Use Of Flash Glucose Monitoring Research Articles

Use of Flash Glucose Monitoring in Patients on Intensive Insulin Treatment

Use of Flash Glucose Monitoring in Patients on Intensive Insulin Treatment

Use of flash glucose monitoring for post-bariatric hypoglycaemia diagnosis and management

Our aim was to assess the potential of flash glucose monitoring (FGM) for diagnostic workup of suspected post-bariatric hypoglycaemia (PBH). Patients (N = 13) with suspected PBH underwent a food and symptoms diary (FSD) record along with FGM over 14 days. Targeted data analysis confirmed the occurrence of low glucose events in parallel to meal-triggered symptoms. Glycaemic variability, as assessed by Mean Absolute Glucose change (MAG change), was increased, while a higher risk of glycaemic excursions towards both hyper and hypoglycaemia (ADRRFGMGT) was observed in those with more frequent and severe hypoglycaemia. The herein described hypoglycaemia risk index (LBGIFGMGT) with a cut-off value of 4.6 showed to have 100% sensitivity and 100% specificity for PBH. This pilot proof-of-concept study highlighted that FSD coupled with FGM followed by targeted data analysis, provides relevant insights towards PBH diagnosis and grading in a user-friendly and easy to implement study protocol. Furthermore, LBGIFGMGT demonstrated to be an excellent index for PBH diagnosis. The unexpected improvement of glucose profile noticed along the monitoring time also unravels a possible application for PBH management.

Assessing Diabetes Distress and Sleep Quality in Young Adults with Type 1 Diabetes Using FreeStyle Libre: A Prospective Cohort Study.

IntroductionThe burden of diabetes, its potential complications, and related self-care activities can induce negative psychosocial effects in patients with type 1 diabetes mellitus (T1DM). This prospective cohort study investigated the psychosocial benefits associated with 3 months of FreeStyle Libre (FSL) flash glucose monitoring use in young adults with T1DM in Saudi Arabia.MethodsPatients completed the Diabetes Distress Scale (DDS) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires at baseline and 3 months. HbA1c, number of confirmed hypoglycemia episodes per month, and frequency of blood glucose testing were also collected at baseline and 3 months.ResultsOf 95 patients analyzed, significant reductions were observed in mean DDS (3.8 vs. 2.5; p < 0.001) and PSQI (8.7 vs. 3.9; p < 0.001) scores from baseline to 3 months. Furthermore, HbA1c and confirmed hypoglycemia episodes per month also decreased from baseline to 3 months (HbA1c 8.3 vs. 7.7% [67 vs. 61 mmol/mol], p < 0.001; hypoglycemia episodes 3.0 vs. 2.3, p < 0.001). In contrast, mean frequency of blood glucose testing per day increased from baseline to 3 months (2.5 vs. 5.2; p < 0.001).ConclusionThese data demonstrate improvements in diabetes distress and sleep quality as well as glycemic outcomes following 3 months’ FSL use in young adults with T1DM.

894-P: Intermittent Use of Flash Glucose Monitoring (FGM) and Education Improves Glycemia in Type 2 Diabetes (T2D) in Singapore: Pilot Data from Glimpse Project

Limited evidence exists on the use of FGM in people with type 2 diabetes (T2D) on non-prandial insulin therapies. Aim: To study the feasibility of intermittent FGM and education among sub-optimally controlled T2D. Adult T2Ds on any treatment but prandial insulin, HbA1c 7.5-10%, received Freestyle Libre sensor and structured education. Sensor use was continuous for 6 weeks (w), then 2 weekly up to 24w. A blinded sensor was worn at -2w and 24w. n=28, 11 men, mean age 55± 12 y, BMI 27.2 ± 4 kg/m2, 6/28 on basal insulin. Mean HbA1c fell from baseline of 8.5 ± 0.5% to 7.9 ± 0.9% (69 to 63 mmol/mol, p=0.001) and was sustained to 24w (fig 1). SD and TAR (&amp;gt;13.9 mmol/L) showed a trend to improvement (Table 1). Intermittent FGM use with education in T2D showed a sustained improvement in glycemia up to 24 weeks. Disclosure S. Rama Chandran: None. M. Gandhi: None. K. Adaikan: None. N. Tan: None. I.K.Y. Phoon: None. D. Gardner: None. Funding Singapore Ministry of Health (MH34:31/2)

FreeStyle Libre and diabetes distress: a pilot analysis in a real‐life secondary care clinic setting

The use of flash glucose monitoring has been shown to reduce hypoglycaemic episodes and improve diabetes control, but there is little evidence regarding its psychological impact. Here, a pilot evaluation is presented which assesses whether or not the use of FreeStyle Libre impacted on patient anxiety scores.

