JMIR Publications

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 a 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 healthcare team.

Objective:

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 pre- and post-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 aged 15-24 with type 1 diabetes for more than 6 months were recruited from within a public university’s endocrinology clinics. Participants were randomized to enhanced standard care or enhanced standard care plus the IDEAL CGM intervention using a 1:3 randomization scheme. HbA1c and psychosocial measures were assessed at baseline and 3 months after start of the intervention.

Results:

10 eligible subjects were approached for recruitment and eight 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 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.

Conclusions:

This pilot study underscores the importance of continued research efforts to optimimize the use of web-based intervention tools for their potential to improve adherence, glycemic control and the psychosocial impact of the use of diabetes technologies without adding significant burden to the healthcare 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. Clinical Trial: Registration: ClinicalTrials.gov NCT03367351, https://clinicaltrials.gov/ct2/show/NCT03367351.