Discovery
The topic and the nursing practice issue related to the topic
Modern technologies of continuous monitoring of glycemia: developing possibilities of control and management. The information obtained during long-term monitoring allows nurses to determine the outpatient glycemic profile, which reflects a complete picture of the patient’s diabetes status.
The rationale for the topic selection
In modern endocrinology, devices for continuous monitoring of glycemia have become an essential tool for managing diabetes. In addition, they are becoming more accurate and convenient to use, and new options for assessing the glycemic profile are emerging, such as information on the trend of changes in the glycemic curve and quantitative assessment of the duration and amplitude of fluctuations in glucose levels. The information about the current glucose level obtained during long-term monitoring and retrospective data on glucose levels allow them to be used to build an outpatient glycemic profile.
Summary
The practice problem
The fundamental factor of DM management is achieving adequate and safe patient glycemic control. To date, the measurement of glycated hemoglobin (HbA1c) remains an important indicator for assessing glycemic control and predicting the risk of complications. In this regard, continuous monitoring of glycemia is increasingly being used in modern practice. There is no doubt that this method allows us to significantly expand the understanding of the quality of compensation for carbohydrate metabolism and acquires the role of an integral part of diabetes management.
PICOT Question: In diabetic patients, how do continuous monitoring technologies, compared to standard practice, influence the lowering of Glycemic numbers over six months?
The systematic review
Cappon, G., Vettoretti, M., Sparacino, G., & Facchinetti, A. (2019). Continuous glucose monitoring sensors for diabetes management: A Review of Technologies and Applications. Diabetes & Metabolism Journal, 43(4), 383–397. Web.
Other sources used for data and information
Montero, A. R., Toro-Tobon, D., Gann, K., Nassar, C. M., Youssef, G. A., & Magee, M. F. (2021). Implications of remote monitoring technology in optimizing traditional self-monitoring of blood glucose in adults with T2DM in primary care. BMC Endocrine Disorders, 21(1). Web.
This article discusses additional indicators that characterize the features of the use of technologies for dehumidification of indicators in patients with diabetes.
The main findings from the systematic review
Continuous monitoring of glycemia is a method of recording changes in glucose concentration in the blood, in which the measurement results are recorded at least every 5 minutes for a long time (more than a day). Currently, used monitoring devices allow nurses to obtain data on glycemia indirectly by the concentration of glucose in the interstitial fluid. Currently, the possibilities of Continuous glycemic control are increasingly being used not only in science but also in the daily practice of endocrinologists, becoming an essential tool for optimizing the management of diabetes types 1 and 2.
Evidence-based solutions for the trial project
The fact has been studied that both rapid increases in glycemia and decreases in blood glucose relative to average values negatively affect the human body. In addition to simply increasing the number of glucose measurements, continuous monitoring provides detailed information about the nature and trends of changes in glucose levels, allows nurses to identify periods of latent nocturnal hypoglycemia, postprandial hyperglycemia and adjust hypoglycemic therapy, make changes to the diet and physical activity plan. Most real-time monitoring devices can provide alarms warning of low, high, falling, or rising glucose levels. Finally, continuous monitoring devices can be integrated with an insulin pump, which allows the device to automatically regulate or suspend basal insulin delivery in response to glycemic changes.
Translation
Care standards, practice guidelines, and protocols to support the intervention planning
The 2022 Standards of Medical Care in Diabetes, which incorporate all of the American Diabetes Association’s (ADA) current clinical practice recommendations, are designed to give clinicians, patients, researchers, payers, and others information about the elements of diabetes care, general treatment objectives, and instruments to assess the quality of care. The guidelines are based on a thorough analysis of the clinical diabetes literature, with help from the ADA staff and the larger medical community. American Association of Clinical Endocrinology Clinical Practice Guideline covers a wide range of subjects related to managing diabetes, such as the COVID-19 vaccine, telehealth, social determinants of health, male and female infertility, secondary diabetes, and dietary supplements.
