Important Drop in Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study

Roussel, Ronan; Riveline, Jean‐Pierre; Vicaut, Éric; Pouvourville, Gérard de; Detournay, B.; Émery, C.; Levrat-Guillen, Fleur; Guerci, Bruno

doi:10.2337/dc20-1690

Cited by 94 publications

(63 citation statements)

References 24 publications

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“…We have confirmed and extended previous glycaemic outcome findings of small-scale studies in Scotland [ 6 , 22 ] by providing generalisable results. We have also augmented the scope of recent large-scale studies [ 13 , 14 ] by extensively exploring variations in HbA 1c and DKA outcomes following the initiation of FM use across sociodemographic strata, which has not been done before and provides novel information crucial to clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…However IMPACT was restricted to adults with good glycaemic control (HbA 1c ≤ 58 mmol/mol [7.5%]) [4], and is therefore not representative of the range of current recipients of this technology from the NHS. Observational studies have shown reductions in HbA 1c , diabetic ketoacidosis (DKA) and hypoglycaemia with use of FMs [5][6][7][8][9][10][11][12][13][14]. Greater effects on HbA 1c have been found in individuals with high initial HbA 1c but, apart from this, study of variation in effectiveness across different subgroups of recipients has been limited, particularly for DKA, where there is a gap in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Flash monitor initiation is associated with improvements in HbA1c levels and DKA rates among people with type 1 diabetes in Scotland: a retrospective nationwide observational study

et al. 2021

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Aims/hypothesis We assessed the real-world effect of flash monitor (FM) usage on HbA1c levels and diabetic ketoacidosis (DKA) and severe hospitalised hypoglycaemia (SHH) rates among people with type 1 diabetes in Scotland and across sociodemographic strata within this population. Methods This study was retrospective, observational and registry based. Using the national diabetes registry, 14,682 individuals using an FM at any point between 2014 and mid-2020 were identified. Within-person change from baseline in HbA1c following FM initiation was modelled using linear mixed models accounting for within-person pre-exposure trajectory. DKA and SHH events were captured through linkage to hospital admission and mortality data. The difference in DKA and SHH rates between FM-exposed and -unexposed person-time was assessed among users, using generalised linear mixed models with a Poisson likelihood. In a sensitivity analysis, we tested whether changes in these outcomes were seen in an age-, sex- and baseline HbA1c-matched sample of non-users over the same time period. Results Prevalence of ever-FM use was 45.9% by mid-2020, with large variations by age and socioeconomic status: 64.3% among children aged <13 years vs 32.7% among those aged ≥65 years; and 54.4% vs 36.2% in the least-deprived vs most-deprived quintile. Overall, the median (IQR) within-person change in HbA1c in the year following FM initiation was −2.5 (−9.0, 2.5) mmol/mol (−0.2 [−0.8, 0.2]%). The change varied widely by pre-usage HbA1c: −15.5 (−31.0, −4.0) mmol/mol (−1.4 [−2.8, −0.4]%) in those with HbA1c > 84 mmol/mol [9.8%] and 1.0 (−2.0, 5.5) mmol/mol (0.1 [−0.2, 0.5]%) in those with HbA1c < 54 mmol/mol (7.1%); the corresponding estimated fold change (95% CI) was 0.77 (0.76, 0.78) and 1.08 (1.07, 1.09). Significant reductions in HbA1c were found in all age bands, sexes and socioeconomic strata, and regardless of prior/current pump use, completion of a diabetes education programme or early FM adoption. Variation between the strata of these factors beyond that driven by differing HbA1c at baseline was slight. No change in HbA1c in matched non-users was observed in the same time period (median [IQR] within-person change = 0.5 [−5.0, 5.5] mmol/mol [0.0 (−0.5, 0.5)%]). DKA rates decreased after FM initiation overall and in all strata apart from the adolescents. Estimated overall reduction in DKA event rates (rate ratio) was 0.59 [95% credible interval (CrI) 0.53, 0.64]) after FM vs before FM initiation, accounting for pre-exposure trend. Finally, among those at higher risk for SHH, estimated reduction in event rates was rate ratio 0.25 (95%CrI 0.20, 0.32) after FM vs before FM initiation. Conclusions/interpretation FM initiation is associated with clinically important reductions in HbA1c and striking reduction in DKA rate. Increasing uptake among the socioeconomically disadvantaged offers considerable potential for tightening the current socioeconomic disparities in glycaemia-related outcomes. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Flash monitor initiation is associated with improvements in HbA1c levels and DKA rates among people with type 1 diabetes in Scotland: a retrospective nationwide observational study

