A review of flash glucose monitoring in type 2 diabetes

Abstract

Background Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy. Main body The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction. Conclusion T2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits.

The Impact of the FreeStyle Libre<sup>TM</sup> Flash Glucose Monitoring System on Glycemic Control in Patients with Diabetes; Observational Multicenter 15-Months Study

“…The decreasing number of hypoglycemic events supports this over time (9.54 ± 1.73 3 -6 months before using the flash glucose monitoring system to 0.52 ± 0.50 last six months of the study). These results are consistent with current literature suggesting that the flash glucose monitoring system decreases the incidence of hypoglycemic events [20] [21] [22] [23] [24].…”

Real-Time Flash Glucose Monitoring Had Better Effects on Daily Glycemic Control Compared With Retrospective Flash Glucose Monitoring in Patients With Type 2 Diabetes on Premix Insulin Therapy

“…The essence of this result is that on the basis of clinicians' adjustment of diabetic therapy according to retrospective FGM data once a month, patients can improve their blood glucose better, modulating their diet and exercise according to visible FGM data more effectively compared with regular SMBG. By using the retrospective FGM as a control, the present study was able to compare TIR between the two groups and partially eliminated the interference of physician-led drug adjustment, both of which have not been discussed in previous studies comparing FGM with SMBG (17)(18)(19).…”

Role of Continuous Glucose Monitoring in Diabetic Patients at High Cardiovascular Risk: an Expert-based Multidisciplinary Delphi Consensus

“…Two large randomized controlled trials have demonstrated a signi cant reduction of hypoglycaemic events and GV, as well as increase in TIR and patients' satisfaction in subjects with T1DM (30) and insulin treated T2DM (31) managed with FGM, as compared to SMBG. In addition, real-world studies showed greater reductions in HbA1c levels using FGM compared to SMBG (32,33), also showing that the number of glucose scans is inversely associated with time spent in hypoglycaemia or hyperglycaemia and is positively correlated with TIR (34). Consequently, besides hypoglycaemic, and hyperglycaemic episodes, according to the panel, also GV and TIR should now be assessed as part of the routine management of diabetes (10).…”