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den Braber N, Braem CIR, Vollenbroek-Hutten MMR, Hermens HJ, Urgert T, Yavuz US, Veltink PH, Laverman GD. Consequences of Data Loss on Clinical Decision-Making in Continuous Glucose Monitoring: Retrospective Cohort Study. Interact J Med Res 2024; 13:e50849. [PMID: 39083801 PMCID: PMC11325125 DOI: 10.2196/50849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/21/2024] [Accepted: 04/10/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The impact of missing data on individual continuous glucose monitoring (CGM) data is unknown but can influence clinical decision-making for patients. OBJECTIVE We aimed to investigate the consequences of data loss on glucose metrics in individual patient recordings from continuous glucose monitors and assess its implications on clinical decision-making. METHODS The CGM data were collected from patients with type 1 and 2 diabetes using the FreeStyle Libre sensor (Abbott Diabetes Care). We selected 7-28 days of 24 hours of continuous data without any missing values from each individual patient. To mimic real-world data loss, missing data ranging from 5% to 50% were introduced into the data set. From this modified data set, clinical metrics including time below range (TBR), TBR level 2 (TBR2), and other common glucose metrics were calculated in the data sets with and that without data loss. Recordings in which glucose metrics deviated relevantly due to data loss, as determined by clinical experts, were defined as expert panel boundary error (εEPB). These errors were expressed as a percentage of the total number of recordings. The errors for the recordings with glucose management indicator <53 mmol/mol were investigated. RESULTS A total of 84 patients contributed to 798 recordings over 28 days. With 5%-50% data loss for 7-28 days recordings, the εEPB varied from 0 out of 798 (0.0%) to 147 out of 736 (20.0%) for TBR and 0 out of 612 (0.0%) to 22 out of 408 (5.4%) recordings for TBR2. In the case of 14-day recordings, TBR and TBR2 episodes completely disappeared due to 30% data loss in 2 out of 786 (0.3%) and 32 out of 522 (6.1%) of the cases, respectively. However, the initial values of the disappeared TBR and TBR2 were relatively small (<0.1%). In the recordings with glucose management indicator <53 mmol/mol the εEPB was 9.6% for 14 days with 30% data loss. CONCLUSIONS With a maximum of 30% data loss in 14-day CGM recordings, there is minimal impact of missing data on the clinical interpretation of various glucose metrics. TRIAL REGISTRATION ClinicalTrials.gov NCT05584293; https://clinicaltrials.gov/study/NCT05584293.
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Affiliation(s)
- Niala den Braber
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
- Internal Medicine, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Carlijn I R Braem
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
- Internal Medicine, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
| | - Hermie J Hermens
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
| | - Thomas Urgert
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
- Internal Medicine, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Utku S Yavuz
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
| | - Peter H Veltink
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Biomedical Signal and Systems, Faculty of Electrical Engineering, Mathematics And Computer Science, University of Twente, Enschede, Netherlands
- Internal Medicine, Ziekenhuisgroep Twente, Almelo, Netherlands
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Gutiérrez-Pastor A, Quesada JA, Soler-Martínez MM, Carratalá Munuera C, Pomares-Gómez FJ. Effect of switch from flash glucose monitoring to flash glucose monitoring with real-time alarms on hypoglycaemia in people with type 1 diabetes mellitus. Prim Care Diabetes 2024; 18:333-339. [PMID: 38677966 DOI: 10.1016/j.pcd.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024]
Abstract
We aimed to evaluate the utility of the FreeStyle Libre 2 device for reducing time below range level 1 and level 2 compared with the Freestyle Libre device (without alarms) in people with type 1 diabetes mellitus. We conducted longitudinal observational follow-up study of a cohort of 100 people with type 1 diabetes mellitus who had switched from FreeStyle Libre to FreeStyle Libre 2 as part of routine clinical practice. Three months after switching to FreeStyle Libre 2, compared with results with FreeStyle Libre, there were a significant improvements in time below range level 1 (p = 0.02) and level 2 (p <0.001), time in range (p <0.001), time above range level 1 (p = 0.002), glucose management indicator (p= 0.04) and mean glucose (p= 0.04) during follow-up. Furthermore there was a significant direct association between age and change in TIR with a coefficient of 0.23, and a significant inverse association between age and change in TAR-1 with a coefficient of 0.11. Switching to a flash glucose monitoring system with alarms improves time below range, time in range and coefficient of variation in people with type 1 diabetes mellitus.
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Affiliation(s)
- A Gutiérrez-Pastor
- Department of Health of San Juan de Alicante, Provincial-Pla Hospital, Spain
| | - J A Quesada
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - M M Soler-Martínez
- Department of Health of San Juan de Alicante, Endocrinology and Nutrition, Spain
| | - C Carratalá Munuera
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - F J Pomares-Gómez
- Department of Health of San Juan de Alicante, Endocrinology and Nutrition, Spain
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Canecki-Varzic S, Prpic-Krizevac I, Cigrovski Berkovic M, Rahelic D, Schonberger E, Gradiser M, Bilic-Curcic I. Flash Glucose Monitoring in Croatia: The Optimal Number of Scans per Day to Achieve Good Glycemic Control in Type 1 Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1893. [PMID: 38003943 PMCID: PMC10673386 DOI: 10.3390/medicina59111893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The purpose of this study is to determine the optimal number of scans per day required for attaining good glycemic regulation. Materials and Methods: The association of scanning frequency and glucometrics was analyzed according to bins of scanning frequency and bins of time in range (TIR) in the Croatian population of type 1 diabetes (T1DM) patients. Results: Intermittently scanned continuous glucose monitoring (isCGM) Libre users in Croatia performed on average 13 ± 7.4 scans per day. According to bins of scanning frequency, bin 5 with 11.2 ± 02 daily scans was sufficient for achieving meaningful improvements in glycemic regulation, while decreasing severe hypoglycemia required an increasing number of scans up to bin 10 (31 ± 0.9), yet with no effect on TIR improvement. When data were analyzed according to bins of TIR, an average of 16.3 ± 10.5 scans daily was associated with a TIR of 94.09 ± 3.49% and a coefficient of variation (CV) of 22.97 ± 4.94%. Improvement was shown between each successive bin of TIR but, of notice, the number of scans performed per day was 16.3 ± 10.5 according to TIR-based analysis and 31.9 ± 13.5 in bin 10 according to scan frequency analysis. Conclusions: In conclusion, an optimal average number of scans per day is 16.3 in order to achieve glucose stability and to minimize the burden associated with over-scanning.
