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Flash glucose monitoring: Impact on markers of glycaemic control and patient-reported outcomes in individuals with type 1 diabetes mellitus in the real-world setting

Published:October 24, 2019DOI:https://doi.org/10.1016/j.diabres.2019.107893

      Abstract

      Aims

      We aimed to evaluate both glycaemic parameters and patient-reported outcomes in patients prescribed FGM based on the local criteria at our institution.

      Methods

      This retrospective observational study included patients aged > 18 years with a diagnosis of type 1 diabetes mellitus (T1DM) who were prescribed FreeStyle Libre FGM (n = 90). Quantitative data on glycaemic parameters was collected pre- and post-initiation of FGM in addition to patient-reported outcome measures (PROMs). The primary outcome was change in pre- and post-FGM levels of glycosylated haemoglobin (HbA1C).

      Results

      There was a mean reduction in HbA1c of −7.29 ± 10.76 mmol/mol (p < 0.001, CI95% 4.94–9.64) sustained to the latest reading. There was also a mean reduction in the number of hypoglycaemic episodes per week of 3.20 (percentage reduction 51.86%, p < 0.001, CI95% 1.64–4.77). A significant improvement in quality of life scores was noted in all five domains of the abbreviated DDS between before and after starting FGM (p < 0.001). Key themes highlighted in inductive content analysis include ‘life-changing’, ‘positive experience’, and ‘convenient’.

      Conclusion

      Flash glucose monitoring is associated with significant improvement in HbA1c to a mean follow-up of 4.6 months. Additionally, patients reported positive experiences of FGM with significant improvement in all aspects of a focussed Diabetes Distress Scale.

      Keywords

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      References

        • Nathan D.M.
        • Genuth S.
        • Lachin J.
        • Cleary P.
        • Crofford O.
        • Davis M.
        • et al.
        The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
        N Engl J Med. 1993; 329: 977-986
        • Nathan D.M.
        • Group D.E.R.
        The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview.
        Diabetes Care. 2014; 37: 9-16
        • Bolinder J.
        • Antuna R.
        • Geelhoed-Duijvestijn P.
        • Kröger J.
        • Weitgasser R.
        Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial.
        Lancet. 2016; 388: 2254-2263
        • Simmons J.H.
        • Chen V.
        • Miller K.M.
        • McGill J.B.
        • Bergenstal R.M.
        • Goland R.S.
        • et al.
        Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D Exchange Clinic Registry.
        Diabetes Care. 2013; 36: 3573-3577
      1. NICE. Type 1 diabetes in adults: diagnosis and management 2015 [Available from: https://www.nice.org.uk/guidance/ng17].

        • Russo G.T.
        • Scavini M.
        • Acmet E.
        • Bonizzoni E.
        • Bosi E.
        • Giorgino F.
        • et al.
        The burden of structured self-monitoring of blood glucose on diabetes-specific quality of life and locus of control in patients with noninsulin-treated type 2 diabetes: The PRISMA study.
        Diabetes Technol Ther. 2016; 18: 421-428
        • Leelarathna L.
        • Wilmot E.G.
        Flash forward: a review of flash glucose monitoring.
        Diabet Med. 2018; 35: 472-482
      2. Health, Technology, Wales. Statement on prescribing Freestyle Libre flash glucose monitoring system for type 1 and type 2 diabetes 2017 [Available from: http://www.a-c-d-c.org/wp-content/uploads/2012/08/HTW-Statement-FreeStyle-Libre-glucose-monitoring-v1.1.pdf.

