Glucose monitoring technology: Do you and your patients have the skills and knowledge to use it effectively?

I have been pleasantly surprised at how, with a sustained campaign, the uptake of flash glucose monitoring for people with type 1 diabetes has increased across England (Figure 1; Kar, 2019).

Allocation of central funding has granted access to this technology for many people, and the initial national target is to have around 20% of people with type 1 diabetes using flash monitoring (NHS England, 2019). In order to identify a cohort of patients who are likely to benefit from the device, the criteria in Box 1 have been agreed.

Since the launch of flash glucose monitoring, I have worked with people who have declared it “life-changing” and “a game changer”, and it has provided them with the information to feel “in control and able to make real-time decisions” regarding insulin dosing and other aspects of glucose management. We are also seeing the device used in innovative ways to improve service delivery, as Jane Rowney and David Lipscomb report in this issue. However, on the flip side, I have worked not only with people who have found the sheer volume of information both overwhelming and confusing, but also with people who, more disappointingly, had not even looked at any of the information screens available to them.

As we report in our Journal scan section, this year, an international group of experts developed a consensus document, concluding that continuous and flash glucose monitoring technology can provide valuable information on “time in range” (Battelino et al, 2019). HbA_1c is seen as a key marker of control in relation to development of long-term complications; however, it is well recognised that this provides little to no information on daily glycaemic highs and lows. Supporting people to use the information available from flash technology to identify patterns and adjust insulin, exercise and dietary regimens to maximise the percentage of time spent in target glycaemic range is seen as the clear way forward in diabetes management.

During consultations, when I have shown the data screens displaying time in range, ambulatory glucose profile and daily profiles, many users have said they were unaware of the screens or that they did now know what they represented and so did not use them. Most people, in my experience, have used the immediate glucose result with directional arrow to deal with their diabetes on a moment-by-moment, forward-looking premise. However, they had not understood how to interpret the information that would allow them to make measurable changes to their regimens.

As with all advances in technology, the information available has to be well understood in order for it to have a positive impact on lives and daily decisions. It is imperative that all healthcare professionals not only understand the technology and the information it provides but also, vitally, are able to interpret it. This knowledge will allow us to have meaningful conversations with our patients in order to support them in improving their daily glycaemic control.

If we are to truly maximise the potential of this technology, it is imperative that clinicians have the skills and competence required. If we are to be able to offer the best care and advice to our patients, we absolutely have to keep abreast of changes, understand the new language used and access any training available to us.