Determinants of HbA1c reduction with FreeStyle Libre flash glucose monitoring (FLARE-NL 5)

Abstract

Aims To identify factors predicting HbA1c reduction in patients with diabetes mellitus (DM) using FreeStyle Libre Flash Glucose Monitoring (FSL-FGM). Methods Data from a 12-month prospective nation-wide FSL registry were used and analysed with multivariable regression. For the present study we included patients with hypoglycaemia unawareness or unexpected hypoglycaemias (n = 566) and persons who did not reach acceptable glycaemic control (HbA1c > 70 mmol/mol (8.5%)) (n = 294). People with other indications for use, such as sensation loss of the fingers or individuals already using FSL-FGM or rtCGM, were excluded (37%). Results Eight hundred and sixty persons (55% male with a mean age of 46.7 (±16.4) years) were included. Baseline HbA1c was 65.1 (±14.5) mmol/mol (8.1 ± 1.3%), 75% of the patients had type 1 DM and 37% had microvascular complications. Data concerning HbA1c was present for 482 (56.0%) at 6 months and 423 (49.2%) persons at 12 months. A significant reduction in HbA1c (≥5 mmol/mol (0.5%)) was present in 187 (22%) persons. For these persons, median HbA1c reduction was −9.0 [−13.0, −4.0] mmol/mol (−0.82 [−1.19, −0.37]%) at 6 months and −9.0 [−15.0, −7.0] mmol/mol (−0.82 [−1.37, −0.64]%) at 12 months. In multivariable regression analysis with age, gender and SF-12 physical and mental component scores as covariates, only baseline HbA1c was significant: −0.319 (SE 0.025; p < 0.001; R 2 = 0.240 for the model). In exploratory analysis among subgroups with different indications for FSL-FGM use (hypoglycaemia unawareness or persistently high HbA1c) and persons with a significant HbA1c decrease over the study period, baseline HbA1c remained the only significant predictor. Conclusions Among the variables we analysed in the present study, only high HbA1c at baseline predicts significant HbA1c reduction during FSL-CGM use.

Marked Improvement in A1C Levels After Initiation of Intermittently Scanned Continuous Glucose Monitoring Is Maintained Over 4 Years in Patients With Type 1 Diabetes

“…The reduction in the A1C levels in our study at 6 and 12 months (−0.54% [−5.9 mmol/mol] and −0.42% [−4.6 mmol/mol], respectively) after the start of isCGM is in line with previous real-world studies ( 9 , 14 ). Tyndall et al ( 10 ) demonstrated a −0.37% (−4 mmol/mol) decrease in A1C in a prospective cohort of 900 patients.…”

“…As seen in other studies ( 8 , 9 , 14 , 17 ), the patients in our study with poor glucose control (baseline A1C >9% [75 mmol/mol]) benefited the most from initiation of isCGM (A1C reduction −0.97% [−10.6 mmol/mol] at 12 months). In a subgroup analysis, patients with poor glycemic control (A1C >9% [75 mmol/mol]) before starting isCGM maintained the achieved A1C level for a longer time period.…”

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review

“…A recent study evaluating the implementation of home delivery of medication for various illness during the COVID-19 pandemic found that patients and providers preferred the continuance of this approach, with overall improvements in patient adherence to medication 47 . The eHealth model observed a clinically relevant reduction of HbA1c 48 . In a systematic review conducted to determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries 10 , telemedicine yielded significant reductions in HbA1c, with interventions via telephone and short message service yielding the highest treatment effects 10 .…”

Safety and effectiveness of do‐it‐yourself artificial pancreas system compared with continuous subcutaneous insulin infusions in combination with free style libre in people with type 1 diabetes

“…In addition to CSII, many DIYAPS use flash (intermittently scanned) CGM (isCGM) such as FreeStyle Libre (FSL). This is an alternative to conventional finger‐prick testing and measures interstitial glucose concentrations 14,15 . Previously conducted studies on the use of FSL have demonstrated reduction of time spent in hypoglycaemia, lower frequency of hypoglycaemic events and greater satisfaction 16,17 …”

“…This is an alternative to conventional finger-prick testing and measures interstitial glucose concentrations. 14,15 Previously conducted studies on the use of FSL have demonstrated reduction of time spent in hypoglycaemia, lower frequency of hypoglycaemic events and greater satisfaction. 16,17 Given the described benefits, combining isCGM or CGM with insulin pump therapy might be expected to yield significant benefits to the user without the addition of an APS algorithm.…”