Impact of flash glucose monitoring on glucose control and hospitalization in type 1 diabetes: A nationwide cohort study.
Diabetes mellitus type 1
diabetic ketoacidosis
flash
glucose monitoring
hospitalization
hypoglycemia
Journal
Diabetes/metabolism research and reviews
ISSN: 1520-7560
Titre abrégé: Diabetes Metab Res Rev
Pays: England
ID NLM: 100883450
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
04
03
2020
revised:
21
04
2020
accepted:
12
05
2020
pubmed:
30
5
2020
medline:
27
1
2022
entrez:
30
5
2020
Statut:
ppublish
Résumé
We evaluated the impact of flash continuous glucose monitoring (FCGM) on glycemic control and healthcare burden in a large real-world cohort of patients with type 1 diabetes (T1D) initiating FCGM technology. In this retrospective cohort study, we included adults (age ≥18 years) with T1D from a large Health Maintenance Organization in Israel, who initiated FCGM during 2018. Primary outcomes included change in HbA1c ≥3 months following FCGM commencement and change in rate of internal-medicine hospitalization. Additional outcomes included changes in glucose test strip purchases, diabetes related outpatient health care visits and hospitalization for diabetic ketoacidosis (DKA) and/or severe hypoglycemia. The study included 3490 patients, followed for a median of 14 (inter-quartile range 11-15) months after FCGM commencement. Among 2682 patients with an HbA1c measured both at baseline and ≥3 months after FCGM initiation, average HbA1c declined from 8.1% ± 1.46% to 7.9% ± 1.31% (P < .001) at first measurement and was maintained during follow up. Specifically, in those with HbA1c ≥8%, a mean decline of 0.5% (P < .001) was observed. A clinically significant HbA1c reduction of ≥0.5% was experienced by 25.5% of the patients. The rate of internal medicine hospitalization, visits to primary care, or visits to endocrine/diabetes specialists in the period following FCGM commencement vs the 6 months prior was significantly reduced (P < .001). Hospitalization for DKA and/or hypoglycemia declined as well (P = .004). FCGM was associated with significant and durable improvement in glycemic control as well as reduced consumption of healthcare services.
Sections du résumé
BACKGROUND
We evaluated the impact of flash continuous glucose monitoring (FCGM) on glycemic control and healthcare burden in a large real-world cohort of patients with type 1 diabetes (T1D) initiating FCGM technology.
METHODS
In this retrospective cohort study, we included adults (age ≥18 years) with T1D from a large Health Maintenance Organization in Israel, who initiated FCGM during 2018. Primary outcomes included change in HbA1c ≥3 months following FCGM commencement and change in rate of internal-medicine hospitalization. Additional outcomes included changes in glucose test strip purchases, diabetes related outpatient health care visits and hospitalization for diabetic ketoacidosis (DKA) and/or severe hypoglycemia.
RESULTS
The study included 3490 patients, followed for a median of 14 (inter-quartile range 11-15) months after FCGM commencement. Among 2682 patients with an HbA1c measured both at baseline and ≥3 months after FCGM initiation, average HbA1c declined from 8.1% ± 1.46% to 7.9% ± 1.31% (P < .001) at first measurement and was maintained during follow up. Specifically, in those with HbA1c ≥8%, a mean decline of 0.5% (P < .001) was observed. A clinically significant HbA1c reduction of ≥0.5% was experienced by 25.5% of the patients. The rate of internal medicine hospitalization, visits to primary care, or visits to endocrine/diabetes specialists in the period following FCGM commencement vs the 6 months prior was significantly reduced (P < .001). Hospitalization for DKA and/or hypoglycemia declined as well (P = .004).
CONCLUSIONS
FCGM was associated with significant and durable improvement in glycemic control as well as reduced consumption of healthcare services.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3355Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Federation ID. IDF Diabetes Atlas, 8th edn. 2017; http://www.diabetesatlas.org.
Bullard KMC, Cowie CC, Lessem SE, et al. Prevelence of diagnosed Diabetes in adults by diabetes type - United States, 2016. Morb Mortal Wkly Rep. 2016;67(12):359-361.