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Affiliation(s)
- Silvija Canecki-Varzic
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (S.C.-V.); (I.P.-K.); (E.S.)
- Department of Pathophysiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivana Prpic-Krizevac
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (S.C.-V.); (I.P.-K.); (E.S.)
- Department of Internal Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Maja Cigrovski Berkovic
- Department of Medicine of Sports and Exercise, Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia;
| | - Dario Rahelic
- University Clinic for Diabetes Vuk Vrhovac, 10000 Zagreb, Croatia;
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Ema Schonberger
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (S.C.-V.); (I.P.-K.); (E.S.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marina Gradiser
- Department of Internal Medicine, County Hospital Čakovec, 40000 Čakovec, Croatia;
| | - Ines Bilic-Curcic
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (S.C.-V.); (I.P.-K.); (E.S.)
- Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
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Lameijer A, Bakker JJ, Kao K, Xu Y, Gans ROB, Bilo HJG, Dunn TC, van Dijk PR. Real-life 24-week changes in glycemic parameters among European users of flash glucose monitoring with type 1 and 2 diabetes and different levels of glycemic control. Diabetes Res Clin Pract 2023:110735. [PMID: 37276981 DOI: 10.1016/j.diabres.2023.110735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
AIM To evaluate real-life changes of glycemic parameters among flash glucose monitoring (FLASH) users who do not meet glycemic targets. METHODS De-identified data were obtained between 2014 and 2021 from patients using FLASH uninterrupted for a 24-week period. Glycemic parameters during first and last sensor use were examined in four identifiable groups: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) on basal-bolus insulin, T2DM on basal insulin, and T2DM without insulin treatment. Within each group, subgroup analyses were performed in persons with initial suboptimal glycemic regulation (time in range (TIR; 3.9-10 mmol/L) <70%, time above range (TAR; >10 mmol/L) >25%, or time below range (TBR; <3.9 mmol/L) >4%). RESULTS Data were obtained from 1,909 persons with T1DM and 1,813 persons with T2DM (1,499 basal-bolus insulin, 189 basal insulin, and 125 non-insulin users). In most of the performed analyses, both overall and in the various subgroups, significant improvements were observed in virtually all predefined primary (TIR) and secondary endpoints (eHbA1c, TAR, TBR and glucose variability). CONCLUSIONS 24-weeks FLASH use in real life by persons with T1DM and T2DM with suboptimal glycemic regulation is associated with improvement of glycemic parameters, irrespective of pre-use regulation or treatment modality.
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Affiliation(s)
- Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Julia J Bakker
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | | | | | - Rijk O B Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Henk J G Bilo
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Isala, Diabetes Research Center, Zwolle, The Netherlands
| | | | - Peter R van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands; Isala, Diabetes Research Center, Zwolle, The Netherlands.
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Marco A, Pazos-Couselo M, Moreno-Fernandez J, Díez-Fernández A, Alonso-Sampedro M, Fernández-Merino C, Gonzalez-Quintela A, Gude F. Time above range for predicting the development of type 2 diabetes. Front Public Health 2022; 10:1005513. [PMID: 36568777 PMCID: PMC9772988 DOI: 10.3389/fpubh.2022.1005513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Aim To investigate the prognostic value of time range metrics, as measured by continuous glucose monitoring, with respect to the development of type 2 diabetes (T2D). Research design and methods A total of 499 persons without diabetes from the general population were followed-up for 5 years. Time range metrics were measured at the start and medical records were checked over the period study. Results Twenty-two subjects (8.3 per 1,000 person-years) developed T2D. After adjusting for age, gender, family history of diabetes, body mass index and glycated hemoglobin concentration, multivariate analysis revealed 'time above range' (TAR, i.e., with a plasma glucose concentration of >140 mg/dL) to be significantly associated with a greater risk (OR = 1.06, CI 1.01-1.11) of developing diabetes (AUC = 0.94, Brier = 0.035). Conclusions Time above range provides additional information to that offered by glycated hemoglobin to identify patients at a higher risk of developing type 2 diabetes in a population-based study.
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Affiliation(s)
- Alejandra Marco
- Primary Care Center, Santiago de Compostela, Spain,Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Marcos Pazos-Couselo
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain,*Correspondence: Marcos Pazos-Couselo
| | - Jesús Moreno-Fernandez
- Endocrinology and Nutrition Service, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Ana Díez-Fernández
- Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuela Alonso-Sampedro
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Clinical Epidemiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Fernández-Merino
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Primary Care Center, A Estrada, Spain
| | - Arturo Gonzalez-Quintela
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain,Department of Clinical Epidemiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Hansen KW, Bibby BM. The Frequency of Intermittently Scanned Glucose and Diurnal Variation of Glycemic Metrics. J Diabetes Sci Technol 2022; 16:1461-1465. [PMID: 34041961 PMCID: PMC9631535 DOI: 10.1177/19322968211019382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relation between the frequency of intermittently scanned continuous glucose monitoring (isCGM) and diurnal variation of time in range (TIR) and time below range (TBR) is unknown. METHOD A total of 163 persons with type 1 diabetes who used isCGM had glucose data for 60 days downloaded. Mean TIR and median TBR were calculated for 15-minute periods and presented for daytime and nighttime. The values for tertiles of scanning frequency were compared. RESULTS The 1st tertile (n = 53) of the population scanned <10 times; the 2nd tertile (n = 56) 10-13 times, and the 3rd tertile (n = 54) >13 per 24 hours. TIR (%, mean ± (SD)) increased significantly from the 1st to the 3rd scan tertile both during the day (43.8 ± 14.8, 52.0 ± 12.3, 62.1 ± 12.8) and the night (44.5 ± 17.3, 52.3 ± 18.5, 64.0 ± 13.9; P < .0001). In contrast, TBR (median, (IQR)) was not significantly associated with scan tertiles during daytime (3.5% (1.1-7.8), 4.4% (1.8-6.1), 3.5% (2.1-6.1); P = .85) or nighttime (3.8% (1.4-13.7), 5.0% (1.6-9.6), 5.7% (3.6-10.9); P = .24). In a multiple regression model, a 50% increase in 24-hour scanning frequency was associated with a 7.8 percentage point increase in TIR (95% CI, 5.6-10.0). CONCLUSIONS Increased scanning frequency was associated with a higher TIR both during daytime and nighttime with no change in TBR.
