medwireNews: Flash glucose monitoring improves glycemic control and reduces diabetic ketoacidosis (DKA) rates across nearly all age, sex, and sociodemographic strata, regardless of insulin pump use, according to UK observational data.
Anita Jeyam, from Edinburgh University, and co-investigators say: “These data support provision of [flash monitoring] for people with type 1 diabetes wishing to use them and emphasise the importance of maximizing uptake and benefit in most-deprived socioeconomic groups.”
Using the Scottish national diabetes registry, the researchers found that the prevalence of flash monitoring use among people with type 1 diabetes increased from 3.1% in 2017 to 45.9% (n=14,682) by mid-2020. Of note, the devices became freely available in 2018 to people meeting eligibility criteria from the National Health Service in Scotland.
Usage rates were higher in women than men, as well as those with a history of insulin pump usage or a previous hospitalization for severe hypoglycemia, but use decreased with age.
There were also variations by baseline glycated hemoglobin (HbA1c) levels, with the lowest prevalence rates (42.3%) among people with the highest HbA1c (>9.8%; 84 mmol/mol), and by socioeconomic status. In this case people in the least deprived quintile were more likely to use flash monitoring than those in the most deprived quintile (54.4 vs 36.2%).
Analysis of glycemic outcomes among 12,256 flash monitor users who initiated the device before November 2019 revealed that, overall, median HbA1c levels fell by a significant 0.2% (2.5 mmol/mol) during the first year of use. The greatest reduction, a significant 1.4% (15.5 mmol/mol), occurred among people with a baseline HbA1c above 9.8%, whereas individuals in the lowest HbA1c category (<7.1%; 54 mmol/mol) had a nonsignificant 0.1% (1.0 mmol/mol) increase in HbA1c during the first year.
Furthermore, Jeyam and team observed significant improvements in HbA1c across all age, sex, and socioeconomic strata and irrespective of prior or current pump use, completion of a diabetes education program, or early adoption of flash monitoring.
The researchers also observed a 25% reduction (19.2 vs 17.5 events per 1000 person–years) in rates of hospitalization for severe hypoglycemia overall from before to after flash monitoring initiation, with the reduction increasing to 75% (312.2 vs 106.7 events per 1000 person–years) among those with a history of previous hospitalization for severe hypoglycemia.
Finally, the investigators looked at the impact of flash monitoring use on DKA rates. They found that these fell by a significant 41% following flash monitoring initiation, after accounting for pre-use DKA trends.
Moreover, crude DKA rates decreased in all of the subgroups analyzed, with the exception of adolescents (13–18 years), where an increase was observed. However, when the data were adjusted for the increasing DKA rate in pre-flash monitoring years, its use was associated with a reduction in DKA rate among adolescents.
Writing in Diabetologia, the authors conclude: “[Flash monitoring] initiation is associated with clinically important reductions in HbA1c and striking reduction in DKA rate.”
They say that the “reduction in DKA across the sociodemographic spectrum following [flash monitoring] use is of major clinical importance,” but stress that further studies are required “to better understand how to increase the uptake of [flash monitoring] use and the drivers and features of its effect in order to tighten the existing socioeconomic gaps.”
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Diabetologia 2021; doi:10.1007/s00125-021-05578-1