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Sebastian-Valles F, Martínez-Alfonso J, Arranz Martin JA, Jiménez-Díaz J, Hernando Alday I, Navas-Moreno V, Armenta Joya T, Fandiño García MDM, Román Gómez GL, Lander Lobariñas LE, Martinez de Icaya P, Sampedro-Nuñez MA, Martínez-Vizacaíno V, Marazuela M. Scans per day as predictors of optimal glycemic control in people with type 1 diabetes mellitus using flash glucose monitoring: what number of scans per day should raise a red flag? Acta Diabetol 2024; 61:343-350. [PMID: 37930420 PMCID: PMC10948530 DOI: 10.1007/s00592-023-02204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
AIMS This study aimed to determine the minimum frequency of flash glucose monitoring (FGM) scans necessary for optimal glycemic control in patients with type 1 diabetes (T1D). METHODS Data were collected from 692 patients (47.5% female, with a median age of 47.4 years) who used FGM systems daily and recorded their clinical variables and device data. RESULTS Logistic regression models showed that performing more than 12 scans per day was associated with improved T1D control (OR = 4.22, p < 0.001) and a reduction in HbA1c (7.6 vs 7.0%, 60-53 mmol/mol p < 0.001). However, those performing less than 6 scans showed no improvement in HbA1c (7.9 vs 7.8%, 63-61 mmol/mol p = 0.514). Thirteen daily scans were determined as the optimal cutoff point for predicting optimal glycemic control using a maximally selected rank algorithm. Significant reductions were observed in mean glucose (< 0.001), coefficient of variation (< 0.001), HbA1c (< 0.001), and an increase in TIR (< 0.001) in patients who performed more than 12 daily scans. CONCLUSIONS The results suggest that a higher frequency of daily scans by T1D patients using FGM systems leads to improved chronic glycemic control. The minimum recommended frequency for optimal control is 13 scans per day, and more than 6 daily scans are needed to improve HbA1c.
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Affiliation(s)
- Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain.
| | - Julia Martínez-Alfonso
- Department of Family and Community Medicine, Hospital La Princesa/Centro de Salud Daroca, 28006, Madrid, Spain
| | - Jose Alfonso Arranz Martin
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Jessica Jiménez-Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28194, Leganés, Madrid, Spain
| | - Iñigo Hernando Alday
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, 48013, Bilbao, Spain
| | - Victor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Teresa Armenta Joya
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | | | - Gisela Liz Román Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28194, Leganés, Madrid, Spain
| | | | | | - Miguel Antonio Sampedro-Nuñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Vicente Martínez-Vizacaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
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Jakubowska Z, Malyszko J. Continuous glucose monitoring in people with diabetes and end-stage kidney disease-review of association studies and Evidence-Based discussion. J Nephrol 2024; 37:267-279. [PMID: 37989976 DOI: 10.1007/s40620-023-01802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
Diabetic nephropathy is currently the leading cause of end-stage kidney disease. The present methods of assessing diabetes control, such as glycated hemoglobin or self-monitoring of blood glucose, have limitations. Over the past decade, the field of continuous glucose monitoring has been greatly improved and expanded. This review examines the use of continuous glucose monitoring in people with end-stage kidney disease treated with hemodialysis (HD), peritoneal dialysis (PD), or kidney transplantation. We assessed the use of both real-time continuous glucose monitoring and flash glucose monitoring technology in terms of hypoglycemia detection, glycemic variability, and efficacy, defined as an improvement in clinical outcomes and diabetes control. Overall, the use of continuous glucose monitoring in individuals with end-stage kidney disease may improve glycemic control and detection of hypoglycemia. However, most of the published studies were observational with no control group. Moreover, not all studies used the same assessment parameters. There are very few studies involving subjects on peritoneal dialysis. The small number of studies with limited numbers of participants, short follow-up period, and small number of manufacturers of continuous glucose monitoring systems are limitations of the review. More studies need to be performed to obtain more reliable results.
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Affiliation(s)
- Zuzanna Jakubowska
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw, Poland.
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw, Poland
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Rodríguez de Vera Gómez P, Mateo Rodríguez C, Rodríguez Jiménez B, Hidalgo Sotelo L, Peinado Ruiz M, Torrecillas Del Castillo E, Ruiz-Aranda D, Serrano Olmedo I, Candau Martín Á, Martínez-Brocca MA. Impact of Flash Glucose Monitoring on the Fear of Hypoglycemia Phenomenon in Adults with Type 1 Diabetes. Diabetes Technol Ther 2024. [PMID: 38315507 DOI: 10.1089/dia.2023.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Objective: To assess the clinical impact of flash glucose monitoring (FGM) systems on fear of hypoglycemia (FoH) and quality of life in adults with type 1 diabetes mellitus (T1DM). Methods: Prospective quasi-experimental study with a 12-month follow-up. People with T1DM (18-80 years old) and self-monitoring by blood capillary glycemia controls were included. The FH15 questionnaire, a survey validated in Spanish in a comparable study population, was used to diagnose FoH with a cutoff point of 28 points. Results: A total of 181 participants were included, with a FoH prevalence of 69% (n = 123). A mean reduction in FH15 score of -4 points (95% confidence interval [-5.5 to -3]; P < 0.001) was observed, along with an improvement in quality of life (EsDQOL-test (Diabetes Quality of Life, Spanish version), -7 points [-10; -4], P < 0.001) and satisfaction with treatment (Diabetes Treatment Satisfaction questionnaire, self-reported version [DTSQ-s] test, +4.5 points [4; 5.5], P < 0.001). At the end of the follow-up, 64.2% of the participants saw an improved FoH intensity, compared to 35.8% who scored the same or higher. This improvement in FoH status was associated with a higher time-in-range at the end of the follow-up (P = 0.003), as well as a lower time spent in hyperglycemia (P = 0.005). In addition, it was linked to participants with a high baseline FoH levels (P < 0.001) and those who were university degree holders (P = 0.07). Conclusions: FGM is associated with an overall reduction of FoH in adults with T1DM and with an increase in their quality of life. Nevertheless, a significant percentage of patients may experience an increase of this phenomenon leading to clinical repercussions and a profound impact on quality of life.
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Affiliation(s)
| | - Carmen Mateo Rodríguez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Lucía Hidalgo Sotelo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Mercedes Peinado Ruiz
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | - Isabel Serrano Olmedo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ángela Candau Martín
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
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Rebollo-Román Á, Tabernero-Urbieta MC, Villaécija J, Luque-Salas B. Mediterranean diet adherence and glycemic control in children and adolescents with type 1 diabetes. Eur J Pediatr 2024; 183:453-460. [PMID: 37930397 DOI: 10.1007/s00431-023-05325-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
To effectively manage type 1 diabetes (T1D) insulin is essential, with dosages based on lifestyle. The Mediterranean diet has demonstrated its advantages in preventing and enhancing the management of chronic diseases. Our objective was to investigate the potential mediation of sensor activity on the relationship between adherence to the Mediterranean diet and glycemic control in children and adolescents. A total of 150 children and adolescents (mean age = 13.09, SD = 3.54; 44% female) with T1D were recruited. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire which evaluates 16 items and gives higher scores when adherence is higher. Glycemic control and the duration of sensor activity were evaluated with data from flash glucose monitoring. The data confirmed our hypothesis by revealing that adherence to the Mediterranean diet positively influenced glycemic control (direct effect = 1.505; P < 0.01) and that this relationship was mediated by the duration of sensor activity (indirect effect = 0.531; P < 0.01). Conclusions: Our results support the increased utilization of glycemic control devices, as they contribute to improve glycemic control and mediate on the positive relationship between adherence to the Mediterranean diet and adequate glycemic control. Furthermore, our findings highlight the importance of incorporating Mediterranean diet recommendations to achieve better glycemic control in children and adolescents with T1D. What is Known: • The Mediterranean diet and glycemic control have proven benefits in improving cardiovascular health in the general population. Scarce evidence exists of these benefits among children and adolescents with T1D. What is New: • Adherence to the Mediterranean diet and greater use of glucose monitoring devices in children and adolescents with T1D are related to better glycemic control. These variables can be enhanced by psychoeducational interventions such as structured diabetes education programs or peer group-based sessions, which highlights the importance of focusing on these aspects.
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Affiliation(s)
- Ángel Rebollo-Román
- Department of Endocrinology and Nutrition, University Hospital Reina Sofía, Avda. Menéndez Pidal S/N, 14004, Córdoba, Spain.
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain.
| | - Mª Carmen Tabernero-Urbieta
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Department of Social Psychology and Anthropology, University of Salamanca, Salamanca, Spain
- Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, Salamanca, Spain
| | - Joaquín Villaécija
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Bárbara Luque-Salas
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
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Sakane N, Hirota Y, Yamamoto A, Miura J, Takaike H, Hoshina S, Toyoda M, Saito N, Hosoda K, Matsubara M, Tone A, Kawashima S, Sawaki H, Matsuda T, Domichi M, Suganuma A, Sakane S, Murata T. Association of scan frequency with CGM-derived metrics and influential factors in adults with type 1 diabetes mellitus. Diabetol Int 2024; 15:109-116. [PMID: 38264231 PMCID: PMC10800315 DOI: 10.1007/s13340-023-00655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/27/2023] [Indexed: 01/25/2024]
Abstract
Introduction This study aimed to investigate the association between scan frequency and intermittently scanned continuous glucose monitoring (isCGM) metrics and to clarify the factors affecting scan frequency in adults with type 1 diabetes mellitus (T1D). Methods We enrolled adults with T1D who used FreeStyle® Libre. Scan and self-monitoring of blood glucose (SMBG) frequency and CGM metrics from the past 90-day glucose data were collected. The receiver operating characteristic curve was plotted to obtain the optimal cutoff values of scan frequency for the target values of time in range (TIR), time above range (TAR), and time below range (TBR). Results The study was conducted on 211 adults with T1D (mean age, 50.9 ± 15.2 years; male, 40.8%; diabetes duration, 16.4 ± 11.9 years; duration of CGM use, 2.1 ± 1.0 years; and mean HbA1c, 7.6 ± 0.9%). The average scan frequency was 10.5 ± 3.3 scan/day. Scan frequency was positively correlated with TIR and negatively correlated with TAR, although it was not significantly correlated with TBR. Scan frequency was positively correlated with the hypoglycemia fear survey-behavior score, while it was negatively correlated with some glycemic variability metrics. Adult patients with T1D and good exercise habits had a higher scan frequency than those without exercise habits. The AUC for > 70% of the TIR was 0.653, with an optimal cutoff of 11 scan/day. Conclusions In real-world conditions, frequent scans were linked to improved CGM metrics, including increased TIR, reduced TAR, and some glycemic variability metrics. Exercise habits and hypoglycemia fear-related behavior might affect scan frequency. Our findings could help healthcare professionals use isCGM to support adults with T1D.Clinical Trial Registry No. UMIN000039376.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine Hyogo, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017 Japan
| | - Akane Yamamoto
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine Hyogo, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017 Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Sari Hoshina
- Division of Diabetology and Metabolism, Department of Internal Medicine Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1143 Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1143 Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565 Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565 Japan
- Department of General Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522 Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-ku, Okayama-shi, Okayama, 700-8511 Japan
| | - Satoshi Kawashima
- Kanda Naika Clinic, 5-21-3 Hannan-cho, Abeno-ku, Osaka-shi, Osaka, 545-0021 Japan
| | - Hideaki Sawaki
- Sawaki Internal Medicine And Diabetes Clinic, 1-1-501A Konyamachi, Takatsuki-shi, Osaka, 569-0804 Japan
| | - Tomokazu Matsuda
- Matsuda Diabetes Clinic, 78-7 Ohtsukadai, Nishi-ku, Kobe City, Hyogo, 651-2135 Japan
| | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
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Eer ASY, Ho RCY, Hearn T, Hachem M, Freund M, Burchill LJ, Atkinson-Briggs S, Singh S, Eades S, O'Brien RC, Furler JS, O'Neal DN, Story DA, Zajac JD, Braat S, Brown A, Clarke P, Sinha AK, McLean AG, Twigg SM, Ekinci EI. Feasibility and acceptability of the use of flash glucose monitoring encountered by Indigenous Australians with type 2 diabetes mellitus: initial experiences from a pilot study. BMC Health Serv Res 2023; 23:1377. [PMID: 38066492 PMCID: PMC10704698 DOI: 10.1186/s12913-023-10121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is highly prevalent within the Indigenous Australian community. Novel glucose monitoring technology offers an accurate approach to glycaemic management, providing real-time information on glucose levels and trends. The acceptability and feasibilility of this technology in Indigenous Australians with T2DM has not been investigated. OBJECTIVE This feasibility phenomenological study aims to understand the experiences of Indigenous Australians with T2DM using flash glucose monitoring (FGM). METHODS Indigenous Australians with T2DM receiving injectable therapy (n = 8) who used FGM (Abbott Freestyle Libre) for 6-months, as part of a clinical trial, participated in semi-structured interviews. Thematic analysis of the interviews was performed using NVivo12 Plus qualitative data analysis software (QSR International). RESULTS Six major themes emerged: 1) FGM was highly acceptable to the individual; 2) FGM's convenience was its biggest benefit; 3) data from FGM was a tool to modify lifestyle choices; 4) FGM needed to be complemented with health professional support; 5) FGM can be a tool to engage communities in diabetes management; and 6) cost of the device is a barrier to future use. CONCLUSIONS Indigenous Australians with T2DM had positive experiences with FGM. This study highlights future steps to ensure likelihood of FGM is acceptable and effective within the wider Indigenous Australian community.
