Abstract
Aims/hypothesisThe aim of this work was to evaluate changes in glycaemic control (HbA1c) and rates of severe hypoglycaemia over a 2 year period after initiation of flash glucose monitoring (FM) in type 1 diabetes.MethodsUsing data from the Swedish National Diabetes Registry, 14,372 adults with type 1 diabetes with a new registration of FM during 2016–2017 and with continued FM for two consecutive years thereafter, and 7691 control individuals using conventional self-monitoring of blood glucose (SMBG) during the same observation period, were included in a cohort study. Propensity sores and inverse probability of treatment weighting (IPTW) were used to balance FM users with SMBG users. Changes in HbA1c and events of severe hypoglycaemia were compared.ResultsAfter the start of FM, the difference in IPTW change in HbA1c was slightly greater in FM users compared with the control group during the follow-up period, with an estimated mean absolute difference of −1.2 mmol/mol (−0.11%) (95% CI −1.64 [−0.15], −0.75 [−0.07]; p < 0.0001) after 15–24 months. The change in HbA1c was greatest in those with baseline HbA1c ≥70 mmol/mol (8.5%), with the estimated mean absolute difference being −2.5 mmol/mol (−0.23%) (95% CI −3.84 [−0.35], −1.18 [−0.11]; p = 0.0002) 15–24 months post index. The change was also significant in the subgroups with initial HbA1c ≤52 mmol/mol (6.9%) and 53–69 mmol/mol (7.0–8.5%). Risk of severe hypoglycaemic episodes was reduced by 21% for FM users compared with control individuals using SMBG (OR 0.79 [95% CI 0.69, 0.91]; p = 0.0014)].Conclusions/interpretationIn this large cohort, the use of FM was associated with a small and sustained improvement in HbA1c, most evident in those with higher baseline HbA1c levels. In addition, FM users experienced lower rates of severe hypoglycaemic events compared with control individuals using SMBG for self-management of glucose control.Graphical abstract
Highlights
The benefit of optimal glucose control in reducing the risk for diabetes-related complications is an accepted paradigm
We have identified all adults with type 1 diabetes in the National Diabetes Registry (NDR) who have initiated and maintained flash glucose monitoring (FM) use for two consecutive years and those who have remained continuous glucose monitoring (CGM)/FM naive during the same time period, to allow propensity-score-adjusted analyses of long-term changes in glucose control after initiation of FM in comparison with conventional self-monitoring of blood glucose (SMBG)
Longitudinal observational study, we examined the long-term effectiveness of FM on glucose control in adults with type 1 diabetes
Summary
The benefit of optimal glucose control in reducing the risk for diabetes-related complications is an accepted paradigm. Glucose sensor-based technologies are probably the most innovative recent clinical advancements to aid self-management of glycaemic control. As stand-alone devices, systems for real-time continuous glucose monitoring (CGM) enable the user to gain instant information on the current glucose control and temporal trend, include alarms for hypo- and hyperglycaemia, and permit detailed retrospective analyses of day and night glucose control. In 2014, another technology, based on intermittently scanned glucose measurements ( named flash glucose monitoring [FM]), became available. Unlike CGM, this device requires active self-scanning of the glucose sensor and may be viewed as a more convenient alternative to conventional self-monitoring of blood glucose (SMBG). The sensor is factory-calibrated without the need for manual calibration during the 14 days wear time, and the accuracy is comparable with other CGM systems [1, 2]
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