The usefulness of the FlashStyle Libre system in glycemic control in children with type 1 diabetes during summer camp

Abstract

Type 1 diabetes requires the patient to be very involved in the treatment process, especially in terms of proper self-control. The new method of non-invasive glycemic control by scanning is an attractive alternative for patients requiring multiple measurements due to the high dynamics of glycemic changes. The aim of the study was to evaluate the usefulness of Flash FreeStyle Libre in glycemic control in children during summer camp on the basis of the participants' completed questionnaire and on the basis of the assessment o the suitability of the system performed by medical staff based on a comparative analysis: glycemia by sensor and glucometer. Material and Methods. A study using the new Flash FreeStyle Libre glycemic control system was conducted at a seaside summer camp for children with diabetes at the seaside. The study included 75 children (32 boys and 43 girls), in mean 13.4 (SD 4.6) years old, with an average duration of diabetes of 6.5 (SD 4.5) years and mean HbA 1 c of 7.81% (SD 2.05). All camp participants were provided with Libre sensors, however, routine glucose control measurements with therapeutic decisions was made using traditional glucose meters. On the last day of the camp, after the removal of the sensors, a satisfaction survey was conducted to assess with a new self-monitoring method and a comparative analysis of the glucose results from the sensor with the personal glucose meters -MARD, MAD, and clinical errors on the Clarke Error Grid were calculated. Results. In the Libre user's survey, wearing comfort and ease of installation were described as very good / good by 86% and 94% of the respondends, respectively. Ease of reading blood glucose by scan was positively evaluated by 92% of the respondents, 95% of the subjects did not report any side effects. The sensor remained intact for 14 days in 46 children (62%), which value was the basis for the statistical calculations. Comparative analysis of glucose results obtained from Libre measurements performed with glucose meters (3143 measurements) showed a relatively good MARD index -18.22% on average, with a large individual variation (6.36-29.51%). Clarke Error Grid showed that 75.2% (2309) of the results were in Zone A (Acceptable Errors) and 95.81% (3012) in Zone A and B (Non-Negative Errors). Conclusion. Libre user's satisfaction survey revealed that most of the respondents rated the cooperation with Flash FreeStyle Libre positively. The relatively good results of Libre in comparison with glucose meters have confirmed the usefulness of this method of monitoring glucose in summer camps for children with diabetes.

An Evaluation of the Accuracy of a Flash Glucose Monitoring System in Children with Diabetes in comparison with Venous Blood Glucose

“…Several studies have demonstrated the accuracy of this system by comparing the sensor results with capillary BG values and venous YSI measurements in adults [3, 4]. The accuracy has been evaluated in children in several studies through comparison of the sensor results with capillary BG values [5–7], in trial or real-life settings, and also analysis of the factors that might affect its accuracy, including stable or fluctuating glycaemic conditions and time of day. The results have demonstrated that the accuracy depends on the glucose trend [6]; however, all the reported data in paediatric populations used capillary BG as a reference, which is affected by many factors and does not reflect the real blood glucose level.…”

Estimating plasma glucose with the FreeStyle Libre Pro continuous glucose monitor during oral glucose tolerance tests in youth without diabetes

“…Replacing or supplementing self‐measured blood glucose with CGM data can be useful in mitigating inaccuracies in self‐measured blood glucose due to human error, physiological discrepancies, medication interference, or extreme environmental conditions and may be deemed more acceptable to patients and research volunteers. If found to read glucose accurately, the FLP system would seem a valuable CGM for pediatric research use due to the extended, 14‐day sensor wear time, factory calibration, and usability of the device . When FLP readings are compared to self‐measured capillary blood glucose (ie, results obtained using bedside glucometers) in children with T1DM, the FLP has been reported to provide acceptable glucose measurements, with an increase in accuracy at night .…”

“…If found to read glucose accurately, the FLP system would seem a valuable CGM for pediatric research use due to the extended, 14-day sensor wear time, factory calibration, and usability of the device. 2,7,8,10,17,18 When FLP readings are compared to self-measured capillary blood glucose (ie, results obtained using bedside glucometers) in children with T1DM, the FLP has been reported to provide acceptable glucose measurements, with an increase in accuracy at night. 8,17,24,25 Contrary to these findings, the data presented here identified that in fasted states, the FLP CGM glucose readings were not significantly correlated with plasma glucose readings.…”

“…In individuals without diabetes, CGMs could help determine glycemic ranges in specific demographic samples and evaluate changes in glucose tolerance over time . In most cases, patients with diabetes have found these devices easy to use, relatively painless, and preferential to traditional finger‐prick methods of measuring glucose . However, some published literature has offered data suggesting that CGM accuracy, relative to venous measurements, may need to be adjusted for time lags and may be affected by meal macronutrient composition .…”

“…[12][13][14][15][16] In most cases, patients with diabetes have found these devices easy to use, relatively painless, and preferential to traditional finger-prick methods of measuring glucose. 8,10,17,18 However, some published literature has offered data suggesting that CGM accuracy, relative to venous measurements, may need to be adjusted for time lags and may be affected by meal macronutrient composition. [19][20][21][22] As new CGMs become increasingly available, it remains important to study each device to understand accuracies and limitations, and to define their scope of use.…”