Effect Of Flash Glucose Monitoring Research Articles

Albuminuria, glycemic variability and effect of flash glucose monitoring based decision making on short term glycemic variability in Indian type 2 diabetes patients: Indi-GlyVar study.

Glycemic variability (GV) denotes the fluctuations in the glucose values around the baseline. High glycemic variability is associated with a higher risk of diabetes-associated complications. In this study, we sought to determine the impact of therapeutic interventions based on flash glucose monitoring on rapid, short-term glycemic variability. We also studied the prevalent albuminuria in diabetic kidney disease and its effect on glycemic variability. In a 14-day, single-center, prospective intervention study, we measured the GV indices at baseline (days 1-4) and ten days after ambulatory glucose profile-based intervention using flash glucose monitoring (Abbott Libre Pro, Abbott Diabetes Care, Alameda, California, USA) in patients with type 2 diabetes. An EasyGV calculator was used to estimate the flash glucose monitoring (FGM)-derived measures of GV. The primary outcome was to assess the impact of FGMS-based therapeutic interventions on glycemic variability markers: SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD],Mvalue, and coefficient of variance [%CV], AUC below 70 mg/dl, low blood glucose index, AUC above 180 mg/dl [AUC >180], high blood glucose index [HBGI], and J index. Time-related matrices (time in range (%), time above range (%), and time below range (%) were also calculated from the ambulatory glucose profile. Renal function parameters (serum creatinine, estimated glomerular filtration rate, urine albumin excretion) were calculated. The GV with regard to albumin excretion rate was compared. Fifty-eight T2DM patients (63.8%, males) with a mean age of 51.5 ± 11.9 years were studied. When compared with baseline (days 1-4), on day 14, there was a significant improvement in mean sensor glucose (mg/dl) median (IQR) [155 (116-247) vs 131 (103-163)(p ≤0.001)], JINDEX [15,878 (7,706-28,298) vs 8,812 (5,545-14,130)(p ≤0.001)], HBGI [361 (304-492) vs 334 (280-379)(p ≤0.001)], MAGE (mg/dl) [112 (8-146) vs 82 (59-109)(p ≤0.001)], M-value [2,477 (1,883-3,848) vs 2,156 (1,667-2,656)(p ≤ 0.001)], MAG (mg/dl) [111 (88-132) vs 88 (69-102)(p ≤ 0.001)]. Patients with albuminuria at baseline had high mean sensor glucose (mg/dl) median (IQR) [190 (131-200) vs 131 (112-156)(p = 0.001)], CONGA (mg/dl) median (IQR) [155 (101-165) vs 108 (83-120) (p = 0.001)], JINDEX, HBGI, MAGE (mg/dl), and M-value are, median (IQR) [20,715 (10,970-26,217 vs 91,118 (6,504-15,445))(p ≤ 0.01)], [415 (338-423) vs 328 (292-354)(p = 0.001)], [125 (102-196) vs 103 (74-143)(p ≤ 0.01)], [3,014 (2,233-3,080) vs 2,132 (1,788-2,402)(p ≤0.01)], respectively. In type 2 diabetes, flash glucose monitoring-guided therapeutic interventions can reduce glycemic variability in a brief span (10 days) of time. Also, albuminuria in type 2 diabetes is associated with high glycemic variability. Reduced diabetes complications may ultimately result from this reduced glycemic variability.

The Impact of Flash Glucose Monitoring on Markers of Glycaemic Control and Patient Satisfaction in Type 2 Diabetes.

Introduction: The effect of flash glucose monitoring on glycaemic control and patient satisfaction in insulin-treated type 2 diabetes (T2D) from Saudi Arabia is uncertain. The aim of this prospective observational study was to evaluate the change in HbA1c (Hemoglobin A1c) and satisfaction with treatment following the initiation of flash glucose monitoring.Methods: This single-arm, single-centre prospective observational study included flash glucose monitoring-naive adult patients with T2D managed with multiple daily injections of insulin therapy (MDI) and HbA1c ≥7%. HbA1c was measured, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ, Arabic version) and Glucose Monitoring Satisfaction Survey (GMSS) were completed at baseline and 12 weeks.Results: For participants (n=54) from one diabetes centre, HbA1c significantly improved by 0.44% from 8.22%±0.69 (mean±SD) at baseline to 7.78%±0.71 at 12 weeks, p<0.001. Confirmed hypoglycaemic episodes reduced from 4.43±1.51 episodes/month to 1.24±1.15 (-3.19, p<0.001). Glucose monitoring frequency improved, indicated by the number of scans per day, with a mean increase of 5.13 (p <0.001) tests/day. GMSS scores improved across all four categories, as did overall treatment satisfaction (p<0.001 for all categories). Patients perceived clear improvements across all questions relating to satisfaction and frequency of hypo- or hyperglycaemic episodes.Conclusion: Following initiation of flash glucose monitoring in patients with T2D and MDI insulin therapy, HbA1c improved with reduced hypoglycaemic events and increased patient-reported satisfaction. This study contributes valuable data on the use of flash glucose monitoring in this population, and a larger multicentre study is warranted to inform future health policy for T2D in Saudi Arabia.

Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls

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

Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit.

OBJECTIVEThe FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions.RESEARCH DESIGN AND METHODSClinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA1c following the use of FSL. Within-person variations of HbA1c were calculated using .RESULTSData were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (±18.8) years, 51% female, diabetes duration 16.0 (±49.9) years, and BMI of 25.2 (±16.5) kg/m2 (mean [±SD]). FSL users demonstrated a −5.2 mmol/mol change in HbA1c, reducing from 67.5 (±20.9) mmol/mol (8.3%) at baseline to 62.3 (±18.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4–7.8) months of follow-up (n = 3,182) (P < 0.0001). HbA1c reduction was greater in those with initial HbA1c ≥69.5 mmol/mol (>8.5%), reducing from 85.5 (±16.1) mmol/mol (10%) to 73.1 (±15.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (±1.8) and reduced to 2.4 (±1.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ≥4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis.CONCLUSIONSWe show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.

Effects of unrestricted access to flash glucose monitoring in type 1 diabetes.

AimsWe assessed adherence and long‐term effects on HbA1c of unrestricted access to flash glucose monitoring (FGM) in a single diabetes centre.MethodsIn this observational study, we reviewed data files for all 411 patients with type 1 diabetes attending our clinic during a 2‐year period. Adherence was reported in those who initiated FGM in our clinic (n = 321). Baseline and final HbA1c were noted for patients who continued FGM for more than 6 months without clinical conditions or interventions at baseline that could interfere with the effect of FGM on glycaemic control (n = 270).ResultsAfter 2 years, the fraction of patients using FGM increased from 3% to 72%. Adherence to FGM was 88%. Baseline and final HbA1c was median (interquartile range) 63 mmol/mol (56, 74) (7.9% (7.3, 8.9)) and 59 mmol/mol (53, 68) (7.6% (7.0, 8.4)), respectively. The estimated difference final‐baseline HbA1c was −4 mmol/mol (95% CI −5, −3) (−0.4% (−0.5, −0.3)) (P < .001). No significant difference was seen for patients with baseline HbA1c ≤ 7% (53 mmol/mol). The interval from initiation of FGM to final HbA1c was median 562 days (IQR 417, 662). The number of scans/day was median 11 (IQR 8, 13) and correlated negatively with both final and baseline HbA1c but not with change in HbA1c.ConclusionsFollowing the introduction of unlimited access, nearly three quarters of the patients were FGM users. Long‐term adherence was good, and HbA1c improved in all patients except in those with optimal glycaemic control at baseline.

The Effect of Flash Glucose Monitoring on Glycemic Control in Patients with Type 1 Diabetes

Introduction: Freestyle Libre Flash glucose monitoring system is a new approach to self-monitoring of glucose. We investigated the effect on glycaemic control of applying this system in patients with type 1 diabetes in a real world clinical setting. Materials and Methods: A total of 210 consecutive patients with type 1 diabetes were included in an observational study investigating the change in glycaemic control upon introducing Freestyle Libre Flash Glucose monitoring (FGM) system (Abbott Diabetes Care Ltd, Range Road Witney, Oxon OX29 OYL; UK). Hba1c was monitored prior to the application of FGM and every 3-4 months during a follow-up of between 3 and 15 months. Results: HbA1C decreased significantly by 5 mmol/mol (IQR 10, P &amp;lt;0.0001) after 3 months as compared with baseline, where after HbA1c stabilized. When subdividing patients according to baseline glycemic control (Hba1c &amp;lt;53 mmol/mol, 54-70 mmol/mol, &amp;gt;70 mmol/mol) at inclusion in the study, we found a significant decrease in Hba1c in two groups (54-70: 4 mmol/mol, P&amp;lt;0.0001, &amp;gt;70: 7 mmol/mol, P&amp;lt;0.0001) from baseline to 3 months. Conclusion: In this observational study, we found a significant decrease in Hba1c- levels after the introduction of flash glucose monitoring in subjects with type 1 diabetes; this decrease was maintained throughout the 12-month study period. Disclosure G.H. Dørflinger: None. J.A. Østergaard: None. S. Fisker: Other Relationship; Self; Novo Nordisk A/S. S.T. Knudsen: Advisory Panel; Self; Novo Nordisk A/S, Merck &amp; Co., Inc., Sanofi-Aventis, Eli Lilly and Company, Boehringer Ingelheim GmbH, AstraZeneca. Speaker's Bureau; Self; Merck &amp; Co., Inc., Boehringer Ingelheim GmbH, AstraZeneca. T.K. Hansen: Advisory Panel; Self; Abbott, AstraZeneca, Novo Nordisk A/S. Research Support; Self; Novo Nordisk Foundation. Advisory Panel; Self; Merck Sharp &amp; Dohme Corp..

