Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Abstract

Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness. Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use. Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use. Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model. Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.

The long‐term impact of glucose monitoring with theFreeStyleLibre on glycaemic control and hypoglycaemia awareness in people with type 1 diabetes: Insights from the Association of British Clinical Diabetologists national audit

“…The baseline GOLD score (to assess hypoglycaemia awareness) was 2.7 (±1.8), which improved to 2.4 (±1.7) ( p < 0.0001) at follow‐up. Furthermore, we showed that FSL users reported a reduction in diabetes‐related distress (using the 2‐point Diabetes Distress Screening scale questionnaire – DDS score), hospital admissions, 3 and that the improvement in glycaemic control and hypoglycaemia awareness was independent of structured education attendance 2 . In this study, we explore the impact of long‐term FSL use on glycaemic control, hypoglycaemia awareness and diabetes‐related distress in people living with T1D.…”

“…The FreeStyle Libre (FSL) glucose monitoring system is one such technology. To obtain a glucose reading, the libre reader is held near the sensor, and the device then displays glucose information over the preceding 8 h, which includes current glucose and forecasts changes in glucose levels, thus allowing the operator to make necessary adjustments to diet and/or insulin dosing 1,2 . In clinical practice, the FSL monitoring system was first introduced in 2014.…”

“…To obtain a glucose reading, the libre reader is held near the sensor, and the device then displays glucose information over the preceding 8 h, which includes current glucose and forecasts changes in glucose levels, thus allowing the operator to make necessary adjustments to diet and/or insulin dosing. 1,2 In clinical practice, the FSL monitoring system was first introduced in 2014. It became available in the National Health Service (NHS), UK, in November 2017 for people with T1D, and, since then, has been widely used for glucose monitoring in this cohort.…”

“…It became available in the National Health Service (NHS), UK, in November 2017 for people with T1D, and, since then, has been widely used for glucose monitoring in this cohort. 2 Previously, using data from the Association of British Clinical Diabetologists (ABCD) nationwide audit on FSL use in people with T1D, our research group has shown that FSL users demonstrated a −5 mmol/mol (0.5%) change in HbA1c, reducing from 67 ± 21 mmol/mol (8.3 ± 1.9%) at baseline to 62 ± 19 mmol/mol (7.9 ± 1.7%) after 7.5 (interquartile range 3.4-7.8) months of follow-up (p < 0.0001). The baseline GOLD score (to assess hypoglycaemia awareness) was 2.7 (±1.8), which improved to 2.4 (±1.7) (p < 0.0001) at follow-up.…”

flash glucose monitoring revolution: the Sat Nav journey

“…However, in contrast to the assumptions made, our work demonstrated that it did not matter whether somebody had attended structured education or not -HbA1c reduction was seen across the board independent of prior education status. 5 This finding is further supported by the realworld data which showed that during the pandemic lockdown, a period when people with diabetes had limited support from healthcare professionals, there was an improvement in time in range, reflecting improved self-management. 6 Finally, and possibly most importantly, the ABCD audit has also demonstrated that flash glu- cose monitoring is associated with a significant reduction in diabetes-related distress (50% to 26%, p<0.001).…”