Endocrine Abstracts

Introduction: Clinical trial data demonstrate improved glycemic control in individuals with type 1 diabetes (T1D),especially, reduction of time in hypoglycaemia with flash glucose monitoring (FGM);however real-life conditions can modify this scenario.

Aim: To examine real world use and glycemic control following a standardized initiation process of FGM.

Methods: Individuals aged 18 years or older with T1D were prospectively recruited from consecutive visits in our outpatient clinic. Pregnancy, diabetic ketoacidosis or use of continuous glucose monitoring (CGM) in the previous 6 months were exclusion criteria. CGM metrics from baseline (first 14 days of use) and 12 months were compared. Subgroup analysis by sex was performed. The clinical targets for CGM established in the 2019 ATTD consensus were used.

Results: Thirty individuals were included (56.7% males); mean age of 49.6 ± 13.2 years and diabetes duration of 26.2 ± 12.4 years; 90% were on multiple daily injections and the remainder on insulin pump therapy. Forty-seven percent (n = 14) had at least one established T1D chronic complication. Mean HbA1c was 7.7 ± 1.1% and 7.5 ± 1.2% at baseline and 12 months, respectively (P = 0.153) Mean time in range (TIR) was 50.9 ± 17.1% and 56.5 ± 17.3 at baseline and 12 months, respectively (P = 0.113). At baseline 10.7% reached the goal of TIR > 70%, rising to 20% at 12 months (P = 0.003). Mean time above range (TAR) had a similar evolution, from a median of 43.6 ± 18.2 to 38.2 ± 19.2 at baseline and 12 months, respectively (P = 0.188). At baseline, 14.3% of the individuals had a TAR < 25%, compared to 23.3% at 12 months (P = 0.011). There was no difference neither in time below range (TBR) nor on duration or percentage of level 2 hypoglycemia. A severe hypoglycemia event in the previous 6 months was reported by 16.7% of the patients at baseline, compared to 3.3% at 12 months. Median number of scans per day was 7.0 (IQR 5.0) and 8.0(6.0) at baseline and 12 months, respectively (P = 0.066). In the analysis by sex,the percentage of male individuals attaining their TIR and TAR goals increased from 6.7% at baseline to 23.5% at 12 months (P = 0.038) and from 13.3% at baseline to 35.3% at 12 months (P = 0.012), respectively; no statistical difference found on TBR. In the female group no difference was found on the proportion of individuals reaching their CGM goals.

Discussion: At 12 months, there was an increasing number of individuals who reached the CGM targets for T1D while also reducing severe hypoglycemic events. Our data support the benefit of FGM on glucose control in T1D.