Three European Retrospective Real-World Chart Review Studies to Determine the Effectiveness of Flash Glucose Monitoring on HbA1c in Adults with Type2 Diabetes.

IntroductionThe impact of flash glucose monitoring technology on HbA1c in type 2 diabetes managed by basal bolus insulin is uncertain. Three parallel European retrospective non-interventional chart review studies collected data reported in medical records. Each country’s study aim was to determine the effectiveness of the device on HbA1c when used by their population for 3–6 months as their standard of care for management of glycaemia in a real-world setting.MethodsMedical records were eligible for adult patients with type 2 diabetes, on a basal bolus insulin regimen for 1 year or more, device use for 3 months or more before the start of the study, an HbA1c concentration up to 3 months prior to starting device use (patients were using blood glucose monitoring for self-management) between 64 and 108 mmol/mol (8.0–12.0%) plus an HbA1c determination 3–6 months after commencing flash glucose monitoring use.ResultsRecords were analysed from 18 medical centres in Austria (n = 92), France (n = 88) and Germany (n = 183). Baseline HbA1c results, recorded up to 90 days before the start of device use, were comparable across the three countries and were reduced significantly by 9.6 ± 8.8 mmol/mol mean ± SD (Austria [0.9 ± 0.8%], p < 0.0001), 8.9 ± 12.5 mmol/mol (France [0.8% ± 1.1], p < 0.0001) and 10.1 ± 12.2 mmol/mol (Germany [0.9% ± 1.1], p < 0.0001). No significant differences were detected between age group, sex, BMI or duration of insulin use.ConclusionsThree European real-world, chart review studies in people with type 2 diabetes managed using basal bolus insulin therapy each concluded that HbA1c was significantly reduced after changing to use of flash glucose monitoring for 3–6 months in a real-world setting.Electronic supplementary materialThe online version of this article (10.1007/s13300-019-00741-9) contains supplementary material, which is available to authorized users.

Exploring parental perspectives after commencement of flash glucose monitoring for type 1 diabetes in adolescents and young adults not meeting glycaemic targets: a qualitative study.

To explore parental perspectives after flash glucose monitoring commencement in adolescents and young adults with type 1 diabetes who were not meeting glycaemic targets. Twelve semi-structured interviews were conducted among parents of adolescents and young adults between the ages of 14 and 20 years (inclusive) with type 1 diabetes and not meeting glycaemic targets [HbA1c 81-130 mmol/mol (9.6-14.0%)] participating in a randomized controlled trial. Interviews were transcribed, then thematic analysis was performed to identify themes regarding parental experiences. Four key themes were found: flash glucose monitoring improved parental emotional well-being; flash glucose monitoring reduced diabetes-specific conflict within families; flash glucose monitoring facilitated the parental role in diabetes management; and sensor-related challenges, particularly sensors falling off, interfered with using flash glucose monitoring for diabetes management. The cost of self-funded sensors was the only barrier to continuing flash glucose monitoring that parents reported. This study provides new insights into the potential benefits and challenges of flash glucose monitoring use, drawn from the perspective of parents of adolescents and young adults not meeting glycaemic targets. As parents are often key partners in obtaining or purchasing this technology, these findings can be used to further inform parental expectations of this technology.

Initial experiences of adolescents and young adults with type 1 diabetes and high-risk glycemic control after starting flash glucose monitoring - a qualitative study.

This study explored early experiences with a flash glucose monitoring system among adolescents and young adults with type 1 diabetes and high-risk glycemic control. Adolescents and young adults with high-risk glycemic control (HbA1c ≥ 75mmol/mol (9.0%) in the previous 6months) who had recently commenced on flash glucose monitoring as part of a trial took part in a semi-structured interview exploring their experiences with the technology. All interviews were recorded, transcribed and analyzed using an inductive approach. Fifteen interviews were conducted. Overall, participants enjoyed flash glucose monitoring and planned to continue using their system. Key findings included flash glucose monitoring reduced diabetes management burden and increased glucose monitoring. Other impacts of flash glucose monitoring use included perceived improved mood and energy, increased capacity for physical activity and less parental conflict. While participants reported healthier glycemic control, participants' mean interstitial glucose level remained above the target range of 3.9-10.0mmol/L (70-180mg/dL) over the first month of flash glucose monitoring. Common challenges included premature sensor loss and decreased scanning over the first month of use. Flash glucose monitoring may be an acceptable self-management tool to increase monitoring frequency in adolescents and young adults with type 1 diabetes and high-risk glycemic control, with the potential to improve long-term glycemic control. Initial support efforts should focus on practical strategies to prolong sensor wear and motivate frequent scanning as well as education on interpreting glucose data and making informed treatment decisions to maximize the benefits of this technology.