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Affiliation(s)
- Audrey Sing Yi Eer
- Austin Health, Heidelberg, VIC, Australia
- The University of Melbourne (Austin Health), Melbourne, VIC, Australia
| | | | - Tracey Hearn
- The University of Melbourne, Melbourne, VIC, Australia
- Rumbalara Aboriginal Co-Operative, Mooroopna, VIC, Australia
| | - Mariam Hachem
- The University of Melbourne (Austin Health), Melbourne, VIC, Australia
- Centre for Research and Education in Diabetes and Obesity (CREDO), Faculty of Dentistry Health Sciences and Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
| | - Megan Freund
- Research Academic, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Luke James Burchill
- Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine (Royal Melbourne Hospital), Aboriginal Cardiovascular Health Equity Research Group, The University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Atkinson-Briggs
- Rumbalara Aboriginal Co-Operative, Mooroopna, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Satpal Singh
- Rumbalara Aboriginal Co-Operative, Mooroopna, VIC, Australia
| | - Sandra Eades
- Faculty of Medicine Dentistry and Health Sciences, 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
| | - Richard Charles O'Brien
- Austin Clinical School, The University of Melbourne, Melbourne, VIC, Australia
- Graduate Programs and Executive Education, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- Lipid Services, Austin Health, Heidelberg, VIC, Australia
| | - John Stuart Furler
- Department of General Practice, Faculty of Medicine Dentisty and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - David Norman O'Neal
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
- St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- The University of Melbourne (St. Vincent's Hospital), Melbourne, VIC, Australia
| | - David Andrew Story
- Austin Health, Heidelberg, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Melbourne Academic Centre for Health (MACH), Melbourne, VIC, Australia
| | - Jeffrey David Zajac
- The University of Melbourne (Austin Health), Melbourne, VIC, Australia
- Division of Medicine, Medical Services CSU and Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Alex Brown
- Indigenous Genomics, Australian National University and Telethon Kids Institute, Canberra, Australian Capital Territory, Australia
| | - Phillip Clarke
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
- Health Economics, Nuffield Department of Public Health, Univeristy of Oxford, Oxford, UK
- Academic, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ashim Kumar Sinha
- Diabetes and Endocrinology, Cairns Hospital, Cairns, QLD, Australia
- James Cook University, Cairns, QLD, Australia
| | - Anna Gerardina McLean
- Endocrinology and General Medicine, Cairns Hospital, Cairns, QLD, Australia
- Menzies School of Health Research, Darwin, NT, Australia
| | - Stephen Morris Twigg
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Endocrinology, Stan Clark Chair in Diabetes, Faculty in Diabetes, The University of Sydney, Sydney, NSW, Australia
| | - Elif Ilhan Ekinci
- Austin Health, Heidelberg, VIC, Australia.
- The Australian Centre for Accelerating Diabetes Innovation (ACADI), The University of Melbourne, Parkville, Australia.
- Sir Edward Weary Dunlop Principal Research Fellow in Metabolic Medicine, University of Melbourne, Melbourne, VIC, Australia.
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McLean A, Barr E, Tabuai G, Murphy HR, Maple-Brown L. Continuous Glucose Monitoring Metrics in High-Risk Pregnant Women with Type 2 Diabetes. Diabetes Technol Ther 2023; 25:836-844. [PMID: 37902969 DOI: 10.1089/dia.2023.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Objective: To describe glucose metrics in a high-risk population of women with type 2 diabetes (T2DM) in pregnancy and to explore the associations with neonatal outcomes. Research Design and Methods: Prospective observational study of 57 women. Continuous glucose monitoring (CGM) trajectories were determined from metrics collected in early and late gestation using the first and last two (mean 16 and 35) weeks of Freestyle Libre data. Logistic regression was used to examine associations of CGM metrics with neonatal hypoglycemia (glucose <2.6 mmol/L requiring intravenous dextrose) and large for gestational age (LGA) (>90th percentile for gestational age and sex). Pregnancy-specific target glucose range was 3.5-7.8 mmol/L (63-140 mg/dL). Results: Forty-one women used CGM for 15 weeks (mean age 33 years, 73% Aboriginal or Torres Strait Islander, 32% living remotely). There was limited change in average metrics from early to late pregnancy. For the subgroup with sensor use >50% (n = 29), mean time in range (TIR) increased by 9%, time above range reduced by 12%, average glucose reduced by 1 mmol/L, and time below range increased by 3%. Neonatal hypoglycemia was associated with most CGM metrics, HbA1c and CGM targets, particularly those from late pregnancy. LGA was associated with hyperglycemic metrics from early pregnancy. Each 1% increase TIR was associated with a 4%-5% reduction in risk of neonatal complications. Conclusion: In this high-risk group of women with T2DM, CGM metrics only improved during pregnancy in those with greater sensor use and were associated with LGA in early pregnancy and neonatal hypoglycemia throughout. Culturally appropriate health care strategies are critical for successful use of CGM technology.
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Affiliation(s)
- Anna McLean
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Endocrinology Department, Cairns Hospital, Cairns, Australia
| | - Elizabeth Barr
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Georgina Tabuai
- Endocrinology Department, Cairns Hospital, Cairns, Australia
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, Australia
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Majewska A, Stanirowski PJ, Tatur J, Wojda B, Radosz I, Wielgos M, Bomba-Opon DA. Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial. Acta Diabetol 2023; 60:1171-1177. [PMID: 37160787 PMCID: PMC10359198 DOI: 10.1007/s00592-023-02091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) is the most common type of hyperglycaemia in pregnancy. GDM is a risk factor of adverse perinatal outcomes, with the incidence rate increasing proportionally to the level of maternal dysglycaemia. Therefore, glycaemic control plays an important role in management of GDM. The aim of this study was to assess the efficacy of flash glucose monitoring (FGM) in GDM. MATERIALS AND METHODS This was a non-blinded, randomised controlled trial, that recruited 100 pregnant women diagnosed with GDM between 24 and 28 weeks of gestation at the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw. After meeting the inclusion criteria patients were randomly allocated to the study group (FGM, n = 50) or control group (self-monitoring of blood glucose-SMBG, n = 50). Clinical and laboratory results were assessed at four follow-up visits. The primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes. RESULTS There was no significant difference in mean glycaemia between the groups (p = 0.437) Compared to the control group, the study group significantly reduced their fasting (p = 0.027) and postprandial glycaemia (p = 0.034) during the first 4 weeks following GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09, 95% CI 0.47-2.57). Incidence of fetal macrosomia was significantly higher in SMBG as compared to FGM group (OR 5.63, 95% CI 1.16-27.22). CONCLUSIONS Study results indicate that FGM has an impact on glycaemic control, dietary habits and incidence of fetal macrosomia in patients with GDM. Trial registration clinicaltrials.gov ID: NCT04422821.
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Affiliation(s)
- Agata Majewska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland.
- Polish Society of Gynecologists and Obstetricians, Club 35, 02-677, Warsaw, Poland.
| | - Paweł Jan Stanirowski
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland
- Polish Society of Gynecologists and Obstetricians, Club 35, 02-677, Warsaw, Poland
| | - Jacek Tatur
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland
| | - Barbara Wojda
- Department of Nutrition and Nutritional Value of Food, National Institute of Public Health NIH-National Research Institute, Chocimska St. 24, 00-791, Warsaw, Poland
| | - Iwona Radosz
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015, Warsaw, Poland
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9
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Contreras M, Mesa A, Pueyo I, Claro M, Milad C, Viñals C, Roca D, Granados M, Giménez M, Conget I. Effectiveness of flash glucose monitoring in patients with type 1 diabetes and recurrent hypoglycemia between early and late stages after flash glucose monitoring initiation. J Diabetes Complications 2023; 37:108560. [PMID: 37480703 DOI: 10.1016/j.jdiacomp.2023.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
AIMS Evaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. METHODS Ambispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimbursed FGM (FreeStyle Libre 2). The primary outcome was the number of SH events (requiring third party assistance) and main secondary outcomes were time below range < 70 (TBR < 70) and < 54 mg/dL (TBR < 54), impaired awareness of hypoglycemia (IAH) and quality of life (QoL). Logistic regression models were constructed to explore variables associated with success of the intervention. RESULTS We included 110 patients (52.7 % women, mean age 47.8 ± 17.0 years). SH events at 1-year follow-up decreased from 0.3 ± 0.6 to 0.03 ± 0.2 (p < 0.001). Significant reductions in patients presenting an SH (26.4 % vs. 2.9 %, p < 0.001) and IAH (47.1 % vs. 25.9 %, p = 0.002) were observed, as well as improvements in QoL. TBR < 70 and TBR < 54 were not significantly reduced. Baseline GMI was inversely associated with a decrease in TBR < 70 [OR 0.37 (0.15-0.93)] and directly with an increase in time in range 70-180 mg/dL [OR 2.10 (1.03-4.28)]. CONCLUSIONS FGM decreased SH and improved hypoglycemia awareness and QoL. Initial tight glycemic control was associated with a decrease in hypoglycemia, while patients with suboptimal control reduced hyperglycemia.
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Affiliation(s)
- Macarena Contreras
- Endocrinology and Nutrition Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Maria Claro
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Montse Granados
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
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10
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Al Hayek AA, Al Dawish MA. Use of Flash Glucose Monitoring and Glycemic Control in Patients with Type 2 Diabetes Mellitus Not Treated with an Intensive Insulin Regimen: 1-Year Real-Life Retrospective Cohort Study. Adv Ther 2023; 40:2855-2868. [PMID: 37133646 DOI: 10.1007/s12325-023-02508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Estimation of laboratory-derived glycated hemoglobin (HbA1c) cannot be individually used to monitor clinically significant trends in glucose variability. Hence, clinicians advise use of continuous glucose monitoring (CGM) devices such as the Freestyle Libre™ flash glucose monitoring system (FLASH) to optimize glycemic control by estimating glucose monitoring index (GMI) values, which convert mean glucose into an estimate of simultaneously measured laboratory HbA1c. This study aimed to investigate the sustainability of intermittently scanned continuous glucose monitoring (isCGM) in patients with type 2 diabetes mellitus (T2DM) not on intensive insulin regimen, and correlations between GMI values obtained from isCGM and laboratory-derived HbA1c values. METHODS A retrospective review of 93 patients with T2DM not on intensive insulin regimen, using FLASH device, was conducted at a major tertiary hospital in Saudi Arabia, over 1 year of continuous device use. To determine the sustainability of isCGM, various glycemic markers such as average glucose and time in range were evaluated. Paired t test or Wilcoxon signed-rank test was used to assess differences in markers of glycemic control, and Pearson's correlation was used to determine correlations between HbA1c and GMI values. RESULTS Descriptive analysis shows the mean HbA1c value significantly decreased following continued use of isCGM. Pre-isCGM mean HbA1c value of 8.3% improved to 8.1% (p < 0.001) and 7.9% (p < 0.001) in the first 90 and last 90 days of device use, respectively. For both 90-day time periods, correlation analysis revealed a statistically significant positive correlation and linear regression between laboratory-derived HbA1c and GMI values (first 90 days r = 0.7999, p < 0.001; last 90 days r = 0.6651, p < 0.001). CONCLUSION Continuous use of isCGM demonstrated reductions in HbA1c levels for patients with T2DM not on an intensive insulin regimen. The GMI values showed high levels of agreement with measured HbA1c, indicating their accuracy in glucose management.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Kingdom of Saudi Arabia.
