Confidence, Aptitude Using CGM Alone Among People Living With Insulin-Requiring Diabetes
In this podcast, Ellen Ospelt, RN, BS, CDCES, discusses the confidence and aptitude that people living with insulin-requiring diabetes demonstrate in using CGM alone, including understanding technology, numeracy, and diabetes distress. She also discussed this topic during her poster presentation at ADCES 2023 titled “Is CGM Alone Appropriate for All People With Diabetes on MDI Therapy? Confidence Versus Aptitude.”
Additional Resource:
Ospelt E, Benessere M, Jacoby J, Gilbert C. Is CGM alone appropriate for all people with diabetes on MDI therapy? Talk presented at: ADCES 2023. August 4-7, 2023. Accessed August 24, 2023. https://www.adcesmeeting.org/2023/ADCES23/
TRANSCRIPTION:
Jessica Bard:
Hello, everyone, and welcome to another installment of Podcast 360, your go-to resource for medical education and clinical updates. I'm your moderator, Jessica Bard with Consultant360, a multidisciplinary medical information network. Ellen Ospelt is here to discuss her poster presentation at ADCES 2023.
Ellen Ospelt:
I'm Ellen Ospelt. I am the Senior Medical Science Liaison at Bigfoot Biomedical.
Jessica Bard:
If you don't mind, please provide an overview of your poster presentation at ADCES 2023 titled, Is CGM Alone Appropriate for All People with Diabetes on MDI Therapy?
Ellen Ospelt:
Sure. So yeah. So with expanded access to continuous glucose monitoring therapies, Bigfoot Biomedical and Seagrove Partners sought to find out if people living with insulin-requiring diabetes demonstrated both confidence and aptitude in using CGM alone. We presented this poster at the ADCES 2023, and we highlighted two of the areas within the survey related to CGM therapies.
All participants were presented with images of sensor scans and then asked about their confidence in what they would do with those scans and what actions they would take. Most people were very confident in their ability, with 80% saying they were confident or extremely confident, but when they were asked what they would do around what actions they would take, a quarter of them selected things that might be dangerous such as taking glucose tablets when they were already running high.
Jessica Bard:
And why would you say that's such an important topic to study?
Ellen Ospelt:
What is exciting about CGM therapies is there's some expanded access going on with CMS, and the coverage has changed in 2023 allowing more and more people to gain access to CGM therapies. The ADA Standards of Care 2023 and the AACE Clinical Practice Guidelines all share the recommended use of CGM devices for those with insulin-requiring diabetes. But we know that, even with all these great advances, glycemic control continues to not meet the glycemic goals of less than 7%. So Bigfoot wanted to find out more and ask questions of what could be the reasons.
And we know that diabetes literacy, health literacy, and numeracy can all be possibilities. So if you're not familiar with diabetes numeracy, it's the ability to understand numbers to address issues and then be able to perform self-management tasks for diabetes care. And those with diabetes numeracy issues typically have a higher A1c. So we wanted to ask more questions of, do people know, when they see a sensor reading or scan, what to do? And so that was the main gist of why we wanted to move forward with the study.
Jessica Bard:
I know you touched on a couple of the results of the survey, but do you mind taking a little bit of a deeper dive into some of the results of the survey and how they might impact clinical practice going forward?
Ellen Ospelt:
Yeah, sure. So before we talk about the results, let's discuss who participated in this study, because I think it's important to recognize that these patients who participated were not new to diabetes. So Seagrove Partners reached out to about 90 people living with insulin-requiring diabetes. They were asked about their personal demographics, their history, and what diabetes therapies they're currently using. 87 patients participated in this study. All of them were current CGM users, and all were living with insulin-requiring diabetes.
We excluded those who were on insulin pumps and on AID. 45% were type 1. 55 were type 2. They were all pretty much between the ages of 35 and 64. 78% had been on MDI therapy for five years or more, 20%, for three or four years, so almost 90% were greater than three years on MDI therapy. These were users of all the CGM devices on the market, and we didn't focus on just one, and 62% stated that their glycemic control was above average of 7.2%. So I think it's important to understand that these were not patients that were new to diabetes.
