continuous glucose monitoring apps

Continuous Glucose Monitoring
One of the many new innovations in healthcare is continuous glucose monitoring, which has really only been around for about 20 years. The earliest systems were short-term, and at that point in time they were more or less independent systems, such as MiniMed, the first to gain FDA approval (Mastrototaro, 2000). Continuous monitoring represents an advancement over more traditional intermittent monitoring, as it provides a constant stream of real time data. While the earliest continuous glucose monitoring systems were viewed as having less accuracy than intermittent systems (Klonoff, 2005), that gap has since closed. Continuous glucose monitoring has been found to associate with improved glycemic control in adults with Type 1 diabetes, by alerting them in a timely manner as to the changes in their glucose levels (Tamborlane et al, 2008).
Nowadays, continuous glucose monitoring devices can still be independent devices, but many work with apps via one’s phone. This has particular benefits for the patient, and implications for nursing practice. For the patient, it means that they can set alerts, should the app record a shift in glucose levels to an undesirable level. In the event that the patient cannot feel this, the app gives early warning, and the alerts can be configured in whatever way works best for the patient.
For nursing practice, this accessibility to information has two key implications. First, nurses have the opportunity to coach patients who are new to glucose monitoring. They can help the patient to set up the app, configure the alerts and ensure that the patient knows what to do when a chance in glucose level is detected. This is a little more like tech support than nursing used to be, but it saves time in the long run because the patient is now more responsible for monitoring their own glucose levels. Also, because the monitoring is done via app, a nurse can monitor multiple patients simultaneously, while they are monitoring themselves. The information can be fed into a central database that provides more granular details about the patients glucose level changes, and the nurse now has access to all of this data, allowing not just for a better standard of care, but puts the nurse in more of a position to help the patients as well.
The obvious advantages are that much more information is available for both nurses and patients. This can be a disadvantage, however, if the information is not processed and presented in a way that makes it easy for the nurse to interpret the data. Nurses do not have time to pore over large, granular data sets, so the app must do this for them and if it does not then this can be a disadvantage. Further, to the extent that there is a gap between intermittent monitoring in the clinical environment and continuous monitoring systems, the continuous system must still be supplemented with periodic usage of static tests to determine precise glucose levels. However, another advantage that is apparent is that a nurse can monitor a lot more patients, because the work is done remotely.
The role of the professional nurse is twofold. First, the nurse can provide some training for the patient in terms of the set-up of the technology, and then its operation. This is where the nurse is helping the patient to help themselves. It is especially important that the nurse can coach the patient to make his or her own adjustments based on the feedback from the app. The other part of the nurse’s role is to receive alerts, and follow-up. If the patient is not at the clinic, for example, the nurse can still receive an alert. If there is no response from the patient within a set time limit, the nurse might be able to send an ambulance and follow-up. The role of the nurse with this technology is somewhat different, but it is nevertheless an engaged role, where the nurse not only helps the patient to help themselves, but is still in a position to respond more quickly to changes in the patient’s condition.
References
Klonoff, D. (2005) Continuous glucose monitoring. Diabetes Care Vol. 28 (5) 1231-1239.
Mastrototaro, J. (2000) The Minimed continuous glucose monitoring system. Diabetes Technology & Therapeutics. Vol. 2 (S1) S13-S18.
Tamborlane, D. (2008) Continuous glucose monitoring and intensive treatment of type 1 diabetes. New England Journal of Medicine Vol. 359 (2008) 1464-1476.