Healthcare professional flash monitoring feasible, but benefits unclear
medwireNews: Giving people with type 2 diabetes “wear-and-forget” masked flash glucose monitoring to allow their healthcare providers (HCPs) access to detailed glucose profiles is feasible in primary care, but it is not clear how beneficial this is, show the results of the GP-OSMOTIC trial.
“GP-OSMOTIC provides another important piece of evidence and fits well into the overall picture, which suggests that reducing HbA1c [glycated hemoglobin] in type 2 diabetes with flash glucose monitoring is not straightforward,” write Norbert Hermanns (Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany) and co-authors in a commentary accompanying the publication in The Lancet Diabetes & Endocrinology.
In the study, 149 adults with type 2 diabetes were randomly assigned to receive the FreeStyle Libre Pro professional-mode flash glucose monitoring system, which is worn for 14 days, after which the HCP can scan it to obtain data for the full period of use. The participants wore the device for up to 14 days prior to their quarterly visits to their regular HCP over the 12 months of the trial.
However, the proportion of people still wearing the flash glucose monitor at the 9-month check-up fell to 78%, and only 73% of these discussed the data with their HCPs.
Hermanns and co-authors cite this as a drawback to the pragmatic study design, saying that although it robustly demonstrates the feasibility of the intervention in the real world, the lesser degree of control over the trial can mean that “potentially effective interventions then lose their potential to inform and modify clinical practice.”
“In this trial, consequently, it cannot be excluded that the efficacy of intermittent, masked flash glucose monitoring would have been greater if fidelity to the study protocol had been higher,” they say.
The fact that HCPs had access to the glucose monitoring data did not have any noticeable effect on their treatment decisions; after 12 months neither the number of medications prescribed, the proportion of people using insulin, nor the average insulin dose differed between the flash monitoring group and the 150 people who received usual care.
There was also no significant difference in the primary endpoint of average HbA1c at 12 months, which fell from 8.9% (74 mmol/mol) in both groups at baseline to 8.2% (66 mmol/mol) and 8.5% (69 mmol/mol) in the flash monitoring and standard care groups, respectively.
The intervention also had no effect on diabetes distress, report John Furler (University of Melbourne, Victoria, Australia) and co-researchers.
However, HbA1c at 6 months was significantly lower in the flash monitoring than the standard care group, at 8.1% versus 8.6% (65 vs 70 mmol/mol), and time in target glucose range at 12 months was significantly higher, at 54.8% versus 46.9%, driven by a 9.2% improvement for the daytime period.
“Interpreted generously,” the commentators believe the overall findings suggest that professional flash glucose monitoring “can reduce HbA1c, but these effects might be rather short-term.”
In the absence of obvious medication changes, they suggest that “behavioural changes (ie, diet, physical activity, and adherence to pharmacological treatment) initiated by the discussion of the glucose monitoring data could be a possible explanation.”
“However, quarterly discussions might not be enough to further improve glycaemic control in the long-term.”
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