Flash glucose monitoring nearly halves DKA rates in type 1, type 2 diabetes
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Among users of a flash glucose monitoring system, rates of diabetic ketoacidosis dropped by 52% for those with type 1 diabetes and by 47% for those with type 2 diabetes, according to data from the RELIEF study.
“Use of flash glucose monitoring — with a sensor rather than with strips — is associated with a drop of the incidence of a major, potentially lethal, acute complication of diabetes in insulin-treated people, [diabetic ketoacidosis],” Ronan Roussel, MD, PhD, chief of the division of endocrinology, diabetes and nutrition at Bichat Hospital in Paris, told Healio. “The magnitude of the protection potentially afforded by the device is huge.”
The Abbott FreeStyle Libre flash continuous glucose monitoring system includes a glucose sensor worn on the upper arm and a touchscreen reader device that displays current glucose level and recent trend data. Use of the system was reimbursed in France beginning on June 1, 2017, for people using at least three daily insulin injections or an insulin pump, Roussel said during a presentation at the American Diabetes Association Scientific Sessions.
Roussel and colleagues analyzed data from the French exhaustive nationwide reimbursement claims database on 33,203 residents of France with type 1 diabetes and 40,955 with type 2 diabetes who used the flash monitoring system between August and December 2017. Data included the number of daily glucose test strips individuals used before the study period and reimbursement for ICD-10 codes for diabetic ketoacidosis (DKA) from 1 year before to 1 year after first use of the FreeStyle Libre.
Overall, hospitalization rates for DKA declined by 52% and 47% for people with type 1 and type 2 diabetes, respectively. Reductions were most dramatic for people who had rarely monitored their blood glucose levels previously — those who had used no test strips — at 60% for those with type 1 diabetes and 51% with type 2 diabetes, and for those who had used more than five daily test strips at 59% for type 1 diabetes and 52% for type 2 diabetes. Additionally, decreases in DKA hospitalization rates were observed among both those using multiple daily injections and those using an insulin pump.
“It is plausible that the use of the FreeStyle Libre system allowed people to detect and limit persistent hyperglycemia and, subsequently, ketoacidosis,” Roussel said during the presentation.
“The adoption of the system is already good, but should continue to increase,” Roussel told Healio. “Stakeholders should consider reimbursement of the device if not covered yet, because the reduction of the incidence of DKA has clinical and potentially economic benefits through reduced cost of emergency care.”
Perspective
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Marina Basina, MD
Management for both type 1 and type 2 diabetes is demanding from many perspectives for the patients themselves and their families: psychologically, medically and financially. Per CDC report, 34.2 million Americans have diabetes, and there is a significant increase in newly diagnosed cases of both type 1 and type 2 diabetes among U.S. youths. In 2016 there were 16 million emergency room visits related to diabetes and 209,000 hospitalizations for hyperglycemic crises, which was a crude rate of 9.1 per 1,000 adults with diabetes. Diabetes Ketoacidosis is a diabetes emergency associated with high morbidity. It is a hallmark in individuals with type 1 diabetes but is also increasingly recognized in patients with type 2 diabetes. In a recent nationwide analysis of health care utilization of DKA in the U.S., the mean hospital charges increased significantly from $18,987 (after adjusting for inflation) per admission in 2003 to $26,566 per admission in 2014 (Desai D, et al. Diabetes Care. 2018;doi:10.2337/dc17-1379). This resulted in increase in the aggregate national bill for DKA hospitalizations from $2.2 billion in 2013 to $5.1 billion in 2014. Therefore, strategies for DKA prevention are urgently needed.
In the last 20 years, the use of continuous glucose monitoring devices revolutionized the way diabetes is managed, and is increasingly becoming an essential part of not only type 1 diabetes treatment, but also of type 2 diabetes.
The RELIEF study, analyzed the data on the use of FreeStyle Flash Libre CGM per the French nationwide reimbursement claims database in individuals with type 1 and type 2 diabetes. It demonstrated that the rate of DKA hospitalizations declined by 52% in type 1 diabetes and 47% in type 2 diabetes among CGM users compared to those who used test strips and glucometers for glucose monitoring. A very important finding to highlight in this study was that this impressive decline was almost the same among those individuals who used no test strips and the ones who used up to 5 test strips per day. Also, it was great to see that over 50% of the CGM users were patients with type 2 diabetes. The data is highly suggestive that the use of CGM can be potentially a cost-effective tool in diabetes management in the long run and needs to be more widely covered by payers.
Conducting a cost-saving analysis, even using the retrospective data, would be the next step as well as collecting patient quality of life surveys on the use of CGM systems, ease of obtaining prescriptions and supplies, time spent on phone calls with pharmacies and vendors, out-of-pocket costs, and reducing the burden of diabetes in a large scale of both type 1 and type 2 diabetes.
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Roussel R. 68-OR. Presented at: American Diabetes Association Scientific Sessions; June 12-16, 2020 (virtual meeting).
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