Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes

Victoria Tyndall; Roland H. Stimson; Nicola N. Zammitt; Stuart A. Ritchie; John A. Mcknight; Anna R. Dover; Fraser W. Gibb

doi:10.1007/s00125-019-4894-1

Marked improvement in HbA_1c following commencement of flash glucose monitoring in people with type 1 diabetes

Victoria Tyndall, Roland H. Stimson, Nicola N. Zammitt, Stuart A. Ritchie, John A. Mcknight, Anna R. Dover, Fraser W. Gibb

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

AIMS/HYPOTHESIS: Minimal evidence supports the efficacy of flash monitoring in lowering HbA_1c. We sought to assess the impact of introducing flash monitoring in our centre.

METHODS: We undertook a prospective observational study to assess change in HbA_1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.

RESULTS: Those with baseline HbA_1c ≥58 mmol/mol (7.5%) achieved a median −7 mmol/mol (interquartile range [IQR] −13 to −1) (0.6% [−1.2 to −0.1]%) change in HbA_1c (p < 0.001). The percentage achieving HbA_1c <58 mmol/mol rose from 34.2% to 50.9% (p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA_1c across a similar timescale (p = 0.508). Higher HbA_1c (p < 0.001), younger age at diagnosis (p = 0.003) and lower social deprivation (p = 0.024) were independently associated with an HbA_1cfall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day (p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring (p = 0.043).

CONCLUSIONS/INTERPRETATION: Flash monitoring is associated with significant improvements in HbA_1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.

Original language	English
Pages (from-to)	1349–1356
Journal	Diabetologia
Volume	62
Issue number	8
Early online date	9 Jun 2019
DOIs	https://doi.org/10.1007/s00125-019-4894-1
Publication status	Published - Aug 2019

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Tyndall V. Diabetologia 2019. Flash glucose monitoring and outcomes.Final published version, 768 KBLicence: Creative Commons: Attribution (CC-BY)

Roland Stimson
- Roland.Stimsoned.acuk
- Deanery of Clinical Sciences - Personal Chair of Endocrinology
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active

Cite this

@article{6c19fb94f1e2482cbf5e81d146aacad2,

title = "Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes",

abstract = "AIMS/HYPOTHESIS: Minimal evidence supports the efficacy of flash monitoring in lowering HbA1c. We sought to assess the impact of introducing flash monitoring in our centre.METHODS: We undertook a prospective observational study to assess change in HbA1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.RESULTS: Those with baseline HbA1c ≥58 mmol/mol (7.5%) achieved a median −7 mmol/mol (interquartile range [IQR] −13 to −1) (0.6% [−1.2 to −0.1]%) change in HbA1c (p < 0.001). The percentage achieving HbA1c <58 mmol/mol rose from 34.2% to 50.9% (p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA1c across a similar timescale (p = 0.508). Higher HbA1c (p < 0.001), younger age at diagnosis (p = 0.003) and lower social deprivation (p = 0.024) were independently associated with an HbA1c fall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day (p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring (p = 0.043).CONCLUSIONS/INTERPRETATION: Flash monitoring is associated with significant improvements in HbA1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.",

author = "Victoria Tyndall and Stimson, {Roland H.} and Zammitt, {Nicola N.} and Ritchie, {Stuart A.} and Mcknight, {John A.} and Dover, {Anna R.} and Gibb, {Fraser W.}",

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language = "English",

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T1 - Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes

AU - Tyndall, Victoria

AU - Stimson, Roland H.

AU - Zammitt, Nicola N.

AU - Ritchie, Stuart A.

AU - Mcknight, John A.

AU - Dover, Anna R.

AU - Gibb, Fraser W.

PY - 2019/8

Y1 - 2019/8

N2 - AIMS/HYPOTHESIS: Minimal evidence supports the efficacy of flash monitoring in lowering HbA1c. We sought to assess the impact of introducing flash monitoring in our centre.METHODS: We undertook a prospective observational study to assess change in HbA1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.RESULTS: Those with baseline HbA1c ≥58 mmol/mol (7.5%) achieved a median −7 mmol/mol (interquartile range [IQR] −13 to −1) (0.6% [−1.2 to −0.1]%) change in HbA1c (p < 0.001). The percentage achieving HbA1c <58 mmol/mol rose from 34.2% to 50.9% (p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA1c across a similar timescale (p = 0.508). Higher HbA1c (p < 0.001), younger age at diagnosis (p = 0.003) and lower social deprivation (p = 0.024) were independently associated with an HbA1c fall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day (p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring (p = 0.043).CONCLUSIONS/INTERPRETATION: Flash monitoring is associated with significant improvements in HbA1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.

AB - AIMS/HYPOTHESIS: Minimal evidence supports the efficacy of flash monitoring in lowering HbA1c. We sought to assess the impact of introducing flash monitoring in our centre.METHODS: We undertook a prospective observational study to assess change in HbA1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.RESULTS: Those with baseline HbA1c ≥58 mmol/mol (7.5%) achieved a median −7 mmol/mol (interquartile range [IQR] −13 to −1) (0.6% [−1.2 to −0.1]%) change in HbA1c (p < 0.001). The percentage achieving HbA1c <58 mmol/mol rose from 34.2% to 50.9% (p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA1c across a similar timescale (p = 0.508). Higher HbA1c (p < 0.001), younger age at diagnosis (p = 0.003) and lower social deprivation (p = 0.024) were independently associated with an HbA1c fall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day (p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring (p = 0.043).CONCLUSIONS/INTERPRETATION: Flash monitoring is associated with significant improvements in HbA1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.

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DO - 10.1007/s00125-019-4894-1

M3 - Article

SN - 0012-186X

VL - 62

SP - 1349

EP - 1356

JO - Diabetologia

JF - Diabetologia

IS - 8

ER -

Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes

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Marked improvement in HbA_1c following commencement of flash glucose monitoring in people with type 1 diabetes