Spectrum - Part 1: Curriculum E-Book

AGDT-AGPD Spectrum Group

• Herausgeber: Kirchheim Verlag
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 201

Veröffentlichungsjahr: 2020

Beschreibung

This product includes the curriculum of the structured training and treatment program Spectrum. For patient training Spectrum - Part 2: Training Slides is also needed (available in pdf-version only). Spectrum is intended to train all patients who have an indication for using an rtCGM system. The diabetes teams have the flexibility to adjust the content depending on the needs, possibilities and limitations of the patients. CGM helps handle complex metabolic problems and enables patients to live a more flexible lifestyle. Patients can only unlock the full potential of a sensor-based intensified insulin therapy with pens or with pump therapy if they receive proper training to optimally use the displayed CGM information and sensibly vary the alarm settings. Spectrum is best suited for use in group training. The group should be 2-4, maximum 5, patients. In groups with more than 5 participants, the risk exists that certain aspects might not be delved into enough, such as aspects which apply to individual participants, the individual evaluation of CGM data or characteristics of the different CGM systems. The training material is suitable for individual consultation although this then lacks the helpful effects of the synergy of the group. Upon completing Spectrum, patients with diabetes have the knowledge to safely and successfully use a CGM system. Contrary to a product training, Spectrum places the focus not on the device characteristics but rather on the therapeutic use of the measurement results and the practical use of the systems in daily life. Patients learn how to understand the information given by the CGM device, how to properly use the alarm functions and how to draw the correct therapeutic conclusions. This product includes the curriculum only! For patient training the "Spectrum - Part 2: Set of Slides" is also needed.

Leseprobe

All about SPECTRUM

The training and treatment program SPECTRUM is a product neutral, manufacturer-independent program which is used to train patients with diabetes in all age groups who wish to begin using realtime continuous glucose monitoring.

SPECTRUM is a cooperation project of the AGDT (Diabetes & Technology Working Group of the German Diabetes Association) and the AGPD (Pediatric Diabetology Working Group of the German Diabetes Association). The SPECTRUM working group of the AGDT developed a set of slides for adult patients with diabetes. Using this, the SPECTRUM working group of the AGPD developed a set of slides to train teenagers and parents of younger children with diabetes. Both working groups also put the necessary curricula together.

The creation of SPECTRUM was done on a voluntary and unsalaried basis. The AGDT covered the organizational costs for the SPECTRUM working group of the AGDT and the costs for the editorial completion of SPECTRUM by the research institute of the Diabetes-Akademie Mergentheim (Berthold Maier, FIDAM). The AGPD covered the organizational costs for the SPECTRUM working group of the AGPD and for the consultation services of an external graphic designer to a lesser extent. The Kirchheim Publishing House covered the costs for photography, layout and graphic design of the original German version.

The Authors

Bernhard Gehr, Senior Diabetologist in Fachklinik Bad Heilbrunn (south of Munich, Germany), is the project leader of the entire SPECTRUM program and head of the adult version on behalf of the AGDT. Martin Holder, Chief Physician in the Stuttgart Clinic, Olgahospital, is head of the pediatric version on behalf of the AGPD.

The set of slides for adults was created under the leadership of Bernhard Gehr (head of Module 1) with the assistance of Bernd Kulzer (head of Module 0), Ulrike Thurm (head of Module 2), Thorsten Siegmund (head of Module 3), Claudia Sahm (head of Modules 4, 5 and 6) and additional support by Eberhard Biermann, Sabine Carstensen (until Feb/2014), Guido Freckmann, Lutz Heinemann, Elke Kerth, Ralf Kolassa, Andreas Liebl, Rosalie Lohr, Berthold Maier, Kerstin Remus, Sandra Schlüter, Marcella Schulz-Braun and Marita Wernsing. Berthold Maier was responsible for unifying and preparing the slide drafts. Mr. Maier was also responsible for preparing the curriculum of the adult version. Elke Kerth and Berthold Maier organized the photo shoot for the adult version.

