Comparison of the Freestyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients with Type 2 Diabetes (T2D) Treated with Basal-Bolus Insulin Regimen

Background: We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care glucose testing among insulin-treated hospitalized patients with type 2 diabetes (T2D). Methods: Prospective study in general medicine and surgery adult patients with T2D. Patient were monitored with POC before meals and bedtime, and with CGM during the hospital stay. Major endpoints included differences between POC and CGM in mean daily blood glucose, hypoglycemia < 70 and < 54 mg/dl, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), and ±15%/15mg/dl, ±20%/20mg/dl, ± 30%/30mg/dl, and Error Grid analysis between matched glucose pairs. Results: Mean daily glucose was significantly higher by POC testing (188.9±37.3 vs. 176.1±46.9 mg/dl), and proportions of patients with glucoses < 70 mg/dl (14% vs 56%) and < 54 mg/dl (4.1% vs 36%) detected by POC BG were significantly lower compared to CGM, all p<0.001. Nocturnal and prolonged CGM hypoglycemia < 54 mg/dl was 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4 to 16.7% for glucoses between 70 and 250 mg/dl, and lower for 51- 69 mg/dL (MARD= 28.0%). The percentage of glucoses within the ±15%/15mg/dl, ±20%/20mg/dl, and ±30%/30mg/dl were 62%, 76%, and 91%, respectively. Error Grid analysis showed 98.0% of glucose pairs within Zones A and B. Conclusions: Compared to POC testing, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM’s accuracy was lower in hypoglycemic range.

Download Full-text

Comparison of the Freestyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients with Type 2 Diabetes (T2D) Treated with Basal-Bolus Insulin Regimen

10.2337/figshare.12302660 ◽

2020 ◽

Author(s):

Rodolfo J. Galindo ◽

Alexandra L. Migdal ◽

Georgia M. Davis ◽

Maria A. Urrutia ◽

Bonnie Albury ◽

...

Keyword(s):

Type 2 Diabetes ◽

Continuous Glucose Monitoring ◽

Point Of Care ◽

Glucose Monitoring ◽

Hospitalized Patients ◽

Glucose Testing ◽

Grid Analysis ◽

Freestyle Libre ◽

Error Grid

Download Full-text

Comparison of the FreeStyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients With Type 2 Diabetes (T2D) Treated With Basal-Bolus Insulin Regimen

Diabetes Care ◽

10.2337/dc19-2073 ◽

2020 ◽

pp. dc192073 ◽

Cited By ~ 4

Author(s):

Rodolfo J. Galindo ◽

Alexandra L. Migdal ◽

Georgia M. Davis ◽

Maria A. Urrutia ◽

Bonnie Albury ◽

...

Keyword(s):

Type 2 Diabetes ◽

Point Of Care ◽

Glucose Monitoring ◽

Insulin Regimen ◽

Glucose Testing ◽

Freestyle Libre ◽

Capillary Glucose ◽

Bolus Insulin ◽

Basal Bolus

Download Full-text

908-P: Accuracy Comparison of the Freestyle Libre Pro Continuous Glucose Monitoring (CGM) and Point-of-Care (POC) Testing in Noncritically Ill Hospitalized Patients with Type 2 Diabetes Treated with Basal-Bolus Insulin Regimen

Diabetes ◽

10.2337/db19-908-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 908-P

Author(s):

RODOLFO J. GALINDO ◽

MARIA A. URRUTIA ◽

GEORGIA DAVIS ◽

AMEER KHOWAJA ◽

BONNIE S. ALBURY ◽

...

Keyword(s):

Type 2 Diabetes ◽

Continuous Glucose Monitoring ◽

Point Of Care ◽

Glucose Monitoring ◽

Insulin Regimen ◽

Accuracy Comparison ◽

Freestyle Libre ◽

Bolus Insulin ◽

Basal Bolus

Download Full-text

68-LB: Acute Diabetes Events and All-Cause Hospitalizations among Continuous Glucose Monitoring Device Recipients with Type 1 and Type 2 Diabetes: A Comparison of FreeStyle Libre and Dexcom

Diabetes ◽

10.2337/db21-68-lb ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 68-LB

Author(s):

IRL B. HIRSCH ◽

GREGORY J. ROBERTS ◽

JENNIFER JOSEPH ◽

YELENA NABUTOVSKY ◽

NAUNIHAL VIRDI ◽

...

