Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit.

Abstract

OBJECTIVE:

The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions.

RESEARCH DESIGN AND METHODS:

Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA1c following the use of FSL. Within-person variations of HbA1c were calculated using [Formula: see text].

RESULTS:

Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (±18.8) years, 51% female, diabetes duration 16.0 (±49.9) years, and BMI of 25.2 (±16.5) kg/m2 (mean [±SD]). FSL users demonstrated a -5.2 mmol/mol change in HbA1c, reducing from 67.5 (±20.9) mmol/mol (8.3%) at baseline to 62.3 (±18.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4-7.8) months of follow-up (n = 3,182) (P < 0.0001). HbA1c reduction was greater in those with initial HbA1c ≥69.5 mmol/mol (>8.5%), reducing from 85.5 (±16.1) mmol/mol (10%) to 73.1 (±15.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (±1.8) and reduced to 2.4 (±1.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ≥4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis.

CONCLUSIONS:

We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.

• Authors: Harshal Deshmukh, Emma G Wilmot, Robert Gregory, Dennis Barnes, Parth Narendran, Simon Saunders, Niall Furlong, Shafie Kamaruddin, Rumaisa Banatwalla, Roselle Herring, Anne Kilvert, Jane Patmore, Chris Walton, Robert E J Ryder, Thozhukat Sathyapalan
• Journal: Diabetes care (Diabetes Care) Vol. 43 Issue 9 Pg. 2153-2160 (09 2020) ISSN: 1935-5548 [Electronic] United States
• PMID: 32669277 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 by the American Diabetes Association.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents

Topics

• Adult
• Blood Glucose (analysis, drug effects, metabolism)
• Blood Glucose Self-Monitoring (instrumentation)
• Clinical Audit
• Diabetes Mellitus (blood, drug therapy, epidemiology, psychology)
• Diabetic Ketoacidosis (blood, epidemiology, psychology)
• Female
• Glycated Hemoglobin (analysis, drug effects, metabolism)
• Glycemic Control (instrumentation, methods)
• Health Resources (statistics & numerical data)
• Hospitalization (statistics & numerical data)
• Humans
• Hyperglycemia (blood, epidemiology, psychology)
• Hypoglycemia (blood, chemically induced, epidemiology, psychology)
• Hypoglycemic Agents (therapeutic use)
• Male
• Middle Aged
• Patient Acceptance of Health Care (psychology, statistics & numerical data)
• Psychological Distress
• State Medicine
• Stress, Psychological (blood, epidemiology)
• United Kingdom (epidemiology)
• Young Adult