Abstract
Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.
Highlights
Self-monitoring of blood glucose (SMBG) has long been one of the key elements of type 1 diabetes mellitus (T1D) management
The appearance of new technologies, such as flash glucose monitoring (FGM), which facilitate the monitoring of interstitial glucose, has changed the lives of many patients with T1D [2,3]
The most modern FGM devices demonstrate a mean absolute relative difference in glucose values of 11.4% compared to SMBG, allowing the collected data to be used for self and hetero adjustment of insulin
Summary
Self-monitoring of blood glucose (SMBG) has long been one of the key elements of type 1 diabetes mellitus (T1D) management. Whereas SMBG provides isolated blood glucose values, FGM, through painless scanning, provides considerably more information, such as the direction and velocity of glycemic changes (i.e., trend arrows), estimated glycated hemoglobin (HbA1c), average glucose, percentage of readings above, below and within the predefined target range, number and duration of hypoglycemic events and daily profiles [2]. This allows for a reduction in hypoglycemic events and glucose variability, as well as an improvement in glycemic control, quality of life and treatment satisfaction [2,4,5].
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