The set of slides for teenagers and parents of children with diabetes was created under the leadership of Martin Holder and with the assistance of Simone von Sengbusch, Ralph Ziegler, Dorothee Deiss, Bettina Heidtmann, Carmen Ludwig-Seibold, Tanja Wadien, Kerstin Remus and Karin Lange. Karin Lange was responsible for preparing the curriculum of the pediatric version. Martin Holder and Tanja Wadien organized the pediatric photo shoot.

We sincerely thank all the CGM wearers who took part in the photo shoot.

Bibliographic Information of the Deutsche Bibliothek (German Library)The Deutsche Bibliothek lists the original German publication in the Deutschen Nationalbibliographie (German National Library); detailed bibliographic data can be called up on the Internet at http://dnb.ddb.de

ISBN ISBN 978-3-87409-713-0

Publisher

© Verlag Kirchheim + Co. GmbH, Kaiserstraße 41, 55116 Mainzwww.kirchheim-shop.de2nd updated version 2017

Arbeitsgemeinschaft Diabetes und Technologie der Deutschen Diabetes-Gesellschaft (Diabetes & Technology Working Group of the German Diabetes Association)

Arbeitsgemeinschaft pädiatrische Diabetologie der Deutschen Diabetes-Gesellschaft (Pediatric Diabetology Working Group of the German Diabetes Association)

Bernhard Gehr, Martin Holder, Bernd Kulzer, Ulrike Thurm, Thorsten Siegmund, Claudia Sahm, Eberhard Biermann, Sabine Carstensen, Guido Freckmann, Lutz Heinemann, Ralf Kolassa, Elke Kerth, Andreas Liebl, Rosi Lohr, Berthold Maier, Kerstin Remus, Marcella Schulz-Braun, Sandra Schlüter, Marita Wernsing, Dorothee Deiss, Bettina Heidtmann, Carmen Ludwig-Seibold, Simone von Sengbusch, Tanja Wadien, Ralph Ziegler, Karin Lange.

SPECTRUM and all of its parts are protected by copyright. Any use outside of narrow bounds of the Copyright Law is not permitted and is punishable by law without consent of the publisher. This applies in particular to reproductions, translations, microfilming, storage and processing in electronic systems.

Photography: Victor S. Brigola, StuttgartDesign: Dupont & Steyer, Windesheim

Reprinting or reproduction, copying of any kind, either in its entirety or in part, is only permitted with the written permission of the publisher.

Protected brand names (trademarks) are not specially indicated. The absence of such notes may not be interpreted to mean that a brand name is unregistered.

SPECTRUM and all of its parts are protected by copyright. Any use outside of narrow bounds of the Copyright Law is not permitted and is punishable by law without consent of the publisher. This applies in particular to reproductions, translations, microfilming, storage and processing in electronic systems.

© Verlag Kirchheim + Co. GmbH, Kaiserstraße 41, 55116 Mainz

Contents

All about SPECTRUM

The Authors

Dear Training Teams, dear Colleagues,

Dear Users,

1.   Frequently asked questions on SPECTRUM (adult version)

2.  Importance of SPECTRUM for successful CGM use

3.  SPECTRUM: Modern didactics and methodology

4.  How to use the curriculum

5.  The authors of SPECTRUM (“The SPECTRONAUTS”)

Module 0: Introduction

0.1  Welcome and introduction

0.2  Short introduction round

0.3  What is CGM?

0.4  How does continuous glucose monitoring work?

0.5  What are the advantages and disadvantages

0.6  What CGM systems are available?

0.7  What does continuous glucose monitoring cost? Is cost reimbursement available?

0.8  Your questions and your decision

0.9  Good-bye

Module 1: Basics of contiuous glucose monitoring (CGM)

1.1  Welcome and introduction

1.2  How a CGM system works

1.3  Display of the CGM system

1.4  Accuracy of the CGM system

1.5  Calibration

1.6  Current glucose trend: interpreting correctly and taking action

1.7  Alarm functions

1.8  Tasks to be performed at home

1.9  What’s next in Module 2

Module 2: CGM Start

2.1  Overview of topics for Module 2

2.2  Basic settings, alarm settings, proven CGM initial settings in detail

2.3  Inserting the first sensor

2.4  What should CGM users observe when calibrating?

2.5  Tips for the first days

2.6  Exercises

2.7  What’s next in Module 3

Module 3: CGM display and alarms

3.1  Overview of topics for Module 3

3.2  The first days with the CGM system: Exchanging experience

3.3  Calibration and alarms

3.4  Correctly interpreting information on the CGM display

3.5  What’s next in Module 4

Module 4: Analyzing personal CGM data (Part 1)

