Measuring the Impact of Flash Glucose Monitoring in a Pediatric Population in Saudi Arabia: A Retrospective Cohort Study

Abstract

Introduction Measurement of glucose levels is the mainstay method of ensuring good glycemic control and preventing complications associated with uncontrolled diabetes. Continuous glucose monitoring enables easy and effective monitoring of interstitial glucose around the clock and hence improves glycemic control. Objectives This study aimed to measure the effect of continuous glucose monitoring on glycated hemoglobin (HbA1c) at 3, 6, and 9 months following sensor insertion. Methods A retrospective cohort study of pediatric and adolescent type 1 diabetes mellitus patients randomly sampled from 32 Ministry of Health diabetes centers across Saudi Arabia was performed. Patients were subjected to flash glucose monitoring using the FreeStyle ® Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, UK), an intermittently scanned continuous glucose monitoring device approved by the Conformité Européenne in 2014. These patients were first-time users of any kind of continuous glucose monitoring system, aged 4–18 years, and received insulin via multiple dose injection or continuous subcutaneous insulin infusion for at least 6 months prior to study start. Patients were excluded if they had used flash glucose monitoring or other interstitial glucose monitoring systems in the past 3 months, were pregnant, or had existing hemoglobinopathies. The flash glucose monitoring sensor was attached to the back of the upper arm at the baseline visit. HbA1c (%) was measured at baseline and 3, 6, and 9 months. Patient demographics were collected from electronic health records. Results 1,307 patients were included, with a mean age of 11.1 years (standard deviation 3.6 years). Where specified, 51.4% were female. Mean HbA1c significantly reduced from baseline (10.8%) to 3 months (9.8%, p < 0.001), 6 months (9.2%, p < 0.001), and 9 months (9.1%, p < 0.001). For individuals with baseline HbA1c > 9%, mean HbA1c was significantly reduced from baseline (11.7%) to 3 months (10.3%, p < 0.001), 6 months (9.6%, p < 0.001), and 9 months (9.5%, p < 0.001). Conclusions Flash glucose monitoring significantly reduced HbA1c levels at 3, 6, and 9 months following sensor insertion. This reduction was greatest in those patients with higher HbA1c at baseline (> 9%).

Diabetic Retinopathy Screening Using Non-Mydriatic Fundus Camera in Primary Health Care Settings – A Multicenter Study from Saudi Arabia

“…A total of seven GPs participated in this study from seven selected PHCs, and they were trained in person in their PHC, to identify presence or absence of DR using these images according to Saudi Diabetes Clinical Practice Guidelines (SDCPG). 23 Dilation of pupil was deemed not necessary as this study was a non-mydriatic approach to take the fundus photographs. A non-mydriatic 45 degree digital retinal TRC-NW8 fundus camera (TopCon Medical Systems Tokyo, Japan) was used to acquire bilateral single field retinal digital photographs centered on the macula and encompassing the optic disc.…”