First Clinical Experience with Retrospective Flash Glucose Monitoring (FGM) Analysis in South Africa: Characterizing Glycemic Control with Ambulatory Glucose Profile

Abstract

Background: In 2014, an innovative blinded continuous glucose monitoring system was introduced with automated ambulatory glucose profile (AGP) reporting. The clinical use and interpretation of this new technology has not previously been described. Therefore we wanted to understand its use in characterizing key factors related to glycemic control: glucose exposure, variability, and stability, and risk of hypoglycemia in clinical practice.

Methods: Clinicians representing affiliated diabetes centers throughout South Africa were trained and subsequently were given flash glucose monitoring readers and 2-week glucose sensors to use at their discretion. After patient use, sensor data were collected and uploaded for AGP reporting.

Results: Complete data (sensor AGP with corresponding clinical information) were obtained for 50 patients with type 1 (70%) and type 2 diabetes (30%), irrespective of therapy. Aggregated analysis of AGP data comparing patients with type 1 versus type 2 diabetes, revealed that despite similar HbA1c values between both groups (8.4 ± 2 vs 8.6 ± 1.7%, respectively), those with type 2 diabetes had lower mean glucose levels (9.2 ± 3 vs 10.3 mmol/l [166 ± 54 vs 185 mg/dl]) and lower indices of glucose variability (3.0 ± 1.5 vs 5.0 ± 1.9 mmol/l [54 ± 27 vs 90 ± 34.2 mg/dl]). This highlights key areas for future focus.

Conclusions: Using AGP, the characteristics of glucose exposure, variability, stability, and hypoglycemia risk and occurrence were obtained within a short time and with minimal provider and patient input. In a survey at the time of the follow-up visit, clinicians indicated that aggregated AGP data analysis provided important new clinical information and insights.

Keywords: advanced glucose sensing technologies; ambulatory glucose profile; flash glucose monitoring.

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LAD received no financial support for the execution of this study. IC was supported by Abbott Diabetes Care as a physician-trainer. RM was supported by Abbott Diabetes Care as a physician-trainer.

© 2016 Diabetes Technology Society.

Figures

Figure 1.

AGP profile of a subject with type 1 diabetes.

Figure 2.

Flow chart of patient data available for analysis.

Figure 3.

Representative daily glycemic patterns from patients with type 2 and type 1 diabetes (top and bottom panels, respectively).

Figure 4.

Individual patient AGP figures most closely representing 1 SD below (left panels) and 1 SD above (right panels) mean for glucose exposure, variability, and stability (type 2 diabetes top panels and type 1 bottom panels).

Figure 5.

Estimated A1C versus paired laboratory HbA1c for all subjects.