Structured self-monitoring of blood glucose (SMBG) and retrospective continuous glucose monitoring (R-CGM) for people with type 2 diabetes (T2D) in primary care: registered nurse-credentialled diabetes educator (RN-CDE) reflections on patient and health professional (HP) responses. — ASN Events

Structured self-monitoring of blood glucose (SMBG) and retrospective continuous glucose monitoring (R-CGM) for people with type 2 diabetes (T2D) in primary care: registered nurse-credentialled diabetes educator (RN-CDE) reflections on patient and health professional (HP) responses. (#383)

Louise Ginnivan 1
  1. Department of General Practice, The University of Melbourne, Carlton, Vic, Australia

Two studies of people with T2D, “Initiation” and “Stepping Up”, focused on initiation and titration of basal +/- prandial insulin in people on maximum oral therapy with sub-optimal glucose levels. RN-CDE played a supporting and mentoring role to General Practitioners and Practice Nurses. In “Initiation” intervention, r-CGM was used to guide titration decisions, whilst “Stepping Up” intervention utilised SMBG 3-day 7-point profiles to ascertain glucose excursions and effect of insulin on designated meal. This paper aims to present RN-CDE’s observation and reflection on the use and acceptance of both these methods of BGLs monitoring in primary care. In the “Initiation” intervention, r-CGM devices were inserted and a 6-day profile of BGL pattern was uploaded. This technology was new to primary care thus required dedicated support from RN-CDE. Patients found r-CGM user friendly requiring minimal effort. HP appreciated the clarity of r-CGM traces; giving confidence to follow the titration schedule more effectively. Both patients and HP appreciated the visual tool, prompting discussion regarding glycaemic excursions and BGL affect of different foods. Whilst r-CGM was widely accepted and perceived to be effective for insulin titration by HP and patients, particularly in recognising prandial excursions, it is cost prohibitive. Uptake of SMBG in the “Stepping Up” intervention was less than expected. Some patients who embraced this profile found it educational to learn the effect of their lifestyle on BGLs and discern patterns across the three days. For HPs, a completed profile was valuable to understand daytime BGL patterns and incorporate this learning into intensifying therapy. Both methods of BGL monitoring in insulin therapy resulted in clinically significant glycaemic improvement, with HbA1c mean change 2.6% in t he “Initiation" study over 6 months, and 1.2% in the "Stepping Up" over 12 months. Further study to compare the effectiveness of the two methods is required.