Effectiveness of the freestyle libre 2 flash glucose monitoring system on diabetes-self-management practices and glycemic parameters among patients with type 1 diabetes using insulin pump

The Relationship Between Hemoglobin A1c, Time in Range, and Glycemic Management Indicator in Patients With Type 1 and Type 2 Diabetes in a Tertiary Care Hospital in Saudi Arabia

OBJECTIVES

This study aimed to assess the correlation between glycated hemoglobin A1 (HbA1c), time in range (TIR), and glycemic management indicator (GMI) in patients with both type 1 diabetes (T1D) and type 2 diabetes (T2D) who were using a flash glucose monitoring (FGM) device (FreeStyle Libre; Abbott Diabetic Care, Witney, UK).

METHODS

This was a retrospective study that looked at T1D and T2D FreeStyle Libre users' LibreView database in the period between January 2020 to June 2022. The study was conducted at the diabetes department at the King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia, following Institutional Review Board (IRB) approval. Data were collected from the LibreView website, as well as from the electronic privacy information center (EPIC) hospital records.

RESULTS

Data were available for 327 patients, mean age of 33.08(±17.1) years old, and 55.7% were females. HbA1c had a statistically significant correlation with both TIR and GMI with coefficient of correlation (r) values of 0.78 (p<0.001) and 0.82 (p<0.001), respectively. A linear regression model between TIR and Hb1Ac was also developed and found to be statistically significant (p<0.001) with an acceptable R2 value (0.60).

CONCLUSION

Study findings revealed that the %TIR could be a reliable predictor of Hb1Ac. Thus, Freestyle Libre was able to determine Hb1Ac as close to the lab results as possible. Therefore, it is necessary to encourage diabetes patients to achieve at least 70% TIR in order to keep Hb1Ac within the desired range.

Effects of continuous glucose monitoring on glycaemic control in type 2 diabetes: A systematic review and network meta-analysis of randomized controlled trials

AIMS

The aim of this study was to assess the efficacy of continuous glucose monitoring (CGM) versus self-monitoring of blood glucose (SMBG) in maintaining glycaemic control among people with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

The protocol was registered in PROSPERO (CRD42023387583). PubMed, Web of Science, EMBASE and OVID databases were searched from 1 January 2000 until 31 December 2022 for randomized controlled trials comparing CGM with SMBG in glycaemic control among the outpatients with T2DM. The primary endpoint was glycated haemoglobin, while the secondary endpoints included time in range, time below range and time above range. Both traditional and network meta-analyses were conducted to explore the efficacy of CGM on glycaemic control in T2DM.

RESULTS

Eleven high-quality studies, involving 1425 individuals with T2DM, were identified. Traditional meta-analysis revealed that CGM exhibited a significantly decreased [mean difference (MD): -0.31, 95% confidence interval (CI) (-0.45, -0.18)], time above range [MD: -9.06%, 95% CI (-16.00, -2.11)], time below range [MD: -0.30%, 95% CI (-0.49, -0.12)] and a significantly increased time in range [MD: 8.49%, 95% CI (3.96, 13.02)] compared with SMBG. The network meta-analysis showed that real-time CGM can improve the glycaemic control of patients with T2DM to the most extent.

CONCLUSIONS

CGM could provide T2DM with greater benefits in glycaemic management compared with SMBG, particularly in patients using real-time CGM. These findings provide an updated perspective on previous research and offer guidance for CGM use in T2DM.

Assessment of Patient-reported Satisfaction and Metabolic Outcomes Following Initiation of the Second Generation of Flash Glucose Monitoring in Patients with Type 1 Diabetes

BACKGROUND AND AIMS

This study aims to assess patient-reported satisfaction and metabolic outcomes following the initiation of the second generation of the Freestyle Libre 2 (FSL2) system in patients with type 1 diabetes (T1D).

METHODS

This non-randomized single-arm observation study was conducted on 86 patients with T1D living in Saudi Arabia, who were asked to wear the FSL2 for 12 weeks. The demographic data were collected at baseline, while the continuous glucose monitoring (CGM) metrics were gathered, i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), and average duration of hypoglycemic events were collected at baseline, 6th week and 12 weeks. Further, the Continuous Glucose Monitoring Satisfaction (CGM-SAT) was collected at the end of the follow-up.

RESULTS

Compared to the 6th week, significant differences were observed in the low glucose events (p = 0.037), % TIR (p = 0.045), and % below 70 mg/dL (p = 0.047) at 12 weeks. Improvement was seen in the other glucometric variables, but no significant changes were evident (p > 0.05). On completion of the study period, the ambulatory glucose profile (AGP) metrics showed a 74.3 ± 5.01 (mg/dL) FSL2 hypoglycemia alarm threshold and a 213 ± 38.1 (mg/dL) hyperglycemia alarm threshold. A majority of the patients stated that CGM-SAT had benefits (mean score > 3.58), although they felt FSL2 had 'additional benefits. With regard to the problems with the use of FSL2 majority of the patients stated that FSL2 has minimal discomfort.

