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Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls

AIMS/HYPOTHESIS: The aim of this work was to evaluate changes in glycaemic control (HbA(1c)) and rates of severe hypoglycaemia over a 2 year period after initiation of flash glucose monitoring (FM) in type 1 diabetes. METHODS: Using data from the Swedish National Diabetes Registry, 14,372 adults wit...

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Autores principales: Nathanson, David, Svensson, Ann-Marie, Miftaraj, Mervete, Franzén, Stefan, Bolinder, Jan, Eeg-Olofsson, Katarina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187189/
https://www.ncbi.nlm.nih.gov/pubmed/33774713
http://dx.doi.org/10.1007/s00125-021-05437-z
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author Nathanson, David
Svensson, Ann-Marie
Miftaraj, Mervete
Franzén, Stefan
Bolinder, Jan
Eeg-Olofsson, Katarina
author_facet Nathanson, David
Svensson, Ann-Marie
Miftaraj, Mervete
Franzén, Stefan
Bolinder, Jan
Eeg-Olofsson, Katarina
author_sort Nathanson, David
collection PubMed
description AIMS/HYPOTHESIS: The aim of this work was to evaluate changes in glycaemic control (HbA(1c)) and rates of severe hypoglycaemia over a 2 year period after initiation of flash glucose monitoring (FM) in type 1 diabetes. METHODS: Using data from the Swedish National Diabetes Registry, 14,372 adults with type 1 diabetes with a new registration of FM during 2016–2017 and with continued FM for two consecutive years thereafter, and 7691 control individuals using conventional self-monitoring of blood glucose (SMBG) during the same observation period, were included in a cohort study. Propensity sores and inverse probability of treatment weighting (IPTW) were used to balance FM users with SMBG users. Changes in HbA(1c) and events of severe hypoglycaemia were compared. RESULTS: After the start of FM, the difference in IPTW change in HbA(1c) was slightly greater in FM users compared with the control group during the follow-up period, with an estimated mean absolute difference of −1.2 mmol/mol (−0.11%) (95% CI −1.64 [−0.15], −0.75 [−0.07]; p < 0.0001) after 15–24 months. The change in HbA(1c) was greatest in those with baseline HbA(1c) ≥70 mmol/mol (8.5%), with the estimated mean absolute difference being −2.5 mmol/mol (−0.23%) (95% CI −3.84 [−0.35], −1.18 [−0.11]; p = 0.0002) 15–24 months post index. The change was also significant in the subgroups with initial HbA(1c) ≤52 mmol/mol (6.9%) and 53–69 mmol/mol (7.0–8.5%). Risk of severe hypoglycaemic episodes was reduced by 21% for FM users compared with control individuals using SMBG (OR 0.79 [95% CI 0.69, 0.91]; p = 0.0014)]. CONCLUSIONS/INTERPRETATION: In this large cohort, the use of FM was associated with a small and sustained improvement in HbA(1c), most evident in those with higher baseline HbA(1c) levels. In addition, FM users experienced lower rates of severe hypoglycaemic events compared with control individuals using SMBG for self-management of glucose control. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-021-05437-z.
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spelling pubmed-81871892021-06-11 Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls Nathanson, David Svensson, Ann-Marie Miftaraj, Mervete Franzén, Stefan Bolinder, Jan Eeg-Olofsson, Katarina Diabetologia Article AIMS/HYPOTHESIS: The aim of this work was to evaluate changes in glycaemic control (HbA(1c)) and rates of severe hypoglycaemia over a 2 year period after initiation of flash glucose monitoring (FM) in type 1 diabetes. METHODS: Using data from the Swedish National Diabetes Registry, 14,372 adults with type 1 diabetes with a new registration of FM during 2016–2017 and with continued FM for two consecutive years thereafter, and 7691 control individuals using conventional self-monitoring of blood glucose (SMBG) during the same observation period, were included in a cohort study. Propensity sores and inverse probability of treatment weighting (IPTW) were used to balance FM users with SMBG users. Changes in HbA(1c) and events of severe hypoglycaemia were compared. RESULTS: After the start of FM, the difference in IPTW change in HbA(1c) was slightly greater in FM users compared with the control group during the follow-up period, with an estimated mean absolute difference of −1.2 mmol/mol (−0.11%) (95% CI −1.64 [−0.15], −0.75 [−0.07]; p < 0.0001) after 15–24 months. The change in HbA(1c) was greatest in those with baseline HbA(1c) ≥70 mmol/mol (8.5%), with the estimated mean absolute difference being −2.5 mmol/mol (−0.23%) (95% CI −3.84 [−0.35], −1.18 [−0.11]; p = 0.0002) 15–24 months post index. The change was also significant in the subgroups with initial HbA(1c) ≤52 mmol/mol (6.9%) and 53–69 mmol/mol (7.0–8.5%). Risk of severe hypoglycaemic episodes was reduced by 21% for FM users compared with control individuals using SMBG (OR 0.79 [95% CI 0.69, 0.91]; p = 0.0014)]. CONCLUSIONS/INTERPRETATION: In this large cohort, the use of FM was associated with a small and sustained improvement in HbA(1c), most evident in those with higher baseline HbA(1c) levels. In addition, FM users experienced lower rates of severe hypoglycaemic events compared with control individuals using SMBG for self-management of glucose control. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-021-05437-z. Springer Berlin Heidelberg 2021-03-27 2021 /pmc/articles/PMC8187189/ /pubmed/33774713 http://dx.doi.org/10.1007/s00125-021-05437-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Nathanson, David
Svensson, Ann-Marie
Miftaraj, Mervete
Franzén, Stefan
Bolinder, Jan
Eeg-Olofsson, Katarina
Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
title Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
title_full Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
title_fullStr Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
title_full_unstemmed Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
title_short Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
title_sort effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187189/
https://www.ncbi.nlm.nih.gov/pubmed/33774713
http://dx.doi.org/10.1007/s00125-021-05437-z
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