collins and Peter Eyre.
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
- continuous glucose monitoring
- cost analysis
- pediatric type 1
- structured education
ASJC Scopus subject areas
- Internal Medicine
- Pediatrics, Perinatology, and Child Health
- Endocrinology, Diabetes and Metabolism