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. 2017 Mar;11(2):284-289.
doi: 10.1177/1932296816661735. Epub 2016 Aug 20.

SPECTRUM

Bernhard Gehr  1 , Martin Holder  2 , Bernhard Kulzer  3 , Karin Lange  4 , Andreas Liebl  1 , Claudia Sahm  5 , Simone von Sengbusch  6 , Sandra Schlüter  7 , Thorsten Siegmund  8 , Ulrike Thurm  9 , Ralph Ziegler  10 , Guido Freckmann  11 , Lutz Heinemann  12 ; SPECTRUM Group
Affiliations

SPECTRUM

Bernhard Gehr et al. J Diabetes Sci Technol. 2017 Mar.

Abstract

Background: Optimal usage of continuous glucose monitoring (CGM) requires adequate training of the users. Providing patients with a CGM system without such a training usually doesn't lead to the intended improvement in metabolic control.

Methods: In Germany we developed a structured training program ("SPECTRUM") to ensure a high quality standard for the use of CGM systems.

Results: This program is suitably for patients of all age groups and is applicable to all CGM systems and all forms of insulin therapy. A curriculum was also developed so that training centers with less experience with CGM could become capable of offering comprehensive CGM training.

Conclusions: We believe that usage of such a program can be an important step forward in achieving more widespread acceptance and use of CGM systems. Translations in other languages and evaluation with a controlled clinical trial are planned.

Keywords: CGM; adolescents; children; continuous glucose monitoring; diabetes; diabetes therapy; educational program; teaching program; training program.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: BG reported advisory activities for Roche Diagnostics and received speakers’ honoraria and reimbursement of travel costs from Dexcom, Nintamed, Roche Diagnostics and Medtronic. MH received speaking fees and reimbursement of travel costs from Medtronic. BK received speakers’ honoraria or consulting fees from Abbott, Bayer, Berlin-Chemie, LifeScan, Novo Nordisk, Roche Diagnostics, Sanofi and Lilly. KL received speakers’ honoraria or consulting fees from Bayer, BDI, Lilly Deutschland, Medtronic, Menarini Berlin-Chemie, Merck Serono, MSD Sharp & Dohme, NovoNordisk, Roche Diagnostics and Sanofi-Aventis. AL reported advisory activities and received speaking fees and reimbursement of travel costs from Dexcom, Nintamed, Roche Diagnostics and Medtronic. CS received speaker’s honoraria from Roche and Medtronic. SvS reported advisory activities for Abbott, Medtronic and NovoNordisk and received speaking fees and reimbursement of travel costs from Abbott, Lilly, Medtronic, NovoNordisk and Pfizer. SS received speakers’ honoraria from Abbott, Astra Zeneca, Bayer, Berlin-Chemie, Lilly, Nintamed, Novo Nordisk, Roche Diagnostics, Sanofi-Aventis and advisory activities for Abbott. TS received speakers’ honoraria from Abbott, Ascensia, Astra Zeneca/Bristol-Myers Squibb, Bayer Vital, Berlin Chemie, Boehringer Ingelheim, Eli Lilly, Medtronic, MSD, Novartis, Novo Nordisk and Sanofi, reported advisory activities for Abbott, Bayer Vital, Boehringer Ingelheim, Eli Lilly, Janssen, Medtronic, MSD, Novo Nordisk and Sanofi, and reported research funding from Astra Zeneca/Bristol-Myers Squibb, Becton Dickinson, Eli Lilly, MSD, Novo Nordisk and Sanofi. UT reported advisory activities for Lilly and Animas and received speaking fees and reimbursement of travel costs from Bayer Healthcare, Berlin Chemie, DiabetikExpress, Novo Nordisk, and Medtronic. RZ received speaker’s honoraria or consulting fees from Abbott, Animas, Novo Nordisk and Roche Diagnostics. GF received speakers’ honoraria or consulting fees from Abbott, Bayer, Berlin-Chemie, Becton-Dickinson, Dexcom, LifeScan, Menarini Diagnostics, Novo Nordisk, Roche Diagnostics, Sanofi, and Ypsomed. LH is a member of a number of national and international Advisory Boards for companies developing novel diagnostic and therapeutic options.

Figures

Figure 1.
Figure 1.
SPECTRUM training file with printed curricula and slides from the memory stick.
Figure 2.
Figure 2.
Examples of slides from the 3 versions of SPECTRUM for adults, for parents with young children, and for adolescents with type 1 diabetes. (a) SPECTRUM was developed as a manufacturer independent educational program by 2 working groups of the German Diabetes Association. This example shows the opening slide of module 1 for adults. (b) This is an example taken from the pediatric version of SPECTRUM for young kids and their parents. Possible advantages and challenges of CGM use are discussed prior to the decision on using CGM. (c) Patients are involved actively into the educational program. In this example taken from the adult version of SPECTRUM the patients should note their personal expectations connected with CGM use on a special card. This card will be stored until the end of SPECTRUM by the diabetes team and then discussed again. (d) As strict product neutrality is crucial for reimbursement of a patient educational program in Germany, we developed a neutral CGM display. This example is taken from the adolescents’ version of SPECTRUM and patients are asked to discuss the correct reaction to a low alarm. (e) This example is taken from the adult version of SPECTRUM and shows how patients are trained for interpreting their CGM display by discussing small “real” cases. Patients are asked in a very structured way to describe what they see on the display, which causes may underlie, and what the patient should do now in this situation. The next slides show the same case a few hours later (not shown). (f) The patients are suggested a structured way of interpreting CGM data (retrospective analysis) in 4 steps: detect recurrent hypoglycemia and assess glucose levels during nighttime and before and after meals. This algorithm is practiced with own CGM data during the training sessions.
See this image and copyright information in PMC

References

    1. Lodwig V, Kulzer B, Schnell O, Heinemann L. Current trends in continuous glucose monitoring. J Diabetes Sci Technol. 2014;8:390-396. - PMC - PubMed
    1. Wolpert H. Establishing a continuous glucose monitoring program. J Diabetes Sci Technol. 2008;2:307-310. - PMC - PubMed
    1. Joubert M, Reznik Y. Personal continuous glucose monitoring (CGM) in diabetes management: review of the literature and implementation for practical use. Diabetes Res Clin Pract. 2012;96:294-305. - PubMed

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