Keyword(s):

Type 2 Diabetes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Monitoring Device ◽

Freestyle Libre ◽

Acute Diabetes

Download Full-text

The Accuracy and Precision of the Continuously Stored Data from Flash Glucose Monitoring System in Type 2 Diabetes Patients during Standard Meal Tolerance Test

International Journal of Endocrinology ◽

10.1155/2020/5947680 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Rengna Yan ◽

Huiqin Li ◽

Xiaocen Kong ◽

Xiaofang Zhai ◽

Maoyuan Chen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glucose Monitoring ◽

Flash Glucose Monitoring ◽

Standard Meal ◽

Grid Analysis ◽

Sensor Glucose ◽

Interstitial Glucose ◽

Error Grid ◽

Diabetes Patients

Background. The purpose of this study was to investigate the accuracy of the continuously stored data from the Abbott FreeStyle Libre flash glucose monitoring (FGM) system in Chinese diabetes patients during standard meal tests when glucose concentrations were rapidly changing. Subjects and Methods. Interstitial glucose levels were monitored for 14 days in 26 insulin-treated patients with type 2 diabetes using the FGM system. Standard meal tests were conducted to induce large glucose swings. Venous blood glucose (VBG) was tested at 0, 30, 60, and 120 min after standard meal tests in one middle day of the first and second weeks, respectively. The corresponding sensor glucose values were obtained from interpolating continuously stored data points. Assessment of accuracy was according to recent consensus recommendations with median absolute relative difference (MARD) and Clarke and Parkes error grid analysis (CEG and PEG). Results. Among 208 paired sensor-reference values, 100% were falling within zones A and B of the Clarke and Parkes error grid analysis. The overall MARD was 10.7% (SD, 7.8%). Weighted least squares regression analysis resulted in high agreement between the FGM sensor glucose and VBG readings. The overall MTT results showed that FGM was lower than actual VBG, with MAD of 22.1 mg/dL (1.2 mmol/L). At VBG rates of change of -1 to 0, 0 to 1, 1 to 2, and 2 to 3 mg/dl/min, MARD results were 11.4% (SD, 8.7%), 9.4% (SD, 6.5%), 9.9% (SD, 7.5%), and 9.5% (SD, 7.7%). At rapidly changing VBG concentrations (>3 mg/dl/min), MARD increased to 19.0%, which was significantly higher than slow changing BG groups. Conclusions. Continuously stored interstitial glucose measurements with the FGM system were found to be acceptable to evaluate VBG in terms of clinical decision during standard meal tests. The continuously stored data from the FGM system appeared to underestimate venous glucose and performed less well during rapid glucose changes.

Download Full-text

Practical Considerations for Initiating and Utilizing Flash Continuous Glucose Monitoring in Clinical Practice

Journal of the Endocrine Society ◽

10.1210/jendso/bvab064 ◽

2021 ◽

Author(s):

Carol H Wysham ◽

Davida F Kruger

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Treatment Adherence ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Treatment Regimens ◽

Freestyle Libre ◽

The Us

Abstract Use of continuous glucose monitoring (CGM) has been shown to improve clinical outcomes in type 1 diabetes (T1D) and type 2 diabetes (T2D), including improved glycemic control, better treatment adherence and an increased understanding of their treatment regimens. Retrospective analysis of CGM data allows clinicians and patients to identify glycemic patterns that support and facilitate informed therapy adjustments. There are currently two types of CGM systems: real-time CGM (rtCGM) and flash CGM. The FreeStyle Libre 2 (FLS2) is the newest flash CGM system commercially available. Because the FLS2 system was only recently cleared for use in the US, many endocrinologists and diabetes specialists may be unfamiliar with strengths, limitations and potential of the FSL2 system. This article focuses on practical approaches and strategies for initiating and using flash CGM in endocrinology and diabetes specialty practices.

Download Full-text

Comparison of Interstitial Fluid Glucose Levels Obtained by Continuous Glucose Monitoring and Flash Glucose Monitoring in Patients With Type 2 Diabetes Mellitus Undergoing Hemodialysis

Journal of Diabetes Science and Technology ◽

10.1177/1932296819882690 ◽

2019 ◽

Vol 14 (6) ◽

pp. 1088-1094 ◽

Cited By ~ 3

Author(s):

