Freestyle libre flash glucose monitoring improves patient quality of life measures in children with Type 1 diabetes mellitus (T1DM) with appropriate provision of education and support by healthcare professionals

Pintus, Donatella; Ng, Sze May

doi:10.1016/j.dsx.2019.07.054

Cited by 49 publications

(85 citation statements)

References 12 publications

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“…Results from two randomized controlled trials indicated that using isCGM reduces time spent in the hypoglycemic glucose range, without changing HbA 1c , in people living with well-controlled type 1 and type 2 diabetes on intensive insulin therapy (10)(11)(12). Some small observational studies describe improved glucose control, reduced hypoglycemia, and improved quality of life in adults (13)(14)(15) as well as in the pediatric age group (16)(17)(18). Recently, an observational study in 900 people with type 1 diabetes who received isCGM funded by the U.K. National Health Service showed significant decrease in HbA 1c (19).…”

mentioning

confidence: 99%

Quality of Life and Glucose Control After 1 Year of Nationwide Reimbursement of Intermittently Scanned Continuous Glucose Monitoring in Adults Living With Type 1 Diabetes (FUTURE): A Prospective Observational Real-World Cohort Study

et al. 2019

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In 2016, nationwide reimbursement of intermittently scanned continuous glucose monitoring (isCGM) for people living with type 1 diabetes treated in specialist diabetes centers was introduced in Belgium. We undertook a 12-month prospective observational multicenter real-world study to investigate impact of isCGM on quality of life and glycemic control. RESEARCH DESIGN AND METHODS Between July 2016 and July 2018, 1,913 adults with type 1 diabetes were consecutively recruited in three specialist diabetes centers. Demographic, metabolic, and quality of life data were collected at baseline, 6 months, and 12 months of standardized clinical follow-up. The primary end point was evolution of quality of life from baseline to 12 months. Secondary outcome measures were, among others, change in HbA 1c , time spent in different glycemic ranges, occurrence of acute diabetes complications, and work absenteeism. RESULTS General and diabetes-specific quality of life was high at baseline and remained stable, whereas treatment satisfaction improved (P < 0.0001). Admissions for severe hypoglycemia and/or ketoacidosis were rare in the year before study (n 5 63 out of 1,913; 3.3%), but decreased further to 2.2% (n 5 37 out of 1,711; P 5 0.031). During the study, fewer people reported severe hypoglycemic events (n 5 280 out of 1,913 [14.6%] vs. n 5 134 out of 1,711 [7.8%]; P < 0.0001) or hypoglycemic comas (n 5 52 out of 1,913 [2.7%] vs. n 5 18 out of 1,711 [1.1%]; P 5 0.001) while maintaining HbA 1c levels. Fewer people were absent from work (n 5 111 out of 1,913 [5.8%] vs. n 5 49 out of 1,711 [2.9%]; P < 0.0001). Time spent in hypoglycemia significantly decreased in parallel with less time in range and more time in hyperglycemia. Eleven percent (n 5 210) of participants experienced skin reactions, leading to stopping of isCGM in 22 participants (1%). CONCLUSIONS Nationwide unrestricted reimbursement of isCGM in people with type 1 diabetes treated in specialist diabetes centers results in higher treatment satisfaction, less severe hypoglycemia, and less work absenteeism, while maintaining quality of life and HbA 1c .

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confidence: 99%

Quality of Life and Glucose Control After 1 Year of Nationwide Reimbursement of Intermittently Scanned Continuous Glucose Monitoring in Adults Living With Type 1 Diabetes (FUTURE): A Prospective Observational Real-World Cohort Study

et al. 2019

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“…44 Differences between capillary glucose values and sensor readings should be explained to school personnel to avoid wrong treatment decisions due to poor knowledge of the device, complemented with frequent updates when new information is available. 45 This single-center unselected pediatric population was wellcontrolled at baseline with mean HbA1c of 7.2% (55 mmol/mol), which is better than what has been reported for other studies assessing the impact of isCGM, [14][15][16]28,46,47 for general populations followed through diabetes registries, [48][49][50][51] and even for the whole Belgian pediatric population. 52 We are the first to follow a population up to 24 months after isCGM initiation.…”

Section: Self-reported Adverse Events and Complaints With Iscgmmentioning

confidence: 71%

“…20 Here, only 5% decided to stop the use of isCGM, which is lower than in other populations where reimbursement was not provided. 14,16,21 Patient 23 This did not change when isCGM was introduced, with even higher satisfaction on the DQOLY questionnaire up to 12 months. This is in line with results from isCGM use among adults with T1D.…”

Section: Self-reported Adverse Events and Complaints With Iscgmmentioning

confidence: 89%

“…13 To date, only few studies report isCGM use of longer than 6 months with a follow-up of maximum 12 months. [14][15][16] These observational studies show mixed results for glycemic outcomes, and quality of life was not always part of the assessment. 14 Additionally, the effect on diabetes-related absence days from school has not been studied before.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16] These observational studies show mixed results for glycemic outcomes, and quality of life was not always part of the assessment. 14 Additionally, the effect on diabetes-related absence days from school has not been studied before. Thus, it remains unclear whether the long-term use of isCGM has a benefit in an unselected population in real-world settings.…”

