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.J.; Sathyapalan, Thozhukat

Abstract

OBJECTIVE The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions.

RESEARCH DESIGN AND METHODS Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA1c following the use of FSL. Within-person variations of HbA1c were calculated using adjusted SD for HbA1c = SD/√(n/[n -0 1]).

RESULTS Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (±18.8) years, 51% female, diabetes duration 16.0 (±49.9) years, and BMI of 25.2 (±16.5) kg/m2 (mean [±SD]). FSL users demonstrated a −5.2 mmol/mol change in HbA1c, reducing from 67.5 (±20.9) mmol/mol (8.3%) at baseline to 62.3 (±18.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4–7.8) months of follow-up (n = 3,182) (P < 0.0001). HbA1c reduction was greater in those with initial HbA1c ≥69.5 mmol/mol (>8.5%), reducing from 85.5 (±16.1) mmol/mol (10%) to 73.1 (±15.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (±1.8) and reduced to 2.4 (±1.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ≥4 at baseline had a score

Citation

Deshmukh, H., Wilmot, E. G., Gregory, R., Barnes, D., Narendran, P., Saunders, S., …Sathyapalan, T. (2020). 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. Diabetes Care, 43(9), 2153-2160. https://doi.org/10.2337/dc20-0738

• Journal Article Type: Article
• Acceptance Date: Jul 8, 2020
• Online Publication Date: Jul 15, 2020
• Publication Date: Sep 1, 2020
• Deposit Date: Jul 17, 2020
• Publicly Available Date: Jul 20, 2020
• Journal: Diabetes Care
• Print ISSN: 0149-5992
• Electronic ISSN: 1935-5548
• Publisher: American Diabetes Association
• Peer Reviewed: Peer Reviewed
• Volume: 43
• Issue: 9
• Article Number: dc200738
• Pages: 2153-2160
• DOI: https://doi.org/10.2337/dc20-0738
• Keywords: Internal Medicine; Endocrinology, Diabetes and Metabolism; Advanced and Specialised Nursing
• Public URL: https://hull-repository.worktribe.com/output/3543732
• Publisher URL: https://care.diabetesjournals.org/content/early/2020/07/03/dc20-0738