Takahiro Yajima ◽

Hiroshi Takahashi ◽

Keigo Yasuda

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Interstitial Fluid ◽

Glucose Monitoring ◽

Relative Difference ◽

Flash Glucose Monitoring ◽

Grid Analysis ◽

Error Grid

Background: The accuracy of flash glucose monitoring (FGM, FreeStyle Libre Pro [FSL-Pro]) remains unclear in patients with type 2 diabetes mellitus (T2DM) undergoing hemodialysis. Methods: We assessed 13 patients with T2DM undergoing hemodialysis. They simultaneously underwent FGM, continuous glucose monitoring (CGM, iPro2), and self-monitoring blood glucose (SMBG). Results: Parkes error grid analysis against SMBG showed that 49.0% and 51.0% of interstitial fluid glucose (ISFG) levels measured using FGM and 93.3% and 6.7% of those measured using CGM fell into zones A and B, respectively. Mean absolute relative difference (MARD) against SMBG for FGM was significantly higher than that for CGM (19.5% ± 13.2% vs 8.1% ± 7.6%, P < .0001). Parkes error grid analysis of 2496 paired ISFG levels between FGM and CGM showed that 53.6%, 46.2%, and 0.2% of the plots fell into zones A, B, and C, respectively. Mean ISFG levels were lower with FGM than with CGM (143.7 ± 67.2 mg/dL vs 164.6 ± 58.5 mg/dL; P < .0001). Mean absolute relative difference of ISFG levels between FGM and CGM was 19.2% ± 13.8%. Among three groups classified according to CGM ISFG levels (hypoglycemia, <70 mg/dL; euglycemia, 70-180 mg/dL; and hyperglycemia, >180 mg/dL), the MARDs for hypoglycemia (31.9% ± 25.0%) and euglycemia (22.8% ± 14.6%) were significantly higher than MARD for hyperglycemia (13.0% ± 8.5%) ( P < .0001 in both). Conclusions: Flash glucose monitoring may be clinically acceptable. Average ISFG levels were lower with FGM than with CGM, and MARDs were higher for hypoglycemia and euglycemia in patients with T2DM undergoing hemodialysis.

Download Full-text

SAT-640 Glycemic Profile of Intravenous Glucocorticoid Induced Hyperglycemia Using Continuous Glucose Monitoring

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1010 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Fan Zhang ◽

Zoe Goldberg ◽

Jocelyne Georges Karam

Keyword(s):

Type 2 Diabetes ◽

Single Dose ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Sensitivity Factor ◽

Insulin Regimen ◽

Freestyle Libre ◽

Glycemic Profile ◽

Long Acting

Abstract Background: Intravenous (IV) steroids are widely used in critically ill patients and with chemotherapy. It is well known that glucocorticoid-induced hyperglycemia (GCIH) occurs within 3 hours following oral administration of steroids with typical postprandial glycemic excursions lasting 24-36 hours. The recent increased availability of Continuous Glucose Monitoring (CGM) has allowed a detailed description of glycemic fluctuations in patients receiving steroids in different settings, however there is no reported observation of CGM findings following a single dose of IV Dexamethasone in a patient with diabetes. We present a case of glycemic pattern documented on CGM of a patient with type 2 diabetes, who had received 11 cycles of a single dose Dexamethasone-containing chemotherapy. Clinical Case: The patent is 70 years old female with history of type 2 DM of 19 years duration and metastatic pancreatic adenocarcinoma, diagnosed in November 2018, and treated with Fluorouracil and Dexamethasone 6mg IV on every other Wednesday since December 2018. Her diabetes was fairly controlled on Metformin, Repaglinide, Pioglitazone and Detemir insulin. Premeal Lispro was added while Metformin and Repaglinide were discontinued with the beginning of chemotherapy. She started using Freestyle Libre CGM in January 2019. During her visit in March 2019, the patient was taking Detemir Insulin 50 units in AM and 30 units at night, and Lispro 15 units before meals, in addition to correction insulin based on an Insulin Sensitivity Factor (ISF) of 1:25 for Blood Glucose (BG) above 200mg/dl. Unlike the reported postprandial hyperglycemic excursions associated with oral steroids, the patient’s CGM data showed a reproducible triphasic glycemic pattern following IV Dexamethasone, consisting of a steady state of hyperglycemia reached within 3 hours and lasting around 18-30 hours, followed by a transient BG improvement for 18-20 hours, and ending with another hyperglycemic plateau of 10-16 hours on day 3 post chemotherapy, with no association to meal intake. Given this recurrent pattern, the patient was advised to increase her bedtime Detemir insulin from 30 to 45 units and her correction ISF from 1:25 to 1:18 on days 1 and 2 after chemotherapy, with subsequent attenuation and shortening of GCIH. Conclusion: Our case report is the first one to describe CGM documented glycemic profile following a single dose of IV Dexamethasone in a patient with type 2 diabetes treated with insulin. The CGM data reveals a consistent steady GCIH, lasting around 48 hours, and reflecting the prolonged action of Dexamethasone. The transient BG improvement seen on day 2 is likely due to the Detemir dose self-increase and the carbohydrates intake decrease in response to day 1 hyperglycemia. A 48 hours modified insulin regimen based on higher dose of long acting and correction insulin improved Dexamethasone induced hyperglycemia.

Download Full-text