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ABCD audit of FreeStyle Libre device for flash glucose monitoring shows improved diabetes control in Type 1 diabetes and fewer hospital admissions

Author: 
Dr Chris Walton (ex Officio Chairman)
Date of the announcement: 
Tuesday, 11 June, 2019

A national UK audit of the first technology device allowed to be prescribed for people with Type 1 Diabetes, presented at the American Diabetes Association in San Francisco, shows important benefits both in lowering glucose levels in those with high levels before use of the device and a reduction of hypoglycaemic attacks (‘hypos’ caused by low blood glucose levels). There is also a reduction in the rate of diabetes related-hospital admissions and a reduction of diabetes-related psychological distress during the initial six months of FreeStyle Libre use.

What is FreeStyle Libre?

FreeStyle Libre (©Abbott Laboratories) is a flash glucose monitoring system which monitors interstitial glucose levels (glucose level in the fluids under the skin) and consists of a sensor with a microfilament, worn on the back of the arm and a hand-held reader. When the reader unit is passed over the sensor, it shows the interstitial glucose levels (https://www.freestylelibre.co.uk/libre/).

FreeStyle Libre has been permitted to be prescribed on the NHS for defined groups of people with Type 1 diabetes currently amounting to about 20% of those with the condition. In addition some people with diabetes self-fund the use of Freestyle Libre. The device allows people with diabetes to monitor glucose levels conveniently and painlessly without finger-prick tests and to have information about glucose levels throughout the day, enabling them to adjust food intake, exercise and insulin doses more effectively to avoid either high glucose levels or dangerously low blood glucose levels.

About ABCD

ABCD is the association of diabetes specialist consultants in the UK and has previously conducted national audits of medications as they are introduced into real world usage in the NHS (https://abcd.care/abcd-nationwide-audits).This is the first ABCD audit of the effects on diabetes control of a technological device rather than a medication. 114 hospitals in the UK have contributed to the audit which has been led by academics from the University of Hull, alongside clinicians from Birmingham, Derby and Hull.

What the audit shows

The audit includes baseline data on 4,709 people with Type 1 diabetes and currently there is follow up data on 1299 people after use of FreeStyle Libre. There is a significant improvement in diabetes control as measured by a blood test called Haemoglobin A1c (which reflects blood glucose levels over the previous 2 months) particularly in those people with higher Haemoglobin A1C levels before using FreeStyle Libre. About 8 in 10 people reported that their glucose level was below normal less often than previously, and hypoglycaemic attacks occurred less frequently during the day in about 3 out of 10 people and at night in about 4 out of 10 people. There has also been a significant improvement in a measurement of how aware someone with diabetes is of a blood glucose falling to dangerously low levels (Gold Score), with about 1 in 10 people recovering awareness of low blood glucose readings (Gold Score falling to less than 4). During the first six months of follow up admissions linked to high blood glucose levels occurred in only 1.9% of people compared with 7.3% in the 12 months before Freestyle Libre use; for hypoglycaemic-admissions the equivalent figures where 0.5% in the six months after, compared with 2.71% in the 12 months before. The audit findings at 6 months if confirmed over a longer period suggest important benefits to people with diabetes, and to the wider community, by avoiding expensive complications of diabetes and reducing hospital admissions.

Contact

To learn more about this audit, please contact

Dr Harshal Deshmukh Clinical Lecturer in Endocrinology and Diabetes, University of  Hull

harshaldeshmukh@nhs.net

Dr Emma Wilmot, Consultant in Diabetes, University Hospitals of Derby and Burton NHS Trust

emma.wilmot2@nhs.net

Dr Chris Walton, Consultant in Diabetes, Hull University Teaching Hospitals NHS Trust

chris.walton@hey.nhs.uk

Dr Bob Ryder, Consultant in Diabetes, Sandwell and West Birmingham Hospitals, NHS Trust

bob.ryder@nhs.net

Prof Thozhukat Sathyapalan, Professor of Diabetes and Endocrinology, Hull York Medical School, University of Hull

Thozhukat.Sathyapalan@hyms.ac.uk