Flash and continuous monitoring

5 posts, 5 contributors

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MIke P DAFNE Graduate
Leicester
8 posts

Does anyone know if there any plans to update the DAFNE course to take account of the dynamic readings from Flash and continuous blood glucose monitors? I ask because I’ve read some recent critical FB posts from recent graduates saying how out of touch the course feels to those who have been using this technology. Is the need for change recognised and if so, are training needs now being addressed?

marke Site Administrator
South East Kent PCT
662 posts

Hi, I should point out that this is a totally personal point of view and does not reflect the DAFNE Programme view OR necessarily Dafneonline.

So with that out of the way, I would say the people lucky enough to have Flash or CGM's are unlikely to be typical DAFNE graduates by a long way, they are likely to be a minority at best. They are of course entitled to their opinions however the vast majority are not going to get access to this technology anytime soon , so why invest a huge amount of effort adjusting the course for a few people. Wow controversial I know but reality I think. As it happens I was chatting yesterday with my Consultant and she told me if I wanted to get the Freestyle Libre on the NHS I needed to test 8 times a day for a month. Apparently the Libre is then cheaper than test strips for the NHS and she can prescribe it. Great logic huh ? She was not convinced it was the best CGM anyway. Apparently Medtronic are just releasing a new pump a 670 ( I have a 640) and it will have an integrated CGM. The sensors for it will cost around £450 per year and are more accurate than the Libre. However again she/we would need to convince the NHS to pay the extra £650 on the base cost of the pump. Then again I guess the majority don't even have pumps so again maybe not relevant.
There is a new DAFNE Course and it will probably include a device to make getting readings into a system easier probably via bluetooth. However I don;t know what stage they have got to with it and again personally I think they are chasing the wrong idea but such is life,,,,,

Warwick DAFNE Graduate
Diabetes Australia-Vic, Melbourne, Victoria
389 posts

I use CGM most of the time (Dexcom) and I find that it is quite compatible with DAFNE. I completed the OZDAFNE course in 2012 and have been using CGM since 2015.

I'm not sure what additions to the course I would make to include CGM. If my BGLs go high, then I inject and if they go low, then I eat. But that is standard stuff anyway that you do if you take a BGL meter reading.

I love seeing patterns on my CGM and it certainly helps with working out if my basal dose is correct or not, but it is just another tool that helps.

torana DAFNE Graduate
Royal North Shore Hospital, St Leonards, NSW
49 posts

Valid criticism or comments are always useful for improving any organisation, especially DAFNE yet there is a lack of research on long term CGM readings leading to lower HBa1c levels. CGM manufacturers’ research suggests that continuous glucose readings lead to lower Hba1c levels in the short term yet other recent research has highlighted that 92% of Type1 diabetics, with or without new technologies, are outside the normative Hba1c range. This seems to compare to the huge profitable weight loss industry where there is also an intense initial educational program with positive expectations, yet the failure rate as we all know is a mammoth 95 per cent in the long term. Yes, we need to question DAFNE in that there may be also initial success but in the long term, statistically, we are tempted by our takeaway culture and the difficulties in juggling the huge number of Type1 variables. No doubt, this reality, no matter how dismal or complex, should always be a foundation for discussion.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

CGM and Libre are simply just a tool to display your glucose levels...........the user still needs to be able to adjust their doses to respond to changes, and that's what DAFNE actually teaches...so the source of the glucose reading is irrelevant....

The big difference between DAFNE educated diabetics and Libre users who haven't done any kind of training before getting their device, is that the DAFNE patients are more pro active in their control......so counting carbs accurately, getting the dose timing right, adjusting basal and ratios to within an inch of their life......whereas Libre users with no dose adjustment experience are more reactive, so responding to the data the Libre provides there and then....which works, don't get me wrong......but that approach shouldn't be relied upon completely.....there needs to be some foundation to work from in the event there becomes a problem with these new devices down the line.....

so should Libre and CGM be incorporated/mentioned in future DAFNE courses or similar, yes......but it shouldn't overshadow the basic principals and skills that all diabetics should have a their disposal....

I use Libre and I am doing well with it......however it wouldn't have made much of a difference to the learning process during my DAFNE training...