METER ACCURACY, SENSOR INSIGHTS, AND TAPING TIPS

POINTERS & PEARLS

METER ACCURACY, SENSOR INSIGHTS, AND TAPING TIPS:

WHAT YOU REALLY NEED TO KNOW

The saying that the whole is greater than the sum of its parts certainly rings true for the MiniMed® 530G with Enlite®. The sensor-augmented pump system includes a number of key features that you can teach patients to use to their fullest potential, including the insulin pump, the CONTOUR®NEXT LINK meter, the Enlite sensor and serter, CareLink® therapy management software, Threshold Suspend, and more. Each of these components is critical when it comes to optimizing the MiniMed 530G with Enlite system for better patient outcomes.

This installment of Pointers & Pearls includes 2 articles filled with practical, actionable advice and tools that you can start using right away: 1) Meter matters—making the connection between blood glucose (BG) results and sensor calibration; and 2) Optimizing Enlite—sensor and serter insights and taping tips.

Also included with the articles are helpful patient education resources that you can leverage to create greater efficiencies while also reinforcing the valuable training and education that you provide. Future articles will focus on other ways to maximize your patients’ use of the MiniMed 530G with Enlite system.


METER MATTERS:

CONNECTING THE DOTS BETWEEN ACCURATE BG RESULTS AND SENSOR CALIBRATION

BY ELIZABETH NARDACCI, MS, FNP-BC, CDE

When self-monitoring of blood glucose (SMBG) first became available, diabetes educators (DEs) spent quite a bit of time educating patients about the correct technique. Now that SMBG is so commonplace, we do not need to spend as much time on the basics with experienced patients. However, the importance of good technique is called to the forefront if patients are using continuous glucose monitoring (CGM). Remember: CGM accuracy is only as good as the BG values used for calibration.

The CONTOUR®NEXT LINK is the only BG meter that is labeled for use with the MiniMed® 530G with Enlite®. This Bayer HealthCare meter is used with high-performance CONTOUR®NEXT test strips and provides seamless integration with the MiniMed 530G system, wirelessly transmitting BG results to the insulin pump.1 Highly accurate BG results help to ensure accurate calibration of the Enlite sensor.

WHY METER ADHERENCE MATTERS

The MiniMed 530G with Enlite offers a number of features not found with other integrated systems—such as Threshold Suspend automation, which mimics some of the functions of a healthy pancreas by automatically stopping insulin delivery when sensor glucose values reach a preset low threshold and the patient does not respond to the alarm.2-4

Now that CGM is used to suspend insulin delivery, it is more important than ever that we ensure patients are using the CONTOUR®NEXT LINK meter as an integral part of the MiniMed 530G system.

CHANGE CAN BE GOOD!

I have found that some patients initially do not understand the importance of switching to the CONTOUR®NEXT LINK meter when using the MiniMed 530G with Enlite. Often, they have a comfort level with another meter, simply because it’s what they are accustomed to.

While it’s human nature to avoid change unless absolutely necessary, in this case it is absolutely necessary for patients to use the CONTOUR®NEXT LINK meter. It’s the only FDA-approved meter for use with the MiniMed 530G system for a reason.

We need to teach patients why and how they will benefit from using the CONTOUR®NEXT LINK meter as part of the MiniMed 530G system. You can guide that dialogue by letting patients know about the meter’s benefits, teaching them to optimize the use of the meter via best practices, and answering any questions they might have.

Features of the CONTOUR®NEXT LINK meter include:1

  • Proven highly accurate
    • Overall mean absolute relative difference (MARD – the difference between the meter and laboratory reference method) has been shown to be 2.7%.5
  • Wireless
    • Sends highly accurate results to compatible Medtronic devices [MiniMed Paradigm REAL-Time Revel and MiniMed 530G with Enlite] for fast and easy bolus dosing and CGM calibration.
  • USB connector
    • Allows for easy downloading to CareLink® software and battery recharging.
  • Second-Chance™ sampling
    • Allows patients to apply more blood to help prevent wasting test strips and to save money.
  • No Coding™ technology
    • Means 1 less step and eliminates errors due to patients’ miscoding.

Patient tips to ensure accurate BG tests and improve sensor performance include:

  • Always wash and dry hands: Substances such as food can affect readings.
  • Use a single linked meter: Many of our patients have multiple meters. Using different meters for calibration is not recommended, since this introduces another variable. Encourage patients to use the CONTOUR®NEXT LINK meter only, to avoid mixing brands, and ideally not to use more than 1 meter. If the patient requires a second meter, they are available to purchase online through Medtronic and may be covered by insurance. These are usually not available from pharmacies or distributors.
  • Calibrate 3-4 times a day, preferably before meals and sleep. Minimum calibration is every 12 hours.
  • Avoid calibrating if there are double-trend arrows.
  • Calibrate IMMEDIATELY upon testing. DO NOT DELAY entering the calibration, since this delay can affect sensor performance/accuracy. Use CareLink Daily Summary Reports to view when the patient is actually calibrating and if they are using the linked feature. Ask your Medtronic Diabetes clinical liaison to review these reports with you for troubleshooting if needed.

