Adults with uncontrolled type 1 diabetes saw a benefit when using intermittently scanned continuous glucose monitoring (CGM), the randomized FLASH-UK trial showed.
Lalantha Leelarathna, Ph.D., of the Manchester Royal Infirmary in England, and colleagues found that using an intermittently scanned CGM, which has optional alarms for high and low blood glucose levels set by the user, reduced HbA1c levels compared to traditional fingerstick testing, with an adjusted mean between-group difference of -0.5 percentage points (95% CI -0.7 to -0.3, P0.001) at 24 weeks.
Specifically, the mean baseline HbA1c level was 8.7±0.9% in the intervention group and 8.5±0.8% in the usual-care group, which decreased to 7.9±0.8% and 8.3±0.9%, respectively, they noted in the New England Journal of Medicine.
“The improvements in glycated hemoglobin levels in the current trial are broadly similar to those in trials of real-time continuous glucose monitoring as compared with participants’ monitoring of their blood glucose levels with the use of fingerstick testing,” Leelarathna and team wrote.
Additionally, users of the intermittently scanned CGM spent 130 minutes per day—or 9% more time—than those using fingersticks in the target glycemic range (70–180 mg/dL). Additionally, they spent 43 fewer minutes per day, or 3% less time, in hypoglycemia (blood sugar < 70 mg/dL), and 86 fewer minutes per day, or 6% less time, or 180 mg/dL or higher, respectively. The average daily total insulin dose was only reduced by 0.5 units for the CGM group, but overall there was no statistically significant difference between the groups. It’s important to highlight that CGM users saw a significant increase in treatment satisfaction as determined by the Diabetes Treatment Satisfaction Questionnaire.
CGM users noticed a reduction in pain compared to those using standard fingersticks. Users of the CGM saw a 7% rise in their satisfaction levels when compared to those who used conventional fingersticks. Both groups saw modest rates of adverse events, with the exception of one incidence of diabetic ketoacidosis in the CGM group and two cases of severe hypoglycemia and two ketosis events that did not require hospitalisation in the fingerstick group. A cutaneous reaction to the sensor was also reported by one CGM user.
156 individuals — 78 in each group — with type 1 diabetes and a baseline HbA1c between 7.5% and 11% participated in this multicenter open-label research. Participants had to be at least 16 years old to participate, and their average age was 44. Participants were mostly Caucasian. Abbott’s FreeStyle Libre 2, which was first approved by the FDA for use in patients 4 years of age and older, was utilised by the participants.
The FDA also approved the newest FreeStyle Libre 3 for these patients by May of this year. The free mobile app or handheld gadget that displays both real-time and historical glucose data is connected to the glucose sensor, which is worn on the arm for 14 days.
While 26% of those in the CGM group and 31% of those in the fingerstick groups employed a continuous subcutaneous insulin infusion pump, both groups’ participants injected insulin many times per day on average. Over a 24-hour period, there were an average of 1.3 sensor scans at night and 11 during the day. On the use and setting of alarms, no data were gathered. Leelarathna and the colleagues said they were unable to determine whether these advantages were brought about by the sensor by itself.