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

Deshmukh, Harshal; Wilmot, Emma G; Gregory, Robert; Barnes, Dennis; Narendran, Parth; Saunders, Simon; Furlong, Niall; Kamaruddin, Shafie; Banatwalla, Rumaisa; Herring, Roselle; Kilvert, Anne; Patmore, Jane; Walton, Chris; Ryder, Robert E.; Sathyapalan, Thozhukat

doi:10.2337/dc20-0738

Cited by 130 publications

(146 citation statements)

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“…This alteration in behaviour during lockdown may have contributed to the increase in number of patients achieving the recommended sensor-based glycaemic targets [ 13 ]. In comparison, national data from the UK Freestyle Libre audit from November 2017 reported a median TIR of only 43% (IQR 27–56%) [ 20 ]. Our data show that at least 30% more patients during lockdown were able to achieve clinically meaningful improvements to their TIR and sensor-based estimated HbA1c levels.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

et al. 2020

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Aims People with type 1 diabetes (T1D) face the daily task of implementing self-management strategies to achieve their glycaemic goals. The UK COVID-19 lockdown has had an impact on day-to-day behaviour, which may affect diabetes self-management and outcomes. We assessed whether sensor-based outcomes pre- and during lockdown periods were different in a cohort of glucose sensor users with T1D. Methods Data were collected from Freestyle Libre (FSL) or Dexcom G6 sensor users who remotely shared their data with the diabetes clinic web platform. Sensor metrics according to international consensus were analysed and compared between pre-lockdown period and 2 and 3 weeks into lockdown (periods 1 and 2). Results Two hundred and sixty-nine T1D patients (baseline HbA1c 57 ± 14 mmol/mol) were identified as FSL (n = 190) or Dexcom G6 (n = 79) users. In patients with sensor use > 70% (N = 223), compared to pre-lockdown period percentage TIR 3.9–10 mM (TIR) significantly increased during period 1 (59.6 ± 18.2 vs. 57.5 ± 17.2%, p = 0.002) and period 2 (59.3 ± 18.3 vs. 57.5 ± 17.2%, p = 0.035). The proportion of patients achieving TIR ≥ 70% increased from 23.3% pre-lockdown to 27.8% in period 1 and 30.5% in period 2. A higher proportion also achieved the recommended time below and above range, and coefficient of variation in periods 1 and 2. Dexcom G6 users had significantly lower % time below range (< 3.9 mM) compared to FSL users during both lockdown periods (period 1: Dexcom G6 vs. FSL: 1.8% vs. 4%; period 2: 1.4% vs. 4%, p < 0.005 for both periods). Conclusion Sensor-based glycaemic outcomes in people with T1D in the current cohort improved during COVID-19 lockdown, which may be associated with positive changes in self-management strategies. Further work is required to evaluate long-term sustainability and support.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

et al. 2020

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“…To date, awareness of %TIR amongst UK diabetes HCPs has been low. 8 Reimbursement and access both to rtCGM and isCGM technologies has been restricted to a small number of qualifying individuals with type 1 diabetes. National Institute of Health and Care Excellence (NICE) guidance NG17 for type 1 diabetes in adults and NG18 for treatment of diabetes in children and young people both recommend the use of rtCGM in certain defined circumstances when SMBG testing is unable or unlikely to meet the need for safe and effective glucose monitoring.…”

Section: On Time In Range: Current Uk Statusmentioning

confidence: 99%

“…A recent Association of British Clinical Diabetologists (ABCD) audit of %TIR measures for people with diabetes using the FreeStyle Libre system has shown substantial variation in target glucose ranges used by clinicians, 8 with only 15% of 2191 cases using the recommended 3.9–10 mmol/l range. As remote consultations become the ‘new normal’, access to TIR measures which do not require a face‐to‐face visit may replace laboratory HbA 1c measurements 19 .…”

Section: Time In Range and Hba1cmentioning

confidence: 99%

“…To date, awareness of %TIR amongst UK diabetes HCPs has been low 8 . Reimbursement and access both to rtCGM and isCGM technologies has been restricted to a small number of qualifying individuals with type 1 diabetes.…”

Section: International Consensus On Time In Range: Current Uk Statusmentioning

confidence: 99%

“…Numerous studies have proven the clinical benefits of rtCGM and isCGM in people with type 1 or type 2 diabetes treated with different intensive insulin regimens, including multiple daily insulin injections and continuous subcutaneous insulin infusion or insulin pump therapy. [1][2][3][4][5][6][7][8][9] In recent years, the improved accuracy of a number of these systems (Dexcom G5 and G6, FreeStyle Libre) means that they can be used safely to make therapeutic decisions, including decisions about insulin dosing, without the need to confirm readings using an adjunct self-monitored blood glucose (SMBG) fingerprick test. 10,11 Continuous glucose monitoring systems allow a different understanding of glycaemia from that previously established.…”

Section: Introductionmentioning

confidence: 99%

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Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID‐19 global pandemic

et al. 2020

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The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID-19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring-generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as Note: Each of these measures of glycaemia can be derived and reported by isCGM or rtCGM systems. They are all endorsed by international consensus guidance on use of CGM systems in the management of diabetes. 11,14,15 Abbreviations: CGM, continuous glucose monitoring; CV, coefficient of variation; eA 1c , estimated HbA 1c ; GMI, glucose management indicator; isCGM, intermittently scanned CGM (flash glucose monitoring); rtCGM, real-time CGM; TAR, time above range; TBR, time below range; TIR, time in range.

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Association of Achieving Time in Range Clinical Targets With Treatment Modality Among Youths With Type 1 Diabetes

et al. 2023

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ImportanceContinuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths.ObjectiveTo assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes.Design, Setting, and ParticipantsThis multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use.ExposuresType 1 diabetes and the use of CGM with or without an insulin pump.Main Outcomes and MeasuresProportion of individuals in each treatment modality group achieving recommended CGM clinical targets.ResultsAmong the 5219 participants (2714 [52.0%] male; median age, 14.4 [IQR, 11.2-17.1] years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% [95% CI, 33.9%-38.4%]), followed by real-time CGM plus injection use (20.9% [95% CI, 18.0%-24.1%]), intermittently scanned CGM plus injection use (12.5% [95% CI, 10.7%-14.4%]), and intermittently scanned CGM plus insulin pump use (11.3% [95% CI, 9.2%-13.8%]) (P &lt; .001). Similar trends were observed for less than 25% time above (real-time CGM plus insulin pump, 32.5% [95% CI, 30.4%-34.7%]; intermittently scanned CGM plus insulin pump, 12.8% [95% CI, 10.6%-15.4%]; P &lt; .001) and less than 4% time below range target (real-time CGM plus insulin pump, 73.1% [95% CI, 71.1%-75.0%]; intermittently scanned CGM plus insulin pump, 47.6% [95% CI, 44.1%-51.1%]; P &lt; .001). Adjusted time in range was highest among real-time CGM plus insulin pump users (64.7% [95% CI, 62.6%-66.7%]). Treatment modality was associated with the proportion of participants experiencing severe hypoglycemia and diabetic ketoacidosis events.Conclusions and RelevanceIn this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.

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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

Cited by 130 publications

References 20 publications

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID‐19 global pandemic

Association of Achieving Time in Range Clinical Targets With Treatment Modality Among Youths With Type 1 Diabetes

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