Improved well-being and decreased disease burden after 1-year use of flash glucose monitoring (FLARE-NL4)

IntroductionThe FreeStyle Libre is a flash glucose monitoring (FSL-FGM) system. Compared with finger-prick based self-monitoring of blood glucose, FSL-FGM may provide benefits in terms of improved glycemic control and decreased...

Use of flash glucose monitoring during hypo/hyperglycaemia and to guide insulin administration in paediatric patients with type 1 diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

102 - Canadian Real-World Analysis of Flash Glucose Monitoring and Impact on Glycemic Control

Prior analyses of global data from real world use of flash glucose monitoring have associated frequency of scanning with greater time in range and lower mean glucose, glucose variability and hypoglycemia.

Cutaneous Complications With Continuous or Flash Glucose Monitoring Use: Systematic Review of Trials and Observational Studies

Continuous glucose monitoring (CGM)/flash glucose monitoring (FGM) use in diabetes management is increasing. Cutaneous complications associated with these devices were reported. We conducted a systematic review to provide an overview of cutaneous complications with CGM/FGM use. We identified observational studies and intervention trials that report on cutaneous complications with CGM/FGM use up to January 14, 2019. Studies were identified through Medline, Embase, and PubMed, or with hand searching of the previous publications. Screening was duplicated and data extracted to consider four main themes: incidence rate and severity, participant perspectives of cutaneous complications, potential solutions, and future directions in diabetic technology relevant to reducing cutaneous complications. A total of 54 eligible studies were identified. The overall event rate of cutaneous complications reported from 19 trials was one event per eight weeks of sensor wear-time of which 1.5% were considered severe. The most common cutaneous complications were wear-related erythema, itching, and induration. Although skin irritations were the most common cause of CGM/FGM discontinuation, most users experienced less pain or discomfort with CGM/FGM than capillary blood glucose testing. Future technological advances may reduce, but not eliminate cutaneous complications. The incidence rate of reported cutaneous complications with CGM/FGM use from the available literature is low, with one event per eight weeks of sensor wear-time. Reported complication severity was also low, leading to low rates of CGM/FGM discontinuation. However, there appear to be discrepancies between reporting in trial and observational data. Greater constancy in reporting is necessary to understand the frequency of this issue.

921-P: Managing Trend Arrows with FGM: Effects on Glycemic Control in Type 1 Diabetic (T1DM) Subjects

Background: The use of flash glucose monitoring (FGM) has expanded widely among diabetic patients. Large randomized controlled trials demonstrated that use of FGM resulted in significant reductions in hypoglycemia, increased time in target range, reduced glycemic variability, and greater patient satisfaction compared with finger stick but no significant effects on glycemic control. Nonetheless, there is sparse guidance for what actions individuals should take based on the trend arrow data. Aim of the Study: To verify the impact of published recommendation (Bianchi C., Aragona M. J Diabetes Complications. 2018 Oct 24) on glycemic control in type 1 diabetic subjects (T1DM). Patients and Methods: Since January 2018, 145 T1DM patients initiated FGM, after a period of education on the system and how to adjust insulin doses based on trend arrow (Trained Group - TG) and compared to a matched group of 204 patients who started FMG before recommendations were elaborated and therefore not being trained (Not Trained Group - NTG). The two groups showed no significant difference in terms of age, sex, duration of disease, type of treatment, BMI and insulin requirements. Results: In TG HbA1c at baseline was 59±14 mmol/mol to decline 55±12 mmol/mol at month 6 (p&amp;lt;0.00001). In NTG HbA1c at baseline was 58±14 mmol/mol with minimal though statistically significant reduction after 6 months (56±12 mmol/mol; p&amp;lt;0.04). In both groups there was no change in BMI and Insulin Requirements. Conclusions and Comments: In our clinical practice, FGM implementation was associated with a small but significant reduction in HbA1c, particularly in trained patients. Prospective and larger studies are needed to validate international guidelines for the education of diabetic patients adopting these new technologies. Disclosure C. Rodia: None. C. Bianchi: None. A. Bertolotto: Speaker's Bureau; Self; Abbott, Lilly Diabetes. R. Giannarelli: None. F. Campi: None. S. Gennai: None. S. Del Prato: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, GlaxoSmithKline plc., Merck Sharp &amp; Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Servier, Takeda Pharmaceutical Company Limited. Board Member; Self; AstraZeneca. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. M. Aragona: None.

