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

Evans, Mark; Welsh, Zoë; Ells, Sara; Seibold, Alexander

doi:10.1007/s13300-019-00720-0

Cited by 140 publications

(154 citation statements)

References 33 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…CGM improves the time spent in euglycaemia and reduces (severe) hypoglycaemia in people with impaired awareness of hypoglycaemia (IAH), decreases HbA 1c levels and ameliorates general measures of glycaemic control, as shown in different randomised (crossover) studies [1][2][3][4]. isCGM reduces the time spent in hypoglycaemia, as shown by randomised controlled studies [5,6], and decreases HbA 1c levels, as shown by a meta-analysis [7] of largely observational studies. Interestingly, switching from isCGM to CGM may have a beneficial impact on hypoglycaemia outcomes in people with a high risk of hypoglycaemia, perhaps because the latter displays data without the need to scan and is augmented by alerts for when the sensor glucose approaches hypoglycaemia, as detailed in a randomised parallel-group study [8].…”

Section: Introductionmentioning

confidence: 96%

Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)

et al. 2020

View full text Add to dashboard Cite

Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.

show abstract

Section: Introductionmentioning

confidence: 96%

Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Of note, telemedicine has been shown to improve psychosocial outcomes in young adults with diabetes [14]. According to a recent metaanalysis, FGM has the potential to improve overall glucose control [15] and to reduce hypoglycaemia in individuals with T1D [16,17].…”

Section: Introductionmentioning

confidence: 99%

Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

et al. 2020

View full text Add to dashboard Cite

Introduction:In late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D). Methods: Data were collected on 33 individuals with T1D who were monitoring their glucose levels using a flash glucose monitoring device and remotely connected to the diabetes clinic on a cloud platform. We retrieved information on average glucose, standard deviation and percentage time in hypoglycaemia (\ 70 mg/ dl), glucose range (70-180 mg/dl) and hyperglycaemia ([ 180 mg/dl). We compared glycaemic measures collected during lockdown to those collected before the SARS-CoV-2 epidemic and to the periods immediately before lockdown. Results: In 20 patients who had stopped working and were at home as a result of the lockdown, overall glycaemic control improved during the first 7 days of the lockdown as compared to the weeks before the spread of SARS-CoV-2. Average glucose declined from 177 ± 45 mg/dl (week before lockdown) to 160 ± 40 mg/dl (lockdown; p = 0.005) and the standard deviation improved significantly. Time in range increased from 54.4 to 65.2% (p = 0.010), and time in hyperglycaemia decreased from 42.3 to 31.6% (p = 0.016). The number of scans per day remained unchanged. In 13 patients who continued working, none of the measures of glycaemic control changed during lockdown. Conclusion: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term.

show abstract

“…Randomized controlled trials (RCTs) have demonstrated that FSL use is associated with a significant reduction in the incidence of hypoglycemia in people with type 1 and type 2 diabetes, but to date, a reduction in HbA 1c has not been reported (6)(7)(8). However, several observational studies have reported improvements in glycemic control (9)(10)(11)(12)(13)(14). There are no comprehensive, real-world, large population-based data sets looking at the impact of FSL on multiple aspects of diabetes care.…”

mentioning

confidence: 99%

Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

et al. 2020

View full text Add to dashboard Cite

The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions. RESEARCH DESIGN AND METHODS Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA 1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA 1c following the use of FSL. Within-person variations of HbA 1c were calculated using adjusted SD for HbA 1c 5 SD/√(n/[n 2 1]). RESULTS Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (618.8) years, 51% female, diabetes duration 16.0 (649.9) years, and BMI of 25.2 (616.5) kg/m 2 (mean [6SD]). FSL users demonstrated a 25.2 mmol/mol change in HbA 1c , reducing from 67.5 (620.9) mmol/mol (8.3%) at baseline to 62.3 (618.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4-7.8) months of follow-up (n 5 3,182) (P < 0.0001). HbA 1c reduction was greater in those with initial HbA 1c ‡69.5 mmol/mol (>8.5%), reducing from 85.5 (616.1) mmol/mol (10%) to 73.1 (615.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (61.8) and reduced to 2.4 (61.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ‡4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis. CONCLUSIONS We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.

show abstract

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

Cited by 140 publications

References 33 publications

Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Contact Info

Product

Resources

About