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Kingdom of Saudi Arabia
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11
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Šoupal J, Kao K, Brandner L, Grunberger G, Prázný M. Low Initial Adherence with Flash Glucose Monitoring is Not a Predictor of Long-Term Glycemic Outcomes: Longitudinal Analysis of the Association Between Experience, Adherence, and Glucose Control for FreeStyle Libre Users. Diabetes Ther 2023:10.1007/s13300-023-01422-4. [PMID: 37211580 DOI: 10.1007/s13300-023-01422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Frequent scanning of FreeStyle Libre (FSL) flash glucose monitoring sensors is known to be important whilst wearing an active sensor, but adherence to sensor reapplication is also critical to effective glucose monitoring. We report novel measures of adherence for users of the FSL system and their association with improvements in metrics of glucose control. METHODS Anonymous data were extracted for 1600 FSL users in the Czech Republic with ≥ 36 completed sensors from October 22, 2018 to December 31, 2021. "Experience" was defined by the number of sensors used (1-36 sensors). "Adherence" was defined by time between the end of one sensor and the start of the next (gap time). User adherence was analyzed for four experience levels after initiating FLASH; Start (sensors 1-3); Early (sensors 4-6); Middle (sensors 19-21); End (sensors 34-36). Users were split into two adherence levels based on mean gap time during Start period, "low" (> 24 h, n = 723) and "high" (≤ 8 h, n = 877). RESULTS Low-adherence users reduced their sensor gap times significantly: 38.5% applied a new sensor within 24 h during sensors 4-6, rising to 65.0% by sensors 34-36 (p < 0.001). Improved adherence was associated with increased %TIR (time in range; mean + 2.4%; p < 0.001), reduced %TAR (time above range; mean - 3.1%; p < 0.001), and reduced glucose coefficient of variation (CV; mean - 1.7%; p < 0.001). CONCLUSIONS With experience, FSL users became more adherent in sensor reapplication, with associated increases in %TIR, and reductions in %TAR and glucose variability.
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Affiliation(s)
- Jan Šoupal
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | | | | | - George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA
- Department of Internal Medicine and Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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12
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Bastobbe S, Heimann Y, Schleußner E, Groten T, Weschenfelder F. Using flash glucose monitoring in pregnancies in routine care of patients with gestational diabetes mellitus: a pilot study. Acta Diabetol 2023; 60:697-704. [PMID: 36840782 PMCID: PMC10063475 DOI: 10.1007/s00592-023-02042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/24/2023] [Indexed: 02/26/2023]
Abstract
AIM Flash glucose monitoring (FGM) has been approved for the care of pregnant women with preexisting diabetes since 2017. However, its use in gestational diabetes (GDM) has been critically discussed. Inaccuracy and missing recommendations for target values are the main arguments against the use of FGM in GDM. To date, there is a lack of data to justify routine use of FGM in GDM pregnancies. Consequently, this new technology has been withheld from GDM-patients. Aim of our pilot study was to analyze the impact of FGM use on pregnancy outcomes, patient's satisfaction and to confirm the safe use in GDM pregnancies. METHODS Cohort study of 37 FGM-managed GDM pregnancies compared with 74 matched women using self-monitoring of blood glucose (SMBG). Group comparison using nonparametric testing concerning patients characteristic and perinatal outcome focusing on adverse outcomes (preeclampsia, preterm delivery, large for gestational age, C-sections, neonatal intensive care unit admission, hyperbilirubinemia and hypoglycemia). Evaluation of patient's treatment satisfaction using the "Diabetes Treatment Satisfaction Questionnaire change" (DTSQc) and patient interviews. RESULTS No significant differences in patient's characteristics despite gestational age at diagnosis (FGM with 20 vs. SMBG with 25 weeks). No difference in gestational weight gain, HbA1c progression and perinatal outcome. Treatment satisfaction obtained by the DTSQc revealed a high level of satisfaction with FGM use. CONCLUSION FGM use was well accepted and did not affect perinatal outcome. Use of FGM during pregnancy is safe and non-inferior to the management with SBGM. FGM should be considered as an option in the management of GDM patients.
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Affiliation(s)
- Sophie Bastobbe
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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13
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Valenzano M, Bertolotti IC. Flash glucose monitoring versus oral glucose tolerance test: mind the gap. Acta Diabetol 2023; 60:591-593. [PMID: 36396794 DOI: 10.1007/s00592-022-02006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Marina Valenzano
- Territorial Department of Diabetology and Endocrinology - Local Health Authority Cuneo 1 (ASL CN1), Via Ospedali 9, 12038, Savigliano, Cuneo, Italy.
| | - Ivan Cibrario Bertolotti
- Institute of Electronics, Information and Telecommunication Engineering, CNR-IEIIT, c.so Duca degli Abruzzi 24, 10129, Torino, Italy
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14
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Williams DM, Crockett E, Aye S, Latheef MR, Chokor M, Roberts R, Bain SC, Stephens JW, Min T. Freestyle libre use in people with type 2 diabetes using basal-bolus insulin is associated with improved glycaemic control: A real-world analysis. Prim Care Diabetes 2023; 17:202-203. [PMID: 36642672 DOI: 10.1016/j.pcd.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Affiliation(s)
- David M Williams
- Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK; Morriston Hospital, Morriston, Swansea SA6 6NL, UK.
| | - Elin Crockett
- Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK
| | - Su Aye
- Morriston Hospital, Morriston, Swansea SA6 6NL, UK
| | | | - Mahmoud Chokor
- Neath Port Talbot Hospital, Baglan Way, Port Talbot SA12 7BX, UK
| | | | - Stephen C Bain
- Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK; Diabetes Research Group, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Jeffrey W Stephens
- Morriston Hospital, Morriston, Swansea SA6 6NL, UK; Diabetes Research Group, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Thinzar Min
- Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK; Neath Port Talbot Hospital, Baglan Way, Port Talbot SA12 7BX, UK; Diabetes Research Group, Swansea University Medical School, Swansea SA2 8PP, UK
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15
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Polonsky WH, Fortmann AL, Soriano EC, Guzman SJ, Funnell MM. The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring. Diabetes Technol Ther 2023; 25:194-200. [PMID: 36409486 DOI: 10.1089/dia.2022.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Susan J Guzman
- Behavioral Diabetes Institute, San Diego, California, USA
| | - Martha M Funnell
- Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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16
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Moncrieff J, Jayagopal V, Yates D. Glycaemic control in critical care: Can flash glucose monitoring help? J Intensive Care Soc 2023; 24:121-122. [PMID: 36874282 PMCID: PMC9975800 DOI: 10.1177/17511437211043356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Good glycaemic control confers an outcome benefit in both diabetic and non-diabetic critically unwell patients. Critically unwell patients receiving intravenous insulin in the intensive care unit (ICU) require hourly glucose monitoring. This brief communication highlights the impact of the introduction of the FreeStyle Libre glucose monitor, a form of continuous glucose monitoring, on the frequency of glucose recordings in patients receiving intravenous insulin in the ICU at York Teaching Hospital NHS Foundation Trust.
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Affiliation(s)
| | - Vijay Jayagopal
- Hull York Medical School, York Teaching Hospital NHS Foundation Trust, York, UK
| | - David Yates
- York Teaching Hospital NHS Foundation Trust, York, UK
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17
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Oriot P, Hermans MP. Intermittent-scanned continuous glucose monitoring with low glucose alarms decreases hypoglycemia incidence in middle-aged adults with type 1 diabetes in real-life setting. J Diabetes Complications 2023; 37:108385. [PMID: 36603333 DOI: 10.1016/j.jdiacomp.2022.108385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE There is limited real-life data demonstrating that hypo-/hyperglycemic alarms added to continuous glucose monitoring (CGM) improve metabolic control in adults with type 1 diabetes (T1D). We evaluated the usefulness of switching from a flash or intermittent-scanned continuous glucose monitoring (is-CGM) device without low or higher glucose alarms to a is-CGM device with alarms to prevent hypoglycemia in adults with T1D. METHODS Individuals with T1D and fearful of hypoglycemia, prone to hypoglycemia unawareness, and/or experiencing severe hypoglycemia while using is-CGM Free Style Libre 1 (FSL1) were switched to FSL2 with individually-programmable low glucose alarms. The primary endpoint was the changes in % time below range (TBR%) <70 mg/dl [3.9 mmol/l] and <54 mg/dl [3.0 mmol/l] after 12 weeks on FSL2 compared with FSL1. Secondary endpoints were changes in % time in range (TIR% 70-180 mg/dl [3.9-10.0 mmol/l]), % time above range (TAR%) >180 [10.0 mmol/l], mean interstitial glucose, glycemic management indicator (GMI), interstitial glucose coefficient of variation (CV%), hemoglobin A1c, and sensor's scans/day. RESULTS We included 108 individuals (57.4 % men), aged 58.2 ± 17.3 [95 % CI: 55.0 to 61.5] years, with mean diabetes duration 25 ± 14.6 [95 % CI: 22.1 to 27.7] years. Among individuals, 40 (37.0 %) had hypoglycemia awareness with Clarke's score ≥4 and 19 (17.5 %) had a history of severe hypoglycemia. The median low glucose alarm threshold was 70 [IQR: 65-70] mg/dl (3.9 [IQR: 3.6-3.9] mmol/L). By comparison of first 12 weeks on FSL2 vs. last 12 weeks on FSL1, TBR% <70 mg/dl decreased from 4.5 ± 4.4 to 2.3 ± 2.8 % (p < 0.001), TBR% <54 mg/dl decreased from 1.4 ± 2.2 to 0.3 ± 0.9 % (p < 0.001). TIR% was not significantly different (51.5 ± 14.9 vs. 52.9 ± 16 % (p = 0.13)), nor was TAR% (43.8 ± 16.2 vs. 44.7 ± 16.5 % (p = 0.5)). CV% decreased from 39.4 ± 6.9 to 37.9 ± 6.1 % (p < 0.001). Those at risk for hypoglycemia (TBR >4 % and >1 %, respectively, at baseline) showed a significant decrease in the incidence of hypoglycemia <70 and <54 mg/dl (p < 0.0001). Patients' satisfaction with hypoglycemia alarms was high, since all individuals opted to pursue using individual alarm beyond the study period. CONCLUSION Switching from FSL1 to FSL2 with low glucose alarms reduced the frequency of hypoglycemia in middle-age adults with T1D, particularly in those who were prone to hypoglycemia awareness or severe hypoglycemia.
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Affiliation(s)
- Philippe Oriot
- Centre Hospitalier de Mouscron, Service de diabétologie et endocrinologie, Mouscron, Belgium.
| | - Michel P Hermans
- Cliniques Universitaires Saint-Luc, Service d'Endocrinologie et Nutrition, Brussels, Belgium
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18
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Wallace T, Heath J, Koebbel C. The impact of flash glucose monitoring on adults with type 1 Diabetes' eating habits and relationship with food. Diabetes Res Clin Pract 2023; 196:110230. [PMID: 36563881 DOI: 10.1016/j.diabres.2022.110230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
AIM To gain a better understanding of how the FreeStyle Libre (FSL) flash glucose monitor influences the eating habits and relationship with food of adults with type 1 diabetes (T1D). METHODS Reflexive thematic analysis was conducted on fifteen semi-structured interviews conducted with adults with T1D, exploring their experiences of at least one year of FSL use. RESULTS Four themes were constructed from the qualitative data: (1) Personal Food Story (what food represented before and after diabetes diagnosis), (2) New Opportunities (the FSL offered novel discoveries and increased self-confidence regarding food choices), (3) Body as a Machine (participants viewed their bodies as a collection of complex processes requiring continuous maintenance), and (4) re-evaluating Diabetes (participants expressed a shift in their expectations of themselves and their diabetes management). Although the FSL offered participants more freedom and flexibility with their eating, this was constrained by feeling forever under scrutiny from the data. CONCLUSIONS Findings suggest the FSL influences users' eating habits, including when, why, what and how much they eat. Participants described both the positive and negative impact of these changes on their emotional wellbeing and relationship with diabetes, arguing for a need to address patients' relationship with food in routine clinic care.