918-P: Real-World Association of Glucose Monitoring Frequency and Glycemic Metrics in the United States

Global data from real world use of flash glucose monitoring have correlated higher frequency of scanning with better glycemic control. Because flash glucose monitoring became available in late 2017 in the United States, U.S. data was not captured in the early global flash glucose monitoring analysis. The objective of this study was highlight real world outcomes in patients using flash glucose monitoring in the U.S. A server collected deidentified data from patients who uploaded their flash glucose monitoring system readers. Data from patients within the U.S. were analyzed through September 2018. Individuals were divided into 10 equal sized groups based on scanning frequency. Average time in range (70- 180 mg/dL) and time above range 180 mg/dL was calculated for each group. This analysis includes 21,853 readers, 115,221 sensors, and 102 million glucose values with an average of 9 scans per day. Patients in the lowest scanning frequency decile (3.4 scans per day) had 55% time in range and 41% time above. Patients in the highest scanning frequency decile (30.7 scans per day) had 74% time in range and 21% time above. This represents a 49% reduction in the time above target and a 34% increase in the time in range. Real world data from U.S. shows how frequency of scanning correlates with time in range and hyperglycemia. This analysis is consistent with prior analyses concluding that patients with diabetes who monitor their glucose more frequently derive greater benefit than patients who monitor less frequently. Disclosure E. Wright: Advisory Panel; Self; Abbott, Sanofi US, Voluntis USA. Consultant; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Eli Lilly and Company. Other Relationship; Self; American Diabetes Association, Medscape, UpToDate. N. Virdi: Employee; Self; Abbott, Proteus Digital Health. Stock/Shareholder; Self; Johnson &amp; Johnson. T. Dunn: Employee; Self; Abbott Laboratories.

919-P: Canada Real-World Analysis of Flash Glucose Monitoring and Impact on Time-in-Range and Hypoglycemia

Prior analyses of global data from real world use of flash glucose monitoring have associated frequency of scanning with greater time in range and lower mean glucose, glucose variability, and hypoglycemia. These analyses did not include data from North America as flash glucose monitoring became available in late 2017. The objective of this follow-up analysis is to focus on real world outcomes in patients using flash glucose monitoring in Canada. A server collected anonymized data from patients whose flash glucose readers are uploaded (by patient or health care professional). Data from patients within Canada was analyzed through September 2018 (approximately 1 year). To understand the relationship between time in range and glucose variability with monitoring frequency, individuals were divided into 10 equal sized groups based on scanning frequency. Average ± SE time in range (glucose 70 mg/dL - 180 mg/dL [3.9 mmol/L - 10.0 mmol/L]) and time in glucose ≤ 54 mg/dL (∼3.0 mmol/L) was calculated for each group. This analysis includes 15,424 readers, 95,103 sensors, and 108 million glucose measurements with an average of 12 scans per day. Patients in the lowest scanning frequency decile (3.7 scans per day) spent 12.6 ± 0.14 hours in range and 28.8 ± 1.2 minutes with a glucose ≤ 54 mg/dL. Patients in the highest scanning frequency decile (29.2 scans per day) spent 16.6 ± 0.12 hours in range and 22.1 ± 1.0 minutes with a glucose ≤ 54 mg/dL. Real-world data from Canada demonstrates that higher frequency of scanning is associated with increased time in range and decreased hypoglycemia. This analysis is consistent with prior analyses and suggests that patients with diabetes who scan to obtain their glucose more frequently derive greater benefit than patients who scan less frequently. Disclosure L. Berard: Advisory Panel; Self; Eli Lilly and Company. Consultant; Self; Abbott, Ascensia Diabetes Care, AstraZeneca, Bayer AG, Becton, Dickinson and Company, Janssen Pharmaceuticals, Inc., LifeScan Canada, Mylan, Novo Nordisk Inc., Sanofi. Research Support; Self; Montmed Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck &amp; Co., Inc. N. Virdi: Employee; Self; Abbott, Proteus Digital Health. Stock/Shareholder; Self; Johnson &amp; Johnson. T. Dunn: Employee; Self; Abbott Laboratories.