4.1  Overview of topics for Module 4

4.2  In retrospect: the first weeks with the CGM system

4.3  Evaluating CGM data: introducing a systematic approach

4.4  Evaluating CGM data: practical exercise using data brought by patients

4.5  Task: My three goals until the next module

4.6  What’s next in Module 5

Module 5: Analyzing personal CGM data (Part 2)

5.1  Overview of topics for Module 5

5.2  In retrospect: the first weeks with the CGM system

5.3  Evaluating CGM data: Repetition of the systematic approach

5.4  Evaluating CGM data: practical exercise using data brought by patients

5.5  Task: My three goals until the next module

5.6  Good-bye and what’s next in Module 6

Module 6: CGM advanced training

6.1  Overview of topics for Module 6

6.2  In retrospect: the past weeks

6.3  Experience with the CGM system over the entire training course

6.4  CGM and physical activity

6.5  CGM in water and in the sauna

6.6  On vacation with the CGM system

6.7  With CGM in the hospital

6.8  Taking stock of the course, other goals, what’s next

6.9  Good-bye

Dear Training Teams, dear Colleagues,

We would like to welcome you to the circle of diabetes teams treating patients with continuous glucose monitoring (CGM). The SPECTRUM program is a structured, manufacturer-independent training and treatment program. The name SPECTRUM comes from „structured patient education for continuous glucose monitoring“.

Two working groups of the Deutsche Diabetes-Gesellschaft (DDG) (German Diabetes Association) participated in the creation of this program: the Arbeitsgemeinschaft Diabetes & Technologie (AGDT) (Diabetes & Technology Working Group of the German Diabetes Association) and the Arbeitsgemeinschaft Pädiatrische Diabetologie (AGPD) (Pediatric Diabetology Working Group of the German Diabetes Association). More than two dozen diabetologists, diabetes advisors, scientists and psychologists from the fields of adult and pediatric diabetology kindly contributed their knowledge, varied experience and Practical tips.

Upon completing SPECTRUM, patients with diabetes have the knowledge to safely and successfully use a CGM system. Contrary to a product training, SPECTRUM places the focus not on the device characteristics but rather on the therapeutic use of the measurement results and the practical use of the systems in daily life. Patients learn how to understand the information given by the CGM device, how to properly use the alarm functions and how to draw the correct therapeutic conclusions.

The SPECTRUM program offers you a training and treatment program which fulfills the needs of different target groups:

There is a SPECTRUM version for adults, one for children and their parents, as well as a version for teenagers with diabetes. The content of the training as well as the language and approach used are tailored to these target groups. SPECTRUM can be used independently of the type of insulin therapy. Patients on injection therapy (MDI) or an insulin pump therapy (CSII) can use the same set of slides and can be trained in the same group. SPECTRUM also takes into account that the glucose units mg/dl and mmol/l are both used in several countries. The sets of slides are available in both units of measure.

SPECTRUM thereby fulfills the quality requirements as specified in the National Medical Guideline „Diabetes – strukturierte Schulungsprogramme“ (Diabetes – structured training programs) as well as the standards defined by the International Diabetes Federation.

Many colleagues have worked on the program thus far but there are bound to be other good ideas – we look forward to your suggestions and feedback.

The authors wish you fun and success with SPECTRUM!

Yours sincerely

Bernhard Gehr,Head of the adult version (AGDT)

Martin Holder,Head of the pediatric versions (AGPD)

... on behalf of the author team: Eberhard Biermann, Sabine Carstensen, Dorothee Deiss, Guido Freckmann, Bernhard Gehr, Bettina Heidtmann, Lutz Heinemann, Martin Holder, Elke Kerth, Ralf Kolassa, Bernd Kulzer, Karin Lange, Andreas Liebl, Rosi Lohr, Carmen Ludwig-Seibold, Berthold Maier, Kerstin Remus, Claudia Sahm, Marcella Schulz-Braun, Sandra Schlüter, Thorsten Siegmund, Ulrike Thurm, Simone von Sengbusch, Tanja Wadien, Marita Wernsing, Ralph Ziegler.

