More evidence for acute complication reduction with real-world flash glucose monitoring
medwireNews: UK audit data confirm multiple benefits linked to real-world use of flash glucose monitoring including reduced paramedic callouts and hospital admissions for acute diabetes complications.
There were also improvements in glycated hemoglobin (HbA1c) levels, hypoglycemia awareness, and diabetes distress in 10,370 people with diabetes after they began using the FreeStyle Libre (FSL) flash glucose monitoring system.
The study participants predominantly had type 1 diabetes (97%) of an average 16 years’ duration. The most common reason for starting flash glucose monitoring was simply as replacement for self-monitored blood glucose (38.45%), with other common reasons being high HbA1c (34.52%), frequent hypoglycemia (21.68%), fear of hypoglycemia (20.23%), high glucose variability (18.43%), and hypoglycemia unawareness (15.96%).
In line with findings from the USA and France presented at the virtual ADA 80th Scientific Sessions in June this year, there were significant reductions in the use of emergency medical services for acute diabetes complications with the initiation of flash glucose monitoring.
Specifically, the number of hyperglycemia and diabetic ketoacidosis admissions fell from 22 to 11 per month, admissions for hypoglycemia fell from 10 to six per month, and paramedic callouts reduced from 22 to five per month. In addition, the number of severe hypoglycemia episodes fell from 86 to 31 per month.
And there were also improvements in glycemic control; participants’ average HbA1c in the 12 months before the introduction of flash glucose monitoring was 69.8 mmol/mol (8.5%), but this reduced significantly to 62.3 mmol/mol (7.9%) during the 7.5 months after they began using the system.
The benefits were particularly marked in people with baseline HbA1c above 69.5 mmol/mol (8.5%), with average levels reducing from 85.5 to 73.2 mmol/mol (10.0 to 8.8%). Indeed, higher baseline HbA1c was one of just two significant predictors of HbA1c reduction, the other being a higher number of daily FSL scans.
Moreover, HbA1c variability significantly reduced after initiation of flash glucose monitoring, an effect that is also seen in randomized trials of continuous glucose monitoring, say Thozhukat Sathyapalan (Hull University Teaching Hospitals NHS Trust, UK) and study co-authors.
“Because HbA1c variability is associated with both micro- and macrovascular complications, at least in people with type 2 diabetes, if reduced HbA1c variability is sustained, it is possible that FSL may be associated with reduced complication rates in due course, beyond the benefits from the described reduction in HbA1c,” they write in Diabetes Care.
Self-reported hypoglycemia awareness significantly improved after initiation of flash glucose monitoring, with average Gold scores falling from 2.7 to 2.4. Among people with both baseline and follow-up Gold scores, 53% of those with a baseline score of 4.0 or higher (hypoglycemia unawareness) reported a follow-up score below 4.0.
Study participants also completed the two-item diabetes distress screening tool, showing significant improvements for both items: “feeling overwhelmed with demands of living with diabetes” and “feeling that I am often failing with my diabetes routine.”
The researchers conclude: “Long-term follow-up and cost-effectiveness analysis are needed to assess if these benefits from FSL are sustained and affordable to health care systems.”
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