Evaluation of flash glucose monitoring after long-term use: A pediatric survey

AimsTo understand the opinions of children with type 1 diabetes about their everyday use of flash glucose monitoring. (FGM). MethodsChildren with type 1 diabetes using the FreeStyle Libre® FGM system and/or their parents were surveyed in several French medical centers between December 2016 and June 2017, regardless of their treatment regimen and metabolic control. ResultsOf the 347 patients recruited, 79.5% had been using the sensor for more than three months (average usage time: 285 days). The main reported motivations for initiating this type of monitoring were to avoid finger prick pain (for 85.9% of patients) and to allow parents to check nocturnal glucose levels (60.8%). Two-thirds of respondents experienced difficulties, mainly the sensor falling off (47.6%), measurement discrepancies (25.1%) and cutaneous reactions (22.2%); 89.5% changed their habits: 70.6% took more scans, 37.2% corrected their hyperglycemia more promptly, and 37.5% used trends to adjust their insulin dosage. About one-third of the study group (35.1%) experienced lower HbA1c levels, and two thirds (67.1%) were satisfied with the device. ConclusionsOur results show that FGM is a widely accepted option for self-monitoring diabetes, but that specific training is required to improve its use for insulin dosage adjustment and metabolic results.

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.

Flash Glucose Monitoring in Children–One-Year Experience

Aims: To characterize the use of Flash Glucose Monitoring (FGM) in type 1 diabetic patients in a pediatric hospital one year after reimbursement by the public health insurance in Belgium. Methods: This retrospective study included all type 1 diabetic children and adolescents who switched to FGM with specific education in our center and for whom A1c, FGM data, and severe hypoglycemic records were available. Results: On the 334 subjects (aged 4-20 years) included, 56 (16.8%) refused to use FGM. At baseline, users were younger [median (IQR)] (13.6 (10.9-16.3) vs. 15.2 (12.2-17.5) years; p=0.012) and performed more SMBG tests (4.3 (3.8-5.0) vs. 4.1 (3.5-4.4) per day; p=0.008) than non-users. During follow-up, FGM users increased glucose monitoring from 4.3 (3.8-5.0) to 7.0 (5.0-10.0) time per day (p=0.011) while severe hypoglycemic events decreased from 6.8% to 0.9% (p=0.011). At the end of follow-up (12.7 (11.9-13.5) months), there were less severe hypoglycemic events in FGM users than in non-users (0.9% vs. 8.9%; p=0.026) but no difference in A1c. In multivariate analysis, ΔA1c during follow-up was independently related to A1c at baseline (R=0.419; p&amp;lt;0.001) for FGM users, and negatively with the frequency of glucose scans (R=0.160; p&amp;lt;0.001). Conclusions: FGM is well accepted in our pediatric population and decreased the risk of severe hypoglycemic events, without changing A1c after one-year follow-up in youth with good glycemic control at baseline. Disclosure A. Messaaoui: None. S. Tenoutasse: None. L. Crenier: None.

Makes FLASH the difference between the intervention group and the treatment-as-usual group in an evaluation study of a structured education and treatment programme for flash glucose monitoring devices in people with diabetes on intensive insulin therapy: study protocol for a randomised controlled trial

BackgroundPeople with diabetes on intensive insulin therapy need sufficient glycaemic control to prevent the onset or progression of diabetic complications. The burden of multiple daily blood glucose self-testing can be lessened by novel diabetes technology like flash glucose monitoring systems which provide more information compared to self-monitoring of blood glucose. Despite this delivered additional information studies are showing no significant effect on HbA1c reduction, but a reduced time spent in a hypoglycaemic glucose range. We assume that users of these devices need additional education and training to integrate the delivered information into treatment decisions. Therefore, FLASH, an education and treatment programme, was developed. The programme evaluation follows herein.Methods/designPatients are recruited through 40 diabetes outpatient study centres located across Germany. They will be randomly assigned to participate in the education and treatment programme (intervention group) or to obtain treatment as usual (control group). All patients have to give blood samples and to answer a bench of questionnaires during baseline assessment, at the end of the intervention, and 6 months after the end of the intervention. Physicians will be asked to declare some additional clinical data (such as details of the diabetes therapy) for every patient at every one of the three assessment points.DiscussionThis study is conducted as a randomised controlled trial to test the hypothesis that the newly developed education and treatment programme combined with the use of a flash glucose monitoring device (intervention group) is superior to reduce HbA1c compared to the use of flash glucose monitoring alone (control group). The first results will be expected in 2018.Trial registrationClinicalTrials.gov, ID: NCT03175315. Registered on 2 May 2017.