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Affiliation(s)
- Klavs W. Hansen
- Diagnostic Centre, Silkeborg Regional
Hospital, University Research Clinic for Innovative Patient Pathways, Silkeborg,
Denmark
- Klavs W. Hansen, MD, DMSCI, Diagnostic
Centre, Silkeborg Regional Hospital, University Research Clinic for Innovative
Patient Pathways, Falkevej 1-3, Silkeborg, 8600, Denmark.
| | - Bo M. Bibby
- Biostatistical Advisory Service,
Faculty of Health, Aarhus University, Aarhus C, Denmark
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Al-Harbi MY, Albunyan A, Alnahari A, Kao K, Brandner L, El Jammal M, Dunn TC. Frequency of flash glucose monitoring and glucose metrics: real-world observational data from Saudi Arabia. Diabetol Metab Syndr 2022; 14:66. [PMID: 35501880 PMCID: PMC9063302 DOI: 10.1186/s13098-022-00831-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This real-world data study analyzed glucose metrics from FreeStyle Libre® flash glucose monitoring in relation to scanning frequency, time in range (TIR) and estimated A1c (eA1c) in Saudi Arabia. METHODS Anonymized reader data were analyzed according to scanning frequency quartiles, eA1c categories (<7%,≥7%‒≤9% or>9%) and TIR categories (<50%,≥50%‒≤70% or>70%). Sensors, grouped by reader, were required to have≥120 h of operation. Differences in scanning frequency, eA1c, TIR, time in hypoglycemia and hyperglycemia, and glucose variability (standard deviation [SD] and coefficient of variation [CV]) were analyzed between groups. RESULTS 6097 readers, 35,747 sensors, and 40 million automatic glucose measurements were analyzed. Patients in the highest scanning frequency quartile (Q4, mean 32.0 scans/day) had lower eA1c (8.47%), greater TIR (46.4%) and lower glucose variation (SD 75.0 mg/dL, CV 38.2%) compared to the lowest quartile (Q1, mean 5.2 scans/day; eA1c 9.77%, TIR 32.8%, SD 94.9 mg/dL, CV 41.3%). Lower eA1c and higher TIR were associated with greater scanning frequency, lower glucose variability and less time in hyperglycemia. CONCLUSIONS Higher scanning frequency in flash glucose users from Saudi Arabia is associated with lower eA1c, higher TIR, lower glucose variability and less time in hypoglycemia or hyperglycemia.
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Affiliation(s)
- Mohammad Y Al-Harbi
- Therapeutic Services Deputyship, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
| | | | | | - Kalvin Kao
- Clinical Affairs, Abbott Diabetes Care, Alameda, CA, USA
| | - Laura Brandner
- Clinical Affairs, Abbott Diabetes Care, Alameda, CA, USA
| | - Manal El Jammal
- Scientific & Medical Affairs, Abbott Diabetes Care, Alameda, CA, USA
| | - Timothy C Dunn
- Clinical Affairs, Abbott Diabetes Care, Alameda, CA, USA
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Maahs DM, Addala A, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2022; 24:S107-S128. [PMID: 35475702 DOI: 10.1089/dia.2022.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Liang B, Koye DN, Hachem M, Zafari N, Braat S, Ekinci EI. Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:849725. [PMID: 36992733 PMCID: PMC10012125 DOI: 10.3389/fcdhc.2022.849725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveFlash glucose monitoring (FlashGM) is a sensor-based technology that displays glucose readings and trends to people with diabetes. In this meta-analysis, we assessed the effect of FlashGM on glycaemic outcomes including HbA1c, time in range, frequency of hypoglycaemic episodes and time in hypo/hyperglycaemia compared to self-monitoring of blood glucose, using data from randomised controlled trials.MethodsA systematic search was conducted on MEDLINE, EMBASE and CENTRAL for articles published between 2014 and 2021. We selected randomised controlled trials comparing flash glucose monitoring to self-monitoring of blood glucose that reported change in HbA1c and at least one other glycaemic outcome in adults with type 1 or type 2 diabetes. Two independent reviewers extracted data from each study using a piloted form. Meta-analyses using a random-effects model was conducted to obtain a pooled estimate of the treatment effect. Heterogeneity was assessed using forest plots and the I2 statistic.ResultsWe identified 5 randomised controlled trials lasting 10 – 24 weeks and involving 719 participants. Flash glucose monitoring did not lead to a significant reduction in HbA1c. However, it resulted in increased time in range (mean difference 1.16 hr, 95% CI 0.13 to 2.19, I2 = 71.7%) and decreased frequency of hypoglycaemic episodes (mean difference -0.28 episodes per 24 hours, 95% CI -0.53 to -0.04, I2 = 71.4%).ConclusionsFlash glucose monitoring did not lead to a significant reduction in HbA1c compared to self-monitoring of blood glucose, however, it improved glycaemic management through increased time in range and decreased frequency of hypoglycaemic episodes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42020165688).
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Affiliation(s)
- Bonnie Liang
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Digsu N. Koye
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Neda Zafari
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- *Correspondence: Elif I. Ekinci,
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10
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de Portu S, Vorrink L, Re R, Shin J, Castaneda J, Habteab A, Cohen O. Randomised controlled trial of Advanced Hybrid Closed Loop in an Adult Population with Type 1 Diabetes (ADAPT): study protocol and rationale. BMJ Open 2022; 12:e050635. [PMID: 35110310 PMCID: PMC8811581 DOI: 10.1136/bmjopen-2021-050635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION For many people with type 1 diabetes who struggle to achieve glycaemic control with multiple daily injections of insulin (MDI) plus self-monitoring of blood glucose, MDI plus intermittently scanned continuous glucose monitoring (IS-CGM) or real-time continuous glucose monitoring (RT-CGM), or insulin administration using insulin pump therapy represent optimised care in many regions. Through technological advances an advanced hybrid closed loop (AHCL) system has been developed; studies of incremental effects relative to MDI plus IS-CGM are lacking. METHODS AND ANALYSIS The Advanced Hybrid Closed Loop study in Adult Population with Type 1 Diabetes (ADAPT) study is a multinational, prospective, open-label, confirmatory and exploratory randomised controlled trial to examine outcomes with the MiniMed 670G version 4.0 AHCL system (with an equivalent algorithm and commercialised as the MiniMed 780G system, referred to as AHCL) relative to MDI plus IS-CGM in adults with baseline HbA1c≥8.0%. An exploratory cohort will compare AHCL with MDI plus RT-CGM. The study will be conducted in approximately 124 adults on MDI plus either IS-CGM or RT-CGM for at least 3 months prior to screening. The primary endpoint will be the difference in mean HbA1c change from baseline to 6 months between the AHCL and the MDI plus IS-CGM arms. Secondary endpoints will include proportion of time spent in hypoglycaemic, euglycaemic and hyperglycaemic ranges. ETHICS AND DISSEMINATION The ADAPT study will be conducted in accordance with the requirements of the Declaration of Helsinki and local laws and regulations, and has been approved by ethics committees. The trial will provide valuable information on the incremental benefits that may be provided by AHCL for patients failing to achieve glycaemic targets on MDI plus IS-CGM or RT-CGM and form a basis for health economic evaluations to support market access. TRIAL REGISTRATION NUMBER NCT04235504; Pre-results.
