Abstract
Flash glucose monitoring system (FGMS) is an improved subset of continuous glucose monitoring with a recognized effectiveness on glycemic control, though validation in patients with Liver Cirrhosis (LC) is lacking. To evaluate the accuracy of FGMS in patients with Type 2 Diabetes Mellitus (DM) and LC, a prospective, case-control study was performed in 61 ambulatory patients with LC and DM (LC group, n = 31) or DM (Control group, n = 30). During 14 days, patients performed 4 assessments per day of self-monitoring of blood glucose (SMBG, reference value) followed by FGMS scanning. There were 2567 paired SMBG and FGMS values used in the accuracy analysis, with an overall mean absolute relative difference (MARD) of 12.68% in the LC group and 10.55% in the control group (p < 0,001). In patients with LC, the percentage of readings within Consensus Consensus Error Grid analysis Zone A and A + B were 80.36% and 99,26%, respectively. Sensor clinical accuracy was not affected by factors such as body mass index, age, gender, Child-Pugh score or edematoascitic decompensation. This is the first study to approach FGMS clinical accuracy in LC, revealing a potential usability of this system to monitor glycemic control in this population.
Highlights
Diagnosis and management of Diabetes Mellitus (DM) in patients with CLD can be extremely challenging[10,11]
62 participants were enrolled in the study, but only 61 patients were included in the analysis: 31 in Liver Cirrhosis (LC) group and 30 in the control group (Fig. 1)
All patients were on oral antidiabetic drug (OAD), mostly metformin (LC group: 76,7% v Control group: 77,4%; p = 0,994)
Summary
Diagnosis and management of DM in patients with CLD can be extremely challenging[10,11]. Glycated Hemoglobin (HbA1c) is routinely used as a standard measure for long-term glucose control[13] and estimates the average glycemic status over the last 3 months[7]. Self-monitoring of blood glucose (SMBG) has been suggested in CLD6,7 It provides an accurate estimation of the real blood glucose control and is not affected by the above mentioned limitations[18,19]. Flash glucose monitoring system (FGMS) is a subset of CGM, with the advantage of not requiring user calibration and displaying the information using graphs and trend arrows[21] It is indicated for individuals with DM over 4 years old, including pregnant women, and has a proven impact on adherence, glycemic control and DM prognosis[22,23,24]. There is insufficient literature about the utility of CGM in these population, the new subset FGMS, which has not been validated as a suitable option for monitoring DM in patients with LC
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