Endocrine Abstracts

The use of FreeStyle Libre (FSL) or Flash Glucose Monitoring (FGM) system becomes increasingly popular among people with diabetes, especially type 1 diabetes (T1DM) and several randomized and controlled study have shown how its use is associated with less and shorter hypoglycemic events without deterioration of HbA1c. Nevertheless, there are not yet consistent and lasting data reporting the impact of FGM in people with diabetes in real-life conditions. In this study we evaluated the safety, the acceptance and the efficacy of the FGM system in routine medical practice. In this 30-month prospective observational study we analyzed the glucometabolic data of 656 patients with DMT1 (85%) or insulin-treated DMT2 (15%) (M/F ratio: 1/1; average age 47 ± 15 years; diabetes duration 20.5 ± 13.0 years; MDI 83%; CSII 17%; BMI 26.1 ± 5.1 kg/m²; total daily insulin dose (TDD) 46 ± 22 IU/day) evaluated every 6 months in our clinic from January 2017 to July 2019. There was a wide diffusion of this type of monitoring and a high percentage of satisfaction (re-prescription rate > 97%). Only 3.6% of patients stopped the system and only a quarter of these because they did not consider the system reliable. There was also a rapid and significant improvement in the glycemic control (HbA1c from 7.9 ± 1.3% to 7.6 ± 1.0% with an average reduction of 0.3 ± 1.1% in the first 6 months of follow-up; P < 0.0001) and this improvement last more than 24 months). This led to a significant increase in the percentage of patients with HbA1c in target (≤7%). This increase was steadily growing throughout the follow-up period from 27.3% at baseline to 41.8% at 24 months (P = 0.005). We also experienced a lower incidence of severe hypoglycemia and ketoacidosisthroughout the follow up period. However, we did not find any differences in BMI or TDD. The analysis of the Ambulatory Glucose Profile after 6 month showed an inverse relationship between the number of scans and HbA1c (R = 0.243; P = 0.0032); estimated HbA1c (R = 0.166; P = 0.03), average glucose (R = 0.161; P = 0.04) and average duration of hypoglycemia (R = 0.190; P = 0.01). There was instead a direct correlation between daily scans and time in range(TIR) (R = 0.181; P = 0.02). Our study shows that the use of FGM is safe (does not increase the risk of severe hypoglycemia or ketoacidosis), effective (early and long-lasting reduction of HbA1c) and represents a valid alternative to self-monitoring of blood glucose.