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Affiliation(s)
- Simona de Portu
- Medtronic Diabetes, Medtronic International Trading Sarl, Tolochenaz, Vaud, Switzerland
| | - Linda Vorrink
- Medtronic Diabetes, Medtronic International Trading Sarl, Tolochenaz, Vaud, Switzerland
| | - Roseline Re
- Medtronic Diabetes, Medtronic International Trading Sarl, Tolochenaz, Vaud, Switzerland
| | - John Shin
- Clinical Research, Biostatistics, and Bioinformatics, Medtronic Diabetes, Northridge, California, USA
| | - Javier Castaneda
- Statistics, Medtronic Bakken Research Center BV, Maastricht, Limburg, The Netherlands
| | - Aklilu Habteab
- Statistics, Medtronic Bakken Research Center BV, Maastricht, Limburg, The Netherlands
| | - Ohad Cohen
- Medtronic Diabetes, Medtronic International Trading Sarl, Tolochenaz, Vaud, Switzerland
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11
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Yeoh E, Png D, Koh PL, Sum CF, Lim SC, Tan HH, Ubeynarayana CU, Subramaniam T. Glucose Awareness to Motivate and Enable Solutions (GAMES) in diabetes mellitus using flash glucose monitoring: A clinical programme. Diabet Med 2022; 39:e14733. [PMID: 34698420 DOI: 10.1111/dme.14733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/21/2021] [Indexed: 01/12/2023]
Abstract
AIMS This real-world observational clinical programme evaluated short and medium-term effects of intermittent flash glucose monitoring on HbA1c, glycaemic variability and lifestyle behavioural changes. METHODS Two first-generation Libre flash glucose monitoring sensors were provided 3-4 months apart with a food, activity diary, user evaluation survey and treatment modification after each sensor wear. T-tests were used to compare glucose variables within each sensor (week 1 vs. week 2) and between sensors (1st sensor vs. 2nd sensor). EasyGV software was used to calculate glycaemic variability. RESULTS From 42 type 1 diabetes and 120 type 2 diabetes participants, there was no statistically significant change in mean HbA1c for participants with type 1 diabetes at 3-4 months after the 1st sensor but there was a statistically significant HbA1c reduction for participants with type 2 diabetes [-4 mmol/mol (-0.4%), p = 0.008], despite no statistically significant differences in carbohydrate intake, exercise frequency and duration. Greater reduction was seen in those with baseline HbA1c> 86 mmol/mol (10%) in both type 1 [-12 mmol/mol (-1.1%), p = 0.009] and type 2 diabetes [-11 mmol/mol (-1.0%), p = 0.001). Both type 1 and type 2 diabetes showed improvements in Glucose Management Indicator and percentage time-above-range when comparing week 1 versus week 2 of the same sensor. Higher scan frequency resulted in improved glycaemic parameters and certain measures of glycaemic variability. The majority of participants (85%) agreed that flash glucose monitoring is a useful device but only 60% were keen to use it for daily monitoring. CONCLUSION Constant feedback from flash glucose monitoring improves glycaemic parameters within the first week of wear. Intermittent use 3-4 months apart resulted in greater improvements for those with higher baseline HbA1c.
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Affiliation(s)
- Ester Yeoh
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | - Doanna Png
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | - Pei Ling Koh
- Department of Nutrition & Dietetics, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Su Chi Lim
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Hwee Huan Tan
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | | | - Tavintharan Subramaniam
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
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12
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Alhodaib HI, Alsulihem S. Factors influencing the effectiveness of using flash glucose monitoring on glycemic control for type 1 diabetes in Saudi Arabia. World J Diabetes 2021; 12:1908-1916. [PMID: 34888015 PMCID: PMC8613657 DOI: 10.4239/wjd.v12.i11.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In 2017, 35000 Saudi children and adolescents were living with a type 1 diabetes (T1D) diagnosis. Diabetic complications are minimized upon strengthened glycemic regulation. The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications. The use of flash glucose monitoring (FGM) enables better diabetes treatment and thereby improves glycemic control. Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources, resulting in improved outcomes.
AIM To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin (HbA1c) levels/glycemic control among T1D patients.
METHODS A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed. T1D patients who began FGM between 2017 and 2019 were included.
RESULTS The data included 195 T1D patients (70 males and 125 females) with a mean age of 23.6 ± 8.1 years. Among them, 152 patients used multiple daily injection and 43 used an insulin pump. The difference in HbA1c level from baseline and after using FGM was -0.60 ± 2.10, with a maximum of 4.70 and a minimum of -6.30. There was a statistically significant negative correlation between the independent variables (age, duration of diabetes, level of engagement) and HbA1c. The group with the highest HbA1c mean (9.85) was 18-years-old, while the group with the lowest HbA1c mean (7.87) was 45-years-old. Patients with a low level of engagement (less than six scans per day) had the highest HbA1c mean (9.84), whereas those with a high level of engagement (more than eight scans per day) had the lowest HbA1c mean (8.33).
CONCLUSION With proper education, FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.