CONCLUSION

Using second-generation FSL2 in patients with T1D is positively associated with patient- reported satisfaction and metabolic outcomes.

A comparison of continuous glucose monitors (CGMs) in diabetes management: A systematic literature review

BACKGROUND AND AIMS

As diabetes prevalence has continued to increase in the United States, as well as globally, utilization of disease management techniques has also improved. The evolution in disease management for diabetes has adapted greatly from the initial dipstix method. Continuous glucose monitors have grown in popularity with its introduction to the market. After introduction of CGMs as part of DM management, various advancements have been made to the current models to promote the usage CGMs to promote glycemic control. The main competitors in the CGM market is Medtronic, Dexcom, Freestyle, and Eversense.

METHODS

Information was primarily gathered by employing various PubMed scholarly articles for real-world examples in addition to data extraction from supplementary manuscripts. Articles were evaluated from over the past 20 years.

RESULTS

Clinically improvement of disease management of blood glucose levels, specifically with regards to mean absolute relative difference (MARD) was utilized to highlight effectiveness of continuous glucose monitors.

CONCLUSION

Of the four key continuous glucose monitors device on the market in the US, all have demonstrated to have similar beneficial qualities which can be utilized in both T1DM and T2DM patients. The best device for an individual would be based on their specific diabetes management goal (maintain TIR, decreasing TBR/TAR, decrease A1c).

Effectiveness of Using the FreeStyle Libre® System for Monitoring Blood Glucose during the COVID-19 Pandemic in Diabetic Individuals: Systematic Review

BACKGROUND

Artificial Intelligence (AI) is an area of computer science/engineering that is aiming to spread technological systems. The COVID-19 pandemic caused economic and public health turbulence around the world. Among the many possibilities for using AI in the medical field is FreeStyle Libre^® (FSL), which uses a disposable sensor inserted into the user's arm, and a touchscreen device/reader is used to scan and retrieve other continuous monitoring of glucose (CMG) readings. The aim of this systematic review is to summarize the effectiveness of FSL blood glucose monitoring during the COVID-19 pandemic.

METHODS

This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and was registered in the international prospective register of systematic reviews (PROSPERO: CRD42022340562). The inclusion criteria considered studies involving the use of the FSL device during the COVID-19 pandemic and published in English. No publication date restrictions were set. The exclusion criteria were abstracts, systematic reviews, studies with patients with other diseases, monitoring with other equipment, patients with COVID-19, and bariatrics patients. Seven databases were searched (PubMed, Scopus, Embase, Web of Science, Scielo, PEDro and Cochrane Library). The ACROBAT-NRSI tool (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies) was used to evaluate the risk of bias in the selected articles.

RESULTS

A total of 113 articles were found. Sixty-four were excluded because they were duplicates, 39 were excluded after reading the titles and abstracts, and twenty articles were considered for full reading. Of the 10 articles analyzed, four articles were excluded because they did not meet the inclusion criteria. Thus, six articles were included in the current systematic review. It was observed that among the selected articles, only two were classified as having serious risk of bias. It was shown that FSL had a positive impact on glycemic control and on reducing the number of individuals with hypoglycemia.

CONCLUSION

The findings suggest that the implementation of FSL during COVID-19 confinement in this population can be confidently stated to have been effective in diabetes mellitus patients.

Long-term glucose-lowering effect of intermittently scanned continuous glucose monitoring for type 1 diabetes patients in poor glycaemic control from Region North Denmark: An observational real-world cohort study

BACKGROUND

Lowering glucose levels is a complex task for patients with type 1 diabetes, and they often lack contact with health care professionals. Intermittently scanned continuous glucose monitoring (isCGM) has the potential to aid them with blood glucose management at home. The aim of this study was to investigate the long-term effect of isCGM on HbA1c in type 1 diabetes patients with poor glycaemic control in a region-wide real-world setting.

METHODS

All patients with type 1 diabetes receiving an isCGM due to poor glycaemic control (≥70 mmol/mol [≥8.6%]) in the period of 2020-21 in Region North Denmark ("T1D-CGM") were compared with all type 1 diabetes patients without isCGM ("T1D-NOCGM") in the same period. A multiple linear regression model adjusted for age, sex, diabetes duration and use of continuous subcutaneous insulin infusion was constructed to estimate the difference in change from baseline HbA1c between the two groups and within subgroups of T1D-CGM.

RESULTS

A total of 2,527 patients (T1D-CGM: 897; T1D-NOCGM: 1,630) were included in the study. The estimated adjusted difference in change from baseline HbA1c between T1D-CGM vs T1D-NOCGM was -5.68 mmol/mol (95% CI: (-6.69 to -4.67 mmol/mol; p<0.0001)). Older patients using isCGM dropped less in HbA1c.

