Glucose sensing in primary care: A new digital training package

The latest updates to the NICE NG17 and NG28 guidelines recommend wider access to real-time continuous glucose monitoring (rtCGM) and intermittently scanned CGM (isCGM, commonly known as “flash”) for people living with diabetes. The use of isCGM and rtCGM has been proven to improve time spent in target glucose range (3.9–10.0 mmol/L), improve quality of life and reduce the risk of hospital admissions for severe hypoglycaemia and diabetic ketoacidosis.

CGM works through a tiny sensor that is inserted under the skin, usually on the stomach or back of the arm. The sensor measures the amount of glucose in the interstitial fluid between the cells. Current rtCGM systems (like the Dexcom ONE) automatically transmit glucose data in real time to a receiver, smartwatch or smartphone. isCGM (like the FreeStyle Libre) provides the same type of glucose data but requires the user to scan the sensor intermittently (at least every 8 hours in the case of the Libre) to obtain the information.

Who can access CGM?

Historically, these devices have been limited to certain people with type 1 diabetes who required support from secondary care specialist teams. However, the updated NICE guidance recommends that all people with type 1 diabetes and some people with type 2 diabetes using multiple daily insulin injections (see Box 1) be offered this technology. With the change in guidance, initiation and prescribing of these technologies may now begin to take place in primary care.

How can we learn more?

Healthcare professionals working in primary care can now increase their knowledge and confidence in using isCGM and rtCGM thanks to a new suite of digital training resources. The Implementing glucose sensing in primary care training package has been developed by the award-winning EDEN team at Leicester Diabetes Centre, in partnership with and endorsed by the Primary Care Diabetes Society and the Diabetes Technology Network UK.

For some healthcare professionals who are not familiar with CGM, the prospect of up-skilling may feel challenging. Some common concerns have been around the complexity of using CGM, and the time needed to review and interpret glucose data. The digital package is designed to allay any uncertainty and provide structured learning to improve knowledge and confidence. This training will equip healthcare professionals with the skills needed to support people living with diabetes and using CGM.

Implementing glucose sensing in primary care

The digital training package includes a comprehensive suite of resources suitable for healthcare professionals, which can be completed in bite-sized chunks. It comprises four elements that can be completed at an individual pace and convenience. The elements can be completed as stand-alone sections or as a complete package and include the following:

Video resources

The package includes two introductory videos. The first features Professor Pratik Choudhary and Dr Clare Hambling, covering:

• What is CGM?
• The use of CGM in primary care.
• When would you use isCGM or rtCGM?
• What education patients need.
• Ensuring equitable access.
• Time lag in glucose reading.

The second is a more detailed discussion with EDEN educators Mike Skarlatos and Vicki Alabraba, covering:

• The difference between isCGM and rtCGM.
• The benefits of using these technologies.
• Using time in range as a clinical measure.
• How to access glucose data.
• High and low alarms.
• Driving regulations.

Interactive case studies

The short case studies (5–10 minutes each) include both people with type 1 diabetes and those with type 2 diabetes, and incorporate both FreeStyle Libre (isCGM) and Dexcom (rtCGM) devices. They guide the user in a step-by-step process through the common glucose data reports that are available on the product-specific, cloud-based data-sharing platforms. Common themes, action planning and how to best support people living with diabetes are explored. Working through the case studies will be a useful way for healthcare professionals to familiarise themselves with each glucose report, learn how to interpret the data and decide on how to best support their patients.

Product-specific e-Learning modules

Product-specific e-Learning modules are available for both the FreeStyle Libre and Dexcom devices, and each module is divided into two parts. The first part explores how to use each system, along with the underpinning evidence and accessibility. The second part provides more detail on trend arrows, time in range targets, hypoglycaemia management, glycaemic variability and navigating the cloud-based data-sharing platforms (LibreView and Clarity). Each module includes frequently asked questions as well as practical case studies to consolidate learning.

Product-specific implementation toolkits

Digital implementation toolkits are available for both isCGM and rtCGM devices. These offer practical solutions to start using this technology with patients and to review glucose data. This includes information on:

• National guidance.
• Setting up user and clinic accounts.
• Alarms.
• Trend arrows.
• Time in range.
• Hypoglycaemia management.

The digital training package also signposts users to the Diabetes Technology Network UK, which provides further education on diabetes technology for healthcare professionals as well as service users. By collating all the product-specific resources and storing them in one place, we always have access to a simple set of resources.

Find out more

The training package is free to access, and is available at: https://www.glucose-sensing.com

The EDEN team can be contacted at eden@uhl-tr.nhs.uk for any further information.