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Affiliation(s)
- Hala Ibrahim Alhodaib
- Community Health Sciences Department, King Saud University, Riyadh 11564, Saudi Arabia
| | - Sama Alsulihem
- College of Medicine, King Saud University, Riyadh 11564, Saudi Arabia
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13
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Hohendorff J, Gumprecht J, Mysliwiec M, Zozulinska-Ziolkiewicz D, Malecki MT. Intermittently Scanned Continuous Glucose Monitoring Data of Polish Patients from Real-Life Conditions: More Scanning and Better Glycemic Control Compared to Worldwide Data. Diabetes Technol Ther 2021; 23:577-585. [PMID: 33794101 PMCID: PMC8377514 DOI: 10.1089/dia.2021.0034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Randomized trials and observational studies have shown that the use of FreeStyle Libre® intermittently scanned continuous glucose monitoring system (isCGMS) is associated with improved glycemic indices and quality of life. Materials and Methods: In this retrospective, real-world data analysis, we described country-specific glucometrics among isCGMS users from Poland and compared them with international data. The analyzed time period for the Polish data ranged between August 2016 and August 2020, and the analyzed time period for the international data ranged from September 2014 to August 2020. Results: Data from the Polish population were collected from 10,679 readers and 92,627 sensors with 113 million automatically recorded glucose readings. The worldwide database included information from 981,876 readers and 11,179,229 sensors with 13.1 billion glucose readings. On average, the users of isCGMS from Poland performed substantially more scans/day (21.2 ± 14.2 vs. 13.2 ± 10.7), achieved lower eHbA1c (7.0% ± 1.2% vs. 7.5% ± 1.5%), and spent more time-in-range (TIR) (64.2% ± 17.3% vs. 58.1% ± 20.3%) and less time-above-range (TAR) (29.7% ± 18.0% vs. 36.6% ± 21.3%) (P < 0.0001 for all comparisons). Moreover, they were more likely to achieve TIR >70% (36.3% vs. 28.8%), but spent more time-below-range (TBR) (4.7% vs. 3.6%). Our results confirmed that analyzed glucometrics improve as the scan rate frequency increases. However, at a similar scanning frequency to the comparative group, users from Poland achieved lower eHbA1c, higher TIR, and lower TAR, but higher TBR. Conclusions: We report more scanning and better glycemic control in isCGMS users in Poland than worldwide. The cause of this observation remains unknown. Our data also show that in real-life practice, a large number of patients may be willing to perform scanning more frequently than it is usually assumed.
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Affiliation(s)
- Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Poland
| | | | - Maciej Tadeusz Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Address correspondence to: Maciej Tadeusz Malecki, MD, PhD, Department of Metabolic Diseases, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow 30-688, Poland
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14
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Alzahrani B, Alzahrani S, Almalki MH, Elabd SS, Khan SA, Buhary B, Aljuhani N, Jammah AA. Glycemic Variability in Type 1 Diabetes Mellitus Saudis Using Ambulatory Glucose Profile. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2021; 14:11795514211013789. [PMID: 34017209 PMCID: PMC8114280 DOI: 10.1177/11795514211013789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022]
Abstract
Background Glucose variability (GV) is a common and challenging clinical entity in the management of people with type 1 diabetes (T1DM). The magnitude of GV in Saudi people with T1DM was not addressed before. Therefore, we aimed to study GV in a consecutive cohort of Saudis with T1DM. Methods We prospectively assessed interstitial glucose using FreeStyle® Libre flash glucose monitoring in people with TIDM who attended follow-up in the diabetes clinics at King Fahad Medical City between March and June 2017. Glycemia profile, standard deviation (SD), coefficient of variation (CV), mean of daily differences (MODD), and mean amplitude of glucose excursion (MAGE) were measured using the standard equations over a period of 2 weeks. Results Fifty T1DM subjects (20 males) with mean age 20.2 ± 6.1 years and mean fortnight glucose 192 ± 42.3 mg/dl were included. The mean SD of 2-week glucose readings was 100.4 ± 36.3 mg/dl and CV was 52.1% ± 13%. Higher levels of glucose excursions were also observed. MODD and MAGE were recorded as 104.5 ± 51.7 and 189 ± 54.9 mg/dl, respectively which is 2 to 4 times higher than the international standards. Higher MODD and MAGE were observed on weekends compared to weekdays (111.3 ± 62.1 vs 98.6 ± 56.2 mg/dl and 196.4 ± 64.6 vs 181.7 ± 52.4 mg/dl, respectively; P ⩽ .001). Conclusion Higher degree of glycemic variability was observed in this cohort of TIDM Saudis. Weekends were associated with higher glucose swings than weekdays. More studies are needed to explore these findings further.
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Affiliation(s)
- Bader Alzahrani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Family Medicine, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia
| | - Saad Alzahrani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mussa H Almalki
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Souha S Elabd
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shawana Abdulhamid Khan
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Badurudeen Buhary
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naji Aljuhani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Anwar A Jammah
- Endocrinology and Diabetes Units, Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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15
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Krakauer M, Botero JF, Lavalle-González FJ, Proietti A, Barbieri DE. A review of flash glucose monitoring in type 2 diabetes. Diabetol Metab Syndr 2021; 13:42. [PMID: 33836819 PMCID: PMC8035716 DOI: 10.1186/s13098-021-00654-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/18/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy. MAIN BODY The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction. CONCLUSION T2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits.
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Affiliation(s)
- Marcio Krakauer
- Department of Technology (Coordinator) SBD-Brazilian Diabetes Society, Science Valley Research Center, Liga de Diabetes, ABC Medical School, Avenida 12 de Outubro 286, Santo André, SP, CEP 09030-640, Brazil.
| | | | | | - Adrian Proietti
- Institute of Diabetes and Applied Technology (IDTA), Buenos Aires, Argentina
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16
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Hu K, Peng H, Ma Y, Li X, Bai R, Wang J, Xu J, Fu L, Liu J, Bai J, Wu H, Wang H, Jiang H. Analysis of Glycemic Improvement in Hemodialysis Patients Based on Time in Range, Assessed by Flash Glucose Monitoring. Blood Purif 2021; 50:883-890. [PMID: 33774625 DOI: 10.1159/000513162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to investigate the application value of "time in ranges (TIRs)" in dialysis patients with diabetes and summarize the experience of optimizing glycemic control by flash glucose monitoring (FGM) system. METHODS In this monocentric 2-week pilot study, FGM was applied for 14 days in 57 type 2 diabetes mellitus medically stable patients under maintenance hemodialysis to determine their glycemic improvement. The diagnostic value of TIR versus HbA1c in detecting glucose fluctuations and levels was evaluated using receiver operating characteristic analysis. RESULTS Average glucose exhibited stronger association with TIR (r = -0.785, p < 0.001) than HbA1c (r = 0.644, p < 0.001), and mean amplitude of glycemic excursion (MAGE) had the same conclusion (r = -0.568, p < 0.001 for TIR vs. r = 0.423, p = 0.016 for HbA1c). TIR exhibited a higher area under curve than HbA1c in detecting significant derangements in glucose fluctuation, using a 14-day average FGM-derived coefficient of variation >36% as the reference standard (difference between areas: 0.237; 95% CI 0.092-0.383, p = 0.001). We found a significant improvement in TIR (58.38 ± 19.42 vs. 46.45 ± 24.42 mmol/L, p < 0.001) and a significant decline in MAGE (median 5.64 vs.7.42 mmol/L, p < 0.001) compared to the baseline without deterioration of time spent in hypoglycemia. CONCLUSION TIR seems to be feasible and clinically useful for AGP analysis in dialysis patients with diabetes, and FGM can be used to improve glycemic control.
