Feasibility of the Web-Based Intervention Designed to Educate and Improve Adherence Through Learning to Use Continuous Glucose Monitor (IDEAL CGM) Training and Follow-Up Support Intervention: Randomized Controlled Pilot Study

Abstract

Background Proper training and follow-up for patients new to continuous glucose monitor (CGM) use are required to maintain adherence and achieve diabetes-related outcomes. However, CGM training is hampered by the lack of evidence-based standards and poor reimbursement. We hypothesized that web-based CGM training and education would be effective and could be provided with minimal burden to the health care team. Objective The aim of this study was to perform a pilot feasibility study testing a theory-driven, web-based intervention designed to provide extended training and follow-up support to adolescents and young adults newly implementing CGM and to describe CGM adherence, glycemic control, and CGM-specific psychosocial measures before and after the intervention. Methods The “Intervention Designed to Educate and improve Adherence through Learning to use CGM (IDEAL CGM)” web-based training intervention was based on supporting literature and theoretical concepts adapted from the health belief model and social cognitive theory. Patients new to CGM, who were aged 15-24 years with type 1 diabetes for more than 6 months were recruited from within a public university’s endocrinology clinic. Participants were randomized to enhanced standard care or enhanced standard care plus the IDEAL CGM intervention using a 1:3 randomization scheme. Hemoglobin A1c levels and psychosocial measures were assessed at baseline and 3 months after start of the intervention. Results Ten eligible subjects were approached for recruitment and 8 were randomized. Within the IDEAL CGM group, 4 of the 6 participants received exposure to the web-based training. Half of the participants completed at least 5 of the 7 modules; however, dosage of the intervention and level of engagement varied widely among the participants. This study provided proof of concept for use of a web-based intervention to deliver follow-up CGM training and support. However, revisions to the intervention are needed in order to improve engagement and determine feasibility. Conclusions This pilot study underscores the importance of continued research efforts to optimize the use of web-based intervention tools for their potential to improve adherence and glycemic control and the psychosocial impact of the use of diabetes technologies without adding significant burden to the health care team. Enhancements should be made to the intervention to increase engagement, maximize responsiveness, and ensure attainment of the skills necessary to achieve consistent use and improvements in glycemic control prior to the design of a larger well-powered clinical trial to establish feasibility. Trial Registration ClinicalTrials.gov NCT03367351, https://clinicaltrials.gov/ct2/show/NCT03367351.

Telehealth Technologies in Diabetes Self-management and Education

“…Indeed, a study conducted in young adults and adolescents newly diagnosed with diabetes and using CGM devices found that web-based training improved health outcomes and adherence. 44 Similarly, another prospective study that focused on individuals diagnosed with type 2 diabetes and prescribed real-time continuous glucose monitoring system reported that remote personalized coaching in combination with video-based coaching decreased HbA1c by 1.6% compared with baseline levels. 45 Interactive Web sites can tremendously assist patients in diabetes self-management by offering them tools and resources that improve knowledge, and by providing online tutorials and training for remote device initiation and usage.…”

“…Some Web sites also offer online record keeping tools where patients can track and monitor their diet, physical activity routine, as well as print reports or logs. 44 Many Web sites include blogs, healthy recipes, menus, and holiday meal planning guides. Some of the clinical web-based supportive educational tools include virtual chatting, message boards, e-mailing options, or options to connect with a live diabetes coach.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents

“…More complex therapeutic regimens with multiple daily injections, use of different insulins and insulin analogs, CSII, as well as using CGM devices require comprehensive education and practical training. Structured age‐specific education programs for adults, adolescents, or parents of younger children with T1D on the use of real‐time CGM systems and data interpretation have shown improvements in knowledge, satisfaction, glycemic control, and acceptance of real‐time CGM systems 102–104 . Using automated insulin delivery systems or hybrid‐closed loop systems requires comprehensive education and reeducation of all family members on nutrition and carbohydrate counting, safety behaviors, and an understanding of the integration of these elements into the daily activities of the child/adolescent using the system 105–107 .…”

“…Structured age‐specific education programs for adults, adolescents, or parents of younger children with T1D on the use of real‐time CGM systems and data interpretation have shown improvements in knowledge, satisfaction, glycemic control, and acceptance of real‐time CGM systems. 102 , 103 , 104 Using automated insulin delivery systems or hybrid‐closed loop systems requires comprehensive education and reeducation of all family members on nutrition and carbohydrate counting, safety behaviors, and an understanding of the integration of these elements into the daily activities of the child/adolescent using the system. 105 , 106 , 107 A key prerequisite for these diabetes technologies is that all team members are appropriately trained and able competently to manage these systems.…”

Collaboratively Designing an App for a More Personalized, Community-Endorsed Continuous Glucose Monitoring Onboarding Experience: An Early Study

“…20,21 Although there has been discussion of the importance of PWD's perspective in developing diabetes technology, 22 few studies have specifically examined HCD applied to diabetes. 10,[23][24][25] We investigated whether we could apply an HCD method and process to improve orienting PWD to CGM. Our specific aims were (1) to develop, applying a co-designing approach, a prototype of an app for facilitating onboarding to CGM and (2) to obtain early feedback on its usability.…”