消除英国初级医疗实践中使用连续血糖监测对使用胰岛素的成人 2 型糖尿病患者进行管理的障碍:专家共识。

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Samuel Seidu, Lorraine Avery, Heather Bell, Pam Brown, Jane Diggle, Su Down, Ritesh Dua, Patrick Holmes, Rahul Mohan, Nicola Milne, Thinzar Min, James Ridgeway, Waqas Tahir, Sanjay Tanna
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引用次数: 0

摘要

目的:本专家共识回顾了2型糖尿病(T2D)患者接受非强化胰岛素治疗的初级保健临床管理的现实,重点是在该参与者组中使用连续血糖监测(CGM)技术进行有效护理。在这里,我们确定了一线医疗环境中未满足的技能和系统开发的关键需求,以及与有效管理这些变化相关的主要挑战和机遇。方法:作者参加了于2023年11月28日和2024年5月21日举行的两次初级保健共识小组。这些专家小组的重点是了解初级保健中未满足的需求,以管理接受非强化胰岛素治疗并结合使用CGM系统的成人T2D。在英国的初级保健糖尿病技术网络成员中进行了一项德尔菲调查,以了解在初级保健中使用胰岛素和CGM管理成年t2dm患者的普遍态度。基于这些活动,在第二次德尔菲调查中测试了一系列共识陈述。结果:所描述的活动涉及具有糖尿病管理专业知识的初级保健保健专业人员(HCPs),确定了英国全科实践中的一系列培训和教育需求,这些培训和教育需求对于胰岛素治疗和CGM技术应用的成人T2D护理技能发展至关重要。确定了使用CGM装置对t2dm患者进行有效初级保健管理的潜在障碍。令人关注的领域包括对使用CGM系统管理T2D的国家和地方指南的信心,卫生保健提供者和T2D患者缺乏经验,临床工作流程和系统,以及初级保健团队对变革的固有抵制。然而,专家组明确表示,使用CGM技术作为标准护理,为接受非强化胰岛素治疗的T2D患者提供护理的目标是可以实现的(94.3%,n = 33)。这将为T2D患者带来临床益处,并改善初级保健的临床工作流程。还确定了一项成果,即节省了保健服务的费用。结论:需要适应胰岛素治疗T2D患者的管理,这给初级保健团队目前的工作流程和技能带来了巨大压力。本文讨论了克服这些直接压力的步骤,以确保对T2D患者进行有效的临床管理,并提出了一系列共识声明,确定了需要管理的关键变革领域。最终,绝大多数专业初级保健HCPs有信心或非常有信心使用CGM技术将成为初级保健中使用胰岛素治疗的t2dm患者的标准护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Removing barriers to management of adults with type 2 diabetes on insulin using continuous glucose monitoring in UK primary care practice: An expert consensus

Aims

This expert consensus reviews the reality of primary care clinical management of people with type 2 diabetes (T2D) on non-intensive insulin therapy, with an emphasis on the use of continuous glucose monitoring (CGM) technology for effective care in this participant group. Here, we identify key unmet needs for skills and systems development within this frontline healthcare setting, along with major challenges and opportunities associated with managing these changes effectively.

Methods

The authors participated in two primary care consensus panels held on 28 November 2023 and on 21 May 2024. The focus for these expert panels was to understand the unmet needs within primary care to manage adults with T2D treated with non-intensive insulin therapy and incorporating the use of CGM systems. A Delphi Survey was undertaken among a wider group of Primary Care Diabetes Technology Network members in the United Kingdom, to understand prevalent attitudes to management of adults with T2D on insulin and using CGM in primary care. Based on these activities, a series of consensus statements were tested in a second Delphi Survey.

Results

The activities described, involving primary care healthcare professionals (HCPs) with expertise in diabetes management, identified a series of training and educational needs within UK general practice that are central to skills development for the care of adults with T2D on insulin therapy and the application of CGM technology. Potential barriers to effective primary care management of people with T2D using CGM devices were identified. Areas of concern included confidence in national and local guidelines for the management of T2D using CGM systems, lack of experience on the part both of HCPs and people with T2D, clinical workflows and systems, as well as inbuilt resistance to change among primary care teams. However, the expert group were clear that the goal of providing care for people with T2D on non-intensive insulin therapy using CGM technology as standard of care could be met (94.3%, n = 33). This will deliver clinical benefits for people with T2D, and improvements to clinical workflows in primary care. Cost-savings to the health service were also identified as an outcome.

Conclusions

The need to adapt to the management of people with T2D on insulin therapy puts significant pressure on current workflows and skills for primary care teams. Steps in overcoming these immediate pressures, to ensure effective clinical management of people with T2D, are discussed, along with a series of consensus statements that identify the key areas of change to manage. Ultimately, the great majority of expert primary care HCPs were confident or very confident that using CGM technology will become the standard of care for people with T2D treated with insulin in primary care.

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来源期刊
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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