Evaluation of flash glucose monitoring after long-term use: A pediatric survey

Vergier, Julia; Samper, Martine; Dalla‐Vale, Fabienne; Ventura, Valérie; Baucher, F.; Joubert, Florence; Pons, Charlotte; Oliveira, Murielle De; Salet, Randa; Faure-Galon, Noémie; Adiceam, P.; Baechler-Sadoul, Elysabeth; Epstein, Sophie; Simonin, G.; Reynaud, Rachel

doi:10.1016/j.pcd.2018.08.004

Cited by 31 publications

(47 citation statements)

References 41 publications

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“…Indeed, FGM is fully supported by the public health insurance since its introduction in Belgian pediatric clinics, as it was already the case for SMBG. In this context, according to a recent study, 14 we show that FGM was initially well accepted even if, unexpectedly, only 70% of our patients still use it after 1-year of FU. There are several reasons for this.…”

Section: Discussionsupporting

confidence: 55%

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Messaaoui

Tenoutasse

Crenier

2019

Diabetes Technology & Therapeutics

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Background: Flash glucose monitoring (FGM) is covered by the Belgian public health insurance for type 1 diabetes since 2016. The objective of this study was to describe the use of FGM and diabetes outcomes in type 1 diabetic children and adolescents 1 year after reimbursement. Methods: All patients had the choice to convert to FGM or to continue with self-monitoring of blood glucose (SMBG). Clinical data were collected at baseline, at the next visit, and after 12 months; glucose profiles at next visit and after 12 months. Regression analyses were performed to identify predictors of FGM acceptance and changes in metabolic control. Results: A total of 334 subjects were included, of whom 278 (83.2%) switched to FGM. They were younger (13.6 vs. 15.2 years; P = 0.012) and performed more SMBG testing at baseline than patients who did not switch (4.3 vs. 4.1 tests daily; P = 0.008). At the end of follow-up, the rate of severe hypoglycemia decreased by 53% in the group of FGM users (P = 0.012) while it remained stable in SMBG users. Median glycated hemoglobin did not change significantly in both groups. Among subjects who switched to FGM, 15.8% reverted to SMBG after a median use of 5.3 months. Adverse events, diabetes duration, and FGM utilization were independent predictors of the risk for reverting. FGM-related adverse events were associated with a fivefold increased risk to revert to SMBG (hazard ratio = 5.12; P < 0.0001). Conclusions: FGM is relatively well accepted and decreases the risk of severe hypoglycemic events in our pediatric population. FGM is more often discontinued in patients experiencing adverse events and with longer diabetes duration.

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Section: Discussionsupporting

confidence: 55%

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Messaaoui

Tenoutasse

Crenier

2019

Diabetes Technology & Therapeutics

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“…The FGMS allows patients to monitor their glucose levels with no discomfort at any time of the day, thereby avoiding even the pain of fingerpricks. In addition, both individual blood glucose readings (as registered using glucometers) and glucose level trends (as determined using continuous glucose monitoring) can be easily recorded [12][13][14][15]. Several recent studies have shown that FGMS is precise, with high patient tolerance and that it can reliably decrease glucose variability and lengthen the time in range; it is also uncomplicated in terms of wearing and usage [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the Freestyle Libre Flash Glucose Monitoring System on Diabetes Distress Among Individuals with Type 1 Diabetes: A Prospective Study

2020

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Aim: To study and explore the intervention of the flash glucose monitoring system (FGMS) on diabetes-related distress (DRD) in children and adolescents with type 1 diabetes (T1D). Methods: A 12-week prospective study was performed from March 2019 to July 2019 involving 187 children and adolescents (age range 13-19 years; 56.7% female) with T1D who were self-testing their glucose levels using the conventional fingerprick method. At the time of the baseline visit, FGMS sensors were fixed by a trained diabetes educator onto each patient in the study population. A trained interviewer also administered the 28-item T1-Diabetes Distress Scale (T1-DDS) questionnaire to each participant at the baseline visit and again after 12 weeks to determine the T1-DDS score. Results: Comparison of the baseline (fingerprick) data with data collected at 12 weeks after the patients had switched to the FGMS revealed a significant decrease in the subdomains of the T1-DDS as follows: powerlessness (p = 0.0001); management distress (p = 0.0001); hypoglycemia distress (p = 0.0001); negative social perceptions (p = 0.0001); eating (p = 0.0001); physician distress (p = 0.0001); friend/family distress (p = 0.0001); and total T1-DDS score (p = 0.0001). Similarly, analysis of the data revealed that there was also a substantial drop from baseline to 12 weeks after initiation of the intervention in the clinical variables assessed, such as glycosylated hemoglobin; specifically, there was a considerable decrease after 12 weeks in the frequency of hypoglycemia. Interestingly, the frequency of glucose monitoring also showed an upswing among users of the FGMS. Conclusion: The outcomes of this study clearly demonstrate that once the patients had been switched from the fingerprick method to FGMS, the DRD and related clinical parameters showed remarkable improvement. However, further studies are necessary to determine whether the continued and consistent use of the FGMS will achieve better results.

