HbA1c response and hospital admissions following commencement of flash glucose monitoring in adults with type 1 diabetes

Abstract

IntroductionOur aim was to assess the effect of introducing flash monitoring in adults with type 1 diabetes with respect to change in hemoglobin A1c (HbA1c) and frequency of hospital admissions.Research design and methodsProspective observational study of adults with type 1 diabetes in our center, in whom a prescription for a flash monitoring sensor was collected. Primary outcome was change in HbA1c between 2016 and after flash monitoring. Rates of hospital admission were compared between the first year after flash monitoring and the corresponding 12-month period 2 years earlier.ResultsApproximately half of all adults with type 1 diabetes, attending our center, collected prescriptions for flash monitoring sensors (n=2216). Median fall in HbA1c was −1 (−0.1) mmol/mol (%) (p<0.001) and was greatest in those with baseline HbA1c >75 (9.0) mmol/mol (%): −10 (−0.9) mmol/mol (%), p<0.001. 43% of those with a baseline HbA1c >53 mmol/mol (7%) experienced a ≥5 mmol/mol (0.5%) fall in HbA1c. In addition to higher HbA1c, early commencement within 1 month of NHS-funded flash monitoring (p<0.001), and male gender (p=0.013) were associated with a fall in HbA1c of ≥5 (0.5) mmol/mol (%). Socioeconomic deprivation (p=0.009) and collecting fewer than 2 sensors per month (p=0.002) were associated with lack of response. Overall, hospital admissions did not change but an increase in admissions for hypoglycemia was observed (1.1% vs 0.3%, p=0.026).ConclusionsFlash monitoring is associated with reduction in HbA1c in individuals with HbA1c >58 mmol/mol. Numerous clinical features are independently associated with HbA1c response. An increase in hypoglycemia admissions occurred following flash monitoring.

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

“…Stimson et al explored the change in HbA1c and the rates of hospital admission following FSL monitoring in people with T1DM and reported a median fall in HbA1c of 1 mmol/mol over a median duration of 38 weeks while observing no change in overall hospital admissions. 18 In this study, DAFNE attendance was among the factors associated with a greater fall in HbA1c. However, as this was a univariate analysis and was not adjusted for other variables (baseline HbA1c, age, gender, etc), it should be interpreted with caution.…”

“…Several studies have demonstrated improved glycaemic control with FSL use, which was reported to be greater in people with higher pre-FSL HbA1c levels and the number of FSL scans over 14 days. [15][16][17][18][19][20] In a large observational study, we have previously shown that FSL use is associated with improved glycaemic control and hypoglycaemia awareness among other clinically beneficial outcomes. However, on linear regression modelling, structured education was not a significant factor in the reduction of HbA1c (β=0.82, p=0.090).…”

“…It is likely related to the increase in glucose monitoring frequency, a conclusion supported by the results of our analysis and several previous studies where the number of FSL scans over 14 days was a predictor of improvement in HbA1c . [15][16][17][18][19][20] Perhaps attendance at a targeted, intensive and flexible education programme combined with FSL initiation may be a helpful approach in securing optimum benefit in terms of glycaemic control in people living with T1D who are started on FSL. However, well-designed randomised controlled trials will be needed to establish this conclusively.…”

Cross‐sectional analysis of emergency hypoglycaemia and outcome predictors among people with diabetes in an urban population

“…Similarly, median (IQR) GCS on arrival was also lower among incidents stratified as T1DM 13. [9][10][11][12][13][14][15] All mean pulse rates were within the normal physiological range, and seizure rates were significantly higher in type 1 diabetes 1.1% (n = 17) compared with type 2 diabetes 0.3% (n = 4).…”

“…12 Additionally, a recent observational study identified a threefold increase in hypoglycaemiarelated hospital admissions in the 12 months following the introduction of flash glucose monitoring compared with the corresponding 12-month period 2 years earlier (1.1% vs. 0.3%, p = 0.026). 13 Improvements in HbA 1c , time in range and diabetes distress scores when combining structured education with flash glucose monitoring highlight the importance of education in harnessing the efficacy of diabetes technologies. 14 Diabetes currently accounts for an estimated 10% of the NHS budget and is predicted to rise to 17% by 2035.…”