Measuring the Impact of Flash Glucose Monitoring in a Pediatric Population in Saudi Arabia: A Retrospective Cohort Study

INTRODUCTION

Measurement of glucose levels is the mainstay method of ensuring good glycemic control and preventing complications associated with uncontrolled diabetes. Continuous glucose monitoring enables easy and effective monitoring of interstitial glucose around the clock and hence improves glycemic control.

OBJECTIVES

This study aimed to measure the effect of continuous glucose monitoring on glycated hemoglobin (HbA1c) at 3, 6, and 9 months following sensor insertion.

METHODS

A retrospective cohort study of pediatric and adolescent type 1 diabetes mellitus patients randomly sampled from 32 Ministry of Health diabetes centers across Saudi Arabia was performed. Patients were subjected to flash glucose monitoring using the FreeStyle^® Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, UK), an intermittently scanned continuous glucose monitoring device approved by the Conformité Européenne in 2014. These patients were first-time users of any kind of continuous glucose monitoring system, aged 4-18 years, and received insulin via multiple dose injection or continuous subcutaneous insulin infusion for at least 6 months prior to study start. Patients were excluded if they had used flash glucose monitoring or other interstitial glucose monitoring systems in the past 3 months, were pregnant, or had existing hemoglobinopathies. The flash glucose monitoring sensor was attached to the back of the upper arm at the baseline visit. HbA1c (%) was measured at baseline and 3, 6, and 9 months. Patient demographics were collected from electronic health records.

RESULTS

1,307 patients were included, with a mean age of 11.1 years (standard deviation 3.6 years). Where specified, 51.4% were female. Mean HbA1c significantly reduced from baseline (10.8%) to 3 months (9.8%, p < 0.001), 6 months (9.2%, p < 0.001), and 9 months (9.1%, p < 0.001). For individuals with baseline HbA1c > 9%, mean HbA1c was significantly reduced from baseline (11.7%) to 3 months (10.3%, p < 0.001), 6 months (9.6%, p < 0.001), and 9 months (9.5%, p < 0.001).

CONCLUSIONS

Flash glucose monitoring significantly reduced HbA1c levels at 3, 6, and 9 months following sensor insertion. This reduction was greatest in those patients with higher HbA1c at baseline (> 9%).

Frequency of flash glucose monitoring and glucose metrics: real-world observational data from Saudi Arabia

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.

A Unique Genotype of Pseudohypoaldosteronism Type 1b in a Highly Consanguineous Population

Context

Pseudohypoaldosteronism (PHA) is a condition in which serum aldosterone level is normal or elevated but its action is deficient.

Objective

This study describes the molecular genetics of PHA 1b in the highly consanguineous population of 2 Arabian Gulf countries, Saudi Arabia and Oman.

Methods

This study enrolled 22 patients from 13 unrelated families (2 families with 5 patients from Oman and 11 families with 17 patients from Saudi Arabia). All of these patients had presented within the first 10 days of life with nausea and vomiting, hyponatremia, hyperkalemia, and hypotension. We isolated DNA from peripheral blood and PCR-sequenced all exons and exon-intron boundaries of SCNN1A and, if negative, SCNN1B and SCNN1G using the Dideoxy Chain termination method.

Results

We found a total of 8 mutations in 13 families as follows: 6 mutations in SCNN1A, 1 in SCNN1B, and 1 in SCNN1G. All of these mutations were novel except one. SCNN1A mutations were: c.1496A>G, p.Q499R (novel) in 1 patient; c.1453C>T, p.Q485X (novel) in 1 patient; c.1322_1322delA, p.N441Tfs*41 (novel) in 2 patients of 1 family; c.876 + 2 delGAGT (novel) in 3 patients of 1 family; c.203_204 delTC, p.I68Tfs*76 (a known mutation) in 8 patients of 5 families; and whole SCNN1A gene deletion (novel) in 2 patients of 2 families. In addition, a nonsense SCNN1B mutation c.1694C>A, p.S565X (novel) was found in 3 siblings from 1 Omani family, and an SCNN1G deletion mutation c.527_528 delCA, p.T176Rfs*9 (novel) in 2 siblings from another Omani family.

Conclusion

We characterized a unique genotype of PHA 1b with several novel gene structure-disrupting mutations in SCNN1A, SCNN1B, and SCNN1G in a highly consanguineous population.