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., Furlong, N., Kamaruddin, S., Banatwalla, R., Herring, R., Kilvert, A., Patmore, J., Walton, C., Ryder, R. E., & 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
• 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