Management of Continuous Glucose Monitors and Insulin Pumps during Radiation Therapy

Abstract

Purpose/Aim

Insulin Pumps (IPs) or Continuous Glucose Monitors (CGMs) may be damaged if they are worn during diagnostic imaging tests or during radiation therapy treatments due to exposure of electromagnetic fields as per manufacturers warnings. This means that blood sugar readings may not be accurate. In order to comply with the manufacturers recommendations, the sensor or transmitter attached to the patient needs to be removed before CT simulation and left off for all radiation treatments. Within our institution, there has not previously been a process in place to manage CGMs or IPs prior to radiation therapy treatments.

Methods/Process

An interprofessional working group was initiated in order to review the latest evidence on the subject and to determine a plan for implementing a process to align with manufacturers recommendations. There is a significant cost associated with removing the sensor or transmitter for patients without drug coverage, which also needed to be considered in the context of the removal recommendations. The working group collaborated with the Diabetes Education Program (DEP) at our institution to setup a pathway whereby Radiation Oncologists (ROs) could enter referrals to the DEP for Type 2 diabetic patients as needed for the purposes of ensuring timely support for radiation patients requiring alternate monitoring methods (finger stick testing). It was decided that the initial conversation with applicable patients should occur at the radiation consult appointment and the discussion would be facilitated by the RO and/or nurse. In order to help facilitate this conversation and to ensure patients were made aware of the risks associated with leaving the device(s) on, a patient education handout was developed by the working group and subsequently reviewed by our institution's Cancer Centre Patient Education Advisory Group which includes patient advisors. Checklists were built within the radiation oncology electronic record to document the presence of CGM and IP devices at CT Sim as well as to follow up at Day 1 treatment appointments. The radiation therapists at CT Sim confirm the patient has removed the devices, educating about risks if they decline to remove for CT Simulation and/or radiation treatments. Documentation to occur by radiation therapists in order to capture details of the conversations and to reinforce safety elements and ability to provide the patient education handout as needed.

Results or Benefits/Challenges

Implementation has streamlined expectations for our patients and reduced questions or concerns from the team as they have been addressed. There have been a few scenarios post implementation, where patients are unaware at the time of CT Simulation about the recommendation to remove their devices. In addition, there have been no referrals by ROs to the DEP after a 5-month period since implementation. Follow up is occurring to ensure adequate supports are in place for this patient population.

Conclusions/Impact

The ability to readily pull data from the electronic radiation record will allow for tracking of volumes and to be able to determine the compliance with the recommendations for removal. There is also a plan to seek more formal feedback from patients directly impacted to ensure we are meeting their needs and to determine any opportunities for improvement.