ABCD audit data reveal improved glycemic control with use of FreeStyle Libre, canagliflozin
medwireNews: Analyses of real-world audit data show positive initial results for the flash glucose monitoring system FreeStyle Libre (FSL; Abbott Diabetes Care, Alameda, California, USA), and the sodium-glucose cotransporter 2 inhibitor canagliflozin.
The findings were presented during an oral session at the 2019 Diabetes UK Professional Conference in Liverpool.
The Association of British Clinical Diabetologists (ABCD) nationwide audit collected data for 170 FSL users, with a mean type 1 diabetes duration of 14 years and median baseline glycated hemoglobin (HbA1c) levels of 65 mmol/mol.
After a median follow-up of 6 months, there was a significant reduction in median HbA1c levels from 65.7 mmol/L pre-FSL to 59.0 mmol/L post-FSL, reported Harshal Deshmukh (University of Hull, UK), with consistent results across different geographic areas.
Moreover, the median Gold Score also decreased, from 3.29 to 2.79, indicating an improvement in hypoglycemia awareness following introduction of the FSL. However, “more data [are] needed to see if reversal of hypoglycemia unawareness” can be achieved, said Deshmukh.
In the 12 months prior to introduction of the FSL, 5% of the patients attended hospital for a diabetes-related complication, which dropped to 1% after the 6-month follow-up, and there was a 1% discontinuation rate, which was mostly linked to lack of funding, Deshmukh highlighted.
The overall user experience of FSL was described as “very good” or “excellent” by patients, with a corresponding drop in Diabetes Distress Score from 3 points at baseline to 2 points at follow-up.
While these are encouraging data from a real-world setting, Deshmukh concluded that there is a “need for more follow-up data to see if beneficial effects are sustained.”
Using data from the same nationwide audit, Amar Puttanna (Sandwell and West Birmingham NHS Trust, UK), on behalf of the ABCD Nationwide Canagliflozin Audit Contributors, presented 2-year follow-up data evaluating the efficacy of canagliflozin in a clinical setting. The analysis included 690 patients from 21 centers across the UK.
Results revealed significant mean HbA1c reductions of between 4.0 and 12.1 mmol/mol, depending on the number of add-on therapies, with the greatest benefit shown in those on quadruple combination regimes.
Following stratification for specific medications, significant reductions in HbA1c were again observed, said Puttanna. This ranged from 10.4 mmol/mol when added to metformin to 14.0 mmol/mol when added to sulfonylureas.
These findings reveal sustained and significant reductions in HbA1c with canagliflozin use and offer “a real-world insight into the use and glycemic-lowering effects of canagliflozin,” Puttanna concluded.
Results from additional UK audits were presented in the same session, which highlighted positive real-world data for a switch from primarily insulin detemir or glargine to insulin degludec in type 1 diabetes and the use of the duodenal-jejunal sleeve bypass EndoBarrier (GI Dynamics Inc., Lexington, Massachusetts, USA) in advanced type 2 diabetes and obesity.
Also presented was the first study to attempt to quantify the impact investment in diabetes medications is having on healthcare costs of type 2 diabetes.
By Rebecca Cox
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