Glucose Awareness to Motivate and Enable Solutions (GAMES) in diabetes mellitus using flash glucose monitoring: A clinical programme.

Abstract

This real-world observational clinical programme evaluated short and medium-term effects of intermittent flash glucose monitoring on HbA1c, glycaemic variability and lifestyle behavioural changes. Two first-generation Libre flash glucose monitoring sensors were provided 3-4months apart with a food, activity diary, user evaluation survey and treatment modification after each sensor wear. T-tests were used to compare glucose variables within each sensor (week 1 vs. week 2) and between sensors (1st sensor vs. 2nd sensor). EasyGV software was used to calculate glycaemic variability. From 42 type 1 diabetes and 120 type 2 diabetes participants, there was no statistically significant change in mean HbA1c for participants with type 1 diabetes at 3-4months after the 1st sensor but there was a statistically significant HbA1c reduction for participants with type 2 diabetes [-4mmol/mol (-0.4%), p=0.008], despite no statistically significant differences in carbohydrate intake, exercise frequency and duration. Greater reduction was seen in those with baseline HbA1c> 86mmol/mol (10%) in both type 1 [-12mmol/mol (-1.1%), p=0.009] and type 2 diabetes [-11mmol/mol (-1.0%), p=0.001). Both type 1 and type 2 diabetes showed improvements in Glucose Management Indicator and percentage time-above-range when comparing week 1 versus week 2 of the same sensor. Higher scan frequency resulted in improved glycaemic parameters and certain measures of glycaemic variability. The majority of participants (85%) agreed that flash glucose monitoring is a useful device but only 60% were keen to use it for daily monitoring. Constant feedback from flash glucose monitoring improves glycaemic parameters within the first week of wear. Intermittent use 3-4months apart resulted in greater improvements for those with higher baseline HbA1c.