Dear Users,

The first section of this curriculum is intended to empower diabetes professionals to use the SPECTRUM program in its version for adults. Two more versions of SPECTRUM for pediatric target groups will be covered later in this curriculum.

On the following pages we would like to present the central ideas of SPECTRUM to explain this training and treatment program and the methodology we have chosen. You will also find information and tips to help you prepare and present the SPECTRUM course.

The attending physician is responsible for prescribing a continuous glucose monitoring system, for accompanying the start of CGM use with measures such as this training course, for the optimization of alarm settings and the regular evaluation of the saved CGM information.

In order for patients to properly use CGM in their day-to-day lives and for them to draw the correct conclusions for their insulin therapy, the consultations with the physician and diabetes advisor should go hand-in-hand with this training. For this reason, SPECTRUM places the emphasis on close cooperation between all parties for the evaluation of the measured glucose values, the interpretation of glucose trends and the individual definition of therapeutic consequences.

We would like to wish you much success in the use of SPECTRUM for adults!

Yours truly, the Author Team.

1. Frequently asked questions on SPECTRUM (adult version)

What is the target group for SPECTRUM?

For several years now there have been systems available on the market for continuous glucose monitoring (CGM). Real-time CGM systems display a current glucose value and have various alarm functions (rtCGM).

SPECTRUM is intended to train all patients who have an indication for using an rtCGM system. The diabetes teams have the flexibility to adjust the content depending on the needs, possibilities and limitations of the patients. CGM helps handle complex metabolic problems and enables patients to live a more flexible lifestyle. Patients can only unlock the full potential of a sensor-based intensified insulin therapy with pens or with pump therapy if they receive proper training to optimally use the displayed CGM information and sensibly vary the alarm settings.

In order for patients to profit from SPECTRUM, they should fulfill the following prerequisites:

high personal motivation for performing insulin therapy and for dealing with diabetes,the necessary cognitive abilities to understand complex metabolic connections and correctly interpret glucose trends andthe willingness to actively participate in the training course. This includes following glucose values and trends closely between the course sessions and implement and consolidate what they have learned with the help of tasks and exercises. It is also important for patients to be ready to share their observations in the course sessions and critically reflect upon therapy decisions.

Participation in the SPECTRUM training and treatment program is not recommended for patients who

expect CGM to be the solution for all their diabetes problems and place the responsibility for the success of their diabetes therapy on the course leader/doctor,are overwhelmed by the high volume of data and information, both for cognitive and psychological reasons,react with strong, dysfunctional fear when dealing with CGM data and/or who might be at risk for trying to handle their fears by using excessive control strategies,are affected by insufficiently controlled psychological problems, abnormalities and disorders (e.g. fear or obsessive-compulsive disorders, addiction or dependence disorders).

How is SPECTRUM for adults set up?

An information session („Module 0“) and a consultation with the diabetes team should precede the actual CGM training course so that patients are informed well enough to decide for or against using CGM. This module contains the basic information on CGM. Module 0 can be used as part of an MDI or insulin pump training or, for example, as part of an information evening as per the possibilities and plans of the diabetes center.

Modules 1 to 6 are intended for people with diabetes who have already decided to use CGM. This modules contain information for participants on the practical use of CGM and participants then practice using it in daily life. Any knowledge or skills already present are refreshed, brought up-to-date and delved into. The modules intend to convey information and skills on using CGM and also to exchange both the experience of daily life with diabetes as well as solutions for difficulties with CGM.

What are the focal points of the modules?

Module 0 conveys basic information on the topic of CGM in order to help patients make an informed decision for or against CGM.Module 1 delves deeper into the most important CGM basics (e.g. CGM display, lag time, calibration).In Module 2, the first sensor is inserted, the alarm settings are set and the start rules for the initial days are stipulated. Module 3 deals with the interpretation of the CGM information on the display and with the further optimization of the alarm settings. In Modules 4 and 5, the saved CGM data is evaluated together by all participants who then exchange their practical experience from the initial weeks of CGM use. Module 6 assists patients in using CGM over a longer period of time and under special circumstances (e.g. physical activity or traveling).

