Introduction: Many people with type 1 diabetes continue to experience suboptimal glycaemic control. We now also know that often HbA1c levels are an inaccurate reflection of glycaemic patterns and variability. We describe here how the systematic use of the FreeStyle Libre flash monitor helped improve the glycaemic control of many people with type 1 diabetes.
Methods: We report the outcomes of 92 consecutive adults (18 years of age or more) with type 1 diabetes who have begun using the FreeStyle Libre flash glucose monitor in East Cheshire, UK. All users were provided education and support by the diabetes specialist nurses (DSNs) prior to initiation. An HbA1c of 60 mmol/mol was taken as the upper threshold for suboptimal glycaemic control.
Results: The mean cohort age was 43 years for men and 39 years for women (overall range 1783 years). In 92 consecutive users, HbA1c decreased by an average of 10.7 mmol/mol (0.98%) after 3 months, and by 16.1 mmol/mol (1.47%) after 6 months. Crucially, there was also a narrowing of the distribution of HbA1c, with many fewer people (7 people at six months compared with 32 at baseline) crossing an HbA1c ≥80 mmol/mol (9.5%) (χ2 3.2, P<0.0001). Neither the gender nor duration of diabetes impart any significant effect upon the changes in HbA1c. In multiple regression modelling, increasing age was associated with a lesser reduction in HbA1c at 6 months (beta= 0.289; P=0.04) independent of BMI and gender.
Conclusion: Flash glucose monitoring has great potential for improving both glycaemic control as well as quality of life for adults with type 1 diabetes. The technology provides significantly more data than the intermittent results obtained by traditional subcutaneous blood glucose monitoring, which may not capture intervals of extreme variability or relatively asymptomatic nocturnal events.