Accuracy of FreeStyle Libre flash glucose monitoring in patients with type 2 diabetes who migrated from highlands to plains

BACKGROUND The FreeStyle Libre flash glucose monitoring(FGM)system entered the Chinese market in 2017 to complement the self-monitoring of blood glucose.Due to its increased usage in clinics,the number of studies investigating its accuracy has increased.However,its accuracy has not been investigated in highland populations in China.AIM To evaluate measurements recorded using the FreeStyle Libre FGM system compared with capillary blood glucose measured using the enzyme electrode method in patients with type 2 diabetes(T2D)who had migrated within 3 mo from highlands to plains.METHODS Overall,68 patients with T2D,selected from those who had recently migrated from highlands to plains(within 3 mo),were hospitalized at the Department of Endocrinology from August to October 2017 and underwent continuous glucose monitoring(CGM)with the FreeStyle Libre FGM system for 14 d.Throughout the study period,fingertip capillary blood glucose was measured daily using the enzyme electrode method(Super GL,China),and blood glucose levels were read from the scanning probe during fasting and 2 h after all three meals.Moreover,the time interval between reading the data from the scanning probe and collecting fingertip capillary blood was controlled to<5 min.The accuracy of the FGM system was evaluated according to the CGM guidelines.Subsequently,the factors influencing the mean absolute relative difference(MARD)of this system were analyzed by a multiple linear regression method.RESULTS Pearson’s correlation analysis showed that the fingertip and scanned glucose levels were positively correlated(R=0.86,P=0.00).The aggregated MARD of scanned glucose was 14.28±13.40%.Parker's error analysis showed that 99.30%of the data pairs were located in areas A and B.According to the probe wear time of the FreeStyle Libre FGM system,MARD_(1 d) and MARD_(2-14 d) were 16.55%and 14.35%,respectively(t=1.23,P=0.22).Multiple stepwise regression analysis showed that MARD did not correlate with blood glucose when the largest amplitude of glycemic excursion(LAGE)was<5.80 mmol/L but negatively correlated with blood glucose when the LAGE was≥5.80 mmol/L.CONCLUSION The FreeStyle Libre FGM system has good accuracy in patients with T2D who had recently migrated from highlands to plains.This system might be ideal for avoiding the effects of high hematocrit on blood glucose monitoring in populations that recently migrated to plains.MARD is mainly influenced by glucose levels and fluctuations,and the accuracy of the system is higher when the blood glucose fluctuation is small.In case of higher blood glucose level fluctuations,deviation in the scanned glucose levels is the highest at extremely low blood glucose levels.

Glucose metabolism profile recorded by flash glucose monitoring system in patients with hypopituitarism during prednisone replacement

BACKGROUND Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment,with adverse effects on glucose metabolism.Disorders associated with glucose metabolism are established risk factors of cardiovascular events,one of the life-threatening ramifications.AIM To investigate the glycometabolism profile in patients with hypopituitarism receiving prednisone(Pred)replacement,and to clarify the impacts of different Pred doses on glycometabolism and consequent adverse cardiovascular outcomes.METHODS Twenty patients with hypopituitarism receiving Pred replacement[patient group(PG)]and 20 normal controls(NCs)were recruited.A flash glucose monitoring system was used to record continuous glucose levels during the day,which provided information on glucose-target-rate,glucose variability(GV),period glucose level,and hypoglycemia occurrence at certain periods.Islet β-cell function was also assessed.Based on the administered Pred dose per day,the PG was then regrouped into Pred>5 mg/d and Pred≤5 mg/d subgroups.Comparative analysis was carried out between the PG and NCs.RESULTS Significantly altered glucose metabolism profiles were identified in the PG.This includes significant reductions in glucose-target-rate and nocturnal glucose level,along with elevations in GV,hypoglycemia occurrence and postprandial glucose level,when compared with those in NCs.Subgroup analysis indicated more significant glucose metabolism impairment in the Pred>5 mg/d group,including significantly decreased glucose-target-rate and nocturnal glucose level,along with increased GV,hypoglycemia occurrence,and postprandial glucose level.With regard to islet β-cell function,PG showed significant difference in homeostasis model assessment(HOMA)-β compared with that of NCs;a notable difference in HOMA-βwas identified in Pred>5 mg/d group when compared with those of NCs;as for Pred≤5 mg/d group,significant differences were found in HOMA-β,and fasting glucose/insulin ratio when compared with NCs.CONCLUSION Our results demonstrated that Pred replacement disrupted glycometabolic homeostasis in patients with hypopituitarism.A Pred dose of>5 mg/d seemed to cause more adverse effects on glycometabolism than a dose of≤5 mg/d.Comprehensive and accurate evaluation is necessary to consider a suitable Pred replacement regimen,wherein,flash glucose monitoring system is a kind of promising and reliable assessment device.The present data allows us to thoroughly examine our modern treatment standards,especially in difficult cases such as hormonal replacement mimicking delicate natural cycles,in conditions such as diabetes mellitus that are rapidly growing in worldwide prevalence.

