Auditing the process of initiating children and young people (CYP) with diabetes on a Intermittent scanned Continuous Glucose

Monitoring (isCGM)
device and their use of CGM by Suzanne Smith and Zahra Olateju
Introduction and Rationale Results
Diabetes affects over 36,000 CYP in the UK.
Successful
[1]
Number of times monitor is scanned per day
Ethnicity of Participants
diabetes control requires regular self-management of blood
glucose levels to avoid complications.[2] isCGM devices have
the potential to improve glycaemic control.[3] NHS England
funding is needed to ensure the provision of these devices and
is dependent on predetermined criteria that hospitals must
meet.[4]

Aims Predetermined Criteria

To determine whether all
CYP placed on isCGM met Patients have Type 1 Attendance to the first training %Time monitor is active %Time spent within target range of interstitial
diabetes.
the predetermined criteria session glucose levels
for isCGM use.
Attendance of patients at
a required number of
To evaluate whether all CYP CGM training sessions
and their carers attended the (n=2).
required training sessions.
The use of the monitor at
least 70% of the time.
To assess the proper use of
isCGM by CYP as per the Agreement to scan the
predetermined criteria. monitor no less than eight
times a day.
Figure 1 Figure 2

Methodology Discussion and Conclusion Recommendations

City and Sandwell Hospital.
Setting
All CYP with Type 1 diabetes who started
isCGM between April 2020-March 2021
Patients
(n=50).
Collection Retrospective data collection. Data was
collected from hospital records and LibreView.
Data was analysed using Excel and assessed
Analysis
for whether all cases met the predetermined
criteria for isCGM.
• There is insufficient data to see whether the correct patients were
placed on isCGM.
• A significant proportion of patients were not meeting the criteria
for compliance with their isCGM monitor. This may be due to the
conscious effort required to scan.
• Additionally, only 54% of patients were in target (3.9-10 mmol/L)
for over 50% of time. Therefore, isCGM may not be effective for
successful glucose control as compliance is suboptimal.
• Socioeconomic factors may be a key factor which affects
patients ability to data share with the hospital.
Limitations
• LibreView data only represents interstitial blood glucose levels
over the last 14 days.
• In conducting a retrospective audit, we are missing some key
data.
• Offer patients real time CGM, which offers a continuous
stream of data, as an alternative monitoring device.
• Offer more regular patient education.
• Provide alternative data sharing options.
• Conduct qualitative research to explore patients and
caregivers attitudes to CGM.
• Reaudit to assess improvement.
References
1. RCPCH State of Child Health. Diabetes [internet]. 2020 [cited 11 October 2021]. Available from:
https://stateofchildhealth.rcpch.ac.uk/evidence/long-term-conditions/diabetes/
2. American Association of Diabetes Educators. Intensive diabetes management: implications of the DCCT and UKPDS.
The Diabetes Educator. 2002; 28(5):735–740.
3. Soni A., Wright N., Agwu J.C., Drew, J. et al. Fifteen minute consultation: practical use of continuous glucose
monitoring. Archives of Disease in Childhood – Education and Practice. 2021; 0: 1-6. Doi: 10.1136/archdischild-2020-
321190
4. NHS England. Flash Glucose Monitoring: National Arrangements for Funding of Relevant Diabetes Patients [internet].
2019 [cited 11 October 2021]. Downloaded from: https://www.england.nhs.uk/wp-
content/uploads/2019/03/National-arrangements-for-funding-of-relevant-diabetes-patients-June-2020-Updated-
final.pdf