Time in range following flash glucose monitoring: Relationship with glycaemic control, diabetes‐related distress and resource utilisation in the Association of British Clinical Diabetologists national audit

• Published in: Diabetic medicine Vol. 39; no. 11; pp. e14942 - n/a
• Main Authors: Deshmukh, Harshal, Wilmot, Emma, Pieri, Beatrice, Choudhary, Pratik, Shah, Najeeb, Gregory, Robert, Kilvert, Anne, Lumb, Alistair, Christian, Peter, Barnes, Dennis, Patmore, Jane, Walton, Chris, Ryder, Robert E. J., Sathyapalan, Thozhukat
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2022
• Subjects: Blood Glucose; Blood Glucose Self-Monitoring; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; diabetes‐related distress; Diabetic ketoacidosis; Disease management; Glucose monitoring; glycaemic control; Glycated Hemoglobin - analysis; Glycemic Control; Gold; Gold score; Hemoglobin; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Hypoglycemic Agents; Ketoacidosis; Regression analysis; time below range; time in range; United Kingdom > UK; glycaemic control; time below range; Gold score; diabetes-related distress; time in range
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.14942

Aims The aim of this study was to understand the relationship between time in range (TIR) achieved using the isCGM with changes in glycaemic control, diabetes‐related distress (DRD) and resource utilisation in people living with diabetes. Methods Clinicians from 106 National Health System (NHS) UK hospitals submitted isCGM user baseline and follow‐up data in a web‐based tool held within the UK NHS network. Linear regression analysis was used to identify the relationship between follow‐up glucose TIR (3.9–10 mmol/L) categories (TIR% 50–70 and TIR% >70) with change in haemoglobin A1c (HbA1c), DRD and Gold score (measure of hypoglycaemia unawareness, where a score ≥4 suggests impaired awareness of hypoglycaemia). Results Of 16,427 participants, 1241 had TIR follow‐up data available. In this cohort, the mean TIR was 44.8% (±22.5). With the use of isCGM, at 7.9 months mean follow‐up, improvements were observed in HbA1c (−6.9 [13.5] mmol/mol, p < 0.001), Gold score (−0.35 [1.5], p < 0.001) and Diabetes Distress Screening (−0.73 [1.23], p < 0.001). In the regression analysis restricted to people living with type 1 diabetes, TIR% 50–70 was associated with a −8.9 mmol/mol (±0.6, p < 0.001) reduction in HbA1c; TIR% >70 with a −14 mmol/mol (±0.8, p < 0.001) reduction in HbA1c. Incremental improvement in TIR% was also associated with significant improvements in Gold score and DRD. TIR% >70 was associated with no hospital admissions due to hypoglycaemia, hyperglycaemia/diabetic ketoacidosis, and a 60% reduction in the paramedic callouts and 77% reduction in the incidence of severe hypoglycaemia. Conclusion In a large cohort of UK isCGM users, we demonstrate a significant association of higher TIR% with improvement in HbA1c, hypoglycaemia awareness, DRD and resource utilisation.