Background: FGM is less invasive than traditional glucometer. Recent studies show benefits on glycemic control and frequency of hypoglycemia, both in type 1 and type 2 diabetes. Nonetheless, experiences on the impact of this technology in the clinical setting are still scantly reported.
Aim of the Study: To verify impact of FGM on glycemic control in type 1 diabetes subjects (T1DM). Patients and Methods: From January 2017 to December 2018, 397 T1DM subjects (age 43±13 years; diabetes duration 21±13 years; MDI 81%, CSII 19%; BMI 25.4±4.8 Kg/m2; Insulin Requirements (IR) 44±21 U/day; 8 episodes of severe asymptomatic hypoglycemia in the previous 6 months; 3 ketoacidosis; Test strips: 158± 28/month) were started on FGM. A 6-month follow-up (FU) was available for 350 subjects, 204 had a 12-month FU and 39 18-month FU.
Results: Out of 397 subjects, 18 discontinued (patch allergy: 4; inaccuracy: 5; switched to other devices: 3). In 6-month FU patients, HbA1c declined from 58±14 to 56±12 mmol/mol (p<0.00001). The improvement was more apparent in MDI (n=271; from 59±15 to 56±12 mmol/mol, p <0.0001) than in CSII (n=79, 57±11 to 55±10 mmol/mol, p=0.14). In 12-month FU patients (n=204), basal, 6, and 12 month HbA1c was 58±14, 56±12 (p=0.04) and 56±12 mmol/mol (p =0.004) also more apparent with MDI (n=152, 59±14, 57±13 - p=0.05, and 56±12 mmol/mol - p<0.0009) than with CSII (n=52, 56±11, 55±10, 56±9 mmol/mol, p=NS). In 18-month FU subjects (n=35) basal, 6, 12 and 18-month HbA1c were 58±11, 56±10 - p=0.06, 56±9 - p=0.19, 55±9 mmol/mol - p =0.03). In multivariate analysis, HbA1c reduction was not correlated with disease duration, age, and baseline HbA1c.In the whole cohort there was 1 episode of severe asymptomatic hypoglycemia and 2 of ketoacidosis in the CSII group.
Conclusions and comments: In our clinical practice, FGM was associated with small but significant reduction in HbA1c (particularly for patient on MDI) and severe asymptomatic hypoglycemia.
C. Rodia: None. C. Bianchi: None. A. Bertolotto: Speaker's Bureau; Self; Abbott, Lilly Diabetes. R. Giannarelli: None. F. Campi: None. S. Del Prato: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, GlaxoSmithKline plc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Servier, Takeda Pharmaceutical Company Limited. Board Member; Self; AstraZeneca. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. M. Aragona: None.