EDUCATOR RESOURCES

In today’s managed care era, we must be cognizant of formulary requirements. Patients and office staff are frequently unaware of how straightforward it can be to obtain prior authorization (PA) for CONTOUR®NEXT test strips, which are essential to obtain highly accurate results. A simple phone call or completing a PA form is all it takes in most instances.

In addition, Bayer has an excellent resource called the Bayer Diabetes Care Reimbursement Support Program. It is free of charge and is designed to help both insured and uninsured patients. The contact information is: 866-296-1436 (Monday-Friday, 8 a.m.-7 p.m. EST); or reimbursement@contournexthelp.com.

CONNECTING THE DOTS FOR PATIENTS

The CONTOUR®NEXT LINK meter is simple to use and highly accurate—and it’s the only meter that is approved for use with the MiniMed 530G with Enlite system. Reinforcing that message with patients while teaching them about the relationship between the BG readings they use for calibration and sensor accuracy will help them embrace the importance of using the Bayer meter exclusively.

When patients understand that their meter really does matter, they will derive the greatest benefit possible from the MiniMed 530G system—and we will all move closer to the goals of better patient outcomes and greater satisfaction.

REFERENCES:
1. ContourNextPRO: CONTOUR®NEXT LINK communicates wirelessly with Medtronic insulin devices for seamless integration. Bayer Diabetes Care. http://www.contournextpro.com/Blood-Glucose-Monitoring/NEXTProducts/CONTOUR-Next-Link. Accessed May 6, 2015.
2. Medical devices: The Artificial Pancreas Device System (APDS). U.S. Food and Drug Administration. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ArtificialPancreas/default.htm. Accessed May 6, 2015.
3. Medical devices: MiniMed 530G system. U.S. Food and Drug Administration. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm372176.htm. Accessed May 6, 2015.
4. Medical devices: Types of Artificial Pancreas Device Systems—Threshold Suspend device system. U.S. Food and Drug Administration. http://www.fda.gov/medicaldevices/productsandmedicalprocedures/homehealthandconsumer/consumerproducts/artificialpancreas/ucm259555.htm. Accessed May 6, 2015.
5. Greene C, Brown D, Wallace J, Pardo S, Pflug B. Comparative accuracy of 3 blood glucose monitoring systems that communicate with an insulin pump. Endocr Pract. 2014;1:1-29.
6. Settings & features: Linking your pump to a meter. Medtronic Diabetes. http://www.medtronicdiabetes.com/customer-support/device-settings-and-features/meter-settings/link-meter. Accessed May 6, 2015.
7. Settings & features: Setting up your meter communication. Medtronic Diabetes. http://www.medtronicdiabetes.com/customer-support/device-settings-and-features/meter-settings/setup-meter. Accessed May 6, 2015.

Elizabeth (Beth) Nardacci, MS, FNP-BC, CDE, is a family nurse practitioner at Capital Region Diabetes and Endocrine Care in Albany, NY. Her special interests include diabetes technologies, including professional and personal CGM and insulin pump therapy, chronic kidney disease, and renal transplantation. She is a principal investigator in the OpT2mise international pivotal trial for use of insulin pump therapy in type 2 diabetes. Beth serves as an advisor to the American Association of Clinical Endocrinologists Task Force on Continuous Glucose Monitoring. She has made numerous presentations and published clinical papers on diabetes technologies and was a recipient of the Juvenile Diabetes Research Foundation’s Inspiration Award and has made numerous presentations and published clinical papers on diabetes technologies.

OPTIMIZING ENLITE®:

SENSOR/SERTER INSIGHTS AND TAPING TIPS—CHECKLIST FOR SUCCESS

BY NIKKI RETZKI, RD, CD, CDE

As you know from working on the front lines educating and training patients with diabetes, integrated pump therapy with CGM provides many positive benefits. Specifically, some of the benefits of using the MiniMed® 530G with Enlite® include peace of mind, improved glucose control, and proactive management of diabetes.

Much of the success of an integrated pump system with CGM hinges on optimal use of the sensor. When initially starting your patients on CGM, it’s important to provide them with step-by-step instructions and best practices to prepare and secure the sensor site so that the sensor remains in place. Reinforcing that training at follow-up can help ensure even greater success with the sensor and overall therapy.