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Affiliation(s)
- Keyan Hu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Huifang Peng
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Yujin Ma
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Xuefeng Li
- The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | | | - Junxia Wang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiayun Xu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Liujun Fu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Jing Liu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Jinlei Bai
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Hongli Wu
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
| | - Hongyun Wang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongwei Jiang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.,Luoyang Clinical Medicine Research Center of Endocrine and Metabolic Diseases, Luoyang, China
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17
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Biester T, Grimsmann JM, Heidtmann B, Rami-Merhar B, Ermer U, Wolf J, Freff M, Karges B, Agena D, Bramlage P, Danne T, Holl RW. Intermittently Scanned Glucose Values for Continuous Monitoring: Cross-Sectional Analysis of Glycemic Control and Hypoglycemia in 1809 Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:160-167. [PMID: 33084351 DOI: 10.1089/dia.2020.0373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objective: Intermittent scanning continuous glucose monitoring (iscCGM) is increasingly used for glycemic monitoring in diabetes care. In this cross-sectional real-world analysis, iscCGM data were compared to traditional parameters of glycemic control in young people with type 1 diabetes. Methods: Using the DPV registry, most recent data from children and adolescents aged <18 years with uploaded iscCGM sensor profiles with at least 14 days of data and a > 50% completeness were evaluated using recommended parameters of sensor metrics. Analysis was performed stratified by age group, glycemic control, and type of therapy; data were taken from DPV data pool in February 2020. Results: Glucose sensor profiles and clinical data from 1809 individuals (mean age 13.4 years, 53% male, and mean diabetes duration 5.02 years) were evaluated in this study. More than 50% of this population (n = 965) reached the current German treatment target of hemoglobin A1c (HbA1c) <7.5%. In this target, the mean scanning frequency was higher than in groups with HbA1c >7.5 or >8.0% (12.0 vs. 10.2 vs 7.6 times per day). The group of preschool children had the highest frequency of scanning (16.6 vs. 13.3 times per day in school kids and 7.9 in adolescents), the lowest HbA1c level, and the lowest risk for hypoglycemia (low blood glucose index 0.8 vs. 1.0 vs 1.2). Conclusion: Real-world data will help to determine the value of iscCGM to improve clinical and patient-related outcomes in pediatric diabetology. Not only the use of a device but also the intensity of use seems to have a high and direct impact on glycemic control.
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Affiliation(s)
- Torben Biester
- Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Julia M Grimsmann
- Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | | | - Birgit Rami-Merhar
- Medical University of Vienna, Austria, Department od Pediatric and Adolescent Medicine, Vienna, Austria
| | - Uwe Ermer
- Kliniken St. Elisabeth, Klinik für Kinder-und Jugendmedizin, Neuburg, Germany
| | - Johannes Wolf
- Klinik für Kinder-und Jugendmedizin St. Louise, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Markus Freff
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Beate Karges
- Bethlehem Gesundheitszentrum, Klinik für Kinder-und Jugendmedizin, Stolberg, Germany
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Dirk Agena
- Kinderärztliche Gemeinschaftspraxis Franziska Fritz und Dirk Agena, Hildesheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thomas Danne
- Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Reinhard W Holl
- Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
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18
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Hu Y, Shen Y, Yan R, Li F, Ding B, Wang H, Su X, Ma J. Relationship Between Estimated Glycosylated Hemoglobin Using Flash Glucose Monitoring and Actual Measured Glycosylated Hemoglobin in a Chinese Population. Diabetes Ther 2020; 11:2019-2027. [PMID: 32696267 PMCID: PMC7434821 DOI: 10.1007/s13300-020-00879-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the relationship between actual measured glycated hemoglobin (HbA1c) and estimated glycated hemoglobin (EA1c) in the flash glucose monitoring (FGM) system in Chinese patients with type 2 diabetes. METHODS This study was conducted in Nanjing First Hospital. Each patient used FGM twice in a 3-month period (during the first 14 days immediately after baseline and during a second 14-day period from days 76 to 90 after baseline). HbA1c measurements were made using a high-performance liquid chromatography assay before the start of the first FGM period (baseline) and at the end of the second FGM period. RESULTS A total of 74 patients (35 men; mean age ± standard deviation [SD] 67.6 ± 5.2 years) were enrolled in the study. The mean (± SD) duration of diabetes was 11.9 ± 7.8 months. The first and second HbA1c measurements were both higher than the EA1c (both p < 0.001). Mean glucose (MG) gradually decreased over time and was the lowest on day 14. Linear regression showed that only HbA1c at baseline affected the gap between HbA1c and EA1c (β = 0.319, p = 0.01) when the educational level, age, gender, duration of diabetes, body mass index, HbA1c at baseline, and number of scans daily were included as independent variables. The best model for calculating EA1c was EA1c% = MG mmol/L × 0.669 - 0.213 × 8th MG + 3.351 when MG > 9.7 mmol/L, and EA1c % = (MG mmol/L + 2.590)/1.590 when MG ≤ 9.7 mmol/L. The correlation coefficient for EA1c and HbA1c in this model (model 7) is higher than that reported the original model in the FGM system 1 (0.955 vs. 0.822, respectively; p < 0.001). CONCLUSIONS The EA1c used by FreeStyle Libre™ is lower than the actual measured HbA1c. Improvement in the glucose levels during FGM in these patients may contribute to the lowering of EA1c. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov, number NCT03785301.
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Affiliation(s)
- Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Shen
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rengna Yan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fengfei Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huiying Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
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Kingsnorth AP, Whelan ME, Orme MW, Routen AC, Sherar LB, Esliger DW. Resistance to data loss from the Freestyle Libre: impact on glucose variability indices and recommendations for data analysis. Appl Physiol Nutr Metab 2020; 46:148-154. [PMID: 32813987 DOI: 10.1139/apnm-2020-0386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Like many wearables, flash glucose monitoring relies on user compliance and is subject to missing data. As recent research is beginning to utilise glucose technologies as behaviour change tools, it is important to understand whether missing data are tolerable. Complete Freestyle Libre data files were amputed to remove 1-6 h of data both at random and over mealtimes (breakfast, lunch, and dinner). Absolute percent errors (MAPE) and intraclass correlation coefficients (ICC) were calculated to evaluate agreement and reliability. Thirty-two (91%) participants provided at least 1 complete day (24 h) of data (age: 44.8 ± 8.6 years, female: 18 (56%); mean fasting glucose: 5.0 ± 0.6 mmol/L). Mean and continuous overall net glycaemic action (CONGA) (60 min) were robust to data loss (MAPE ≤3%). Larger errors were calculated for standard deviation, coefficient of variation (CV) and mean amplitude of glycaemic excursions (MAGE) at increasing missingness (MAPE: 2%-10%, 2%-9%, and 4%-18%, respectively). ICC decreased as missing data increased, with most indicating excellent reliability (>0.9) apart from certain MAGE ICCs, which indicated good reliability (0.84-0.9). Researchers and clinicians should be aware of the potential for larger errors when reporting standard deviation, CV, and MAGE at higher rates of data loss in nondiabetic populations. But where mean and CONGA are of interest, data loss is less of a concern. Novelty: As research now utilises flash glucose monitoring as behavioural change tools in nondiabetic populations, it is important to consider the influence of missing data. Glycaemic variability indices of mean and CONGA are robust to data loss, but standard deviation, CV, and MAGE are influenced at higher rates of missingness.
