Spectrum - Part 1: Curriculum. AGDT-AGPD Spectrum Group
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 | 0Introduction, decision | 1CGM basics | 2CGM start | 3CGM display, alarms | 4CGM evaluation I | 5CGM evaluation II | 6CGM 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