et al. 2021

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“…Under these circumstances the value of telemonitoring with CGM can make the difference between early intervention and treatment, or a potentially life-threatening acute DKA episode. Both the FUTURE study in three specialist diabetes centres in Belgium [65] and the larger nationwide RELIEF study in France [66] have reported a significant fall in acute diabetes events (ADE), including DKA, after reimbursement of the FreeStyle Libre CGM system was approved within each health service. A recent retrospective, real-world analysis of a medical insurance claims database in the USA has shown a similar fall in ADE and related hospitalizations, including for DKA, once the FreeStyle Libre system was prescribed for people with diabetes [67].…”

Section: Fear Of Infection Changes Engagement With Health Services For People With Diabetesmentioning

confidence: 99%

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

et al. 2021

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People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

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“…Findings from large retrospective studies have also reported similar clinical outcomes [19]. Recent analyses showed significant reductions in diabetes-related events and allcause hospitalisations among adults with T2D using flash glucose monitoring [9,19]. An assessment of hospitalisation for acute diabetesrelated complications using the French national claims database showed a decrease in hospitalisation for hypoglycaemia (-10.8%) as well as for hyperglycaemia (-26.5%) among individuals with T2D.…”

Section: Introductionmentioning

confidence: 85%

“…To improve glycaemic control, frequent testing of glucose levels via glucometers, selfmonitoring of blood glucose (SMBG) and continuous glucose monitoring have been shown to be critical in detecting and reducing the risk of hypoglycaemia and hyperglycaemia requiring hospitalisation or diabetic ketoacidosis [6][7][8][9]. However, SMBG only provides sporadic data and can be inconvenient to patients [10,11].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of the FreeStyle Libre® System Versus Blood Glucose Self-Monitoring in Individuals with Type 2 Diabetes on Insulin Treatment in Sweden

et al. 2021

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Introduction: Frequent glucose monitoring is essential to obtain glucose control. This is done by periodic self-monitoring of blood glucose (SMBG) using finger-prick testing, or by using continuous glucose monitoring devices, wherein a sensor records interstitial glucose data automatically. This study assessed the costeffectiveness of using the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) compared to SMBG in individuals with type 2 diabetes (T2D) treated with insulin from a Swedish societal perspective. Methods: Cost-effectiveness analysis was conducted using the IQVIA Core Diabetes model v9.5, with demographic and clinical inputs from a real-world study using Swedish National Diabetes Register data. Two cohorts of individuals with T2D were considered based on baseline HbA1C (HbA1c: 8-9% [64-75 mmol/mol]; HbA1c: 9-12% [75-108 mmol/mol]). HbA1c reductions with FSL were -0.41% (-4 mmol/ mol; SD: 0.94%-10 mmol/mol) and -1.30% (-14 mmol/mol; SD: 1.40%-15 mmol/mol) for the two cohorts, respectively. Utilities, treatment costs and diabetes-related complication costs were obtained from published sources.Analyses were conducted over a lifetime horizon, applying annual discounting of 3% on costs and effects. Scenario analyses and probabilistic sensitivity analyses were performed.Results: Individuals with T2D who had a baseline HbA1c of 8-9% (64-75 mmol/mol) and 9-12% (75-108 mmol/mol) and used FSL gained 0.50 and 0.57 quality-adjusted life-years (QALYs), respectively, at an incremental cost of SEK109,957 and SEK82,170 compared to SMBG, generating an incremental cost-utility ratio of SEK219,127 and SEK144,412 per QALY gained.

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Important Drop in Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study

Cited by 94 publications

References 24 publications

Flash monitor initiation is associated with improvements in HbA1c levels and DKA rates among people with type 1 diabetes in Scotland: a retrospective nationwide observational study

Flash monitor initiation is associated with improvements in HbA1c levels and DKA rates among people with type 1 diabetes in Scotland: a retrospective nationwide observational study

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

Cost-Effectiveness of the FreeStyle Libre® System Versus Blood Glucose Self-Monitoring in Individuals with Type 2 Diabetes on Insulin Treatment in Sweden

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