CONCLUSIONS

Our results indicate that patients with type 1 diabetes in poor glycaemic control from Region North Denmark in general benefit from using isCGM with a sustained 24-month improvement in HbA1c, but the effect on HbA1c may be less pronounced for older patients.

Flash Glucose Monitoring System facilitates sustainable improvements in glycemic control in patients with type 1 diabetes: A 12-month follow-up study in real life

BACKGROUND AND AIMS

Examine the glycemic control on Type 1 Diabetes (T1D) wearing the Flash Glucose Monitoring (FGM) system for a one-year period of time.

METHODS

This prospective study done using 187 patients with T1D (14-40yrs) who self-tested their glucose levels by FGM. Continuous glucose monitoring (CGM) metrics were gathered i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), and average duration of hypoglycemic events at the 3, 6, and 12 month time periods.

RESULTS

At 6th, 9th and 12th months, for values of GV, % in target, TAR and %>250 mg/dL, no significant changes (p > 0.05) were noted compared to 3 months. However, significant changes from the baseline were evident for the values of the mean glucose level at the 3rd (p = 0.028), 9th (p = 0.048) and 12th months (p = 0.022). When the mean glucose value at 3 months was compared to the same at 6, 9, and 12 month period, no significant changes (p > 0.05) were seen. When compared with baseline values, low glucose events at 3 months (p = 0.028), 6 months (p = 0.048), 9 months (p = 0.022) and 12 months (p = 0.038) showed significant changes. However, the percentage below 70 mg/dL (barring the value at 12 months, p = 0.046), no significant changes were observed. The HbA1c revealed significant drop in 3, 6, 9 and 12 months compared to baseline values.

CONCLUSION

Significant improvement was noted in CGM metrics when patients switched from conventional finger pricking method over to FGM system, and the effect was observed during the entire study period.

Longitudinal study of the flash glucose monitoring system in type 1 diabetics: An mHealth ally in times of COVID-19

AIMS AND OBJECTIVES

The aim of this study was to assess the effect of the FreeStyle Libre device implantation in adult type 1 diabetics in a Health Area of Castilla La Mancha (Spain) during the COVID-19 pandemic.

BACKGROUND

FreeStyle Libre is a so-called mHealth device that supports health care. During COVID-1 confinement, diabetic patients could have improved their glycaemic monitoring thanks to these devices, although health care in these patients may have been limited due to confinement.

METHODS

A 12-month longitudinal study in which a total of 206 type I diabetics participated, belonging to a single health area. Sociodemographic and analytical data and the Self Care Inventory Revised questionnaire (SCI-R) were collected. STROBE checklist was followed.

RESULTS

The analysis showed differences related to the use of the sensor. After the study period, patients obtained better levels of basal glucose, glycosylated haemoglobin, creatinine, cholesterol, triglycerides and LDL. In addition, a significant increase in the total score of the SCI-R questionnaire was observed after the use of the monitor (MD -7.77; 95% CI -10.43, -8.29). The same occurred with different SCI-R items such as diet (MD -2.995; 95% CI -3.24, -2.57), glucose determination (MD -3.21; 95% CI -3.52, -2.91), medication administration (MD -2.58; 95% CI -2.53, -1.96) and hypoglycaemic episodes (MD -1.07; 95% CI -1.21, -0.93). In the analysis by groups, worse values of glycosylated haemoglobin and adherence to treatment (p < .05) were observed in overweight/obese subjects versus those with normal weight after one year of study.

CONCLUSION

The use of flash monitoring is related to better adherence to most of the recommended habits in diabetes. Nevertheless, there seems to be no relationship with an improvement in physical exercise and preventive aspects of diabetes. A good nursing intervention to support physical exercise and the use of mHealth devices could improve the control of diabetic patients.

RELEVANCE TO CLINICAL PRACTICE

The use of this mHealth device has shown positive results and reduced complications. Despite less contact with healthcare facilities due to the pandemic, type 1 diabetic patients have improved their blood results and adherence after using the device for one year. Nursing staff should focus on promoting physical activity and routine disease care in type 1 diabetics.

Effectiveness of adding alarms to flash glucose monitoring in adults with type 1 diabetes under routine care

AIM

Whether glucose sensor alarms improve metabolic control and are accepted by individuals with diabetes is unclear. Here, we investigated whether switching from a standard flash glucose monitoring system (FGM1) to a system equipped with hypo- and hyperglycemia alarms (FGM2) improves glycemic control and psychological outcomes in adults with type 1 diabetes (T1D).