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Affiliation(s)
- T Wallace
- Doctoral Programme in Clinical Psychology, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
| | - J Heath
- Doctoral Programme in Clinical Psychology, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK; Bedford Hospital Adult Diabetes Service, Bedfordshire Hospitals NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road, Bedford MK42 9DJ, UK.
| | - C Koebbel
- Luton and Bedfordshire Eating Disorders Service, East London NHS Foundation Trust, Mountbatten House, 56 High Street South, Dunstable, Bedfordshire LU6 3HD, UK
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19
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Guerci B, Roussel R, Levrat-Guillen F, Detournay B, Vicaut E, De Pouvourville G, Emery C, Riveline JP. Important Decrease in Hospitalizations for Acute Diabetes Events Following FreeStyle Libre System Initiation in People with Type 2 Diabetes on Basal Insulin Therapy in France. Diabetes Technol Ther 2023; 25:20-30. [PMID: 36094418 DOI: 10.1089/dia.2022.0271] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims/Hypothesis: Initiation of insulin therapy in people with type 2 diabetes (T2DM) may be necessary to achieve glycemic targets but is associated with acute diabetes events (ADEs), including severe hypoglycemia (SH) or diabetic ketoacidosis (DKA). We assessed the impact of initiating FreeStyle Libre® system (FSL) on hospitalizations for ADEs in people with T2DM on basal insulin only regimen±noninsulin antidiabetic drugs. Materials and Methods: A retrospective study of the French national Système National des Données de Santé reimbursement claims database (≈66 million French people) identified people with T2DM on basal insulin therapy receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. Claims data for the 12 months before, and up to 24 months after FSL initiation, were analyzed. Hospitalizations for ADEs were identified, using ICD-10 codes as main or related diagnosis, for: SH events; DKA events; comas; and hyperglycemia-related admissions. Results: A total of 5933 people with T2DM on basal insulin therapy initiated FSL during the selection period. Of the patients, 78.9% were on basal insulin and other hypoglycemic agents. Among the 5933 patients identified, 2.01% had at least one hospitalization for any ADE in the year before FSL initiation, compared to 0.75% (1 year) and 0.60% (2 years). Reductions in ADEs were driven by 75% fewer DKA admissions, with a 44% reduction in SH admissions. These patterns of reduced ADEs persisted after 2 years, with a further 43% reduction in DKA rates. Conclusions/Interpretation: This study emphasizes the value of the FSL system in reducing ADEs in people with T2DM in France not on intensive insulin therapy and initially treated with basal-only insulin therapy.
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Affiliation(s)
- Bruno Guerci
- Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ronan Roussel
- Institut Necker Enfants Malades (INEM), Unité INSERM U1151 INEM, IMMEDIAB Laboratory, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
| | | | | | - Eric Vicaut
- Clinical Research Unit, Fernand Vidal Hospital, Paris, France
| | | | | | - Jean-Pierre Riveline
- Department of Endocrinology and Diabetology, Lariboisière Hospital, Paris, France
- Institut Necker Enfants Malades, INSERM U1151, CNRS UMR 8253, IMMEDIAB Laboratory, Paris, France
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20
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Radovnická L, Hásková A, Do QD, Horová E, Navrátilová V, Mikeš O, Cihlář D, Parkin CG, Grunberger G, Prázný M, Šoupal J. Lower Glycated Hemoglobin with Real-Time Continuous Glucose Monitoring Than with Intermittently Scanned Continuous Glucose Monitoring After 1 Year: The CORRIDA LIFE Study. Diabetes Technol Ther 2022; 24:859-867. [PMID: 36037056 DOI: 10.1089/dia.2022.0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The aim was to compare the efficacy of real-time continuous glucose monitoring (rtCGM) and intermittently scanned continuous glucose monitoring (isCGM) focusing on glycated hemoglobin (HbA1c) as the primary endpoint. Methods: The CORRIDA LIFE was a 12-month, real-world, nonrandomized study that is part of the CORRIDA clinical trials program. The study compared rtCGM (Dexcom G5 or G6) and isCGM (FreeStyle Libre 14-Day; Abbott) in adults with type 1 diabetes (T1D). Only patients on multiple daily insulin injections or continuous subcutaneous insulin infusion with no automatic functions were included in this study. Primary outcome was the difference in HbA1c between study groups at 12 months. Results: One hundred ninety-one adults with T1D (mean age 40 ± 13 years, HbA1c 8.1% ± 3.4% [65 ± 14 mmol/mol]) participated in this study; 81 patients initiated rtCGM and 110 initiated isCGM. After 12-months, HbA1c was significantly lower with rtCGM versus isCGM (7.1% ± 3.1% [54.1 ± 10.1 mmol/mol] vs. 7.7% ± 3.3% [61.2 ± 12.2 mmol/mol]), P = 0.0001. The percentage of time in hypoglycemia (<70 mg/dL [<3.9 mmol/L]) was lower among rtCGM vs. isCGM participants [4.3% ± 2.8% vs. 6.4% ± 5.3%], P = 0.003). Patients with rtCGM spent less time in clinically significant hypoglycemia (<54 mg/dL [<3.0 mmol/L]) (0.9% ± 1.0% vs. 2.3% ± 2.5%, P < 0.0001) and more time in target range (70-180 mg/dL [3.9-10 mmol/L]) than isCGM users (67.5% ± 14.8% vs. 57.8% ± 17.0%), P = 0.0002. Conclusions: rtCGM was superior to isCGM in HbA1c, hypoglycemia, and other glycemic outcomes. Our findings provide guidance to clinicians when discussing monitoring options with their patients. The study was registered at www.clinicaltrials.gov (NCT04759495).
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Affiliation(s)
- Lucie Radovnická
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Aneta Hásková
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Quoc Dat Do
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Eva Horová
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Vendula Navrátilová
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Ondřej Mikeš
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - David Cihlář
- Department of Physical Education and Sport, Pedagogical Faculty, Jan Evangelista Purkyně University in Ústí nad Labem, Ústí nad Labem, Czech Republic
| | | | | | - Martin Prázný
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
| | - Jan Šoupal
- Third Department of Internal Medicine, First Faculty of Medicine Charles University, Prague, Czech Republic
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21
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Ajjan R, Bilir SP, Hellmund R, Souto D. Cost-Effectiveness Analysis of Flash Glucose Monitoring System for People with Type 2 Diabetes Receiving Intensive Insulin Treatment. Diabetes Ther 2022; 13:1933-1945. [PMID: 36287387 PMCID: PMC9607728 DOI: 10.1007/s13300-022-01325-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS For people with type 2 diabetes (T2D) on intensive insulin therapy, the use of flash continuous glucose monitoring ("flash monitoring") is associated with improved average glucose control and/or reduced hypoglycemic exposure. This study assessed the cost-effectiveness of flash monitoring versus traditional blood glucose monitoring (BGM) in people with T2D using intensive insulin in the United Kingdom (UK). METHODS The IQVIA CORE Diabetes Model (IQVIA CDM; v9.0) was used to analyze the impact of flash monitoring versus BGM over a 40-year time horizon from the UK payer perspective. Model inputs included baseline characteristics, intervention effects, resource utilization, costs, and utilities, based on recently published literature and national databases. UK National Health Service reimbursed costs of flash monitoring and BGM were used. An intervention-related health utility was obtained from a time trade-off study. Alternative scenarios were explored to assess the impact of key assumptions on base case results. RESULTS In base-case analysis, flash monitoring compared with BGM resulted in an incremental cost of £5781 and an additional 0.47 quality-adjusted life years (QALYs). This provides an incremental cost-effectiveness ratio (ICER) of £12,309/QALY. HbA1c and the intervention-related health utility were the key drivers of differentiation. All scenario analyses, including different discount rates, time horizons, effects on HbA1c and on the intervention-related health utility, as well as glycemic emergencies, generated ICERs of less than £20,000 per QALY. CONCLUSIONS The consistent results across base case and a range of scenario analyses indicate that long-term flash glucose monitoring use is cost-effective compared with BGM in a UK population of T2D on intensive insulin therapy based on updated clinical effects and a cost-effectiveness threshold of £20,000-30,000 per QALY.
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Affiliation(s)
- Ramzi Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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22
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Nieto de la Marca MDLO, Díaz-Soto G, Sánchez Ibáñez M, Del Amo Simón S, Fernández Velasco P, Torres Torres B, López Gómez JJ, Gómez Hoyos E, Ortolá Buigues A, Delgado García E, de Luis Román D. Metabolic control and satisfaction in a diabetes education programme in flash glucose monitoring through telemedicine in type 1 diabetes. ENDOCRINOL DIAB NUTR 2022:S2530-0180(22)00198-6. [PMID: 36456461 DOI: 10.1016/j.endien.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate metabolic control and satisfaction with a telemedicine diabetes education programme for the initiation of flash glucose monitoring (FGM) in type 1 diabetes. MATERIAL AND METHODS Prospective study in 48 patients (52.1% women, 22.9% on insulin pump) who started FGM. They were analysed at baseline and 3 months after the beginning of the FGM. The results were compared with an on-site learning cohort matched by age, sex and HbA1c. RESULTS At the beginning and 3 months after the MFG, HbA1c improvement was observed (7.9±1.4 vs 7.3±1.1%), p<0.01; with a decrease in time below range - TBR - (4.7±4.9 vs 3.5±3.5%), p<0.05 and number of hypoglycaemic events (9.4±8.7 vs 6.9±5.7/15 days), p<0.05, associated with a worsening in time above range - TAR - (33.5±19.9 vs 37.0±20.9%), p<0.05. No significant differences were observed in the TIR 70-180mg/dl (61.7±18.6 vs 59.4±20.0%), glycemic variability or the use of FGM. Patient satisfaction with telemedicine training was 4.8±0.3 out of 5. No significant differences were observed in the follow-up, either in HbA1c or other glucometer parameters between on-site and online training. In a multivariate analysis adopting the HbA1c at follow-up as the dependent variable, only the TIR (β=-0.034; p<0.001) and the initial HbA1c (β=0.303; p<0.001) maintained statistical significance, unrelated to the on-site or online training (β=0.136; p=ns). CONCLUSIONS A telemedicine programme is an adequate tool for training in FGM, with results similar to on-site training, and it was associated with a high degree of satisfaction.
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Affiliation(s)
- María de la O Nieto de la Marca
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain.
| | - Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Marta Sánchez Ibáñez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Sofía Del Amo Simón
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Pablo Fernández Velasco
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Beatriz Torres Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Juan José López Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Emilia Gómez Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Ana Ortolá Buigues
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Esther Delgado García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Daniel de Luis Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
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Rodríguez de Vera-Gómez P, Mateo-Rodríguez C, Vivas-López C, Serrano-Olmedo I, Méndez-Muros M, Morales-Portillo C, Sevillano Jiménez M, Hernández-Herrero C, Martínez-Brocca MA. Effectiveness of a flash glucose monitoring systems implementation program through a group and telematic educational intervention in adults with type 1 diabetes. ENDOCRINOL DIAB NUTR 2022; 69:657-668. [PMID: 36424340 DOI: 10.1016/j.endien.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/15/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes. PATIENTS AND METHODS Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla. RESULTS Eighty-eight participants were included (men: 46.6%; mean age (years) 38.08, SD: 9.38); years of DM1 evolution: 18.4 (SD: 10.49); treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was -0.45% (95% CI [-0.6, -0.25], P < 0.01), increasing to -1.08% in the group that started with HbA1c ≥ 8% (P < 0.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of -6.5 points was observed (P < 0.01). In the global score of the Spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was -8.44 points (P < 0.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in + 4 points (P < 0.01). CONCLUSIONS The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice.
