medwireNews: Real-world data presented at the virtual ADA 80th Scientific Sessions highlight the benefits of the FreeStyle Libre continuous glucose monitoring (CGM) system in reducing acute complications in people with type 1 or type 2 diabetes.
The first study, presented by Ronan Roussel (Hôpital Bichat, Paris, France), focused on rates of hospitalization for diabetic ketoacidosis (DKA) in people with type 1 or type 2 diabetes, while the second study, given by Richard Bergenstal (International Diabetes Center, Minneapolis, Minnesota, USA), looked at a composite outcome of acute diabetes-related events (ADE) and all-cause hospitalizations in patients with type 2 diabetes.
Roussel reported that, among 33,203 people with type 1 diabetes registered in a nationwide French reimbursement claims database, DKA hospitalization rates fell by 52% in the year after FreeStyle Libre initiation compared with the year before. Prior to initiation in August–December 2017 the DKA hospitalization rate in this group was 5.46 events per 100 person–years whereas after it was 2.59 events per 100 person–years.
Similar results were observed for the 40,955 people with type 2 diabetes. Here the DKA hospitalization rate fell from 1.70 to 0.90 events per 100 person–years, a 47% reduction.
Roussel noted that, in the year before FreeStyle Libre initiation, a high proportion (24–29%) of the participants were not using self-monitoring blood glucose (SMBG) strips according to pharmacy claims. These individuals derived the greatest benefit from CGM, with 60% and 51% reductions in DKA hospitalizations in the year following initiation for type 1 and type 2 diabetes, respectively. And the rates fell regardless of whether participants were using multiple daily injections or an insulin pump.
Individuals with high adherence to SMBG (>5 strips/day) also showed a large benefit from CGM, with 59% and 52% reductions in DKA hospitalizations in the type 1 and type 2 diabetes cohorts, respectively.
Roussel concluded: “It is plausible that the use of the FreeStyle Libre system allowed people to detect and limit persistent hyperglycemia, and subsequently ketoacidosis.”
He added that the analysis “has significant implications for patient-centered clinical care in diabetes and also for long-term health economic outcomes in the treatment of diabetes at a national level.”
In the same session, Bergenstal reported that the rate of ADE among 2463 individuals with type 2 diabetes from the US-based IBM MarketScan claims database fell from 0.180 to 0.072 events per patient–year (221 vs 84 events) in the 6 months before versus the 6 months after FreeStyle Libre system purchase.
This was equivalent to a significant 60% reduction in the risk for ADE before versus after CGM initiation, with ADE defined as inpatient and emergency outpatient visits for hypoglycemia, hyperglycemia, DKA, and hyperosmolarity.
Bergenstal and team also found that all-cause hospitalization rates fell, by a significant 33%, in the 6 months following FreeStyle Libre system purchase from 0.420 to 0.283 events per patient–year (516 vs 331 events).
And not only did hospitalization rates fall, but the reasons for admission changed. Endocrine, nutritional and metabolic problems were the second most common cause for admission in the 6 months before CGM, but were only the fifth most common in the 6 months after, with rates falling from 6.4 to 2.6 events per patient–year. Rates of infectious disease, respiratory, renal, and hepatobiliary admissions were also all reduced in the 6 months after FreeStyle Libre purchase.
However, Bergenstal cautioned: “As striking and positive as the data [are] there are some limitations in our study.”
He said these include the fact that the retrospective nature of the study means that the strong associations do not necessarily equal strict cause and effect, while the lack of certain populations, such as those on Medicare or Medicaid, means the findings are not completely generalizable.
Nonetheless, Bergenstal concluded that the results “provide compelling support for the use of flash CGM to improve clinical outcomes, and beyond that they are potentially strong indicators of possible reduced cost for this patient population.”
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ADA Scientific Sessions; 12–16 June 2020 (68-OR)
ADA Scientific Sessions; 12–16 June 2020 (69-OR)