scholarly journals HbA1c and hypoglycaemia outcomes for people with type 1 diabetes due to the introduction of a single-day structured education programme and flash glucose monitoring

Author(s):  
Gillian Garden ◽  
David W Hunt ◽  
Karen Mackie ◽  
Beverly Tuthill ◽  
Helen Griffith ◽  
...  

People with type 1 diabetes who met NHS England funding criteria attended an accredited, intensive one-day structured education programme and completed the online FreeStyle Libre Academy training module followed by a 30-minute healthcare professional face-to-face practical training session. HbA1c, Gold hypoglycaemia score and Diabetes Distress Screening score were documented before commencement of the intervention and at 6 months. 213 people with type 1 diabetes (52% men; average age 48 years (range 18–87)) completed the 6-month intervention. Overall mean HbA1c reduced by 6 mmol/mol (0.5%) from 62±14 mmol/mol (7.8%) to 56±12 mmol/mol (7.3%) (p<0.0001). Subgroup analysis of participants with a baseline HbA1c ≥54 mmol/mol (7.1%) revealed a more dramatic reduction of 10 mmol/mol (0.9%) from 69±12 mmol/mol (8.5%) to 59±11 mmol/mol (7.6%). No deterioration was demonstrated for people with HbA1c <54 mmol/mol (7.1%). 143 people (75%) reported a reduction in hypoglycaemia episodes and 162 (85%) reported a reduction in time spent in the hypoglycaemic range. There was significant improvement in the Gold score (p<0.0001) and Diabetes Distress Screening score (p=0.0001). Rates of hospital admissions, paramedic call-outs and third-party assistance were reduced. The combination of a one-day intensive structured education programme alongside flash glucose monitoring initiation provides a pragmatic, cost-effective and easily implemented intervention with positive clinical outcomes at 6 months.

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Calvin Young ◽  
Aleksandra Grobelna

Flash glucose monitoring (FGM) is a method of glucose testing where a sensor inserted into the skin continuously measures interstitial glucose levels. It can be used by people with diabetes to inform treatment decisions, such as insulin dosing, as an alternative or complement to blood glucose testing. Evidence of variable quality from 2 randomized controlled trials and 8 non-randomized studies, including those summarized within systematic reviews, suggests that FGM may improve quality of life, patient satisfaction, diabetes distress, self-efficacy, and frequency of glucose monitoring compared to self-monitoring blood glucose techniques in pediatric populations with type 1 diabetes. Findings related to other outcomes, such as hemoglobin A1C, glucose time in range metrics, and adverse events were mixed or inconclusive (i.e., in some studies the use of FGM was associated with improved outcomes, while in other studies it was not). While the results summarized in this report generally suggest that the use of FGM is associated with improved clinical outcomes in pediatric populations with type 1 diabetes, the limitations of the included literature should be considered when interpreting these findings. No studies were identified that compared the clinical effectiveness of FGM systems with hypoglycemic, hyperglycemia, or signal loss alarms (e.g., FreeStyle Libre 2) to FGM systems without these features (e.g., FreeStyle Libre) in people of any age with diabetes requiring insulin therapy.


2021 ◽  
Author(s):  
Ronan Roussel ◽  
Jean-Pierre Riveline ◽  
Eric Vicaut ◽  
Gérard de Pouvourville ◽  
Bruno Detournay ◽  
...  

<b>Objective</b> <p>The RELIEF study assessed rates of hospitalization for acute diabetes complications in France, before and after initiating the FreeStyle Libre system. </p> <p><b>Research Design and Methods</b></p> <p>74,011 patients with type 1 diabetes or type 2 diabetes who initiated the FreeStyle Libre system were identified from the French national claim database (SNDS) using ICD-10 codes, from hospitalizations with diabetes as a contributing diagnosis, or the prescription of insulin. Patients were sub-classified based on SMBG strip-acquisition prior to starting FreeStyle Libre. Hospitalizations for DKA, severe hypoglycemia, diabetes-related coma and hyperglycemia were recorded for the 12 months before and after initiation. </p> <p><b>Results</b></p> <p>Hospitalizations for acute diabetes complications fell in type 1 diabetes (-49.0%) and in type 2 diabetes (-39.4%) following FreeStyle Libre initiation. DKA fell in type 1 diabetes (-56.2%,) and in type 2 diabetes (-52.1%), as did diabetes-related comas in type 1 diabetes (-39.6%) and in type 2 diabetes (-31.9%). Hospitalizations for hypoglycemia and hyperglycemia decreased in type 2 diabetes (-10.8% and -26.5%, respectively). Before initiation, hospitalizations were most marked for people non-compliant with SMBG and for those with highest acquisition of SMBG, which fell by -54.0% and 51.2% respectively following FreeStyle Libre initiation. Persistence with FreeStyle Libre at 12 months was 98.1%.</p> <p><b>Conclusions</b></p> <p>This large retrospective study on hospitalizations for acute diabetes complication shows that a significantly lower incidence of admissions for DKA and for diabetes-related coma is associated with use of flash glucose monitoring. This study has significant implications for patient-centered diabetes care and potentially for long-term health economic outcomes.</p> <br> <p> </p>


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