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Affiliation(s)
| | - Carmen Mateo-Rodríguez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Carmen Vivas-López
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Isabel Serrano-Olmedo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mariola Méndez-Muros
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - María Sevillano Jiménez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
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24
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Gao Y, Zhou M, Xu X, Chen WY. Effects of flash glucose monitoring on glycemic control in participants with diabetes mellitus: A meta-analysis of randomized controlled trials. J Diabetes Complications 2022; 36:108314. [PMID: 36208566 DOI: 10.1016/j.jdiacomp.2022.108314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND With the introduction of flash glucose monitoring (FGM) into the international market in 2014, academics worldwide are exploring whether this device improves glycemic control in participants with diabetes mellitus. OBJECTIVE A study was conducted in which participants were evaluated to determine the effect of FGM on glycemic control. METHODS From inception to April 9, 2022, we searched the Cochrane Library, PubMed, SinoMed, Embase, Web of Science, MEDLINE, CNKI, Wan Fang Data, and VIP databases to collect randomized controlled trials (RCTs) related to the effect of FGM on glycemic control in participants with diabetes mellitus. Outcomes included glycated hemoglobin, the occurrence of hypoglycemic events, fasting plasma glucose (FPG), and 2-h postprandial glucose (2hPG) levels. The statistical analysis was performed using R 4.1.3 software. RESULTS We included 19 studies involving 2013 participants, all of which were RCTs. Meta-analysis results revealed that compared to self-monitoring of blood glucose (SMBG), FGM significantly reduced glycated hemoglobin levels in participants with type 2 diabetes mellitus [mean difference = -0.74 [95 % CI-1.16, -0.32], P < 0.01] and type 1 diabetes mellitus combined with type 2 diabetes mellitus [mean difference = -1.14 [95 % CI-3.14, 0.87], P < 0.01], with a greater effect in participants aged ≤65 years with type 2 diabetes mellitus (mean difference = -1.38 [95 % CI-2.05, -0.72], P < 0.01). However, there was no effect of FGM on the improvement of glycated hemoglobin levels in patients with type 1 diabetes mellitus [P = 0.45]. Furthermore, fasting plasma glucose levels and 2-h postprandial glucose levels were significantly lower in FGM than SMBG, and the number of hypoglycemic events was also significantly lower. CONCLUSION Comparing SMBG with FGM indicated that FGM improves fasting plasma glucose levels, 2-h postprandial glucose levels, and glycated hemoglobin levels, and it reduces the number of hypoglycemic events.
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Affiliation(s)
- Yuan Gao
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China; Nursing School of Nanchang University, Nanchang, China
| | - Min Zhou
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China.
| | - Xuan Xu
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China
| | - Wen Yu Chen
- The Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, China
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25
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Abstract
Capillary blood glucose monitoring is a standard safety protocol before administering insulin. Over the past 12 months, there has been a notable increase in patients under the district nursing service using a flash glucose sensor (FGS), which is a portable technological device inserted into the skin via a stamp-like mechanism. The device sits in the interstitial fluid under the skin; the device can be scanned using a sensor to obtain glucose readings, which can eliminate the need for capillary finger pricking. From experience, some people opt for this device, considering the pain and inconvenience associated with capillary finger pricking. Despite some patients already utilising FGS, some community teams may still have to take a capillary finger prick before insulin administration, depending on local trust policy. Interestingly, while looking into the reasons for this, one discovered some contradictory concerns over the safety of FGS due to a difference in time lag, where interstitial fluid readings differ from blood glucose readings. However, new national guidelines reflect the push towards this technological innovation that could revolutionise patient care in glucose monitoring and diabetes management.
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Affiliation(s)
- Lianne Bailey
- Community Specialist Practitioner Student, Manchester Metropolitan University
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26
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Riveline JP, Roussel R, Vicaut E, de Pouvourville G, Detournay B, Emery C, Levrat-Guillen F, Guerci B. Reduced Rate of Acute Diabetes Events with Flash Glucose Monitoring Is Sustained for 2 Years After Initiation: Extended Outcomes from the RELIEF Study. Diabetes Technol Ther 2022; 24:611-618. [PMID: 35604792 DOI: 10.1089/dia.2022.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The RELIEF study has previously shown a fall in the rate of acute diabetes events (ADEs) in people living with type 1 diabetes (PwDT1) or people living with type 2 diabetes (PwDT2) in the 12 months after initiation of flash glucose monitoring (FLASH) in France. The 2-year follow-up has provided new insights on the frequency of ADEs, including severe hypoglycemia and diabetic ketoacidosis (DKA), during use of FLASH. Methods: The RELIEF study included 31,446 PwDT1 and 41,027 PwDT2 with a first delivery of FreeStyle Libre (FSL) between August 1 and December 31, 2017. Hospitalizations for DKA, severe hypoglycemia, diabetes-related coma, and hyperglycemia were recorded for the 12 months before and 24 months after FSL initiation. Persistence of the FSL system use was estimated through a Kaplan-Meier survival curve. Change in usual blood glucose monitoring was estimated through acquisition of blood glucose test strips. Results: In the 2 years after FSL initiation, hospitalizations for ADEs were reduced by 49% and by 48% in PwDT1 or PwDT2, respectively, driven by reductions in DKA. After 2 years, 88% of patients persisted with the system and estimated mean consumption of blood glucose test strips had fallen after 2 years by -82% and by -84% in type 1 diabetes mellitus and type 2 diabetes mellitus, respectively. Conclusion: Use of FSL consistently reduces the rates of hospitalization for ADEs, mainly DKA, 2 years after initiation, confirming this is not a transitory effect. Use of FSL also results in a clear and progressive drop in use of blood glucose test strips over the 2-year period.
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Affiliation(s)
- Jean-Pierre Riveline
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université de Paris Cité, IMMEDIAB Laboratory, Paris, France
- Service of Diabetology, Endocrinology and Nutrition, Lariboisière Hospital, Féderation de Diabétologie, Assistance Publique - Hôpitaux de Paris, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
| | - Ronan Roussel
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université de Paris Cité, IMMEDIAB Laboratory, Paris, France
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Paris, France
- Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Paris, France
| | - Eric Vicaut
- Clinical Research Unit, Fernand Vidal Hospital, Paris, France
| | | | | | | | | | - Bruno Guerci
- Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
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27
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Teo E. Continuous glucose monitoring and hypoglycaemia events: unmet needs. Reply to Papaioannou TG, Snoudou D and Tsiofis C [letter]. Diabetologia 2022; 65:1571. [PMID: 35739277 DOI: 10.1007/s00125-022-05740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Evelyn Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
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Messaaoui A, Tenoutasse S, Hajselova L, Crenier L. Comparison Between Continuous Versus Flash Glucose Monitoring in Children, Adolescents, and Young Adults with Type 1 Diabetes: An 8-Week Prospective Randomized Trial. Diabetes Ther 2022; 13:1671-1681. [PMID: 35870074 PMCID: PMC9399330 DOI: 10.1007/s13300-022-01297-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION To assess the impact of real-time continuous glucose monitoring (RT-CGM) instead of first-generation flash glucose monitoring (FGM) on hypoglycaemia in children and adolescents with type 1 diabetes. METHODS In this randomized controlled interventional study, young individuals with type 1 diabetes used RT-CGM or FGM for 8 weeks. We evaluated changes in time below range (TBR), severe hypoglycaemia (SH), HbA1c, glycaemic variability, and impaired awareness of hypoglycaemia with RT-CGM (intervention group) in comparison with FGM. RESULTS We randomly assigned 37 participants to either the intervention group (n = 19) or the control group (n = 18). At 8 weeks, we did not find a decrease in TBR in either group, but there was a significant reduction in SH in the intervention group. For participants with TBR ≥ 5% at baseline, we observed significant reductions in 24-h TBR, wake TBR, sleep TBR, and glucose variability at 8 weeks in the intervention group. CONCLUSIONS The use of RT-CGM versus FGM decreased SH in young individuals with type 1 diabetes, and TBR and glucose variability in patients with a higher TBR at baseline. The patient's history should be taken into account when advising on the method of blood glucose monitoring, as RT-CGM could be more effective in younger patients at high risk for SH. TRIAL REGISTRATION ClinicalTrials.gov NCT04249102.
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Affiliation(s)
- Anissa Messaaoui
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), HUDERF, 15 Jean-Joseph Crocq avenue, 1020 Brussels, Belgium
| | - Sylvie Tenoutasse
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), HUDERF, 15 Jean-Joseph Crocq avenue, 1020 Brussels, Belgium
| | - Lucia Hajselova
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), HUDERF, 15 Jean-Joseph Crocq avenue, 1020 Brussels, Belgium
| | - Laurent Crenier
- Department of Endocrinology, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Lennik Route, 1070 Brussels, Belgium
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Shimizu N, Ogawa A, Hayashi A, Shichiri M. Discordance in the reduction rate between glycated albumin and glycated hemoglobin levels in type 2 diabetes patients receiving SGLT2 inhibitors. J Diabetes Complications 2022; 36:108225. [PMID: 35690574 DOI: 10.1016/j.jdiacomp.2022.108225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
AIMS Although the difference in HbA1c reduction between sodium-glucose cotransporter 2 (SGLT2) inhibitors and other oral glucose-lowering agents is relatively small, SGLT2 inhibitors exhibit beneficial cardiorenal protection. This study was based on the hypothesis that changes of HbA1c in patients treated with SGLT2 inhibitors may not accurately reflect an improved glycemic profile. METHODS Two studies were conducted: 1) a retrospective cohort study of 3039 patients administered with either an SGLT2 or a dipeptidyl peptidase-4 (DPP4) inhibitor for 12 months comparing the changes in glycated albumin (GA) and HbA1c levels and 2) a pilot study of 10 patients whose glycemic dynamics were evaluated using flash glucose monitoring at baseline and 2 months after treatment with an SGLT2 inhibitor. RESULTS SGLT2 inhibitors reduced GA more markedly than HbA1c in both studies. DPP4 inhibitors decreased both GA and HbA1c to a comparable degree. The mean glucose levels and glycemic standard deviation were significantly reduced after treatment with an SGLT2 inhibitor, in concordance with GA decline, although the lowering of HbA1c was marginal. CONCLUSIONS Changes in HbA1c levels underestimated the glucose-lowering effect and the diminished glycemic fluctuation induced by SGLT2 inhibitors. Thus, the distinct biomarker roles of GA and HbA1c should be reevaluated.
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Affiliation(s)
- Naoya Shimizu
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Akifumi Ogawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Akinori Hayashi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo 153-8934, Japan.
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Sánchez Conejero M, González de Buitrago Amigo J, Tejado Bravo ML, de Nicolás Jiménez JM. Impact of COVID-19 lockdown on glucemic control in children and adolescents with type 1 diabetes mellitus. An Pediatr (Engl Ed) 2022; 97:22-29. [PMID: 35725820 PMCID: PMC9186430 DOI: 10.1016/j.anpede.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). PATIENTS AND METHODS Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl) and hyperglycemia (>180 and> 250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey. RESULTS 80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs 74.8±10.5%; P=0.011) with lower time in hypoglycemia both <70mg/dl (4.6±3.2 vs 3.2±2.7%; P<0.001) and <54mg/dl (1.2±1.6 vs 0.7±1.2%; P<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs 3.7±3.7%; P=0.038). CV also decreased (35.8±6.3 vs 33.1±6.1%; P<0.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact. CONCLUSIONS Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control.
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Duarte DB, Fonseca L, Santos T, Silva VB, Puga FM, Saraiva M, Silva IL, Teixeira S, Vilaverde J, Cardoso MH. Impact of intermittently scanned continuous glucose monitoring on quality of life and glycaemic control in persons with type 1 diabetes: A 12-month follow-up study in real life. Diabetes Metab Syndr 2022; 16:102509. [PMID: 35598543 DOI: 10.1016/j.dsx.2022.102509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM We sought to prospectively assess the impact of intermittently scanned continuous glucose monitoring (isCGM) initiation in the glycaemic control and quality of life (QoL) in type 1 diabetes mellitus (T1DM) patients followed in real-live conditions. METHODS Prospective, observational, cohort, single-centre and single-arm study conducted between September 2018 and March 2020, enrolling adults with T1DM with at least one year of diagnosis, interested in using isCGM. After training at isCGM initiation, CGM metrics and QoL were assessed at baseline and 12 months. RESULTS Thirty-six individuals (55.6% male) were included; median age at inclusion was 49.0 (43.5-62.5)years and the mean(±SD) duration of T1DM was 25.5 ± 12.0 years. Median (interquartile range) HbA1c decreased from 7.6(7.0-8.7)% to 7.4(6.8-7.7)% at 12 months (p = 0.02), driven by the subgroup of individuals with baseline HbA1c ≥ 7.5%. The number of scans per day increased from 7.0(5.5-10.0) to 10.0(7.0-14.0) but no correlation was found between the number of daily scans and CGM metrics. Total daily insulin dose remained unchanged, however the proportion of basal insulin decreased, and the proportion of bolus insulin increased over time. Multiple QoL subscales scores improved significantly, including disease-burden subscale for which TIR proved to be a significant predictive factor. CONCLUSION isCGM improved both glycaemic control, namely time in range, time below range and glycaemic variability, as well as QoL scores in the long term. The increase of the bolus insulin proportion suggests a behavioural change. However, the appraisal of our results must consider our substantial rate of drop-out limiting the external validity of our findings.
