NEW ABCD AUDIT DATA demonstrate better glucose controlAND fewer hospital admissions for people with type 1 diabetes using the FLASH glucose monitoring system
People in the UK living with Type 1 diabetes who use the FreeStyle Libre system spend a greater time in the ideal glucose range over a 14-day period the more they scan and this increased time in range is associated with a significant improvement in Haemoglobin A1c (HbA1c). People with Type 1 diabetes who used the FreeStyle Libre showed a reduction in diabetes distress and were less likely to be admitted to hospital, according to new audit data1,2,3 released at The American Diabetes Association® (ADA) 80th Scientific Sessions: A Virtual Experience, by the Association of British Clinical Diabetologists (ABCD).
The ABCD audit, an independent national audit supported by an unrestricted educational grant from Abbott, looks at the real-world experience of people using the FreeStyle Libre system and how it impacts their glycaemic control. Clinicians are invited to submit the data they collect to a secure web-based tool. A total of114 NHS sites have registered for the audit.
Time in range, glycaemic control and hypoglycaemia awareness
In the first of three abstracts presented at the ADA annual meeting, data for 2,191 people with over seven and a half months follow-up show that a time in range (TIR) of more than 50% across 14 days was associated with a significant improvement in HbA1c in those with higher HbA1c levels at the start of the audit. The greater TIR was also linked to a significant improvement in patient’s awareness of an impending hypoglycaemia, measured by the Gold score1.
Time in range (TIR) is a novel measure of glucose control endorsed by an international consensus group. HbA1c is the recognised measure of long-term glucose control and reflects blood glucose levels over the previous two to three months. A high HbA1c is associated with an increased risk of developing diabetes-related complications.
International recommendations for time in range
The results of the second abstract highlight that in only 15% of cases did clinicians report on the internationally accepted TIR (3.9-10mmol/L)2. Taking both international and individualised TIR together, 37% of people had more than 50% TIR over 14 days. In addition, the number of scans per day with the FreeStyle Libre system and baseline HbA1c determined a higher TIR.
Diabetes control, diabetes distress and hospital admissions
Additional data for 3,182 people also show a significant reduction in HbA1c with FreeStyle Libre use: from 67.5mmol/mol (8.3%) at the start of the audit to 62.3 mmol/mol (7.8%) after over seven months follow-up. The reduction was even greater in those with higher HbA1c at the start3.
The audit also looked at awareness of impending hypoglycaemia in people with diabetes. The median Gold score, which measures hypoglycaemia unawareness, fell after over seven months of using the FreeStyle Libre system. The reduction was particularly noticeable in people with a higher Gold score at the start: In those with paired baseline and follow-up data, 53% of those with baseline Gold score of ≥4 reported a score of <4 at follow-up
(regaining hypoglycaemia awareness), while 5% of those with baseline Gold score of <4 (hypoglycaemia awareness) reported a follow-up score of ≥4 (impaired awareness of hypoglycaemia).
The use of FreeStyle Libre was also associated with a significant reduction in diabetes distress, significantly reduced paramedic callouts and hospital admissions due to hypoglycaemia and to hyperglycaemia or diabetic ketoacidosis (DKA)3.
Overall, the results presented this week show that:
- The use of the FreeStyle Libre was associated with a 5mmol/l (0.5%) reduction in HbA1c
- The use of FreeStyle Libre was associated with improved hypoglycaemia awareness and a reduction in hospital admissions.
- The higher the number of scans per day the greater the time in range.
- There is a need for greater awareness of the international recommendations for TIR measures.
These results from the first national audit of the effects of a medical device on diabetes control, rather than medication, confirm and reinforce the first wave results published last year showing significant improvements in glycaemic control, with higher patient numbers and longer follow-up. This population-based study of Free Style Libre continues to inform clinical practice and policy.
- Deshmukh H et al. (2020). Association Of Time In Range Over 14 Days On Glycaemic Controls And Hypoglycaemia Unawareness In Patients Using FreeStyle Libre.
- Wilmot EG et al (2020). The Association Of British Clinical Diabetologists Audit Of Freestyle Libre (FSL) In Diabetes In United Kingdom- Determinants Of Time In Target Range.
- Deshmukh H et al. (2020).Flash Glucose Monitoring: Effect On Glycaemic Control, Hypoglycaemia , Diabetes-related Distress And Resource Utilization - A Nationwide Study.
Notes to Editors
About the FreeStyle Libre System
Abbott’s Free Style Libre system is designed to change how people with diabetes measure their glucose levels and ultimately help them achieve better health outcomes. The system reads glucose levels through a sensor worn on the back of the upper arm, eliminating the need for routine finger pricks.
The device allows people with diabetes to monitor glucose levels conveniently and painlessly without routine 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.
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).
For more information, please contact
Dr Harshal Deshmukh, Clinical Lecturer in Endocrinology and Diabetes, University of Hull
Dr Emma Wilmot, Consultant in Diabetes, University Hospitals of Derby and Burton NHS Trust
Dr Chris Walton, Consultant in Diabetes, Hull University Teaching Hospitals NHS Trust
Dr Bob Ryder, Consultant in Diabetes, Sandwell and West Birmingham Hospitals, NHS Trust
Prof Thozhukat Sathyapalan, Professor of Diabetes and Endocrinology, Hull York Medical School, University of Hull