CGM scanned only intermittently yields ‘stable’ quality of life, reduces hypoglycemia vs. fingerstick tests
Click Here to Manage Email Alerts
When adults with type 1 diabetes use an intermittently scanned continuous glucose monitor, they do not have to sacrifice quality of life to experience benefits, such as fewer hypoglycemia episodes and hospital visits, according to findings published in Diabetes Care.
“We saw a considerable decline in number of people reporting severe hypoglycemia or hypoglycemic coma. Probably related, the number of people who missed work also decreased, which represents an important advantage on both [an] individual and societal level,” Pieter Gillard, MD, PhD, assistant head of clinic in the department of endocrinology at University Hospitals Leuven and associate professor at the University of Leuven in Belgium, told Healio. “[The] data show that the real-life use of intermittently scanned CGM in the context of wide reimbursement and structured education can result in clinical benefits and direct and indirect cost savings. This can be helpful when deciding on reimbursement of intermittently scanned CGM.”
Gillard and colleagues assessed changes in self-reported quality of life as well as episodes of hypoglycemia and ketoacidosis, changes in HbA1c and the number of missed work days among 1,913 adults in Belgium with type 1 diabetes who used an intermittently scanned CGM (mean age, 45.8 years; 46.1% women). The Abbott Freestyle Libre CGM did not include active sensor scanning or alarms for high or low blood glucose levels, required no calibration, and had a sensor life of 14 days. Questionnaires were completed at 6 and 12 months and compared with values recorded at baseline. The researchers also used self-reports and medical records to access HbA1c, number of hospital visits, episodes of hypoglycemia and ketoacidosis, HbA1c and missed workdays at the same intervals across a 1-year period.
At 12 months, the researchers noted an “overall stable” reading in most quality of life measures. Meanwhile, 2.2% of participants experienced hypoglycemia or ketoacidosis that required a hospital visit at 12 months compared with 3.3% of participants who had experienced such events at baseline (P = .031). In addition, 7.8% of participants had hypoglycemia that required help from another person at 12 months compared with 14.6% at baseline (P < .0001). The researchers also found that 1.1% of participants experienced a hypoglycemic coma at 12 months compared with 2.7% of participants at baseline (P = .001). The analysis further revealed that 2.9% of participants missed work for a diabetes-related reason at 12 months vs. 5.8% at baseline (P < .0001).
There were also reductions in the percentage of participants who experienced level 1 hypoglycemia (HbA1c between 54 mg/dL and 70 mg/dL; 4.5% vs. 5.1%; P < .0001) or level 2 hypoglycemia (HbA1c 54 mg/dL; 3.5% vs. 4%; P < .0001) when comparing 12-month data with baseline data, while the researchers noted that HbA1c “return[ed] to the baseline value after 12 months.”
“This observation, combined with the fact that intermittently scanned CGM users rated the system as much more convenient than classical finger-sticking, shows that this technology can be successfully implemented trough specialized diabetes centers,” Gillard said.
The researchers also noted that 1% of participants discontinued the device due to skin reactions, which affected 11% of participants.
“Recently, two causative allergens in the adhesive sensor patch have been identified, namely isobornyl acrylate and N,N-dimethylacrylamide,” the researchers wrote. “The observation that skin reactions could appear early as well as later in the first year seems to indicate that cumulatively, > 11% of people will suffer some kind of skin reaction while using the device. This is in line with the scarce literature on the prevalence of intermittently scanned CGM-related skin allergy.” – by Phil Neuffer
For more information:
Pieter Gillard, MD, PhD, can be reached at pieter.gillard@uzleuven.be.
Disclosures: Gillard reports he has served on the advisory panel for Bayer, Boehringer Ingelheim, Janssen Pharmaceuticals, Medtronic, Novo Nordisk, Roche and Sanofi, and as a speaker for Abbott Laboratories, Bayer, Boehringer Ingelheim, Dexcom, Medtronic, Merck Sharp & Dohme and Roche, and was given travel support by A. Menarini Diagnostics, Medtronic, Roche and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to Top
This is a well done, observational study proving what our patients with diabetes have been telling us since intermittently scanned CGM (isCGM) devices have come on the market — that they are associated with greater treatment satisfaction compared to using fingersticks for glucose measurements. Additionally, patients prefer to use isCGM compared with fingersticks. Other patient-reported outcomes, such as scores on the SF-36, PAID-SF and HFS-Worry [questionnaires], did not change.
Although secondary outcomes such as HbA1C (average of ~7.8%) and time in range did not improve, there were improvements in some metrics. These included a reduction in admissions for severe hypoglycemia and/or ketoacidosis and a reduction in time spent in a hypoglycemic range (level 1 and level 2) compared with baseline.
The patients in this study were followed by multidisciplinary teams in specialized diabetes centers in Belgium — patients with access to the best care and resources available. The fact that introducing isCGM did not improve HbA1c values or time-in-range speaks to the difficulties in managing type 1 diabetes. Clearly more is necessary to help improve glycemic outcomes further, which may come, in part, from hybrid closed-loop systems and other advances in technology. However, improving patient treatment satisfaction and replacing fingerstick testing with CGM makes life better for patients with type 1 diabetes, which is an important outcome and one well worth supporting.
Read more about
Click Here to Manage Email Alerts