A guide for the use of LibreView digital diabetes platform in clinical practice: Expert paper of the Italian Working Group on Diabetes and Technology

Wider access to continuous glucose monitoring systems, including flash glucose monitoring, has enabled people with diabetes to achieve lower HbA1c levels and reduce the amount of time they spend in hypoglycaemia or hyperglycaemia, and has improved their quality of life. An International Consensus Panel proposed different target glucose ranges and recommendations according to different ages and situations (adults, young people and children with type 1 or type 2 diabetes, as well as elderly people who are at higher risk of hypoglycaemia, and women with diabetes during pregnancy). In this expert opinion, we interpret the international recommendations in the context of established clinical practice for diabetes care, and propose three different step-by-step algorithms to help the healthcare professionals use the most innovative glucose metrics, including time in glucose ranges, glucose management indicator, coefficient of variation, and ambulatory glucose profile. In detail, we focus on glucose metrics as measured by the FreeStyle Libre system and as visualized on the LibreView digital diabetes platform to support appropriate interpretation of flash glucose monitoring data. This is specifically structured for healthcare professionals and general practitioners who may have a low level of confidence with diabetes technology, with the aim of optimizing diabetes management, ensuring effective use of healthcare resources and to maximise outcomes for people with diabetes.

Time spent in target range assessed by self-monitoring blood glucose associates with glycated hemoglobin in insulin treated patients with diabetes

BACKGROUND AND AIMS

Self-monitoring blood glucose (SMBG) remains a widespread tool to monitor blood glucose. The development of diabetes management systems (DMS) allows SMBG to provide additional information as time spent in target range (TIR). This study evaluates the association between HbA1c and TIR, evaluated through DMS, over 2 months, and 2 weeks.

METHODS AND RESULTS

Type 1 (T1D) and Type 2 (T2D) insulin-treated patients with diabetes were enrolled. We used the term PIR (Points in Range) instead of TIR, since SMBG provides point-in-time glucose values rather than a continuous trend over time. PIR was calculated in 2-month and 2-week time ranges before available HbA1c measurement. One-hundred ninety-seven patients with T1D and 36 with T2D were recruited. HbA1c and PIR were inversely associated (2 months: R -0.72, 2 weeks R -0.70; p < 0.0001) in all subjects. The relationship did not change when T1D and T2D patients were analyzed separately. For every 10% change of PIR, there was a change of HbA1c by 0.4%.

CONCLUSIONS

Our study, for the first time, demonstrates a significant correlation between HbA1c and PIR calculated by DMS. DMS offers additional information useful in disease management of patients with T1D and T2D performing SMBG.

Improved Glycemic Control in a Patient Group Performing 7-Point Profile Self-Monitoring of Blood Glucose and Intensive Data Documentation: An Open-Label, Multicenter, Observational Study

INTRODUCTION

Regular self-monitoring of blood glucose (SMBG) is recommended as an integral part of therapy for all patients with diabetes treated with insulin. In the current study, the effects on glycemic control of taking 7-point SMBG profiles and using a diabetes management system (DMA) on a smartphone were investigated.

METHODS

In a 12-week, open-label, multicenter, observational study, 51 patients [26 with type 1 diabetes mellitus (T1DM) and 25 with type 2 diabetes mellitus (T2DM)] were instructed to perform SMBG at least seven times a day using DMA combined with the iBGStar ^® SMBG system. HbA1c was measured at regular visits to the study sites. Patients reviewed and managed their data as well as their treatment on their own and there were no further assistance or treatment recommendations. Adverse events (AEs) were recorded throughout.

RESULTS

Overall, mean (SD) change from baseline in HbA1c at week 12 was -0.46 (0.57)% [-5 (6) mmol/mol (p < 0.0001)]. The change in HbA1c was observed in patients with T1DM [-0.27 (0.45)% (-3 [5] mmol/mol; p = 0.0063)] and T2DM [-0.65 (0.62)% (-7 [7] mmol/mol; p < 0.0001)]. The change in HbA1c was not correlated with an increased number of hypoglycemic events (blood glucose less than 55 mg/dL). The majority of AEs were symptomatic hypoglycemic events (42 events; nine patients).

CONCLUSIONS

Glycemic control can be improved, without receiving any recommendations or advice on insulin dose, by performing daily 7-point SMBG profiles and using electronic documentation with a smartphone app. These results must be confirmed in a larger controlled trial, but they already strengthen the importance of structured SMBG in diabetes therapy.

FUNDING

Sanofi.