Intermittent-scanned CGM with low glucose alarms reduces hypoglycemia in type 1 diabetes
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Switching to intermittent-scanned continuous glucose monitors with low glucose alarms reduced hypoglycemia frequency among middle-aged adults with type 1 diabetes, researchers reported.
“Only one prospective study by Boscari et al demonstrated a decrease in hypoglycemia events after switching from Free Style Libre 1 to Free Style Libre 2 with alarms,” Philippe Oriot, MD, from the department of diabetology and endocrinology at the Mouscron Hospital Center, Belgium, and colleagues wrote. “Currently, there are no real-life studies on the effectiveness of FreeStyle Libre 2 with continuous alarms in reducing hypoglycemia compared with FreeStyle Libre 1.”
This single-center observational study, published in the Journal of Diabetes and Its Complications, included 108 adults (mean age, 58.2 years; 57.4% men) with type 1 diabetes who were fearful of hypoglycemia, prone to hypoglycemia unawareness and/or experienced severe hypoglycemia while using intermittent-scanned CGM FreeStyle Libre 1 (Abbott). Participants were switched to intermittent-scanned CGM FreeStyle Libre 2 (Abbott) with individually programmable low glucose alarms.
The primary outcome was changes in the percentage of time below the ranges of less than 70 mg/dL and less than 54 mg/dL after 12 weeks on FreeStyle Libre 2 compared with FreeStyle Libre 1. Secondary endpoints included changes in the percentage of time in the range of 70 mg/dL to 180 mg/dL, percentage of time above the range higher than 180 mg/dL, mean interstitial glucose, glycemic management indicator, interstitial glucose coefficient of variation, HbA1c and sensor’s scans per day.
Researchers observed 37% of individuals with a Clarke hypoglycemia awareness score of four or more, and 17.5% of individuals had severe hypoglycemia history. Overall, the median low glucose alarm threshold was 70 mg/dL.
The percentage of time below the range of less than 70 mg/dL decreased from 4.5% during the first 12 weeks on FreeStyle Libre 2 to 2.3% during the last 12 weeks on FreeStyle Libre 1 (P < .001). The percentage of time below the range of less than 54 mg/dL decreased from 1.4% on FreeStyle Libre 2 to 0.3% on FreeStyle Libre 1 (P < .001). In addition, the percentage of time in the range of 70 mg/dL to 180 mg/dL (51.5% vs. 52.9%; P = .13) and the percentage of time above the range of more than 180 mg/dL (43.8% vs. 44.7%; P = .5) were not statistically significant between FreeStyle Libre 2 and FreeStyle Libre 1. Interstitial glucose coefficient of variation decreased with FreeStyle Libre 1 from 39.4% to 37.9% (P < .001).
Individuals who were at risk for hypoglycemia experienced a decrease in hypoglycemia incidence at less than 70 mg/dL and less than 54 mg/dL (P < .0001). They also reported high satisfaction with hypoglycemia alarms, and all individuals opted to continue using individual alarms beyond the study period.
“These individuals also have comorbidities, such as cognitive loss, that interfere with the prompt identification and/or appropriate treatment of hypoglycemia,” the researchers wrote. “Therefore, FreeStyle Libre 2 with hypoglycemic alarm should be useful to decrease morbidity and mortality associated with hypoglycemia in insulin-treated adults with diabetes.”
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