Factors influencing the effectiveness of using flash glucose monitoring on glycemic control for type 1 diabetes in Saudi Arabia

BACKGROUND In 2017,35000 Saudi children and adolescents were living with a type 1 diabetes(T1D)diagnosis.Diabetic complications are minimized upon strengthened glycemic regulation.The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications.The use of flash glucose monitoring(FGM)enables better diabetes treatment and thereby improves glycemic control.Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources,resulting in improved outcomes.AIM To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin(HbA1c)levels/glycemic control among T1D patients.METHODS A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed.T1D patients who began FGM between 2017 and 2019 were included.RESULTS The data included 195 T1D patients(70 males and 125 females)with a mean age of 23.6±8.1 years.Among them,152 patients used multiple daily injection and 43 used an insulin pump.The difference in HbA1c level from baseline and after using FGM was-0.60±2.10,with a maximum of 4.70 and a minimum of-6.30.There was a statistically significant negative correlation between the independent variables(age,duration of diabetes,level of engagement)and HbA1c.The group with the highest HbA1c mean(9.85)was 18-years-old,while the group with the lowest HbA1c mean(7.87)was 45-years-old.Patients with a low level of engagement(less than six scans per day)had the highest HbA1c mean(9.84),whereas those with a high level of engagement(more than eight scans per day)had the lowest HbA1c mean(8.33).CONCLUSION With proper education,FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.

Exenatide once weekly combined with metformin reduced glycemic variability in type 2 diabetes by using flash glucose monitoring system

BACKGROUND Multiple studies demonstrate that fluctuating blood glucose level produces greater damage compared with sustained hyperglycemia.Flash glucose monitoring system is an effective method in documenting blood glucose variability,contributing to better glucose management and reduced hypoglycemic event occurrence.AIM To investigate the improvement in glycemic variability(GV),blood glucose level,and metabolic indexes of patients with type 2 diabetes mellitus after combined treatment of exenatide once weekly(EXQW)and metformin.METHODS Twenty-five patients with type 2 diabetes mellitus suffering from poor blood glucose control under metformin treatment were recruited.The recruited patients were prescribed with oral metformin only(maintaining a dosage of metformin at≥1500 mg/day)for 2 wk(screening period),and then given EXQW(2 mg,subcutaneous injection)for 12 wk(experimental period).The flash glucose monitoring system was used to document blood glucose values during the screening period and the last 2 wk of the experimental period.RESULTS Four patients were excluded for various reasons,yielding a total of 21 patients,including 17 males and 4 females,with an average age of 48.8 years,who completed this study.The estimated glycated hemoglobin,mean blood glucose,fasting and postprandial blood glucose levels,and percentage of blood glucose above 7.8 mmol/L decreased compared to those at baseline(P=0.003,0.003,0.008,0.010,0.014,0.017,and 0.005,respectively),while the percentage of blood glucose between 3.9 and 7.8 mmol/L significantly increased(P=0.005).Parameters of GV including standard deviation of blood glucose,mean amplitude of glycemic excursions,mean of daily difference,area under the curve difference between percentiles 25 and 75,and area under the curve difference between percentiles 10 and 90 were significantly lower compared to that of baseline(P=0.017,0.006,0.000,0.024,0.036,respectively).The durations of blood glucose below 3.9 mmol/L during the day and nocturnal periods significantly increased after treatment(P=0.041 and 0.028,respectively),but there was no significant increase in severe hypoglycemia(<3.0 mmol/L)compared with that at baseline(P=0.207).In addition,some metabolic indicators improved after EXQW treatment.CONCLUSION EXQW combined with metformin can effectively improve blood glucose levels,reduce GV,and improve metabolic indicators.However,there is still a risk of nocturnal hypoglycemia,and careful attention should be paid to patients with EXQW treatment.

