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 HbA 1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA 1c following the use of FSL. Within-person variations of HbA 1c were calculated using adjusted SD for HbA 1c 5 SD/√(n/[n 2 1]). RESULTS Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (618.8) years, 51% female, diabetes duration 16.0 (649.9) years, and BMI of 25.2 (616.5) kg/m 2 (mean [6SD]). FSL users demonstrated a 25.2 mmol/mol change in HbA 1c , reducing from 67.5 (620.9) mmol/mol (8.3%) at baseline to 62.3 (618.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4-7.8) months of follow-up (n 5 3,182) (P < 0.0001). HbA 1c reduction was greater in those with initial HbA 1c ‡69.5 mmol/mol (>8.5%), reducing from 85.5 (616.1) mmol/mol (10%) to 73.1 (615.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (61.8) and reduced to 2.4 (61.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ‡4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis. CONCLUSIONS We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.

How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. Ipswich Hospital, Ipswich, UK HTA *Corresponding authorObjectives: To determine the comparative effectiveness and cost-effectiveness of three dressing products, N-A ® , Inadine ® and Aquacel ® , for patients with diabetic foot ulcers, as well as the feasibility and consequences of less frequent dressing changes by health-care professionals. Design: A multicentre, prospective, observer-blinded, parallel group, randomised controlled trial, with three arms. Setting: Established expert multidisciplinary clinics for the management of diabetic foot ulcers across the UK. Participants: Patients over age 18 with type 1 or type 2 diabetes with a chronic (present for at least 6 weeks) full-thickness foot ulcer (on or below the malleoli) not penetrating to tendon, periosteum or bone, and with a cross-sectional area between 25 and 2500 mm 2 .Interventions: Participants were randomised 1:1:1 to treatment with one of N-A (a non-adherent, knitted, viscose filament gauze), Inadine (an iodine-impregnated dressing), both traditional dressings, or Aquacel, a newer product. Main outcome measures: The primary outcome ...

The use of insulin lispro in Type 1 diabetes during pregnancy results in outcomes comparable to other large studies of diabetic pregnancy.

BACKGROUNDFreeStyle Libre (FSL), intermittently scanned continuous glucose monitoring (isCGM), is associated with less biochemical hypoglycaemia in people with diabetes, lower HbA1c and diabetes-related distress. 1 Impaired awareness of hypoglycaemia (IAH), which affects 18%-33% of people with type 1 diabetes, 2 is the reduced ability to detect the symptoms of hypoglycaemia and is associated with a 6-fold increased risk of severe hypoglycaemia (SH). 3 Many of the studies of CGM have shown a reduction in rates of hypoglycaemia but have not shown restoration of awareness. [4][5][6] There are limited nationwide data investigating the prevalence of IAH, complete loss of awareness of hypoglycaemia and SH. We have recently shown the use of FSL is associated with improvement in awareness of hypoglycaemia, 1 however, some studies have shown no benefit of FSL on IAH. 5,7 It is therefore important to identify the factors associated with improvement in IAH with the use of FSL. | METHODSThis observational study analysed data collated from November 2017 to August 2021 as part of the nationwide Association of British Clinical Diabetologists (ABCD) audit on FSL. 8 The methodology of the nationwide audit has been described in an article 1 reporting previous results of the audit. In this audit, people with diabetes were using FreeStyle Libre or FreeStyle Libre 2.The Gold score was used to assess awareness of hypoglycaemia. 9 A score of 4 or higher indicates IAH and 7 indicates a complete loss of awareness. 9 Diabetes-related distress was measured using the twoitem diabetes distress screening tool (DDS2). 10 An average of the two questions of the DDS2 scale was calculated. A score of 3 or higher was classified as 'moderate diabetes-related distress' and an average score of less than 3 was considered as 'low distress'.

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