Beneficial Effect of Flash Glucose Monitoring Persists in a Two-Year Perspective—A Clinical Follow-Up Study of 334 Individuals with Type 1 Diabetes

Short term follow-up studies indicate that use of Flash glucose monitoring (FGM) improves metabolic control in people with type 1 diabetes. Whether this effect persists is unknown. The aim of this study was to evaluate long-term effects on HbA1c and treatment satisfaction in people with type 1 diabetes after introduction of FGM in a university hospital diabetes clinic. Treatment satisfaction was measured using DTSQs questionnaires at the one year follow-up. Of the first 334 patients who were introduced to FGM 80.5% were still users after 2 years, 8.7% changed to a CGM-system, 6.6% stopped due to skin reactions, 3.4% did not want to continue and 1.3% had died. Baseline HbA1c among continuers were 71.8±16.6 mmol/mol (8.7%). Compared to baseline, HbA1c was -8.3±9.8 mmol/mol after 1 year and 9.0±11.8 mmol/mol lower after 2 years. Self-estimated treatment satisfaction after 1 year was 2.44±0.74 (+3 to -3) and rating for continued FGM use was 2.87±0.33. Unacceptable high blood glucose was less often present (-0.6) as were unacceptable low blood glucose levels (-0.3). Conclusions: Use of FGM adds clinical significant advantage to individuals with 1 diabetes in terms of HbA1c reduction and improved self-estimated treatment satisfaction also in a 2-year perspective. Disclosure M. Londahl: Speaker's Bureau; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company. Advisory Panel; Self; Amgen Inc.. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk A/S. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; ReApplix AS. K. Fagher: Speaker's Bureau; Self; AstraZeneca, Sanofi, Novo Nordisk A/S, Merck Sharp &amp; Dohme Corp.. P. Katzman: None. K. Filipsson: Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Eli Lilly and Company. Consultant; Self; Eli Lilly and Company. Advisory Panel; Self; MSD K.K.. Speaker's Bureau; Self; Novo Nordisk A/S, Sanofi.

A Multicenter Real-Life Study on the Effect of Flash Glucose Monitoring on Glycemic Control in Patients with Type 1 and Type 2 Diabetes

To assess the efficacy of ambulatory glucose profiling (AGP) generated by FreeStyle LibrePro™ flash glucose monitoring (FCGM) on glycemic control in patients with uncontrolled type 1 diabetes (T1D) and type 2 diabetes (T2D). Clinical and biochemical data were obtained from 5072 patients with diabetes who had an A1c ≥7% (2536 who had been initiated on FCGM-based AGP between March 2015 and October 2016 [cases] and 2536 age-, gender-, A1c-, site- and time-matched controls who were not initiated on AGP) across seven diabetes clinics in India. Anthropometric and clinical measurements were obtained through standardized techniques. Fasting and postprandial plasma glucose and glycated hemoglobin(A1c) were estimated before and after initiation of AGP. Overall, there was a significant decrease in A1c both in cases and controls; however, the magnitude of reduction was higher among cases (1% vs.0.7%; P < 0.001).The overall reduction in A1c among cases was higher in T2D (9.2% to 8.3%) compared with T1D (9.6% to 9.4%); however, the absolute difference in A1c reduction between cases and controls was higher among T1D (0.5% vs. 0.2%) patients. The reduction in glycemic parameters was irrespective of age or gender (P for trend <0.001) across all study sites. The greatest reductions in A1c were noted within 6 months of AGP initiation. Multiple logistic regression showed that those who did not use AGP had a 1.42 higher risk (95% CI: 1.24-1.64) of not achieving even 0.1% reduction in A1c compared with those who were initiated on AGP even after adjusting for age, gender, body-mass index, systolic blood pressure, time to follow-up A1c, and medication use. This study shows that FCGM-based AGP with FreeStyle LibrePro is associated with significant reductions in A1c levels in both T1D and T2D. In addition, improvement in A1c levels was maintained across all age groups and in patients enrolled at different diabetes clinics in India.