The Impact of the FreeStyle LibreTM Flash Glucose Monitoring System on Glycemic Control in Patients with Diabetes;Observational Multicenter 15-Months Study

Objectives: The study was to determine the impact of using the FreeStyle LibreTM flash glucose monitoring system on glycemic control and the rate of events due to diabetes in people with diabetes from different types and age groups. Methods: a retrospective cohort chart review study was carried out at three centers in the Taif region in the Kingdom of Saudi Arabia: The study was approved by an accredited centralized institutional review board. Paper or electronic medical records were included for individuals of any age with diabetes (type 1, type 2, gestational diabetes) managed with diet, insulin therapy, or/and oral antihyperglycemic medication and/or non-insulin injection therapy. The primary outcome measure was the laboratory HbA1c level as well as reduction. Secondary outcome measures were frequency of severe hypoglycemia, admission to hospital or ER visit related to diabetes complications, and severe hyperglycemia (DKA or HHS). Results: Data was analyzed from 1695 patients. The average HbA1c before using the flash glucose monitoring system was 9.60% ± 1.44% and 3 months HbA1c after using the FreeStyle LibreTM flash glucose monitoring system was 8.70% + 1.45% for a difference of -0.90% ([95% CI -0.92: -0.88];p 65 years, (p-values Conclusion: The benefits of using the FreeStyle LibreTM flash glucose monitoring system are self-evident in reducing HbA1c and events due to hyperglycemia or hypoglycemia.

Intrapartum and early postpartum glycemic profiles in women with gestational diabetes mellitus:an observational study

Background: Data on the glycemic profile of pregnant women with gestational diabetes mellitus (GDM) during the perinatal period are sparse. This study described the intrapartum and early postpartum glucose profiles among pregnant women with GDM, and analyzed factors potentially affecting glycemic parameters during the period.Methods: This was a prospective observational study conducted from March 2020 to November 2021. Pregnant women with GDM receiving lifestyle interventions alone during pregnancy and matched women with non-diabetic pregnancies (NDPs) were enrolled from among patients admitted to the obstetrics department for childbirth. Glucose monitoring was performed via a flash glucose monitoring (FGM) system on admission, and glucose readings during labor and early postpartum were analyzed. The clinical characteristics and FGM-based parameters of participants in the two groups were compared.Results: A total of 124 participants (mean age: 29.5 ± 3.5 years, 92 [74.2%] primipara) were included in the final analysis. A total of 17,571 glucose readings were retrieved. There were no significant differences in clinical characteristics between the GDM (n = 60) and NDP (n = 64) groups. The average glucose level was 92.2 mg/dL, and the level was higher in the GDM group (95.5 ± 12.1 mg/dLvs. 89.1 ± 13.4 mg/dL,P = 0.008) during the intrapartum and early postpartum periods. The data were split into the intrapartum period (from the start of labor to delivery of the placenta) and the early postpartum period (within 24 h after placental delivery) for analysis. During intrapartum, women with GDM exhibited glycemic profiles and fluctuations similar to those in the NDP group. However, women with GDM had higher postpartum glucose levels (97.7 ± 13.4 mg/dLvs. 90.8 ± 15.3 mg/dL,P = 0.009), a longer time spent >140 mg/dL (8.7 ± 9.3%vs. 5.9 ± 10.3%,P = 0.011), and greater glycemic fluctuations than those with NDP. Postpartum hyperglycemia in GDM might be associated with high parity and postprandial glucose abnormalities in GDM screening tests.Conclusion: Compared to those with normoglycemia, pregnant women with GDM receiving lifestyle interventions alone had similar intrapartum glucose profiles but higher early postpartum glucose levels and greater glucose variability, providing evidence for modification of the current perinatal glucose monitoring strategy for GDM.Trial Registration: ChiCTR.org.cn, ChiCTR2000030972.