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Affiliation(s)
- Andrew P Kingsnorth
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Leicestershire, UK
| | - Maxine E Whelan
- Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, CV1 5FB, UK
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicestershire, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Leicestershire, LE3 9QP, UK
| | - Ash C Routen
- NIHR Applied Research Collaboration East Midlands (ARC EM), Diabetes Research Centre, University of Leicester, LE5 4PW, UK
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Leicestershire, UK.,NIHR Leicester Biomedical Research Centre-Lifestyle, Leicestershire, LE5 4PW, UK
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Leicestershire, UK.,NIHR Leicester Biomedical Research Centre-Lifestyle, Leicestershire, LE5 4PW, UK
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20
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Castellana M, Parisi C, Di Molfetta S, Di Gioia L, Natalicchio A, Perrini S, Cignarelli A, Laviola L, Giorgino F. Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001092. [PMID: 32487593 PMCID: PMC7265013 DOI: 10.1136/bmjdrc-2019-001092] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Flash glucose monitoring (FGM) is a factory-calibrated sensor-based technology for the measurement of interstitial glucose. We performed a systematic review and meta-analysis to assess its efficacy and safety in patients with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS PubMed, CENTRAL, Scopus and Web of Science were searched in July 2019. Twelve studies with a follow-up longer than 8 weeks, evaluating 2173 patients on prandial insulin, multiple daily insulin injections or continuous subcutaneous insulin infusion were included. The following data were extracted: HbA1c, time in range, time above 180 mg/dL, time below 70 mg/dL, frequency of hypoglycemic events, number of self-monitoring of blood glucose (SMBG) measurements, total daily insulin dose, patient-reported outcomes, adverse events, and discontinuation rate. A comparison with SMBG was conducted. RESULTS FGM use was associated with a reduction in HbA1c (-0.26% (-3 mmol/mol); p=0.002) from baseline to the last available follow-up, which correlated with HbA1c levels at baseline (-0.4% (-4 mmol/mol) for each 1.0% (11 mmol/mol) of HbA1c above 7.2% (55 mmol/mol)). Also, a decrease in time below 70 mg/dL was found (-0.60 hours/day; p=0.04). Favorable findings in patient-reported outcomes and no device-related serious adverse events were reported. When compared with SMBG, FGM was characterized by no statistically different change in HbA1c (p=0.09), with lower number of SMBG measurements per day (-3.76 n/day; p<0.001) and risk of discontinuation (relative risk=0.42; p=0.001). A limited number of studies, with a heterogeneous design and usually with a short-term follow-up and without specific training, were found. CONCLUSIONS The present review provides evidence for the use of FGM as an effective strategy for the management of diabetes.
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Affiliation(s)
- Marco Castellana
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Claudia Parisi
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Sergio Di Molfetta
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Ludovico Di Gioia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Annalisa Natalicchio
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Sebastio Perrini
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Luigi Laviola
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Puglia, Italy
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21
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Ortega JF, Morales-Palomo F, Ramirez-Jimenez M, Moreno-Cabañas A, Mora-Rodríguez R. Exercise improves metformin 72-h glucose control by reducing the frequency of hyperglycemic peaks. Acta Diabetol 2020; 57:715-723. [PMID: 32020414 DOI: 10.1007/s00592-020-01488-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/21/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the separated and combined effects of metformin and exercise on insulin sensitivity and free-living glycemic control in overweight individuals with prediabetes/type 2 diabetes (T2DM). METHODS We recruited 16 adults with BMI of 32.7 ± 4.3 kg m-2 and insulin resistance (HOMA-IR 3.2 ± 0.4) under chronic metformin treatment (1234 ± 465 g day-1) enrolled in a high-intensity interval training (HIIT) program. Participants underwent four 72-h experimental trials in a random-counterbalanced order: (1) maintaining their habitual metformin treatment (MET); (2) replacing metformin treatment by placebo (CON); (3) placebo plus two HIIT sessions (EX + CON), and (4) metformin plus two HIIT sessions (MET + EX). We used intermittently scanned continuous glucose monitoring (isCGM) during 72 h in every trial to obtain interstitial fluid glucose area under the curve (IFGAUC) and the percentage of measurements over 180 mg dL-1 (% IFGPEAKS). Insulin sensitivity was assessed on the last day of each trial with HOMA-IR index and calculated insulin sensitivity (CSI) from intravenous glucose tolerance test. RESULTS IFGAUC was lower in MET + EX and MET than in CON (P = 0.011 and P = 0.025, respectively). In addition, IFGAUC was lower in MET + EX than in EX + CON (P = 0.044). %IFGPEAKS were only lower in MET + EX in relation to CON (P = 0.028). HOMA-IR and CSI were higher in CON in comparison with MET + EX (P = 0.011 and P = 0.022, respectively) and MET (P = 0.006 and P < 0.001, respectively). IFGAUC showed a significant correlation with HOMA-IR. CONCLUSION Intense aerobic exercise in patients with diabetes and prediabetes under metformin treatment reduces free-living 72-h blood hyperglycemic peaks. This may help to prevent the development of cardiovascular complications associated with diabetes.
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Affiliation(s)
- J F Ortega
- Exercise Physiology Laboratory, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - F Morales-Palomo
- Exercise Physiology Laboratory, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - M Ramirez-Jimenez
- Exercise Physiology Laboratory, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - A Moreno-Cabañas
- Exercise Physiology Laboratory, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - R Mora-Rodríguez
- Exercise Physiology Laboratory, University of Castilla-La Mancha, 45071, Toledo, Spain.
