Use of Continuous Glucose Monitors in Older Adults in Home Health
In this podcast, Rena' Thompson, RN, WTA, CDCES, discusses the use of continuous glucose monitors (CGMs) in older adults in home health, including the benefits, challenges, and barriers to using CGMs and the results of a study that gauges clinicians’ knowledge of CGMs in a home health setting. She also discussed this topic at ADCES 2023 during a poster presentation titled "Use of Continuous Glucose Monitors in Older Adults in Home Health."
Additional Resource:
Thompson R, Austin A, Eichorst B, Bouhairie VE, Young E. Use of continuous glucose monitors in older adults in home health. Talk presented at: ADCES 2023. August 4-7, 2023. Accessed September 22, 2023. https://www.adcesmeeting.org/2023/ADCES23/
For more diabetes technology content, visit the Excellence Forum.
TRANSCRIPTION:
Jessica Bard:
Hello, everyone. And welcome to another installment of Podcast360, your go-to resource for medical education and clinical updates. I'm your moderator, Jessica Bard with Consultant360, a multidisciplinary medical information network. Rena Thompson is here to speak with us today about her team's poster presentation at ADCES 2023 titled, Use of Continuous Glucose Monitors in Older Adults in Home Health. Rena' is a registered nurse, a certified diabetes care and education specialist, and the director of Clinical Operations at CenterWell Home Health in Land O'Lakes, Florida. Thank you for joining us today, Rena. Please provide us with an overview of your presentation.
Rena' Thompson:
The motivation for doing the research is that we recently became ADA ERP accredited in a lot of our home health branches, which is something brand new. Normally that is done on an outpatient basis, so we're blazing some trails here. And one of the things that we have found as we've gotten into this is that we had a very low use of continuous glucose monitoring among our senior population, and we were trying to decide, "Okay, why is this?" And one of the things that we determined was, or we thought that our clinicians were not feeling comfortable with it, so consequently were they even putting it up as a possibility for the patients. And with the fact that CGM is now such a widely used technology in the treatment of diabetes, we felt like there's some room for improvement there.
Jessica Bard:
What are the benefits of using CGMs in older adults in home health?
Rena' Thompson:
Continuous glucose monitoring in any setting really, it enables the patient to have a continuous knowledge of what their blood glucose is running at any given moment. Consequently, they can watch for trends, they can watch for peaks and valleys. It also is a safety asset because a lot of times, especially in the senior population, our people with diabetes can get hypoglycemic and they don't feel the same symptoms as somebody younger. On the other hand, it's more serious for them because not having enough glucose to your major organs, including the brain, it can actually promote or it can make dementia develop faster along with the issues that can come with all the organs. So it's really important that we get our senior population to use continuous glucose monitoring. So that's probably one of the biggest advantages. And the other advantage, as I said, is to identify peaks and valleys and what is your blood sugar doing after you eat. Did you take the right amount of insulin before your meal? So there's a lot to it especially for our senior population, and it's just being underutilized.
Jessica Bard:
What are the challenges and barriers to the use of CGMs in older adults in home health?
Rena' Thompson:
There are different reasons. Sometimes cost comes into play. Nowadays though, Medicare has increased coverage for CGM, and the other insurances are falling behind that. So cost is not nearly as much of an issue as it used to be, but it still can be depending on whatever their insurance is. The other part of it is just the conceptualization of what they think this is. A lot of people also feel like there's a privacy issue, "Do I really want my physician or even my family to know what my blood sugars are running?" People are like, "That's my business. Maybe I don't want them to know when I cheat or when I go super high."
So you have to talk to them about that part of it and just let them know, "No judgment. We're just trying to gather information." And then the technology part, although there's a lot of misconception that our seniors are not good with technology, there's a lot more of them that are very savvy and that are able to use it. And I think sometimes people in the medical community don't even suggest it because they're just assuming that somebody who's a senior is not going to be able to handle the technology, and that's just not true anymore.
