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09-21-2022 | EASD 2022 | Conference coverage | News

Libre upgrade illustrates power of hypoglycemia alerts

Author: Eleanor McDermid

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medwireNews: Gaining the use of a low blood glucose alert by switching from the FreeStyle Libre 1 to 2 reduces the amount of time people with type 1 diabetes spend in hypoglycemia, report researchers.

However, this came at the expense of a very slight decrease in time in range (TIR) due to more time spent in hyperglycemia.

Presenting the findings at the 58th EASD Annual Meeting in Stockholm, Sweden, Fraser Gibb (Edinburgh Centre for Endocrinology & Diabetes, UK) explained that, unlike the first approved version of the FreeStyle Libre, the updated device has low- and high-glucose alarms.

Previous comparisons between Dexcom and FreeStyle Libre devices have implied the importance of alarms for improving TIR and reducing time in hypoglycemia, but such comparisons are limited by the large differences between the devices; Dexcom continuous glucose monitors provide real-time information, including an alert when low glucose is impending, whereas the Libre devices, while substantially cheaper, provide information only when scanned by the user.

Gibb reported data on 672 people in the Lothian region of Scotland (median age 42 years, 52% men) who converted from a FreeStyle Libre 1 to Libre 2. At 12 months after the upgrade, the average time spent below range decreased significantly from 3.0% to 2.0% and the average duration of hypoglycemic episodes decreased from 89 to 77 minutes.

However, average TIR fell significantly from 53.2% to 53.0%, explained by an increase in time above range from 42.0% to 45.0%.

A total of 410 people supplied information on their use of alarms, of whom 308 actively used low-glucose alarms and 225 used high-glucose alarms. Those who did not make use of either alarm had a significantly higher median baseline BMI than those who used them (28.0 vs 26.2 kg/m2), did fewer daily scans of their Libre device (median 7.4 vs 9.6), and had poorer glucose control.

Use of the high-glucose alert was independently associated with a 58% increased likelihood of achieving an absolute TIR increase of at least 5%, and use of the low-glucose alert was associated with a 92% increased likelihood of achieving at least a 0.5% absolute reduction in time below range.

Gibb noted that although the alarm thresholds can be customized, many were left at the default settings. He reported that the thresholds used were not significantly associated with outcomes, and although higher baseline time above range was associated with a higher choice of alarm threshold, there was no association between time below range and the chosen low-glucose alarm setting.

“I think this is potentially an important area for us to intervene on,” said Gibb, suggesting that people with a high time below range should be encouraged “to set their sensor threshold higher to get the maximum benefit from this system.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

EASD Annual Meeting; Stockholm, Sweden: Sept 19–23, 2022


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