Section: Introductionmentioning

confidence: 99%

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Intermittently scanned continuous glucose monitoring is associated with high satisfaction but increased HbA1c and weight in well‐controlled youth with type 1 diabetes

Charleer

Gillard

Vandoorne³

et al. 2020

Pediatric Diabetes

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Objective: We undertook a 24-month prospective observational single-center realworld trial to study impact of access to intermittently scanned continuous glucose monitoring (isCGM) on quality of life (QOL) and glycemic control of youth with type 1 diabetes (T1D). Methods: Between September 2016 and November 2017, 138 children and adolescents with T1D were recruited. Demographic, metabolic, and QOL data were collected during 24 months of routine follow-up. Primary endpoint was the evolution of QOL, with secondary outcomes change in HbA1c, occurrence of acute diabetes complications, and school absenteeism. Results: Ninety-two percent of participants found isCGM more user-friendly than capillary finger-stick tests and had high treatment satisfaction, without change in diabetes-specific QOL. HbA1c significantly increased from 7.2% (7.0-7.3) (55 mmol/ mol [53-56]) at baseline to 7.6% (7.4-7.8) (60 mmol/mol [57-62]) at 12 months (P < .0001) and was unchanged up to 24 months. Overall increase was mainly driven by children with baseline HbA1c <7.0% (<53 mmol/mol). Additionally, BMI adjusted for age was higher at study end. In year before isCGM, 228 days per 100 patientyears of school absenteeism were reported, which dramatically decreased to 13 days per 100 patient-years (P = .016) after 24 months. Parents of children also reported less work absenteeism (P = .011). Conclusion: The use of isCGM by T1D pediatrics is associated with high treatment satisfaction and fewer days of school absence. However, increased HbA1c and weight may reflect a looser lifestyle, with less attention to diet and more avoidance of hypoglycemia. Intensive education specifically focusing on these points may mitigate these issues.

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The Impact of Flash Glucose Monitoring on Glycaemic Control as Measured by HbA1c: A Meta-analysis of Clinical Trials and Real-World Observational Studies

et al. 2019

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Introduction: Glycated haemoglobin A1c (HbA1c) is the established standard measurement for assessment of glycaemic control in people with diabetes. Here we report on a metaanalysis of real-world observational studies on the impact of flash continuous glucose monitoring on glycaemic control as measured by HbA1c. Methods: A total of 271 studies were identified in our search, of which 29 contained data reporting changes in HbA1c over periods from 1 to 24 months that could be used in a statistical analysis. Our meta-analysis focuses on observed change in HbA1c at either 2, 3 or 4 months, in adult or paediatric subjects, as well as a longitudinal analysis up to 12 months in adult subjects. These data were drawn from 25 of the studies identified in our initial search. These reported HbA1c data up to 12 months in a total of 1723 participants with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the FreeStyle Libre Ò flash glucose monitoring system. Results: Overall mean change in laboratory HbA1c across study subjects at 2-4 months was-0.55% (95% CI-0.70,-0.39). Amongst the 1023 adults, mean change in HbA1c was-0.56% (95% CI-0.76,-0.36); for the 447 children and adolescents, mean change in HbA1c was-0.54% (95% CI-0.84,-0.23). Based on regression analysis, the degree of change in HbA1c correlated with the initial HbA1c of the study population. A longitudinal analysis in adult subjects (n = 1276) shows that HbA1c fell within the first 2 months and changes were sustained up to 12 months. No significant differences were detected between T1D and T2D. Conclusion: The meta-analysis reported here confirms that starting the FreeStyle Libre system as part of diabetes care results in a significant and sustained reduction in HbA1c for adults and children with T1D and for adults with T2D. Funding: Abbott Diabetes Care.

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Freestyle libre flash glucose monitoring improves patient quality of life measures in children with Type 1 diabetes mellitus (T1DM) with appropriate provision of education and support by healthcare professionals

Cited by 49 publications

References 12 publications

Quality of Life and Glucose Control After 1 Year of Nationwide Reimbursement of Intermittently Scanned Continuous Glucose Monitoring in Adults Living With Type 1 Diabetes (FUTURE): A Prospective Observational Real-World Cohort Study

Quality of Life and Glucose Control After 1 Year of Nationwide Reimbursement of Intermittently Scanned Continuous Glucose Monitoring in Adults Living With Type 1 Diabetes (FUTURE): A Prospective Observational Real-World Cohort Study

Intermittently scanned continuous glucose monitoring is associated with high satisfaction but increased HbA1c and weight in well‐controlled youth with type 1 diabetes

The Impact of Flash Glucose Monitoring on Glycaemic Control as Measured by HbA1c: A Meta-analysis of Clinical Trials and Real-World Observational Studies

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