Seidu Samuel, Avery Lorraine, Bell Heather, Brown Pam, Diggle Jane, Down Su, Dua Ritesh, Holmes Patrick, Mohan Rahul, Milne Nicola, Min Thinzar, Ridgeway James, Tahir Waqas, Tanna Sanjay
Diabetes Research Centre, National Institute for Health Research, Applied Research Collaboration East Midlands, University of Leicester, Leicester, UK.
Solent NHS Trust, Portsmouth, UK.
Diabet Med. 2025 Mar;42(3):e15500. doi: 10.1111/dme.15500. Epub 2024 Dec 15.
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.
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.
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.
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.
本专家共识回顾了2型糖尿病（T2D）患者非强化胰岛素治疗的基层医疗临床管理现状，重点关注连续血糖监测（CGM）技术在该患者群体有效护理中的应用。在此，我们确定了这一一线医疗环境中技能和系统开发的关键未满足需求，以及有效管理这些变化所带来的主要挑战和机遇。
作者参与了2023年11月28日和2024年5月21日举行的两次基层医疗共识小组会议。这些专家小组的重点是了解基层医疗中管理接受非强化胰岛素治疗的成年T2D患者并纳入CGM系统使用的未满足需求。在英国更广泛的基层医疗糖尿病技术网络成员中进行了一项德尔菲调查，以了解对基层医疗中成年T2D患者胰岛素治疗和使用CGM管理的普遍态度。基于这些活动，在第二次德尔菲调查中测试了一系列共识声明。
所描述的活动涉及具有糖尿病管理专业知识的基层医疗保健专业人员（HCP），确定了英国全科医疗中的一系列培训和教育需求，这些需求对于胰岛素治疗的成年T2D患者护理技能发展以及CGM技术应用至关重要。确定了使用CGM设备对T2D患者进行有效基层医疗管理的潜在障碍。关注领域包括对使用CGM系统管理T2D的国家和地方指南的信心、HCP和T2D患者双方缺乏经验、临床工作流程和系统，以及基层医疗团队对变革的内在抵触。然而，专家组明确表示，以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，并改善基层医疗的临床工作流程。卫生服务成本节约也被确定为一个结果。
适应胰岛素治疗的T2D患者管理需求给基层医疗团队当前的工作流程和技能带来了巨大压力。讨论了克服这些紧迫压力以确保T2D患者有效临床管理的步骤，以及一系列确定关键变革管理领域的共识声明。最终，绝大多数专家基层医疗HCP对在基层医疗中使用CGM技术将成为接受胰岛素治疗的T2D患者的标准护理充满信心或非常有信心。
