Improvement in Glucose Control in Difficult-to-Control Patients With Diabetes Using a Novel Flash Glucose Monitoring Device

Self-monitoring of blood glucose (SMBG) is the standard of care for diabetic patients treated with multiple daily insulin injections. ¹ Continuous glucose monitoring systems (CGMs) have the advantages of more complete information that may better guide clinical decision making and alert patients of hypoglycemic events. ² However, CGMs are expensive, are invasive, and need considerable time and skills for use and effective interpretation.^2,3 Freestyle Libre (Abbott Diabetes Care Ltd, Range Road Witney, Oxon OX29 OYL; UK) is a novel factory-calibrated glucose monitoring system that is applied to the upper arm every 2 weeks. This flash glucose monitoring system (FGM) produces an ambulatory glucose profile (AGP) after download of glucose measurements from the sensor to the reader.^3,4 AGP is a way to present the glucose data collected by time of day with several advantages: demonstrates median glucose levels at 25-75th as well as 10-90th percentiles as well as excursions and the tendency for hypo or hyperglycemia throughout the day. This integration of results gives a more complete picture of glucose control throughout the week/s while eliminating “noise” from outliers.^3-5 We hereby report our experience using this technology in patients with difficult-to-control diabetes.

A total of 31 diabetic patients treated with multiple daily insulin injections with an HbA1C ≥7.5% used this CGM device to examine its possible beneficial effect on achieving target glucose levels and minimizing hypoglycemia. The patients had difficult-to-control type1/type 2 diabetes due to compliance/adherence difficulties, brittle diabetes, and fear of hypoglycemia. Patients were followed for 12 weeks in 3 centers in Israel: Diabetes Medical Center (DMC), diabetes clinic at Hadassah Hebrew University Hospital, and the diabetes clinic at Wolfson Hospital.

Study population consisted of 25 patients with type 2 diabetes and 6 patients with type 1 diabetes: 7 women, 24 men, average age 58 ± 16 years, average HbA1C at baseline 8.9 ± 0.26% (mean ± SE).

With the use of this FGM device there was major improvement in glucose control in both type 2 and type 1 diabetic patients: HbA1C decreased by −1.33 ± 0.29% at 8 weeks (mean ± SE respectively, P < .0001) and plateaued thereafter. For those patients who continued using the device (n = 27), the change was maintained for 24 weeks,–1.21 ± 0.42% (P = .009) (Figure 1). There were no events of major hypoglycemia. All patients were satisfied and most (n = 27/31) completed the 6 months of the experience. At the end of 3-6 months of follow-up, patients completed questionnaires: all patients (n = 31) were highly satisfied and stated that they would like to use this FGM device in the future. In addition, the patients unanimously stated that it was easy to use and painless.

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Figure 1.

Mean HbA1C during follow-up.

The physicians in each center stated that this FGM device, and particularly the AGP presentation of data, was an outstanding tool, enabling better and easier control of glucose levels.

In conclusion, use of this FGM device remarkably improved glucose control in our cohort of patients with difficult-to-control diabetes. Further larger controlled studies are warranted to examine closely the effect on glucose variability, known to be an important contributor to diabetic complications.