medwireNews: “Flash” glucose monitoring reduces the time adults with Type 1 diabetes spend in a hypoglycaemic state by about a third, research shows.
The system involves a sensor-based glucose monitor that is precalibrated in the factory. When a reader is brought into close proximity to the sensor it transfers information including current glucose level and a glucose trend arrow.
In this prospective, randomised trial, which appears in The Lancet, use of the device reduced time spent in hypoglycaemia regardless of whether patients had an insulin pump or used multiple injections.
Hood Thabit (University of Cambridge, UK) and co-authors of an accompanying commentary put the results down to a behavioural change. “Users need to respond to glucose measurements by adjusting insulin delivery, modifying eating habits, and exercise management”, they write.
During 6 months of use, the 119 patients assigned to receive the intervention reduced their time spent in hypoglycaemia (<3.9 mmol/L) from 3.38 to 2.03 hours/day. This was a significant 38.0% reduction relative to the 120 patients in the control group, whose baseline and 6-month rates were 3.44 and 3.27 hours/day, respectively. The intervention group also had a 25.8% reduction in the number of hypoglycaemic events relative to the controls.
Reductions in hypoglycaemia time occurred during the first 2 weeks – before patients’ first post-baseline clinic visit. Patients in the intervention group reduced their average daily number of self-monitored blood glucose tests from 5.5 at baseline to 0.5 during the trial, while the average number of daily data readings was 15.1.
“The convenience of inspecting glucose levels quickly, on average once an hour during the daytime, seems key but indicates unrelenting round-the-clock attention to diabetes self-care to limit hypoglycaemia”, observe Thabit et al.
Glycated haemoglobin levels were “essentially unchanged” in the intervention group compared with the control group, report Jan Bolinder (Karolinska Institute, Stockholm, Sweden) and co-researchers. But the intervention significantly improved several other measures, including time spent in hyperglycaemia (by 19.1%) and multiple measures of glucose variability. Patient satisfaction with treatment also improved in the intervention group compared with the control group.
None of the five serious adverse events reported in the intervention group were related to the sensor. There were 13 non-serious sensor-related events, including allergy, itching, rash and insertion-site symptoms, all of which resolved.
The researchers say that the device needs to be tested in a wider patient population; their study excluded patients with severe hypoglycaemia unawareness and was limited to those with well-controlled diabetes, which “implies that participants were highly motivated and successful in their self-management compared with other populations”.
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