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“…providing additional confirmatory evidence that most people will continue to use FGM or CGM despite skin issues. [27][28][29]32 Finally, premature sensor loss was also common among patients using FGM, however, this was primarily related to adhesive issues and not cutaneous AEs.…”

Section: Discussionmentioning

confidence: 99%

“…However, the proportion of participants, including children and youth, that experience FGM associated cutaneous AEs also varies widely between studies, ranging from 6% to 55%. 12,[27][28][29]39,40 T A B L E 2 Cutaneous adverse event symptom frequency and type A novel aspect of this study is that no existing studies have compared cutaneous AEs associated with FGM to SMBG among youth. [27][28][29][39][40][41][42] Overall, total cutaneous AEs were similar to FGMassociated cutaneous AEs, however, significantly more participants from the FGM group reported at least one cutaneous AE compared to the control group.…”

Section: Discussionmentioning

confidence: 99%

“…11,17,18,25 Similarly, FGM use has also demonstrated improvements in HbA1c and reduced time spent in hypoglycemia by up to 46% among adults after 6 months of use. 12,[26][27][28] Both CGM and FGM reduce the burden of SMBG, 28,29 as well as the misreporting of SMBG, 13,14 which may assist in improvements to glycemic control, and the overall burden of living with diabetes. 30 A downside of CGM and FGM technology is the need for subcutaneous placement of a sensor as well as adhesives use to secure sensors for periods of up to 14 days.…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous adverse events in a randomized controlled trial of flash glucose monitoring among youth with type 1 diabetes mellitus

et al. 2020

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Background: The literature regarding flash glucose monitoring (FGM)-associated cutaneous adverse events (AE) is limited. Objectives: This study among youth participating in a 6 month randomized controlled trial aimed to compare cutaneous AE between FGM and self-monitored blood glucose (SMBG) use and evaluate premature FGM sensor loss. Methods: Patients aged 13 to 20 years with type 1 diabetes were randomized to intervention (FGM and usual care) or control (SMBG and usual care). Participants self-reported cutaneous AEs electronically every 14 days. Reports were analyzed to determine frequency, type, and severity of cutaneous AEs, and evaluate premature sensor loss. Results: Sixty-four participants were recruited; 33 randomized to FGM and 31 to control. In total, 80 cutaneous AEs were reported (40 in each group); however, the proportion of participants experiencing cutaneous AEs was greater in the FGM group compared to control (58% and 23% respectively, P = .004). FGM participants most frequently reported erythema (50% of AEs), while controls most commonly reported skin hardening (60% of AEs). For FGM users, 80.0% of cutaneous AEs were mild, 17.5% moderate, and 2.5% severe. Among controls, 82.5% of cutaneous AEs were mild and 17.5% moderate. One participant ceased using FGM due to recurring cutaneous AEs. Additionally, over 6 months, 82% of FGM participants experienced at least one premature sensor loss, largely unrelated to a cutaneous AE. Conclusions: Cutaneous FGM-associated AEs are common, and mostly rated as mild. However, the majority of users continued FGM despite cutaneous AEs. Awareness of cutaneous complications and mitigation measures may reduce cutaneous AEs and improve the overall experience of FGM.

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Evaluation of flash glucose monitoring after long-term use: A pediatric survey

Cited by 31 publications

References 41 publications

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Effectiveness of the Freestyle Libre Flash Glucose Monitoring System on Diabetes Distress Among Individuals with Type 1 Diabetes: A Prospective Study

Cutaneous adverse events in a randomized controlled trial of flash glucose monitoring among youth with type 1 diabetes mellitus

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