Two-year use of flash glucose monitoring is associated with sustained improvement of glycemic control and quality of life (FLARE-NL-6)

Annel Lameijer; Marion J Fokkert; Mireille A Edens; Reinold O B Gans; Henk J G Bilo; Peter R van Dijk

doi:10.1136/bmjdrc-2021-002124

Two-year use of flash glucose monitoring is associated with sustained improvement of glycemic control and quality of life (FLARE-NL-6)

BMJ Open Diabetes Res Care. 2021 Sep;9(1):e002124. doi: 10.1136/bmjdrc-2021-002124.

Authors

Annel Lameijer¹, Marion J Fokkert², Mireille A Edens³, Reinold O B Gans⁴, Henk J G Bilo⁵, Peter R van Dijk⁶

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands a.lameijer@umcg.nl.
² Department of Clinical Chemistry, Isala, Zwolle, The Netherlands.
³ Department of Innovation and Science, Isala, Zwolle, The Netherlands.
⁴ University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands.
⁵ Diabetes Research Center, Isala, Zwolle, The Netherlands.
⁶ University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands.

Abstract

Introduction: The FreeStyle Libre (FSL) is a flash glucose monitoring (FGM) system. The Flash Monitor Register in the Netherlands (FLARE-NL-4) study previously demonstrated the positive effects of FSL-FGM use during 1 year on glycemic control, quality of life and disease burden among persons with diabetes mellitus (DM). The present follow-up study assesses the effects of FSL-FGM after 2 years.

Research design and methods: Patients included in the FLARE-NL-4 study who continued FSL-FGM during the 1-year study period were invited to participate (n=687). Data were collected using questionnaires (the 12-Item Short Form Health Survey version 2 (SF-12^v2) and the EuroQol 5-Dimension 3-Level (EQ-5D-3L) for quality of life), including self-reported hemoglobin A1c (HbA1c).

Results: A total of 342 patients agreed to participate: mean age 48.0 (±15.6) years, 52% men and 79.5% with type 1 DM. HbA1c decreased from 60.7 (95% CI 59.1 to 62.3) mmol/mol before use of FSL-FGM to 57.3 (95% CI 55.8 to 58.8) mmol/mol after 1 year and 57.8 (95% CI 56.0 to 59.5) mmol/mol after 2 years. At the end of the 2-year follow-up period, 260 (76%) persons were still using the FSL-FGM and 82 (24%) had stopped. The main reason for stopping FSL-FGM was financial constraints (55%). Concerning the whole 2-year period, there was a significant decrease in HbA1c among persons who continued use of FSL-FGM (-3.5 mmol/mol, 95% CI -6.4 to -0.7), while HbA1c was unaltered compared with baseline among persons who stopped FSL-FGM (-2.4 mmol/mol, 95% CI -7.5 to 2.7): difference between groups 2.2 (95% CI -1.3 to 5.8) mmol/mol. After 2 years, persons who continued use of FSL-FGM had higher SF-12 mental component score and higher EQ-5D Dutch tariff score and felt less often anxious or depressed compared with persons who discontinued FSL-FGM.

Conclusions: Although the considerable number of non-responders limits generalizability, this study suggests that persons who continue to use FSL-FGM for 2 years may experience sustained improvement in glycemic control and quality of life.

Keywords: continuous glucose monitoring; diabetes mellitus; patient reported outcome measures; type 1.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
Blood Glucose Self-Monitoring*
Female
Follow-Up Studies
Glycemic Control
Humans
Male
Middle Aged
Netherlands / epidemiology
Quality of Life*

Substances

Blood Glucose