METHODS

Subjects with T1D and > 4% of time in hypoglycemia or > 40% of time in hyperglycemia were studied while wearing FGM1 (4 weeks) and after switching to FGM2 for 8 weeks. The primary endpoint was the change in time in range (TIR 70-180 mg/dl [3.9-10.0 mmol/L]) after 4 weeks of FGM2 use. Time below range (TBR), time above range (TAR), mean glucose, coefficient of variation (CV), sensor scans, treatment satisfaction, and hypoglycemia fear were secondary outcomes.

RESULTS

We included 38 subjects aged 33.7 ± 12.6 year. During 4 weeks of FGM2 use, TIR increased from 52.8 to 57.0% (p = 0.001), TBR decreased from 6.2 to 3.4% (p < 0.0001) as did time < 54 mg/dl (from 1.4 to 0.3%, p < 0.0001) and CV (from 39.6% to 36.1%, p < 0.0001). These changes were confirmed after 8 weeks of FGM2 use. Treatment satisfaction improved and fear of hypoglycemia decreased. Subjects who had > 4% of time in hypoglycemia at baseline showed the greatest improvements in glucose control and treatment satisfaction.

CONCLUSION

Switching from FGM1 to FGM2 improved TIR and treatment satisfaction and reduced fear of hypoglycemia. Participants who benefited most from switching from FGM1 to FGM2 were those prone to hypoglycemia.

Evaluation of Patient Reported Satisfaction and Clinical Efficacy of Insulin Glargine 300 U/mL Versus 100 U/mL in Patients With Type 1 Diabetes Using Flash Glucose Monitoring System

Background and Aims:

To analyze patient-reported satisfaction and clinical effectiveness of concentrated insulin glargine 300 U/mL (Gla-300) among patients with type 1 diabetes (T1D) using a flash glucose monitoring (FGM) system.

Methods:

This comparative study was conducted among 86 patients with T1D (aged 14-40 years), who were treated with Glargine 100 U/mL (Gla-100) and switched to Gla-300 at day 1 (baseline). The following data were collected from each patient: demographic information, clinical parameters, and glycemic control markers. All patients completed the Diabetes Treatment Satisfaction Questionnaire (Arabic version), first at baseline and then after 12 weeks. A comparison was done for all the data recorded at baseline (on Gla-100) and after 12 weeks (on Gla-300) and subjected to analysis.

Results:

Compared to patients treated with Gla-100, significant improvements were observed in the Gla-300 group, in terms of the ambulatory glucose profile (AGP) markers, such as percentage of time spent within the target range of the glucose levels (70-180 mg/dL) (P = .037), percentage which fell below the target (<70 mg/dL) (P = .027), and percentage of time spent (<54 mg/dL) (P = .043). Compared to Gla-100, patients treated with Gla-300 experienced significant improvements in the current treatment satisfactions (P = .047), convenient finding treatment recently (P = .034), and flexible finding treatment recently (P = .041), recommend the current treatment (P = .042) and satisfied to continue the current treatment (P = .035).

Conclusion:

Compared to the patients on Gla-100, patients treated with Gla-300 exhibited significant improvements in the AGP markers and degree of treatment satisfaction.

Evaluating the impact of Ramadan fasting on ambulatory glucose profile among patients with type 1 diabetes using Flash Glucose Monitoring System: A comparative study

BACKGROUND AND AIMS

Evaluating the impact of Ramadan fasting on Ambulatory Glucose Profile (AGP) among Patients with Type 1 Diabetes (T1D) using Flash Glucose Monitoring (FGM) System.

METHODS

The present study is a comparative study, performed using 87 patients with T1D, whose health status permitted them to fast, based on the risk stratification adopted by Diabetes and Ramadan (DAR Guidelines). Besides the demographic data, other data connected with the glycemic profile such as the mean Time in Range (TIR), mean Time Above Range (TAR), mean Time Below Range (TBR), mean glucose level, hemoglobin A1c (HbA1c), Glucose Variability (GV), and Glucose Monitoring Indicator (GMI %), were recorded at three specific periods, namely, pre- (prior to), during and post Ramadan.

RESULTS

The mean age of the study population was 21.3 ± 8.2 years, and 52.9% of this population was female. Compared to the pre-Ramadan data, no significant alterations (p > 0.05) were noted in terms of the low glucose events, percentage of glucose level below 70 mg/dL, the average duration of hypoglycemic events, and percentage of glucose level below 54 mg/dL, from the values observed during and post-Ramadan. In comparison with the pre-Ramadan data, no significant changes appeared (p > 0.05) concerning the GV, average glucose, GMI, percentage within target, TAR (181-250 mg/dL), and percentage >250 mg/dL), for the periods during and post-Ramadan, except scanning of FreeStyle Libre (p = 0.042) during Ramadan month compared to pre-Ramadan.

CONCLUSION

Fasting during Ramadan was achievable in patients with T1D who received adequate counseling and support.