Stakeholders and their roles and responsibilities in the change process
Patients
It is necessary to take into account their interests and knowledge about the necessity and importance of the device.
Nurses
They are directly involved in testing devices, as well as in providing feedback on necessary improvements or changes.
Families
Their opinion should be taken into account since the device should be understandable to use in order to avoid misunderstandings or conflict situations.
Head of a medical institution
Their tasks include monitoring the implementation of the change and the necessary materials and tools.
Nursing role in the change process
Nurses are an integral part of the change process, as they are responsible for directly participating in testing new devices or treatment methods. Therefore, nurses must acquire the necessary skills to use continuous monitoring technology. This will allow the medical institution to make the change process effective by observing all the necessary steps. Their feedback also determines the importance of nurses.
Stakeholders by position titles
- Therapist: The functions and tasks of the attending therapist are the diagnosis of pathology of the heart and blood vessels, monitoring the dynamics of the patient’s recovery after the cardiologist prescribes adequate treatment and monitoring indicators.
- Nurse: direct testing of the device.
- Head of a medical institution: allocation of funds for the implementation and integration of changes.
Cost analysis needed prior to a trial
Cost-effectiveness analysis
In this case, economic efficiency analysis allows the company to ensure full employment of its resources, that is, their full use. The ratio of the result to the funds spent determines economic efficiency. To do this, it is necessary to involve patients and their indicators regarding how the medical institution uses current resources to reduce Glycemic numbers. Consequently, financial data will also be needed regarding the technologies already used and spending on them; for this, the finance department should be involved.
Implementation
Gaining permission to plan and begin a trial
Required documents:
- Confidential disclosure agreement (CDA)
- Form FDA 1572
- A curriculum vitae for the principal investigator and sub-investigators
- Independent Ethics Committee (IEC) approval letter and roster
- The principal investigator’s financial disclosure statement.
The plan for educating the staff about the change process trial
Participants in the trial period will be selected among several medical staff members of the institution. Their candidacies will be considered in accordance with the criteria of work experience and knowledge of various devices necessary for the removal of indicators in patients with diabetes. The training will take place in several stages. First, the selected candidates will be provided with text and audio-visual instructions. Then, they will have to pass a small online test showing the acquired knowledge. Then, there will be a lesson with an instructor who will show various aspects of the device’s operation and fix the necessary indicators.
The implementation timeline for the change process
Start time: January 1st, 2023
End time: June 1st, 2023
Steps:
- Collecting information about the resources and financial indicators of the institution
- Obtaining consent for testing
- Hiring candidates
- Obtaining consent from patients
- Data collection and interpretation
- Summing up the results
The measurable outcomes based on the PICOT
Measurements will take place based on Glycemic numbers in patients. Consequently, the main result indicating the success of the change will be a decrease in the glycemic numbers while taking into account the overall financial efficiency.
Recording during the pilot change process
The number of patients who received the ability to measure glycemic indicators, as well as the financial consequences of the evaluation, will be recorded using monitoring and evaluation forms.
Resources available to staff during the change pilot
The main available resources are the finances of the medical organization, as well as existing technologies for the rapid integration of new devices. On the other hand, intangible resources are the knowledge and experience of employees working with patients with diabetes.
Meetings of certain stakeholders throughout the trial
In the course of the process, it will be necessary to hold meetings with nurses to receive feedback for making appropriate changes during the process. In addition, it is necessary to receive information from the patients themselves in order to monitor satisfaction and safety effectively at all stages of the event.
Evaluation
Reporting the outcomes of the trial
A corresponding report will be prepared in which indicators will be presented regarding the effective reduction of Glycemic numbers in diabetic patients after six months of testing the device. The report itself will be prepared in the form of a document and presentation, which will be demonstrated to the management of the medical organization.
The next steps for the use of the change process information
In the future, it is necessary to fully implement the proposed intervention. For more effective monitoring, it is necessary to record important indicators and feedback from patients and employees for a certain period of time. This will allow the medical organization to correct aspects that do not meet the requirements of stakeholders.