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22
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Gomez-Peralta F, Dunn T, Landuyt K, Xu Y, Merino-Torres JF. Flash glucose monitoring reduces glycemic variability and hypoglycemia: real-world data from Spain. BMJ Open Diabetes Res Care 2020; 8:8/1/e001052. [PMID: 32198165 PMCID: PMC7103828 DOI: 10.1136/bmjdrc-2019-001052] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/29/2020] [Accepted: 02/22/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Observations in real-world settings support and extend findings demonstrated in randomized controlled trials that show flash glucose monitoring improves glycemic control. In this study, Spain-specific relationships between testing frequency and glycemic parameters were investigated under real-world settings. RESEARCH DESIGN AND METHODS Deidentified glucose and user scanning data were analyzed and readers were rank ordered into 20 equal sized groups by daily scan frequency. Glucose parameters were calculated for each group: estimated HbA1c, time below range (<70 and ≤54 mg/dL), within range (70-180 mg/dL), and above range (>180 mg/dL). Glycemic variability (GV) metrics were described and data obtained from sensors in Spain and worldwide were compared. RESULTS Spanish users (n=22 949) collected 37.1 million glucose scans, 250 million automatically recorded glucose readings, and checked glucose values via a mean of 13 scans/day. Estimated HbA1c, time below 70 mg/dL, at or below 54 mg/dL, above 180 mg/dL, and GV metrics were significantly lower in the highest compared with lowest scan rate group (39.6 to 3.9 scans/day). Time-in-range was higher for the highest versus lowest scan rate group at 15.6 vs 11.5 hours/day, respectively. GV metrics correlated positively with time below 70 mg/dL, at or below 54 mg/dL, above 180 mg/dL, and negatively with time-in-range. The relationship between glucose metrics and scan rate was similar in Spain and worldwide. However, time in hypoglycemia in Spain was higher in the groups with lower scan rates. CONCLUSIONS As seen in clinical trials, flash glucose monitoring in real-world settings allows frequent glucose checks. High scan rates are associated with the favorable glycemic markers of increased time-in-range and reduced time in hyperglycemia and hypoglycemia, and GV. The same trends, with unique nuances, are observed in both Spanish and global data.
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Affiliation(s)
- Fernando Gomez-Peralta
- Endocrinology and Nutrition Unit, Hospital General de Segovia, Segovia, Castilla y León, Spain
| | - Timothy Dunn
- Research and Development, Abbott Laboratories, Alameda, California, USA
| | | | - Yongjin Xu
- Research and Development, Abbott Laboratories, Alameda, California, USA
| | - Juan Francisco Merino-Torres
- Department of Medicine, Universitat de València Facultat de Medicina i Odontologia, Valencia, Comunitat Valenciana, Spain
- Endocrinology and Nutrition Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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23
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Calliari LEP, Krakauer M, Vianna AGD, Ram Y, Barbieri DE, Xu Y, Dunn TC. Real-world flash glucose monitoring in Brazil: can sensors make a difference in diabetes management in developing countries? Diabetol Metab Syndr 2020; 12:3. [PMID: 31921360 PMCID: PMC6947827 DOI: 10.1186/s13098-019-0513-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND New technologies are changing diabetes treatment and contributing better outcomes in developed countries. To our knowledge, no previous studies have investigated the comparative effect of sensor-based monitoring on glycemic markers in developing countries like Brazil. The present study aims to evaluate the use of intermittent Continuous Glucose Measurements (iCGM) in a developing country, Brazil, regarding (i) frequency of glucose scans, (ii) its association with glycemic markers and (iii) comparison with these findings to those observed in global population data. METHODS Glucose results were de-identified and uploaded to a dedicated database when Freestyle Libre™ readers were connected to an internet-ready computer. Data between September 2014 and Dec 2018, comprising 688,640 readers and 7,329,052 sensors worldwide, were analysed (including 17,691 readers and 147,166 sensors from Brazil). Scan rate per reader was determined and each reader was sorted into 20 equally-sized rank ordered groups, categorised by scan frequency. Glucose parameters were calculated for each group, including estimated A1c, time above, below and within range identified as 70-180 mg/dL. RESULTS In Brazil, reader users performed an average of 14 scans per day, while around the world, reader users performed an average of 12 scans per day (p < 0.01). In Brazil dataset, those in the lowest and in the highest groups scanned on average 3.6 and 43.1 times per day had an estimated A1c of 7.56% (59 mmol/mol) and 6.71% (50 mmol/mol), respectively (p < 0.01). Worldwide, the lowest group and the highest groups scanned 3.4 times/day and 37.8 times/day and had an eA1c of 8.14% (65 mmol/mol) and 6.70% (50 mmol/mol), respectively (p < 0.01). For the scan groups in both populations, the time spent above 180 mg/dL decreased as the scan frequency increased. In both Brazil and around the world, as scan frequency increased, time in range (TIR) increased. In Brazil, TIR increased from 14.15 to 16.62 h/day (p < 0.01). Worldwide, TIR increased from 12.06 to 16.97 h/day (p < 0.01). CONCLUSIONS We conclude that Brazilian users have a high frequency of scans, more frequent than global data. Similarly to the world findings, increased scan frequency is associated with better glycemic control.
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Affiliation(s)
| | - Marcio Krakauer
- Centro de Pesquisa Clínica do Grupo Leforte, São Paulo, Brazil
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White ND, Knezevich E. Flash Glucose Monitoring Technology Impact on Diabetes Self-Care Behavior. Am J Lifestyle Med 2019; 14:130-132. [PMID: 32231476 DOI: 10.1177/1559827619890955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Individuals with diabetes play a significant role in the control of their condition by participating in their own care. Self-monitoring of blood glucose is of particular importance in maintaining adequate glycemic control but when obtained using traditional fingerstick methods, is often limited with by cost, fear of needles or pain and inconvenience. Flash glucose monitoring is an innovative technology available to address these barriers and help people with diabetes better manage their blood glucose levels. Data demonstrating increased frequency in glucose monitoring, patient perspectives related to self-care behaviors, and implications for practice and future research are described.
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Affiliation(s)
- Nicole D White
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | - Emily Knezevich
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
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25
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Sagar RC, Abbas A, Ajjan R. Glucose monitoring in diabetes: from clinical studies to real‐world practice. PRACTICAL DIABETES 2019. [DOI: 10.1002/pdi.2215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca C Sagar
- Leeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Afroze Abbas
- Leeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust Leeds UK
- School of MedicineUniversity of Leeds Leeds UK
| | - Ramzi Ajjan
- Leeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust Leeds UK
- School of MedicineUniversity of Leeds Leeds UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, The LIGHT LaboratoriesUniversity of Leeds Leeds UK
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