J Korean Diabetes.  2020 Dec;21(4):184-190. 10.4093/jkd.2020.21.4.184.

Use of Flash Glucose Monitoring in Patients on Intensive Insulin Treatment

• Moon JS

• KMID: 2511883
• DOI: http://doi.org/10.4093/jkd.2020.21.4.184

Abstract

Glucose monitoring is the key component for successful management of patients with diabetes. Though glycated hemoglobin (HbA1c) and self-monitoring of blood glucose by finger pricking are effective methods for assessing glucose exposure, they provide limited information about glycemic variability. Flash glucose monitoring (FGM) is a factory-calibrated, sensor-based technology worn on the body as a small-sized patch that has a lifetime up to 14 days. On-demand sensor scanning provides patients with comprehensive glucose data, including current glucose level, which is updated every minute, historical glucose readings from the last 8 hours, and trend arrows. Also, ambulatory glucose profiles can be shared with the physician and caregivers. Early clinical studies demonstrated relevant benefits of FGM in patients with type 1 and type 2 diabetes in terms of fewer hypoglycemic episodes but did not differ in metrics of glycemic control such as HbA1c or time-in-range. Another study highlighted the importance of intensive and structured patient education for maximizing the benefits of FGM use. These results suggest that proper FGM use improves the quality of life as well as glycemic control in patients on intensive insulin treatment.

Keyword

Blood; Diabetes mellitus; type 1; Diabetes mellitus; type 2; Glucose self-monitoring; Self care

Reference

1. Bergenstal RM. Glycemic variability and diabetes complications: does it matter? Simply put, there are better glycemic markers! Diabetes Care. 2015. 38:1615–21.

2. Chico A., Aguilera E., Ampudia-Blasco FJ., Bellido V., Cardona-Hernández R., Escalada FJ, et al. Clinical approach to flash glucose monitoring: an expert recommendation. J Diabetes Sci Technol. 2020. 14:155–64.

3. Cappon G., Vettoretti M., Sparacino G., Facchinetti A. Continuous glucose monitoring sensors for diabetes management: a review of technologies and applications. Diabetes Metab J. 2019. 43:383–97.

4. Chehregosha H., Khamseh ME., Malek M., Hosseinpanah F., Ismail-Beigi F. A view beyond HbA1c: role of continuous glucose monitoring. Diabetes Ther. 2019. 10:853–63.

5. Helleputte S., De Backer T., Lapauw B., Shadid S., Celie B., Van Eetvelde B, et al. The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: a systematic review. Diabetes Metab Res Rev. 2020. 36:e3301.

6. Maiorino MI., Signoriello S., Maio A., Chiodini P., Bellastella G., Scappaticcio L, et al. Effects of continuous glucose monitoring on metrics of glycemic control in diabetes: a systematic review with meta-analysis of randomized controlled trials. Diabetes Care. 2020. 43:1146–56.

7. Longo M., Petrizzo M., Esposito K., Maiorino MI. Glucose monitoring in diabetes: a suggested algorithm to choice the best treatment option. Diabetes Res Clin Pract. 2020. 165:108242.

8. Ang E., Lee ZX., Moore S., Nana M. Flash glucose monitoring (FGM): a clinical review on glycaemic outcomes and impact on quality of life. J Diabetes Complications. 2020. 34:107559.

9. Ajjan RA., Cummings MH., Jennings P., Leelarathna L., Rayman G., Wilmot EG. Accuracy of flash glucose monitoring and continuous glucose monitoring technologies: Implications for clinical practice. Diab Vasc Dis Res. 2018. 15:175–84.

10. Unger J., Kushner P., Anderson JE. Practical guidance for using the FreeStyle Libre flash continuous glucose monitoring in primary care. Postgrad Med. 2020. 132:305–13.

11. Abbott Diabetes Care. Overview of ascorbic acid & salicylic acid interference for FreeStyle Libre Flash Glucose Monitoring System. Available from:. https://provider.myfreestyle.com/faq.html.

12. Oskarsson P., Antuna R., Geelhoed-Duijvestijn P., Krger J., Weitgasser R., Bolinder J. Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial. Diabetologia. 2018. 61:539–50.

13. 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. 8:55–73.

14. Evans M., Welsh Z., Ells S., Seibold A. The impact of flash glucose monitoring on glycaemic control as measured by HbA1c: a meta-analysis of clinical trials and real-world observational studies. Diabetes Ther. 2020. 11:83–95.

15. Hermanns N., Ehrmann D., Schipfer M., Kröger J., Haak T., Kulzer B. The impact of a structured education and treatment programme (FLASH) for people with diabetes using a flash sensor-based glucose monitoring system: results of a randomized controlled trial. Diabetes Res Clin Pract. 2019. 150:111–21.

16. Kudva YC., Ahmann AJ., Bergenstal RM., Gavin JR 3rd., Kruger DF., Midyett LK, et al. Approach to using trend arrows in the FreeStyle Libre Flash Glucose Monitoring Systems in adults. J Endocr Soc. 2018. 2:1320–37.

17. Ajjan RA., Cummings MH., Jennings P., Leelarathna L., Rayman G., Wilmot EG. Optimising use of rate-of-change trend arrows for insulin dosing decisions using the FreeStyle Libre flash glucose monitoring system. Diab Vasc Dis Res. 2019. 16:3–12.