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Affiliation(s)
- Diana Borges Duarte
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Liliana Fonseca
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Tiago Santos
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Vânia Benido Silva
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Francisca Marques Puga
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Miguel Saraiva
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Isabel L Silva
- Department of Human and Social Sciences, Universidade Fernando Pessoa, Rua Delfim Maia, 334, 4200-253, Porto, Portugal
| | - Sofia Teixeira
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Joana Vilaverde
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Maria Helena Cardoso
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
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Evans M, Welsh Z, Seibold A. Reductions in HbA1c with Flash Glucose Monitoring Are Sustained for up to 24 Months: A Meta-Analysis of 75 Real-World Observational Studies. Diabetes Ther 2022; 13:1175-1185. [PMID: 35476279 PMCID: PMC9174370 DOI: 10.1007/s13300-022-01253-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Real-world evidence (RWE) confirms that reductions in HbA1c for children and adults with type 1 diabetes (T1DM) and adults with type 2 diabetes (T2DM) are associated with use of the FreeStyle Libre system. This current meta-analysis aims to investigate whether HbA1c benefits are sustained over 24 months and to identify patterns of change in HbA1c for users of the FreeStyle Libre system for people living with T1DM or T2DM. METHODS A bibliographic search up to December 2020 identified 75 studies reporting data on change in lab HbA1c in 30,478 participants with type 1 (n = 28,063; 62 trials) or type 2 diabetes (n = 2415; 13 trials) using the FreeStyle Libre system, including observations on children, adolescents and adults. Meta-analysis was performed using a random effects model. RESULTS Reductions in HbA1c at 3-4 months were similar for adults with T1DM (- 0.53%, 95% CI - 0.69 to - 0.38) or with T2DM (- 0.45%, 95% CI - 0.57 to - 0.33), continuing through 4.5-7.5 months in T1DM (- 0.42%, 95% CI - 0.58 to - 0.27) and in T2DM (- 0.59%, 95% CI - 0.80 to - 0.39). Meta-regression analysis shows that higher starting HbA1c is correlated with greater reductions in HbA1c in T1DM and in T2DM. These patterns of change in HbA1c were sustained for 24 months in T1DM and for at least 12 months in T2DM. CONCLUSIONS Meta-analysis of RWE confirms that using the FreeStyle Libre system is associated with significant reductions in HbA1c for adults with T1DM or with T2DM. Reductions are greater for people with higher baseline HbA1c and are sustained for 24 and 12 months in T1DM and TD2M respectively.
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Affiliation(s)
- Mark Evans
- Wellcome Trust/MRC Institute of Metabolic Science, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Hills Road, IMS MRL Box 289, Cambridge, CB2 0QQ UK
| | - Zoë Welsh
- Abbott Diabetes Care, Range Road, Witney, Oxfordshire, OX28 3FP UK
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Alharbi MY, Albunyan A, Al Nahari A, Al Azmi F, Alenazi B, Al Harbi T, Al Malki M, Al Ahmadi H. Measuring the Impact of Flash Glucose Monitoring in a Pediatric Population in Saudi Arabia: A Retrospective Cohort Study. Diabetes Ther 2022; 13:1139-1146. [PMID: 35441933 PMCID: PMC9174401 DOI: 10.1007/s13300-022-01224-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
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%).
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Affiliation(s)
- Mohammed Y Alharbi
- Therapeutic Services Deputyship, Ministry of Health, Riyadh, 11176, Kingdom of Saudi Arabia.
| | - Abdulhameed Albunyan
- Pediatric Department, Maternity and Children Hospital, Al Hasa, Kingdom of Saudi Arabia
| | | | - Fayez Al Azmi
- Alqurayyat Diabetes Center, Al Qurayyat, Kingdom of Saudi Arabia
| | - Badi Alenazi
- Pediatric Department, Alyammah Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Tayba Al Harbi
- Maternity and Children Hospital, Makkah, Kingdom of Saudi Arabia
| | - Matar Al Malki
- Maternity and Children Hospital, Taif, Kingdom of Saudi Arabia
| | - Husam Al Ahmadi
- Maternity and Children Hospital, Qassim, Kingdom of Saudi Arabia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mateu-Salat M, Moreno-Fernández J, Mangas N, Genua I, Martínez MJ, López A, González C, Chico A. Evaluation of the usefulness of and satisfaction with the flash glucose monitoring system (FreeStyle Libre®) guide for use in patients with type 1 diabetes⋆. ENDOCRINOL DIAB NUTR 2022; 69:316-321. [PMID: 35577748 DOI: 10.1016/j.endien.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 06/15/2023]
Abstract
The Flash Guide (FG) for insulin dosing (A. Chico, C. González) was the first document intended for FreeStyle Libre® (FSL) user patients to help with decision-making depending on glucose level and trend. The objective of the study was to evaluate the usefulness of and the level of satisfaction with the recommendations given by the FG in a group of patients with type 1 diabetes (DM1) who were FSL users. It included 31 subjects (54% women; age 41 ± 15 years; DM duration 21 ± 14 years; 22 with FSL > 12 months) who were provided with the FG. They completed a questionnaire on decision-making depending on glucose trend in different situations (before and three months after using the FG), and a satisfaction questionnaire (ad hoc). Demographic, clinical and glycaemic control data were collected. The percentage of subjects who used glucose trend in decision-making after receiving the FG increased: for adjusting insulin (51 vs. 83; p = 0.016), action without insulin (51 vs. 90%; p = 0.001), and in special circumstances. The FG was evaluated as very useful (4.19/5). There were no significant changes in glycaemic control, although the percentage of data gathered increased significantly (89.07 vs. 94.46%; p = 0.042). In conclusion, the FG was evaluated well for managing glucose trends with FSL by the patients with DM1 analysed, increasing their use of trend in decision-making, with no changes in glycaemic control, but with more data gathered.
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Affiliation(s)
- Manuel Mateu-Salat
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - Natalia Mangas
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María José Martínez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alicia López
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Ana Chico
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Jiménez-Sahagún R, Gómez Hoyos E, Díaz Soto G, Nieto de la Marca MDLO, Sánchez Ibáñez M, Del Amo Simón S, Torres Torres B, López Gómez JJ, Delgado García E, Ortolá Buigues A, de Luis Román D. Impact of flash glucose monitoring on quality of life and glycaemic control parameters in adults with type 1 diabetes mellitus⋆. ENDOCRINOL DIAB NUTR 2022; 69:345-353. [PMID: 35570137 DOI: 10.1016/j.endien.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Flash glucose monitoring (FGM) improves some glycaemic control variables and quality of life parameters. OBJECTIVE Our aim was to evaluate the quality of life and glycaemic control parameters after initiating FGM in patients with type 1 diabetes (DM1) in clinical practice. MATERIAL AND METHODS A prospective observational study in DM1 patients that started using FGM between June 2019 and April 2020. We analysed their scores on the Diabetes Quality of Life (DQOL) questionnaire, Diabetes Distress Scale (DDS), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and glycaemic control parameters at baseline and 3 months after the FGM onset. RESULTS We recruited 114 patients, 56% male, mean age 37.2 (standard deviation, SD 12.4), with 18.7 (SD 11.5) years of DM1, 24.6% of which used continuous subcutaneous insulin infusion. Differences were observed (baseline vs. 3 months) in the DTSQ score (22 [15.5-27] vs. 25 [22-28], P < 0.001) and in the DQOL score (88 [74-104] vs. 84 [70-101], P = 0.017) but not in the DDS score. HbA1c was 7.8% (SD 1.3) vs. 7.4% (SD 1.1) (P < 0.001), without improvement in other glycaemic control variables, except for the mean number of hypoglycaemic events/14 days: 14 (SD 9) at baseline vs. 11.5 (SD 7) at 3 months (P < 0.001). CONCLUSIONS The initiation of FGM, combined with a structured educational programme, was associated with improvement in quality of life and patient satisfaction in DM1 patients. An improvement in HbA1c and a reduction in the number of hypoglycaemia events was observed, but not in the rest of glycaemic control parameters.
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Affiliation(s)
- Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain.
| | - Emilia Gómez Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
| | - Gonzalo Díaz Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
| | | | - Marta Sánchez Ibáñez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Sofía Del Amo Simón
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Beatriz Torres Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
| | - Juan José López Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
| | - Esther Delgado García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
| | - Ana Ortolá Buigues
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
| | - Daniel de Luis Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Endocrinología y Nutrición (IENVA), Facultad de Medicina, Valladolid, Spain
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Di Molfetta S, Rossi A, Assaloni R, Cherubini V, Consoli A, Di Bartolo P, Guardasole V, Laurenzi A, Lombardo F, Maffeis C, Scaramuzza A, Irace C. A guide for the use of LibreView digital diabetes platform in clinical practice: Expert paper of the Italian Working Group on Diabetes and Technology. Diabetes Res Clin Pract 2022; 187:109867. [PMID: 35405166 DOI: 10.1016/j.diabres.2022.109867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone, GO, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy
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Pinheiro SL, Bastos M, Barros L, Melo M, Paiva I. Flash glucose monitoring and glycemic control in type 1 diabetes with subcutaneous insulin infusion. Acta Diabetol 2022; 59:509-515. [PMID: 34786633 DOI: 10.1007/s00592-021-01827-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
AIMS To analyze the association between scan frequency and glycemic measures in continuous subcutaneous insulin infusion (CSII) treated type 1 diabetes (T1DM) adults. METHODS This retrospective study included 140 patients (> 18 years) with T1DM who used flash glucose monitoring (FGM). For each patient, we analyzed the Ambulatory Glucose Profile data over a period of 90 days. Data regarding glucose management indicator (GMI), time above, below and within range (TIR) and coefficient of variation (CV) were correlated with the number of daily scans. The effect of each additional test on glucose parameters was also evaluated. RESULTS Users performed a mean of 8.6 ± 4.4 scans per day. There was an inverse correlation between scanning frequency and GMI (r = - 0.431, p < 0.001), CV (r = - 0.440, p < 0.001), time above and below range (r = - 0.446, p < 0.001 and r = - 0.200, p = 0.018, respectively). The number of daily scans correlated positively with TIR (r = 0.554, p < 0.001). For each additional scan per day, the mean GMI decreased 0.09% and TIR increased 1.60%. CONCLUSIONS In patients with T1DM and CSII, higher rates of scanning correlated with improved glycemic markers, including reduced GMI and CV and increased TIR. For each test performed, there was a significant effect on the improvement of all glucose parameters.
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Affiliation(s)
- Sara Lomelino Pinheiro
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal.
| | - Margarida Bastos
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Luísa Barros
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Paiva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Wright AL, Mattacola EL, Burgess L, Smith L, Finlay KA. The impact of flash glucose monitoring on the clinical practice of healthcare professionals working in diabetes care. Diabetes Res Clin Pract 2022; 183:109157. [PMID: 34863717 DOI: 10.1016/j.diabres.2021.109157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022]
Abstract
AIMS Research has identified that healthcare professionals' attitudes in clinical consultations impact the efficacy of their communication with service users and the blood glucose monitoring behaviours of their clients. Yet no research has sought to understand the impact of flash glucose monitoring on the experience of undertaking clinical consultations. This qualitative study aimed to explore the impact that flash glucose monitoring has on the clinical practice of healthcare professionals. METHODS Semi-structured interviews were conducted with seventeen Healthcare Professionals (female: n = 13; male: n = 4) working with flash glucose monitoring, analysed via Thematic Analysis. RESULTS Three themes were identified: (1) Delivering Person-centred Care; (2) Shift in Diabetes Management; and (3) Time Burden. These themes highlight that flash glucose monitoring facilitates person-centred care through the provision of comprehensive data which improves communication between healthcare professionals and service users. However, preparing for consultations which integrate flash glucose monitoring requires a significant, potentially burdensome time investment. CONCLUSIONS Flash glucose monitoring enhances the strategic ability of healthcare professionals to provide evidence-based patient-centred care. This facilitates growth in service users' self-efficacy and encourages targeted diabetes self-management. However, further training is needed to optimise the ability of clinicians to rapidly interrogate and present monitoring data to users.