Modul

Thema

Module 0

Introduction and help making a decision

Module 1

CGM basics

Module 2

CGM start Inserting the first sensor

Module 3

CGM display and alarms

Module 4

CGM evaluation I

Module 5

CGM evaluation II

Module 6

CGM under special circumstances

Tab. 1: SPECTRUM modules (for adults) and main content

What time frame is sensible?

A time frame of approximately 8 weeks is intended for participation in the entire training and treatment program (4–12 weeks, see Table 2 for the time frame).

Module 0 can be presented at any point in time before beginning the course.Patients who have decided to participate in SPECTRUM are first taught the basics of CGM in Module 1 before inserting the sensor and beginning with CGM one week later as part of Module 2.To get off to a good start with CGM, patients should reflect upon the initial personal experience as part of Module 3 one week later. Any problems at the start should be addressed directly and solved as much as possible. Participants also quickly learn about the display and alarms.Working on Modules 4, 5 and 6 happens at an interval of about 2 weeks (larger intervals due to circumstances such as vacations is possible). In this way, participants have the possibility to gather comprehensive experience with CGM, exchange this experience and profit from the group dynamic.

Module

0

Introduction, decision

1

CGM basics

2

CGM start

3

CGM display, alarms

4

CGM ­evaluation I

5

CGM ­evaluation II

6

CGM under special circumstances

empfohlener Zeitpunkt

Vorfeld

– 1 Woche

0

+ 1 Woche

+ 2 Wochen

+ 4 Wochen

+ 6 Wochen

Zeitfenster

Egal

insgesamt ca. 1–3 Wochen

insgesamt ca. 3–9 Wochen

Tab. 2: Time frame for SPECTRUM for adults

SPECTRUM: individual and/or group training

SPECTRUM is best suited for use in group training. The group should be 2-4, maximum 5, patients. In groups with more than 5 participants, the risk exists that certain aspects might not be delved into enough, such as aspects which apply to individual participants, the individual evaluation of CGM data or characteristics of the different CGM systems. The training material is suitable for individual consultation although this then lacks the helpful effects of the synergy of the group.

Are there ways to prepare for implementing SPECTRUM?

The SPECTRUM AGDT author team offers regional training courses for physicians and qualified training personnel In Germany. For more information, visit www.diabetes-technologie.de.

2. Importance of SPECTRUM for successful CGM use

Training: decisive for gaining the skills needed to properly use CGM

Countless studies show unanimously that the only way that users can expect a benefit from CGM is if they use this technology continuously and correctly. In reality, this is often not the case. The main reason for this is often assumed to be the considerable costs associated with the use of CGM. However, incomplete use of CGM is also observed in patients who are able to use the CGM free of charge.

Two factors appear to be important for the successful use of CGM:

How do patients interpret the information obtained using CGM in the current situation and what are the therapeutic conclusions they draw?How did patients treat their diabetes before using CGM and how well did the patients control their therapy using blood glucose self-monitoring?

This is why structured patient education is of vital importance. Only then are users capable of using CGM technology properly and continuously.

SPECTRUM: Learning how to deal with the volume of data

Patients often react unsure and overwhelmed when they first use CGM. The constant availability of real-time data makes it much clearer to patients just how much their glucose values fluctuate throughout the day. Conventional blood glucose measurements only deliver 4-10 measurement results per day as the basis for making therapy decisions. By contrast, CGM delivers 288 glucose values per day as well as trends and statistics. The volume of data often makes it difficult for users to make the right therapeutic conclusions at the right time for their diabetes treatment. At the beginning it can be very tempting to intervene too frequently on the glucose trend by administering correction insulin or consuming carbohydrates, which often further destabilizes the metabolic state. Practical experience has also shown that compulsive behavior in patients can be worsened by CGM.