And what we did was, for the survey, we showed them sensor scans and asked them questions about how confident they were about knowing what to do with the scan, and then what actions would they take. So one of the images that we shared was a glucose value of 210 with a trending upward arrow, and you would know that that's about 1 to 2 mg/dL per minute going up. And 70% to 80% of them were very confident in what actions they would take.
But when we asked them what actions they actually would take, 55% would take insulin. Many of them said they would maybe avoid carbs and maybe do a little exercise. But many of them did state they would need more information, with 34% of them, especially the type 2, who would research online or contact their doctor for more information. So that's about one in three would want to seek out additional information. And then about 25% of them said they would take a glucose tablet or drink juice. So that was concerning. And one in four would say they would treat that glucose of 210 with an arrow going up.
The second part of the survey that we're sharing is that we also went with a little higher glucose value of 280 with a trending straight up arrow. So that would be about two points per minute. And again, 60% to 70% said they were very confident in what actions they would take. And then, when they asked, "Do you know how much insulin to take?" about 50% of them, again, said that they were very confident in what to do. A little bit lower for the type 2 population, about 45%, so that higher glucose value did cause a little less confidence in that group.
But again, when we asked them what actions they would actually take, many of them, again, would say they would take insulin. But 59% of the type 2 said they would need to call or text their doctor before, HCP, healthcare professional, or educator, to support how much insulin to take. And 21% would need to look it up online on what to do. And again, one in four would take a glucose tablet or juice to treat that 280 going up. So again, a lot of them express confidence, but their aptitude and what actions they would actually take could cause severe hyperglycemia or hypoglycemia with the decisioning that they decided.
Jessica Bard:
What were the four main takeaways from this study?
Ellen Ospelt:
Sure. So I think the biggest takeaway is what the participants reported with what they would do, that seeing a sensor scan image of 210 trending up or 280 with a straight-up arrow, one in four would take a glucose tablet or eight ounces of juice, and that 59% of PWDs would reach out to their HCP to ask how much insulin to take. And I think that's what's really concerning is that, if we think about it, those that were surveyed were not new to diabetes or MDI therapy. And so this is concerning and needs to be shared that there could be definite gaps in understanding CGM therapies and what to do.
Number two is maybe confidence doesn't mean ability, really important to ask questions and accessibility. Having sensor screens like what was done in the survey could be an opportunity to learn, if you have access to a certified diabetes care and education specialist to help with training and education for even the confident patient, which may reduce safety concerns like what we had shared.
And three, remembering that insulin-requiring diabetes is hard. I remember reading an article that stated that a person with insulin-requiring diabetes makes an average of 180 health decisions a day. That's about a healthcare decision every eight minutes. Learning more about health literacy, numeracy, and diabetes distress, all could play a part in that decisioning.
And lastly, data is good, but knowing what to do with it is better. Utilizing tools like the Bigfoot Unity System which is a CGM plus with insulin dose-decisioning could be an option. There are more and more tools in the diabetes technology toolkit. Find the right technology for the right patient at the right time.
Jessica Bard:
And what would you say is next for research on this topic?
Ellen Ospelt:
Yeah, great. So Bigfoot doesn't have a plan to continue researching this particular topic. We do want to spread the word. So we thank you for sharing our message. We do have a study going on at Bigfoot Biomedical called BURST, in which we are looking at clinical outcomes, when we demonstrate what can be achieved when you're combining CGM plus insulin-dosing recommendations, using a tool like Bigfoot Unity System. We did present some three-month interim results at the ADA in June of 2023. So I think if we can just keep talking about this topic, and we're doing our part at Bigfoot to try and learn more, but really hoping that others will learn from this and change some care practices.
Jessica Bard:
And is there anything else that you would like to add today?
Ellen Ospelt:
I think that the expansion of diabetes technology is exciting. Surveys like this do remind us that putting people in technology and not assessing learnings or use could be concerning. I'm glad that the ADA and the ACE guidelines and even the CMS guidelines include the recommendations of three-to-six-month follow-up appointments to document adherence and make sure that therapy management is correct. Again, really, thinking about the patient and making sure it's the right technology for them, and assessing their understanding and learning.
Jessica Bard:
Perfect. Thank you so much for your time. We really appreciate you joining us in the podcast.
Ellen Ospelt:
Thank you.