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Affiliation(s)
- A L Wright
- Department of Psychology, University of Buckingham, Buckingham, Buckinghamshire, MK18 1EG, UK
| | - E L Mattacola
- Department of Psychology, University of Buckingham, Buckingham, Buckinghamshire, MK18 1EG, UK
| | - L Burgess
- Diabetes Multidisciplinary Team, Northamptonshire Healthcare Foundation Trust, St Mary's Hospital, Kettering, Northamptonshire, NN15 7PW, UK
| | - L Smith
- Diabetes Multidisciplinary Team, Northamptonshire Healthcare Foundation Trust, St Mary's Hospital, Kettering, Northamptonshire, NN15 7PW, UK
| | - K A Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, RG6 7BE, UK.
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Urakami T, Yoshida K, Kuwabara R, Mine Y, Aoki M, Suzuki J, Morioka I. Frequent scanning using flash glucose monitoring contributes to better glycemic control in children and adolescents with type 1 diabetes. J Diabetes Investig 2022; 13:185-190. [PMID: 34143544 PMCID: PMC8756333 DOI: 10.1111/jdi.13618] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION We examined the impact of scanning frequency with flash glucose monitoring on glycemic control in children and adolescents with type 1 diabetes. MATERIALS AND METHODS The study included 85 patients, aged 14.0 ± 0.5 years, with type 1 diabetes. The median time in the target glucose range (TIR) and glycosylated hemoglobin (HbA1c) values were 50.0 ± 1.4% and 7.5 ± 0.1%, respectively. RESULTS The median scanning frequency using flash glucose monitoring was 12.0 ± 0.4 times/day. Scanning frequency showed a significant positive correlation with TIR and an inverse correlation with HbA1c. Scanning frequency was identified to be the determinant of TIR and HbA1c by using multivariate analysis. The participants whose scanning frequency was <12 times/day were categorized as the low-frequency group (n = 40), and those who carried out the scanning >12 times/day were categorized as the high-frequency group (n = 45). Patients in the high-frequency group were more likely to be treated with insulin pumps compared with those in the low-frequency group; however, this difference was not significant (21.3 vs 5.3%, P = 0.073). The high-frequency group showed significantly greater TIR than the low-frequency group (57 ± 1.6 vs 42 ± 1.7%, P = 0.002). Furthermore, the high-frequency group showed significantly lower HbA1c levels than the low-frequency group (6.8 ± 0.1 vs 8.0 ± 0.1%, P < 0.001). CONCLUSIONS These findings showed that patients with a higher scanning frequency had better glycemic control, with greater TIRs and lower HbA1c levels, compared with those with a lower scanning frequency. Scanning frequency of >12 times/day might contribute to better glycemic outcomes in real-world practice in children with type 1 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Kei Yoshida
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Remi Kuwabara
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Yusuke Mine
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Masako Aoki
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Junichi Suzuki
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Ichiro Morioka
- Department of PediatricsNihon University School of MedicineTokyoJapan
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Zhao X, Ming J, Qu S, Li HJ, Wu J, Ji L, Chen Y. Cost-Effectiveness of Flash Glucose Monitoring for the Management of Patients with Type 1 and Patients with Type 2 Diabetes in China. Diabetes Ther 2021; 12:3079-3092. [PMID: 34689295 PMCID: PMC8586326 DOI: 10.1007/s13300-021-01166-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/27/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION To compare the cost-effectiveness of flash glucose monitoring versus self-monitoring of blood glucose/point of care testing (SMBG/POCT) in both patients with type 1 and patients with type 2 diabetes (T1D/T2D) receiving insulin therapy. METHODS The IQVIA CORE Diabetes Model (version 9.5) was used to project the lifetime costs and health outcomes of flash glucose monitoring and SMBG/POCT from a Chinese societal perspective. We considered both hospital and individual version flash glucose monitoring to reflect the clinical practice in China. The clinical inputs leveraged the outcomes from both clinical trials and real-world studies. Cohort characteristics, intervention costs, treatment-related disutility and mortality were extracted from the literature. We also conducted scenario analyses and probabilistic sensitivity analyses to test the robustness of results. RESULTS Compared with SMBG/POCT using efficacy results from clinical trial, flash glucose monitoring brought the incremental costs of Chinese yuan (CNY) 58,021 and CNY 90,997 and additional quality-adjusted life years (QALYs) of 1.22 and 0.65 for patients with T1D and patients with T2D, respectively. According to the "WHO-CHOICE threshold" of three times the gross domestic product per capita in China (CNY 217,341 in 2020) as cost-effectiveness threshold, flash glucose monitoring was cost-effective for both patients with T1D and patients with T2D with incremental cost-effectiveness ratios (ICER) of CNY 47,636 and CNY 140,297 per QALY gained, respectively. According to the real-world effectiveness data, flash glucose monitoring was dominant for patients with T1D (lower costs and better effectiveness) and cost-effective for patients with T2D with an ICER of CNY 124,169 per QALY gained compared with SMBG/POCT. Scenario analyses and probabilistic sensitivity analyses confirmed the robustness of the results. CONCLUSION Flash glucose monitoring is likely to be considered as a cost-effective strategy compared to SMBG/POCT for Chinese patients with T1D and patients with T2D receiving insulin therapy.
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Affiliation(s)
- Xinran Zhao
- Real World Solutions, IQVIA, Shanghai, China
| | - Jian Ming
- Real World Solutions, IQVIA, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Shuli Qu
- Real World Solutions, IQVIA, Shanghai, China
| | | | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Yingyao Chen
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China.
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Secher AL, Pedersen-Bjergaard U, Svendsen OL, Gade-Rasmussen B, Almdal T, Raimond L, Vistisen D, Nørgaard K. Flash glucose monitoring and automated bolus calculation in type 1 diabetes treated with multiple daily insulin injections: a 26 week randomised, controlled, multicentre trial. Diabetologia 2021; 64:2713-2724. [PMID: 34495375 DOI: 10.1007/s00125-021-05555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS We aimed to compare the effects of intermittently scanned continuous glucose monitoring (isCGM) and carbohydrate counting with automated bolus calculation (ABC) with usual care. METHODS In a randomised, controlled, open-label trial carried out at five diabetes clinics in the Capital Region of Denmark, 170 adults with type 1 diabetes for ≥1 year, multiple daily insulin injections and HbA1c > 53 mmol/mol (7.0%) were randomly assigned 1:1:1:1 with centrally prepared envelopes to usual care (n = 42), ABC (n = 41), isCGM (n = 48) or ABC+isCGM (n = 39). Blinded continuous glucose monitoring data, HbA1c and patient-reported outcomes were recorded at baseline and after 26 weeks. The primary outcome was change in time in range using isCGM vs usual care. RESULTS Baseline characteristics were comparable across arms: mean age 47 (SD 13.7) years, median (IQR) diabetes duration 18 (10-28) years and HbA1c 65 (61-72) mmol/mol (8.1% [7.7-8.7%]). Change in time in range using isCGM was comparable to usual care (% difference of 3.9 [-12-23], p = 0.660). The same was true for the ABC and ABC+isCGM arms and for hypo- and hyperglycaemia. Also compared with usual care, using ABC+isCGM reduced HbA1c (4 [95% CI 1, 8] mmol/mol) (0.4 [0.1, 0.7] %-point) and glucose CV (11% [4%, 17%]) and improved treatment satisfaction, psychosocial self-efficacy and present life quality. Treatment satisfaction also improved by using isCGM alone vs usual care. Statistical significance was maintained after multiple testing adjustment concerning glucose CV and treatment satisfaction with ABC+isCGM, and treatment satisfaction with isCGM. Discontinuation was most common among ABC only users, and among completers the ABC was used 4 (2-5) times/day and the number of daily isCGM scans was 5 (1-7) at study end. CONCLUSIONS/INTERPRETATION isCGM alone did not improve time in range, but treatment satisfaction increased in technology-naive people with type 1 diabetes and suboptimal HbA1c. The combination of ABC+isCGM appears advantageous regarding glycaemic variables and patient-reported outcomes, but many showed resistance towards ABC. TRIAL REGISTRATION ClinicalTrials.gov NCT03682237. FUNDING The study is investigator initiated and financed by the Capital Region of Denmark.
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Affiliation(s)
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology & Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen N, Denmark
| | - Ole L Svendsen
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen N, Denmark
- Department of Endocrinology, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, Denmark
| | | | - Thomas Almdal
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen N, Denmark
- Department of Endocrinology PE, Rigshospitalet, Copenhagen Ø, Denmark
| | | | | | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen N, Denmark
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhang L, Xu Y, Jiang X, Wu J, Liu F, Fan L, Li X, Yin G, Yang L. Impact of flash glucose monitoring on glycemic control varies with the age and residual β-cell function of patients with type 1 diabetes mellitus. J Diabetes Investig 2021; 13:552-559. [PMID: 34637185 PMCID: PMC8902407 DOI: 10.1111/jdi.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction We aimed to explore the clinical factors associated with glycemic variability (GV) assessed with flash glucose monitoring (FGM), and investigate the impact of FGM on glycemic control among Chinese type 1 diabetes mellitus patients in a real‐life clinical setting. Materials and Methods A total of 171 patients were included. GV was assessed from FGM data. A total of 110 patients wore FGM continuously for 6 months (longitudinal cohort). Hemoglobin A1c (HbA1c), fasting and 2‐h postprandial C‐peptide, and glucose profiles were collected. Changes in HbA1c and glycemic parameters were assessed during a 6‐month FGM period. Results Individuals with high residual C‐peptide (HRCP; 2‐h postprandial C‐peptide >200 pmol/L) had less GV than patients with low residual C‐peptide ( 2‐h postprandial C‐peptide ≤200 pmol/L; P < 0.001). In the longitudinal cohort (n = 110), HbA1c and mean glucose decreased, time in range (TIR) increased during the follow‐up period (P < 0.05). The 110 patients were further divided into age and residual C‐peptide subgroups: (i) HbA1c and mean glucose were reduced significantly only in the subgroup aged ≤14 years during the follow‐up period, whereas time below range also increased in this subgroup at 3 months (P = 0.047); and (ii) HbA1c improved in the HRCP subgroup at 3 and 6 months (P < 0.05). The mean glucose decreased and TIR improved significantly in the low residual C‐peptide subgroup; however, TIR was still lower and time below range was higher than those of the HRCP subgroup at all time points (P < 0.05). Conclusions HRCP was associated with less GV. FGM wearing significantly reduced HbA1c, especially in pediatric patients and those with HRCP. Additionally, the mean glucose and TIR were also found to improve.
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Affiliation(s)
- Liyin Zhang
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yaling Xu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaofang Jiang
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jieru Wu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Fan
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guangming Yin
- Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lin Yang
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
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Ohara M, Nagaike H, Fujikawa T, Kohata Y, Ogawa M, Omachi T, Sasajima R, Chiba H, Ara T, Sugawara A, Hiromura M, Terasaki M, Mori Y, Fukui T, Hirano T, Yokoyama H, Yamagishi SI. Effects of omarigliptin on glucose variability and oxidative stress in type 2 diabetes patients: A prospective study. Diabetes Res Clin Pract 2021; 179:108999. [PMID: 34390762 DOI: 10.1016/j.diabres.2021.108999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 12/15/2022]
Abstract
AIMS To date, no clinical studies have compared once-weekly dipeptidyl peptidase 4 (DPP-4) inhibitors with once-daily DPP-4 inhibitors in terms of glucose variability (GV) and oxidative stress (OS). METHODS Thirty-six patients with type 2 diabetes mellitus (T2DM) treated with once-daily DPP-4 inhibitors for at least 12 weeks were randomized to either continue once-daily DPP-4 inhibitors or receive omarigliptin, a once-weekly DPP-4 inhibitor, for 24 weeks. The primary end points were changes in the diacron-reactive oxygen metabolite (d-ROMs) test, a marker of OS, and GV using flash glucose monitoring. The secondary end point was changes in the diabetes treatment satisfaction questionnaire (DTSQ) scores. RESULTS There were no significant group differences in d-ROMs and DTSQ scores after 24 weeks of treatments. However, omarigliptin was superior to once-daily DPP-4 inhibitors in controlling fasting plasma glucose (FPG) and time in range (TIR). Although FPG and TIR were unchanged at 24 weeks after switching to omarigliptin, these parameters increased in the group receiving maintenance therapy with once-daily DPP-4 inhibitors. No statistically significant changes in hemoglobin A1c were observed between the two groups. CONCLUSIONS Our findings suggest that switching from once-daily DPP-4 inhibitors to omarigliptin may be efficacious for maintaining FPG and TIR in T2DM patients.
