Flash glucose monitoring reduces glycemic variability and hypoglycemia: real-world data from Spain

Abstract

Objective: Observations in real-world settings support and extend findings demonstrated in randomized controlled trials that show flash glucose monitoring improves glycemic control. In this study, Spain-specific relationships between testing frequency and glycemic parameters were investigated under real-world settings.

Research design and methods: Deidentified glucose and user scanning data were analyzed and readers were rank ordered into 20 equal sized groups by daily scan frequency. Glucose parameters were calculated for each group: estimated HbA1c, time below range (<70 and ≤54 mg/dL), within range (70-180 mg/dL), and above range (>180 mg/dL). Glycemic variability (GV) metrics were described and data obtained from sensors in Spain and worldwide were compared.

Results: Spanish users (n=22 949) collected 37.1 million glucose scans, 250 million automatically recorded glucose readings, and checked glucose values via a mean of 13 scans/day. Estimated HbA1c, time below 70 mg/dL, at or below 54 mg/dL, above 180 mg/dL, and GV metrics were significantly lower in the highest compared with lowest scan rate group (39.6 to 3.9 scans/day). Time-in-range was higher for the highest versus lowest scan rate group at 15.6 vs 11.5 hours/day, respectively. GV metrics correlated positively with time below 70 mg/dL, at or below 54 mg/dL, above 180 mg/dL, and negatively with time-in-range. The relationship between glucose metrics and scan rate was similar in Spain and worldwide. However, time in hypoglycemia in Spain was higher in the groups with lower scan rates.

Conclusions: As seen in clinical trials, flash glucose monitoring in real-world settings allows frequent glucose checks. High scan rates are associated with the favorable glycemic markers of increased time-in-range and reduced time in hyperglycemia and hypoglycemia, and GV. The same trends, with unique nuances, are observed in both Spanish and global data.

Keywords: blood glucose monitoring; glycemic control; hypoglycemia.

Conflict of interest statement

Competing interests: TD and YX are employees of Abbott Diabetes Care. KL is an employee of Abbott Diagnostics. FGP has taken part in advisory panels for Abbott Diabetes, Novartis, AstraZeneca, Sanofi and Novo Nordisk; has participated as principal investigator in clinical trials funded by Sanofi, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals, and Lilly; and has acted as a speaker for Abbott Diabetes, Novartis, Sanofi, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals, AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, and Lilly. JFMT has participated as principal investigator in clinical trials funded by: GlaxoSmithKline, Lilly, Novartis, Novo Nordisk, Pfizer, Sanofi-Aventis, Bristol-Myers Squibb, AstraZeneca; has received conference funding from GlaxoSmithKline, Lilly, Merck-Sharp-Dohme, Novartis, Novo Nordisk, Pfizer, Sanofi-Aventis, Menarini, Janssen, Abbott, Kabi-Fresenius, Nutricia; and has collaborated as a consultant with Abbott, AstraZeneca, Esteve, GlaxoSmithKline, Lilly, Novo Nordisk, Novartis, Merck-Sharp-Dohme, Rovi, and Sanofi-Aventis.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Cumulative distribution of daily scans by readers. Each point represents 1147 or 5% of readers for a total of 37.1 million scans and 62.4 million monitoring hours.

Figure 2

Relationship between frequency of daily scans and glucometrics. Estimated A1c (%, A), time in hypoglycemia (min/day below 70 mg/dL, B), time in hypoglycemia (min/day at or below 54 mg/dL, C), time-in-range (hours/day within 70–180 mg/dL, D), time in hyperglycemia (hours/day above 180 mg/dL, E), glycemic variability (glucose SD in mg/dL, F).

Figure 3

Correlation between glycemic variability (glucose SD) and glucometrics by 5% bins of rank-ordered glucose SD. Estimated HbA1c (%, A), time in hypoglycemia (min/day below 70 mg/dL, B), time-in-range (hours/day within 70–180 mg/dL, C), and time in hyperglycemia (hours/day above 180 mg/dL, D).

Figure 4

Spanish (solid line) and worldwide (dashed line) glucometric trends versus daily scans. Estimated HbA1c (%, A), time in hypoglycemia (min/day below 70 mg/dL, B), time in hypoglycemia (min/day at or below 54 mg/dL, C), time-in-range (hours/day within 70–180 mg/dL, D), time in hyperglycemia (hours/day above 180 mg/dL, E) and glucose SD (mg/dL, F). Mean values, error bars are 99.9% CIs.