Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

Abstract

IntroductionFlash glucose monitoring (FGM) is a factory-calibrated sensor-based technology for the measurement of interstitial glucose. We performed a systematic review and meta-analysis to assess its efficacy and safety in patients with type 1 and type 2 diabetes.Research design and methodsPubMed, CENTRAL, Scopus and Web of Science were searched in July 2019. Twelve studies with a follow-up longer than 8 weeks, evaluating 2173 patients on prandial insulin, multiple daily insulin injections or continuous subcutaneous insulin infusion were included. The following data were extracted: HbA1c, time in range, time above 180 mg/dL, time below 70 mg/dL, frequency of hypoglycemic events, number of self-monitoring of blood glucose (SMBG) measurements, total daily insulin dose, patient-reported outcomes, adverse events, and discontinuation rate. A comparison with SMBG was conducted.ResultsFGM use was associated with a reduction in HbA1c (−0.26% (−3 mmol/mol); p=0.002) from baseline to the last available follow-up, which correlated with HbA1c levels at baseline (−0.4% (−4 mmol/mol) for each 1.0% (11 mmol/mol) of HbA1c above 7.2% (55 mmol/mol)). Also, a decrease in time below 70 mg/dL was found (−0.60 hours/day; p=0.04). Favorable findings in patient-reported outcomes and no device-related serious adverse events were reported. When compared with SMBG, FGM was characterized by no statistically different change in HbA1c (p=0.09), with lower number of SMBG measurements per day (−3.76 n/day; p<0.001) and risk of discontinuation (relative risk=0.42; p=0.001). A limited number of studies, with a heterogeneous design and usually with a short-term follow-up and without specific training, were found.ConclusionsThe present review provides evidence for the use of FGM as an effective strategy for the management of diabetes.

The impact of flash glucose monitoring on glycated hemoglobin in type 2 diabetes managed with basal insulin in Canada: A retrospective real-world chart review study

“…8 Furthermore, flash glucose monitoring use in type 1 and type 2 diabetes is associated with a 0.4% decrease in HbA1c for each 1% increase in baseline levels over 7.2% (4 mmol/mol for each 11 mmol/mol over 55 mmol/mol), which supports the HbA1c change in the current study. 9 The observed change in HbA1c was more marked at baseline HbA1c levels above 9%, a pattern which has been noted by others. 4,9 Similarly, to other recent studies assessing flash glucose monitoring use in type 2 diabetes, HbA1c reduction in the current study was not associated with age.…”

“…9 The observed change in HbA1c was more marked at baseline HbA1c levels above 9%, a pattern which has been noted by others. 4,9 Similarly, to other recent studies assessing flash glucose monitoring use in type 2 diabetes, HbA1c reduction in the current study was not associated with age. 4 HbA1c reduction was also observed with low baseline frequency of blood glucose testing, supporting data from France, and the view that minimal blood glucose testing frequency may not influence uptake or benefit from flash glucose monitoring use.…”

The Impact of Flash Glucose Monitoring on Markers of Glycaemic Control and Patient Satisfaction in Type 2 Diabetes

“…More recently, a reduction in HbA1c was demonstrated in a similar population of T2D managed with MDI therapy in a longer RCT from Israel and in three European chart review studies [ 3 , 4 ]. In a recent meta-analysis of the safety and efficacy of flash glucose monitoring by Castellana et al (2020), which included RCTs as well as prospective and retrospective cohort studies of both type 1 diabetes and T2D, the technology was deemed an effective strategy in diabetes management [ 21 ]. Furthermore, in a real-world European analysis of over 60 million glucose tests, Dunn et al (2018) identified reductions in estimated A1c with the use of flash glucose monitoring [ 5 ].…”

Telemedicine and urban diabetes during COVID-19 pandemic in Milano, Italy during lock-down: epidemiological and sociodemographic picture

“…The pilot study we presented herein was conducted during the "first wave" of epidemic and works as a "proof of concept" indicating that remote glucose control allows better glycemic control in a condition of social distancing as the lock-down occurred in March and April 2020. Previous studies had shown the possibility of optimizing glucose control via Flash Glucose Monitoring [41,42], but, at our knowledge, this is the first study utilizing the system during a lockdown ( Fig. 7) to bend the "second wave" of contagion.…”