Abstract
BackgroundContinuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy.Main bodyThe FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction.ConclusionT2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits.
Highlights
Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-moni‐ toring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy.Main body: The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min
This review examines evidence for the flash glucose monitoring system in patients with type 2 diabetes (T2D), several real-world studies had mixed type 1 diabetes (T1D) and T2D populations
Time spent in hyperglycemia was decreased by 37% (P < 0.001), and time in range was increased by 36% (P < 0.001) and in the highest versus lowest scan rate group [26]
Summary
Data on use of flash glucose monitoring in people with T2D are accumulating steadily. Highest vs lowest scan rate group (BG 70–180 mg/dL): Brazil: 16.6 vs 14.2 h/day; P < 0.01 Worldwide: 17.0 vs 12.1 h/day; P < 0.01. ↑ indicates increased; ↓ indicates decreased/reduced a Scanning frequency decreased gradually from > 18 scans/day during first sensor use to ≈ 15 scans/day at 2 months, and was maintained at the lower level for the remainder of the 6-month analysis period b Glucose results were analyzed after being divided into high, medium and low-risk groups based on tertiles of time spent in hypoglycemia (min/day < 70 mg/dL) or hyperglycemia (h/day > 240 mg/dL), and further subdivision into tertiles of glucose scanning frequency (high, medium, low) above or below target values. The evidence indicates that flash glucose monitoring is suitable and safe for use in T2D patients, especially those who could benefit from tighter glycemic control and associated reduction in disease burden
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