SPECTRUM gives patients methods to identify personal „typical CGM patterns“ that influence the success of therapy in a similar way (e.g. CH amount consumed, insulin dose, injection-to-food interval, etc.). At the same time, SPECTRUM participants learn the proper and safe criteria for adjusting the insulin dose in specific situations such as the correction of increased glucose values. One of the important aims of SPECTRUM is to give the users experience and, with increasing practice, reduce the feeling of insecurity and worries; this then makes it easier to optimally control the glucose trend and experience the advantages of CGM.

SPECTRUM: Learning to prevent hypoglycemias and hyper­glycemias

One central goal of SPECTRUM is to convey the skills which help reduce the occurrence of hypoglycemias and hyperglycemias. After starting CGM in Module 2, glucose trends are then analyzed using a structured approach. Each module maintains the focus on the goals of identifying the causes of repeated hypoglycemias and hyperglycemias and developing strategies to prevent such acute complications.

Keeping in mind that the occurrence of hypoglycemias is one of the most severe psychosocial burdens on people with diabetes, SPECTRUM aims to help patients feel able to control their diabetes and thereby reduce the worry associated with complications and situations. The skills learned as part of SPECTRUM thus help improve the well-being and quality of life of people with diabetes.

3. SPECTRUM: Modern didactics and methodology

The complexity of the topics brings with it a certain danger that patients might feel overwhelmed and insecure by the content of SPECTRUM. For this reason, the developers of SPECTRUM have made it possible for the trainers to adjust the didactic and methodical procedures according to the level of the participants. This should enable participants to successfully use CGM in daily life.

Training approach: Empowerment

During the development of SPECTRUM, the developers ensured that suitable illustrations were included to all the topics and content. A word of caution: Especially when using digital presentations, it is easy to end up in „slide overload“. It is important to avoid a flat out transmission of information. Participants should be allowed to work on, develop and exchange experience and ideas as much as possible. Their learning success should be created from their own experience, the joint analysis and the interpretation of their personal CGM trend curves and trying out new therapy strategies.

A mix of conveying information, repetition, practical exercises, ­exchanging experiences

When designing the individual modules, it was important that the participants not only gain new insights with each module, but to also brush up on and delve into existing knowledge. For this reason, the core content is often repeated across the different modules. Many practical exercises and sample case studies in the modules also provide additional support. The time participants take to exchanging experiences is very important.

The focus: practical training

SPECTRUM participants should intensively take part in discussions amongst themselves, in particular about how they experience CGM in their daily lives. Participants must also be given the possibility to articulate their worries and barriers to CGM and critically question their previous mindset towards CGM and/or blood glucose self-monitoring.

Creating references to daily life

Theory is always second-best to practice as diabetes comes to life in daily routines. For this reason SPECTRUM has the aim to depict the lifes of people with diabetes. The practical exercises and case studies often address situations from daily life: incidents at work, situations in relationships – what happens everywhere from family and sports to parties and celebrations.

Cross-product teaching of content

One basic feature of the SPECTRUM program is its strict product neutrality. All the information and illustrations have been prepared in such a way that users of different CGM systems can gain the skills they need to properly use their system. The characteristics and features of the individual systems or system components are presented neutrally.

Simple graphics, simple terms, the least technical terms possible

During development, the training material was carefully monitored to keep complicated facts as simple and clear as possible. Images, metaphors and common descriptions in everyday speech make it easy for participants to understand, solidify and remember this content. The displays, trend curves and statistics were simplified for the participants in order to facilitate learning and develop solutions to problems.

4. How to use the curriculum

When preparing a training course, the curriculum should be worked through using the sets of slides module by module.

Each module in the curriculum begins with a tabular overview of the topics. Information on the time required for the individual topics is also given so that you can estimate in advance the total amount of time you will need.

Every topic in the curriculum is set up as follows. First, the aims of each thematic unit are explained. The procedure is outlined and supplemented with suitable materials. Special notes help make it easier to successfully deal with challenging module situations.

The number is located on the right-hand of each slide. The consistent numeration of the slides makes it easier to follow. The numeration is set up as follows: 2.17 means Module 2, slide 17.

The slides and worksheets are listed with their respective numeration in the curriculum. Scaled-down figures on the right-hand of the page make it easier to find the slides in the respective module file or to find the corresponding text passages in the curriculum.