Jessica Bard:
What is the role of the clinician in the use of CGMs in older adults in home health?
Rena' Thompson:
The clinician has a really big part in it. First of all, we instruct our clinicians, that you want to identify who's a good candidate for CGM. We don't even want to suggest it if it's not the type of person that's going to get any benefit from it. Also, the clinician is really good at figuring out which type of CGM is best for that particular patient with diabetes. For example, we have the ones that need to be scanned and we have the ones that are continuous that just automatically send the results to the receiver. And so if you have a patient, are they going to remember to scan it? Are they going to be monitoring whatever those results are? Are they going to be looking at that, whether it's an app on a smartphone or a receiver, are they going to know what to do with that information?
If they can, if they have the dexterity and they can understand the results, we can teach them how to learn what to do with that information. So not only can we help them put it on for the first time, helping them with just how to interpret the results and what to do about it. And then we can use that also to communicate with the physician so that we can work on utilizing their medications in the best way possible.
Jessica Bard:
Please provide an overview of the results of your study.
Rena' Thompson:
We were a little surprised by some of it. When we started out, the reason, again, as the motivation for this research was that only about 5% of our patients with diabetes were actually utilizing a continuous glucose monitor. And we thought, "Well, that is just way too low." And so what we did is we provided a questionnaire to our clinicians to find out their knowledge level of CGM, and then we provided a lot of education over the course of a couple of months, and then we did a same questionnaire again to see what did they learn. Did we make any progress? How was it? So some of the things that we thought were really significant is that only 47% of our clinicians actually realize that privacy is a reason that sometimes a person with diabetes does not want to use a CGM because those results can go right back to the physician, or a lot of times they'll be able to bring in a family member that can watch and also see what's going on. So privacy was a bigger deal than we thought, and a lot of clinicians really did not realize that.
We also found out that there was a little knowledge deficit related to the signs and symptoms and effects of hypoglycemia. And actually, 16% of our clinicians fail to recognize that hypoglycemia can actually result in seizures and cardiac arrhythmias and then eventually death. It was great that we were able to get that education in there. 70% of the clinicians did really not understand the limitations and uses for CGM, so that was huge. That was a really big motivator for the education. And what was really interesting is when we did the follow-up questionnaire, a hundred percent of the clinicians who received the education said that yes, they understood that there were benefits to our senior population with the use of CGM. However, during the course of this whole thing, we really only increased our use of CGM among our patients by just a few percent. So we definitely have a ways to go, but it was nice to see that they at least felt like it was something that was useful.
Jessica Bard:
And based on those results, what would you say is next for research on this topic?
Rena' Thompson:
So one of the things that we discovered doing all this is we had a few clinicians get the opportunity to actually wear a CGM and be able to learn how it works, and be comfortable with it and really see what it's all about for a patient to actually wear one. And we feel like the next step, and not just even our clinicians in the field, but a lot of people in the medical community that work with senior adults wear it, see if that's going to help. Is that going to really help with our patient population being more open to wearing it, our clinicians being more comfortable with suggesting it and guiding patients on how to use it. And so our next step is really to let our clinicians experience it and see where that takes us and see if that isn't even more effective in getting our clinicians to recommend it for more patients with diabetes.
Jessica Bard:
Is there anything else you'd like to add?
Rena' Thompson:
I guess, the only other thing is just to say that it really opened our eyes to a need in the community, especially in our home health population. A lot of these patients can't get out, they can't go to the physician, they can't go to outpatient clinics to learn about their diabetes. And so the role that home health plays in helping these people with diabetes learn how to manage their disease process is extremely important. And really the main thing is just to try to get it out there to the community and the world to know that patients that are confined to their home don't have to go without care and education, and somebody looking over them and helping them manage. Because the goal, as always, is independence, to help them be independent. We're not going to be there forever.
Jessica Bard:
Well, thank you again for joining us today, Rena.