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Affiliation(s)
- Makoto Ohara
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
| | - Hiroe Nagaike
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomoki Fujikawa
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yo Kohata
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Maiho Ogawa
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takemasa Omachi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Risa Sasajima
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan
| | - Hirotoshi Chiba
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan
| | - Toshimasa Ara
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan
| | - Ayuka Sugawara
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan
| | - Munenori Hiromura
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Michishige Terasaki
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yusaku Mori
- Division of Diabetes, Metabolism, and Endocrinology, Anti-glycation Research Section, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomoyasu Fukui
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tsutomu Hirano
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan; Diabetes Center, Ebina General Hospital, Kanagawa, Japan
| | - Hiroki Yokoyama
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan
| | - Sho-Ichi Yamagishi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Mateu-Salat M, Moreno-Fernández J, Mangas N, Genua I, Martínez MJ, López A, González C, Chico A. Evaluation of the usefulness of and satisfaction with the flash glucose monitoring system (FreeStyle Libre®) guide for use in patients with type 1 diabetes. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00185-3. [PMID: 34452877 DOI: 10.1016/j.endinu.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 10/20/2022]
Abstract
The Flash Guide (FG) for insulin dosing (A. Chico, C. González) was the first document intended for FreeStyle Libre® (FSL) user patients to help with decision-making depending on glucose level and trend. The objective of the study was to evaluate the usefulness of and the level of satisfaction with the recommendations given by the FG in a group of patients with type 1 diabetes (DM1) who were FSL users. It included 31 subjects (54% women; age 41±15 years; DM duration 21±14 years; 22 with FSL>12 months) who were provided with the FG. They completed a questionnaire on decision-making depending on glucose trend in different situations (before and three months after using the FG), and a satisfaction questionnaire (ad hoc). Demographic, clinical and glycaemic control data were collected. The percentage of subjects who used glucose trend in decision-making after receiving the FG increased: for adjusting insulin (51 vs. 83; P=.016), action without insulin (51 vs. 90%; P=.001), and in special circumstances. The FG was evaluated as very useful (4.19/5). There were no significant changes in glycaemic control, although the percentage of data gathered increased significantly (89.07 vs. 94.46%; P=.042). In conclusion, the FG was evaluated well for managing glucose trends with FSL by the patients with DM1 analysed, increasing their use of trend in decision-making, with no changes in glycaemic control, but with more data gathered.
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Affiliation(s)
- Manuel Mateu-Salat
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario de Ciudad Real, Ciudad Real, España
| | - Natalia Mangas
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - María José Martínez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Alicia López
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | - Ana Chico
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España.
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Blissett DB, Attvall S, Hellmund RA. Analysis Estimating the Potential Cost Impact of Utilizing Flash Glucose Monitoring with Optional Alarms in Swedish Adults with Diabetes with Impaired Awareness of Hypoglycaemia, Using Intensive Insulin. Diabetes Ther 2021; 12:2179-2193. [PMID: 34232483 PMCID: PMC8342735 DOI: 10.1007/s13300-021-01099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/10/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The objective of this analysis was to estimate the costs associated with using flash glucose monitoring with optional alarms as a replacement for either traditional continuous glucose monitoring (CGM) or routine self-monitoring of blood glucose (SMBG) in adults with diabetes and impaired awareness of hypoglycaemia (IAH) who use intensified insulin therapy, from a Swedish payer perspective, applying assumptions to simulate hypothetical scenarios. METHODS A simple two-state cohort Markov model was used to calculate the cost per patient treated over a 3-year period, capturing the risk of severe hypoglycaemic events requiring medical assistance and non-adherence using quarterly Markov cycles. The costs considered were those for glucose monitoring and resource use to treat severe hypoglycaemic events. Cost inputs were sourced from Swedish price lists, manufacturer data and resource use reported in the control arm of the HypoDE study. Targeted literature searches were run in PubMed to source the clinical inputs. Uncertainty in the model was considered through one-way sensitivity analysis and scenario analysis. RESULTS Over 3 years, flash monitoring with optional alarms resulted in potential cost-savings of Swedish krona (SEK) 7708 and SEK 69,908 per patient when compared to routine SMBG or CGM respectively. Sensitivity and scenario analyses were largely supportive of this conclusion with respect to SMBG, and large cost-savings were consistent across all sensitivity and scenario analyses with respect to CGM. CONCLUSION Utilizing flash monitoring with optional alarms is potentially a cost-saving treatment strategy compared to routine SMBG or traditional CGM in adults with diabetes using intensive insulin and IAH from a Swedish payer perspective. Future studies in the IAH population will help to assess more precisely the relative cost impact of flash glucose monitoring with optional alarms compared with SMBG and traditional CGM.
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Affiliation(s)
| | - Stig Attvall
- Diabetes, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Díaz-Soto G, Bahíllo-Curieses MP, Jimenez R, Nieto MDLO, Gomez E, Torres B, López Gomez JJ, de Luis D. The relationship between glycosylated hemoglobin, time-in-range and glycemic variability in type 1 diabetes patients under flash glucose monitoring. ENDOCRINOL DIAB NUTR 2021; 68:465-471. [PMID: 34863411 DOI: 10.1016/j.endien.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Flash glucose monitoring in patients with type 1 diabetes provides new glucometric data that allow for the assessment of glycemic control beyond HbA1c. The objective of the study was to evaluate the relationship between HbA1c, time-in-range (TIR) and glycemic variability in a cohort of paediatric and adult patients with type 1 diabetes and treatment with flash glucose monitoring. MATERIAL AND METHODS This was a cross-sectional study in 195 patients with type 1 diabetes (42.6% females, 70 paediatric, 26.2% continuous subcutaneous insulin infusion, 28.7% coefficient of variation [CV]≤36%) in intensive treatment and flash glucose monitoring. Clinical, analytical and glucometric data were evaluated. RESULTS The relationship between the TIR and HbA1c showed a strong negative linear correlation (R=-0.746; R2=0.557; P<.001), modified in those patients with CV≤36% (R=-0.852; R2=0.836) compared to CV>36% (R=-0.703; R2=0.551). A similar correlation was found when evaluating the TIR and the Glucose Management Indicator (R=-0.846; R2=0.715; P<.001); in patients with CV≤36% (R=-0.980; R2=0.960) versus CV>36% (R=-0.837; R2=0.701); P<.001. Both correlations remained stable in the paediatric population (R=-0.724; R2=0.525; P<.001) and adults (R=-0.706; R2=0.498; P<.001) and by type of treatment: multiple doses of insulin (R=-0.747; R2=0.558; P<.001) and continuous subcutaneous insulin infusion (R=-0.711; R2=0.506; P<.001). In a multiple regression analysis evaluating HbA1c as dependent variable, the only parameters that maintained statistical significance were the TIR (β=-0,031; P<.001), CV (β=0.843; P<.05) and TIR-CV interaction (β=-0.017; P<.01). CONCLUSIONS The glycemic variability defined by the CV modifies the relationship between the TIR and HbA1c/Glucose Management Indicator and should be taken into account when individualising TIR targets, regardless of age or the type of treatment used.
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Affiliation(s)
- Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain.
| | | | - Rebeca Jimenez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Maria de la O Nieto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Emilia Gomez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Juan Jose López Gomez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Daniel de Luis
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
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Nathanson D, Svensson AM, Miftaraj M, Franzén S, Bolinder J, Eeg-Olofsson K. Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls. Diabetologia 2021; 64:1595-1603. [PMID: 33774713 PMCID: PMC8187189 DOI: 10.1007/s00125-021-05437-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 11/04/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to evaluate changes in glycaemic control (HbA1c) and rates of severe hypoglycaemia over a 2 year period after initiation of flash glucose monitoring (FM) in type 1 diabetes. METHODS Using data from the Swedish National Diabetes Registry, 14,372 adults with type 1 diabetes with a new registration of FM during 2016-2017 and with continued FM for two consecutive years thereafter, and 7691 control individuals using conventional self-monitoring of blood glucose (SMBG) during the same observation period, were included in a cohort study. Propensity sores and inverse probability of treatment weighting (IPTW) were used to balance FM users with SMBG users. Changes in HbA1c and events of severe hypoglycaemia were compared. RESULTS After the start of FM, the difference in IPTW change in HbA1c was slightly greater in FM users compared with the control group during the follow-up period, with an estimated mean absolute difference of -1.2 mmol/mol (-0.11%) (95% CI -1.64 [-0.15], -0.75 [-0.07]; p < 0.0001) after 15-24 months. The change in HbA1c was greatest in those with baseline HbA1c ≥70 mmol/mol (8.5%), with the estimated mean absolute difference being -2.5 mmol/mol (-0.23%) (95% CI -3.84 [-0.35], -1.18 [-0.11]; p = 0.0002) 15-24 months post index. The change was also significant in the subgroups with initial HbA1c ≤52 mmol/mol (6.9%) and 53-69 mmol/mol (7.0-8.5%). Risk of severe hypoglycaemic episodes was reduced by 21% for FM users compared with control individuals using SMBG (OR 0.79 [95% CI 0.69, 0.91]; p = 0.0014)]. CONCLUSIONS/INTERPRETATION In this large cohort, the use of FM was associated with a small and sustained improvement in HbA1c, most evident in those with higher baseline HbA1c levels. In addition, FM users experienced lower rates of severe hypoglycaemic events compared with control individuals using SMBG for self-management of glucose control.
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Affiliation(s)
- David Nathanson
- Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers Västra Götaland, Gothenburg, Sweden
| | | | - Stefan Franzén
- Centre of Registers Västra Götaland, Gothenburg, Sweden
- Health Metrics, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Bolinder
- Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden.
| | - Katarina Eeg-Olofsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenberg, Sweden
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Tumminia A, Milluzzo A, Festa C, Fresa R, Pintaudi B, Scavini M, Vitacolonna E, Napoli A, Sciacca L. Efficacy of flash glucose monitoring in pregnant women with poorly controlled pregestational diabetes (FlashMom): A randomized pilot study. Nutr Metab Cardiovasc Dis 2021; 31:1851-1859. [PMID: 33975741 DOI: 10.1016/j.numecd.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Good glycemic control is crucial to reduce the risk of adverse pregnancy outcomes. Our aim was to evaluate the efficacy of Flash Glucose Monitoring (FGM) on glucose control in women with pregestational diabetes. METHODS AND RESULTS Forty women with inadequately controlled type 1 (T1D, n = 34) and type 2 (T2D, n = 6) diabetes at conception were randomly assigned to two arms: the Flash Glucose group (FG, n = 21) using FGM, and the control group (CG, n = 19) using self-monitoring of blood glucose (SMBG). Glycated hemoglobin (HbA1c, %), time in (TIR), below (TBR) and above (TAR) range, glucose variability as well as the occurrence of maternal and neonatal adverse outcomes, were evaluated. HbA1c decreased significantly (p < 0.01) and similarly (-0.65 ± 0.7 vs. -0.67 ± 0.8 for FG and CG, respectively; p = 0.89) in both groups during pregnancy. HbA1c reduction was positively associated with the number of daily FGM scans (p < 0.01). TBR (12.1 ± 2.0% vs. 19.6 ± 3.9%, p = 0.04) and the mean of the daily serum glucose difference (MODD) index (59.1 ± 5.4 vs. 77.7 ± 4.6, p = 0.02) were significantly lower in FG at second trimester. The rates of perinatal adverse outcomes were not different in the two studied groups. CONCLUSIONS In women with pregestational diabetes, FGM and SMBG had similar efficacy on glucose control during pregnancy. FGM showed additional advantages in terms of TBR and glucose variability. Achievement of good metabolic results depended on the adequate use of glucose sensor. REGISTRATION At ClinicalTrials.gov as NCT04666818 on December 14, 2020.
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Affiliation(s)
- Andrea Tumminia
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
| | - Agostino Milluzzo
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy.
| | - Camilla Festa
- Department of Experimental Medicine, "Sapienza" University, Rome, Italy
| | - Raffaella Fresa
- Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy
| | | | - Marina Scavini
- Diabetes Research Institute, ''San Raffaele" Hospital & Scientific Institute, Milan, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, University ''G. d'Annunzio", Chieti, Italy
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, ''Sapienza" University, Rome, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
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