Abstract
Aims/hypothesisMinimal evidence supports the efficacy of flash monitoring in lowering HbA1c. We sought to assess the impact of introducing flash monitoring in our centre.MethodsWe undertook a prospective observational study to assess change in HbA1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.ResultsThose with baseline HbA1c ≥58 mmol/mol (7.5%) achieved a median −7 mmol/mol (interquartile range [IQR] −13 to −1) (0.6% [−1.2 to −0.1]%) change in HbA1c (p < 0.001). The percentage achieving HbA1c <58 mmol/mol rose from 34.2% to 50.9% (p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA1c across a similar timescale (p = 0.508). Higher HbA1c (p < 0.001), younger age at diagnosis (p = 0.003) and lower social deprivation (p = 0.024) were independently associated with an HbA1c fall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day (p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring (p = 0.043).Conclusions/interpretationFlash monitoring is associated with significant improvements in HbA1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.
Highlights
MethodsFlash glucose monitoring provides users with an interstitial glucose value upon scanning a glucose sensor with a reader device
We present the largest prospective evaluation of the impact of flash monitoring in people with type 1 diabetes, with respect to change in HbA1c, hypoglycaemia, psychological symptoms, quality of life, flash monitoring data and hospital admissions
Of the 354 (39.3%) individuals who had a history of previous flash monitoring self-funding, 64.0% reported greater than 50% use prior to National Health Service (NHS) funding
Summary
Flash glucose monitoring provides users with an interstitial glucose value upon scanning a glucose sensor with a reader device. Flash monitoring was introduced in the UK in 2015, prior to November 2017 all use was limited to individuals who self-funded the purchase of glucose sensors. Flash monitor use was typically limited to more affluent individuals, with lower than average HbA1c [2]. Most evidence for the effectiveness of flash monitoring in lowering HbA1c comes from small uncontrolled studies [3] and the only large randomised controlled study in type 1 diabetes was limited to people with baseline HbA1c ≤58 mmol/mol (7.5%). There is, a paucity of evidence assessing the effectiveness of flash monitoring in a representative population of people with type 1 diabetes. We present the largest prospective evaluation of the impact of flash monitoring in people with type 1 diabetes, with respect to change in HbA1c, hypoglycaemia, psychological symptoms, quality of life, flash monitoring data and hospital admissions
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