After more than a year of experience with the MiniMed 530G with Enlite, Medtronic’s diabetes clinical managers have found these insertion and taping tips to be extremely helpful:

  • Prior to insertion, discuss proper site selection techniques with patients and help them identify optimal insertion sites. Avoid areas where patients have scar tissue, or where there are a lot of body movements, compression from clothing, or friction that may cause partial removal or removal of the sensor—for example, the beltline.
  • Prior to insertion, ensure that the insertion site has been properly cleaned with an alcohol prep wipe (avoid IV prep or wipes that leave a residue that may affect the sensor). Be sure to reinforce the importance of this step with patients.
  • Make sure that the site area is completely dry prior to insertion. It’s likely that the sensor adhesive will not stick properly to the skin if the area isn’t dry.
  • Use a light touch when inserting the sensor. A key word to reinforce with patients is “Gentle.” When inserting the sensor, they should use a light touch. It’s fine to grip the serter firmly, but patients should avoid pushing the serter into their skin; instead, it should rest flat on top of the skin. Note: When patients are nervous or in a hurry, the tendency may be to push the serter into the skin. Advise them to take a moment to slow down so that this does not occur.
  • Press the green button on the small, “pill-shaped” bump at the bottom of the green button. (This allows the sensor to be inserted with the appropriate amount of force.) Note: It may be helpful to have patients practice the button pressing a couple times without a sensor prior to the actual insertion.
  • To remove the needle after Enlite insertion, teach patients to hold the sensor with 2 fingers. One finger should be on the front of the sensor, and 1 finger on the back of the sensor (“bumblebee”). Pull the needle straight out by the grips on the tip. NOTE: Patients should not hold or squeeze the side arms of the sensor, as doing so may not allow the needle housing to be removed.
  • When connecting the transmitter, ensure that the green light on the transmitter flashes to confirm that a proper connection has been made.
  • After the sensor is taped and the transmitter is connected, gently apply the adhesive tab over the transmitter. Advise patients to be careful not to pull too tightly, as this will cause a teeter-totter affect with the transmitter that could result in sensor pull-out over time.
  • For active patients who need more security, encourage them to utilize extra adhesive—such as a second piece of overtape—to ensure sensor security during times of exercise or prolonged activity. After applying adhesive tape, teach patients to apply pressure for several seconds across the entire overtaped area for best adhesion results.

Following this checklist to train patients on the Enlite sensor helps ensure the best performance possible throughout the 6-day wear cycle. In addition, anticipating issues that might arise and proactively arming patients with the information they need can increase their sensor success and may reduce the number of questions that you receive in between appointments.

ADDITIONAL RESOURCES FOR PATIENTS

To share Additional Tape Tips with patients, click here for a print-ready PDF. Not only is this a helpful resource for you to utilize during sensor-start training, it’s also a great take-home tool for patients to support prolonged sensor success.

For more advice and visuals on properly taping the sensor site, please refer to the Key Taping Methods section of the Medtronic Diabetes website.

The Enlite Sensor User Guide can be accessed here, and the Enlite Serter User Guide is available here.

To reinforce your in-person training, point patients to these educational, step-by-step videos on Medtronic Diabetes’ YouTube Channel: Enhanced Taping Methods for the Enlite® Sensor and a 4-part series on sensor insertion.

You can also share this fun animated video with patients. In the first of a series of videos that feature the MiniMed D-Force with voice-overs from actual Medtronic patients, your patients can learn more about how sensor insertion techniques and taping tips can impact sensor readings. With a focus on patient engagement, each member of the D-Force represents a different type of patient from the D-Type quiz: Busy Bee, Adventurer, Champion, D-tective, or Trendsetter.

SOURCES
Additional tape tips: Options for securing the Enlite® sensor. Medtronic Diabetes. http://www.medtronicdiabetes.com/res/img/pdfs/940M11776-013-Additional-Enlite-Tape-Tips.pdf. Accessed May 6, 2015.
Insertion site management: Key taping methods. Medtronic Diabetes. http://www.medtronicdiabetes.com/customer-support/insertion-site-management/taping-methods#genera. Accessed May 6, 2015.
Enlite® glucose sensor user guide. Medtronic Diabetes. http://www.medtronicdiabetes.com/sites/default/files/library/download-library/user-guides/Mp6025676-2AF1_a_pdf.pdf. Accessed May 6, 2015.
Enlite® serter user guide. Medtronic Diabetes. http://www.medtronicdiabetes.com/sites/default/files/library/download-library/user-guides/Mp6025427-2AF1_a_pdf.pdf. Accessed May 6, 2015.
Enhanced taping methods for the Enlite® sensor [YouTube video]. Medtronic Diabetes. https://www.youtube.com/watch?v=NINTzUEQ6FI. Accessed May 6, 2015.
Preparing to insert the Enlite® sensor [YouTube video]. Medtronic Diabetes. https://www.youtube.com/watch?v=yl02DbfitP4. Accessed May 6, 2015.
Inserting the Enlite CGM sensor with MiniMed D-Force video. Medtronic Diabetes. http://www.loop-blog.com/enlite-insertion-technique-performance/. Accessed May 6, 2015.
What’s your D-type? Medtronic Diabetes Facebook page. https://www.facebook.com/medtronicdiabetes/app_676985679042024. Accessed May 6, 2015.

Nikki Retzki, RD, CDE, is a clinical supervisor in the Wisconsin/North Chicago area for Medtronic Diabetes, where she has worked for the past 9 years. Previously, Nikki worked in a clinical setting as a diabetes educator providing education and medical management to patients with T1D and T2D. Her role also included developing protocols and data collection for an American Diabetes Association (ADA)-recognized program and an insulin pump program.