Lind M, Svensson AM, Kosiborod M, et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014;371(21):1972-1982.
Groop PH, Thomas M, Feodoroff M, Forsblom C, Harjutsalo V, FinnDiane Study G. Excess mortality in patients with type 1 diabetes without albuminuria-separating the contribution of early and late risks. Diabetes Care. 2018;41(4):748-754.
Gagnum V, Stene LC, Leivestad T, Joner G, Skrivarhaug T. Long-term mortality and end-stage renal disease in a type 1 diabetes population diagnosed at age 15-29 years in Norway. Diabetes Care. 2017;40(1):38-45.
Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-2653.
The Diabetes Control and Complications Trial Research Group et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986.
Rawshani A, Rawshani A, Franzen S, et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017;376(15):1407-1418.
Minder AE, Albrecht D, Schafer J, Zulewski H. Frequency of blood glucose testing in well educated patients with diabetes mellitus type 1: how often is enough? Diabetes Res Clin Pract. 2013;101(1):57-61.
American Diabetes Association. 7. Diabetes technology: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S71-S80.
Miller KM, Beck RW, Bergenstal RM, et al. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care. 2013;36(7):2009-2014.
Pfutzner A, Weissmann J, Mougiakakou S, Daskalaki E, Weis N, Ziegler R. Glycemic variability is associated with frequency of blood glucose testing and bolus: post hoc analysis results from the ProAct study. Diabetes Technol Ther. 2015;17(6):392-397.
Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD. Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database. BMJ. 1999;319(7202):83-86.
Shen Y, Zhu W, Lu L, et al. Contribution of structured self-monitoring of blood glucose to self-efficacy in poorly controlled diabetes patients in China. Diabetes Metab Res Rev. 2019;35(1):e3067.
Hortensius J, Kars MC, Wierenga WS, Kleefstra N, Bilo HJ, van der Bijl JJ. Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: a qualitative study. BMC Public Health. 2012;12:167.
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Prefer Adherence. 2014;8:237-246.
Ward JE, Stetson BA, Mokshagundam SP. Patient perspectives on self-monitoring of blood glucose: perceived recommendations, behaviors and barriers in a clinic sample of adults with type 2 diabetes. J Diabetes Metab Disord. 2015;14:43.
Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40(12):1631-1640.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kroger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388(10057):2254-2263.
Tyndall V, Stimson RH, Zammitt NN, et al. Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes. Diabetologia. 2019;62(8):1349-1356.
Dover AR, Stimson RH, Zammitt NN, Gibb FW. Flash glucose monitoring improves outcomes in a type 1 diabetes clinic. J Diabetes Sci Technol. 2017;11(2):442-443.
Campbell FM, Murphy NP, Stewart C, Biester T, Kordonouri O. Outcomes of using flash glucose monitoring technology by children and young people with type 1 diabetes in a single arm study. Pediatr Diabetes. 2018;19(7):1294-1301.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.
Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther. 2019;21(2):66-72.
Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled Trial. Diabetes Ther. 2017;8(1):55-73.
Fokkert M, van Dijk P, Edens M, et al. Improved well-being and decreased disease burden after 1-year use of flash glucose monitoring (FLARE-NL4). BMJ Open Diabetes Res Care. 2019;7(1):e000809.
Akirov A, Diker-Cohen T, Masri-Iraqi H, Shimon I. High glucose variability increases mortality risk in hospitalized patients. J Clin Endocrinol Metab. 2017;102(7):2230-2241.
Takao T, Matsuyama Y, Yanagisawa H, Kikuchi M, Kawazu S. Association between HbA1c variability and mortality in patients with type 2 diabetes. J Diabetes Complicat. 2014;28(4):494-499.
Critchley JA, Carey IM, Harris T, DeWilde S, Cook DG. Variability in glycated hemoglobin and risk of poor outcomes among people with type 2 diabetes in a large primary care cohort Study. Diabetes Care. 2019;42(12):2237-2246.