Suggest education/training/support for CSII and CGM users
STEP 1 — Gather Information
Collect patient demographics, diabetes type, current therapy (CSII + CGM), baseline A1C, hypoglycemia history, glucose variability, willingness/ability to use devices, self-care behaviors (carb counting, SMBG/CGM frequency, infusion site health, DKA prevention, hypoglycemia detection/treatment, emergency supplies, bolus calculator settings if used), insurance coverage, and follow-up availability.
Action: Proceed to assess need for CSII/CGM education and training.
STEP 2 — Rule In / Rule Out
Determine if the patient is using both CSII and CGM. If yes, rule in for education/training/support; if either is missing, rule out (no further action under this skill).
Decision: If both CSII and CGM are used, advance to classification; otherwise, stop here.
STEP 3 — Classify or Stratify
Classify the user by experience level (new initiate vs experienced) and specific deficits (e.g., bolus calculator training, hypoglycemia awareness, infusion site rotation, trend data interpretation) using Table 1 (CSII considerations) and Table 2 (RT-CGM considerations) from the guideline.
Action: Select appropriate education modules based on classification.
STEP 4 — Decide
Implement an individualized education/training plan: provide initial comprehensive training, schedule periodic reassessment (annually or when upgrading device), involve a multidisciplinary diabetes team, deliver hands‑on device training, review troubleshooting and emergency planning, and ensure access to written instructions and support resources.
Action: Arrange follow‑up education and support as per the individualized plan.
Clinical Guardrails / Mimics / Pitfalls
- Do not assume prior knowledge; always verify competency before considering training complete.
- Do not skip formal education when upgrading to new CSII or CGM technology; vendor‑only training is insufficient.
- Ensure hypoglycemia prevention, detection, and treatment are covered in every education session.
- Assess cognitive, visual, dexterity, and mental health factors that may affect device operation.
- Verify insurance coverage and access to supplies; lack of access undermines training effectiveness.
- Avoid relying solely on self‑directed learning; structured clinician‑led education improves outcomes.
Concrete Clinical Example
A 48‑year‑old with type 1 diabetes using CSII and RT‑CGM reports two severe hypoglycemic episodes in the past month. Review shows suboptimal carb counting, outdated bolus calculator ratios, and infrequent infusion site rotation. Provide focused refresher training on carbohydrate counting, bolus calculator adjustment, trend‑based insulin dosing, alarm settings, and site rotation. Schedule quarterly check‑ins to reinforce skills and adjust support as needed.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults, Endocrine Society Clinical Practice Guideline, 2016, doi:10.1210/jc.2016-2534.