        • Mancini G.
        • Berioli M.G.
        • Santi E.
        • Rogari F.
        • Toni G.
        • Tascini G.
        • et al.
        Glucose monitoring: A review of the literature with a special focus on type 1 diabetes.
        Nutrients. 2018; 10
        • Lind M.
        • Polonsky W.
        • Hirsch I.B.
        • Heise T.
        • Bolinder J.
        • Dahlqvist S.
        • et al.
        Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial.
        JAMA. 2017; 317: 379-387
        • Beck R.W.
        • Riddlesworth T.
        • Ruedy K.
        • Ahmann A.
        • Bergenstal R.
        • Haller S.
        • et al.
        Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial.
        JAMA. 2017; 317: 371-378
        • Bailey T.
        • Bode B.W.
        • Christiansen M.P.
        • Klaff L.J.
        • Alva S.
        The performance and usability of a factory-calibrated flash glucose monitoring system.
        Diabetes Technol Ther. 2015; 17: 787-794
        • Giani E.
        • Macedoni M.
        • Barilli A.
        • Petitti A.
        • Mameli C.
        • Bosetti A.
        • et al.
        Performance of the flash glucose monitoring system during exercise in youth with Type 1 diabetes.
        Diabetes Res Clin Pract. 2018; 146: 321-329
      3. NICE. FreeStyle Libre for glucose monitoring 2017 [Available from: https://www.nice.org.uk/advice/mib110/resources/freestyle-libre-for-glucose-monitoring-pdf-2285963268047557].

      4. UK, Diabetes. Diabetes UK consensus guideline for flash glucose monitoring 2017 [Available from: https://www.diabetes.org.uk/resources-s3/2017-09/1190_Flash%20glucose%20monitoring%20guideline_SB_V9%5B4%5D.pdf].

        • Reddy M.
        • Jugnee N.
        • El Laboudi A.
        • Spanudakis E.
        • Anantharaja S.
        • Oliver N.
        A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with Type 1 diabetes and impaired awareness of hypoglycaemia.
        Diabet Med. 2018; 35: 483-490
        • Tyndall V.
        • Stimson R.H.
        • Zammitt N.N.
        • Ritchie S.A.
        • McKnight J.A.
        • Dover A.R.
        • et al.
        Marked improvement in HbA.
        Diabetologia. 2019;
        • Dover A.R.
        • Stimson R.H.
        • Zammitt N.N.
        • Gibb F.W.
        Flash glucose monitoring improves outcomes in a Type 1 diabetes clinic.
        J Diabetes Sci Technol. 2017; 11: 442-443
        • Martín-Timón I.
        • Del Cañizo-Gómez F.J.
        Mechanisms of hypoglycemia unawareness and implications in diabetic patients.
        World J Diabetes. 2015; 6: 912-926
        • Group IHS
        Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management.
        Lancet Diabetes Endocrinol. 2019; 7: 385-396
        • Geddes J.
        • Schopman J.E.
        • Zammitt N.N.
        • Frier B.M.
        Prevalence of impaired awareness of hypoglycaemia in adults with Type 1 diabetes.
        Diabet Med. 2008; 25: 501-504
        • Jordan L.V.
        • Robertson M.
        • Grant L.
        • Peters R.E.
        • Cameron J.T.
        • Chisholm S.
        • et al.
        The Tayside insulin management course: an effective education programme in type 1 diabetes.
        Int J Clin Pract. 2013; 67: 462-468
        • Yeoh E.
        • Choudhary P.
        • Nwokolo M.
        • Ayis S.
        • Amiel S.A.
        Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis.
        Diabetes Care. 2015; 38: 1592-1609
        • Ólafsdóttir A.F.
        • Attvall S.
        • Sandgren U.
        • Dahlqvist S.
        • Pivodic A.
        • Skrtic S.
        • et al.
        A clinical trial of the accuracy and treatment experience of the flash glucose monitor FreeStyle Libre in adults with type 1 diabetes.
        Diabetes Technol Ther. 2017; 19: 164-172
        • Fisher L.
        • Hessler D.
        • Polonsky W.
        • Strycker L.
        • Masharani U.
        • Peters A.
        Diabetes distress in adults with type 1 diabetes: Prevalence, incidence and change over time.
        J Diabetes Complications. 2016; 30: 1123-1128