ESPEYB20 13. Editors' Choice Section (12 abstracts)
13.5. Intermittently scanned continuous glucose monitoring for type 1 diabetes
Leelarathna L , Evans ML , Neupane S , Rayman G , Lumley S , Cranston I , Narendran P , Barnard-Kelly K , Sutton CJ , Elliott RA , Taxiarchi VP , Gkountouras G , Burns M , Mubita W , Kanumilli N , Camm M , Thabit H , Wilmot EG & FLASH-UK Trial Study Group
Diabetes, Endocrinology, and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK. N Engl J Med 2022;387:1477–1487. https://www.nejm.org/doi/full/10.1056/NEJMoa2205650
In Brief: This multicenter, randomised controlled trial in 156 adults (mean age 44 years) with type 1 diabetes (T1D) showed benefits of intermittently scanned continuous glucose monitoring (CGM) (intervention) compared to usual monitoring of blood glucose levels by fingerprick testing on: lower HbA1c (−0.5%; P<0.001), 130 minutes/day longer duration of ‘in target’ glucose levels, and 43 minutes/day shorter time spent with hypoglycaemic blood glucose levels.
Comment: I admit that it has been a very long time since your Yearbook editor (KO) last managed patients with T1D. However, I still follow this literature and highlight from time-to-time papers of notable significance in my opinion. A major longstanding challenge is to persuade patients with T1D to regularly monitor their capillary blood glucose levels with sufficient frequency to inform their self-management. By automating the process, this FLASH-UK trial showed that users of their mobile phone-linked CGM system very frequently monitored their glucose levels during the 24-week trial period: mean(S.D.) 11.0(6.2) number of sensor scans/day. By contrast, usual fingerprick monitoring users started quite well, 4.2(2.1) tests/day at baseline, but this rate declined substantially to 0.6(1.1) tests/day at 24 weeks. This marked increase in frequency of monitoring led to very significant improvements in blood glucose control.
These findings have important translational lessons for the management (and in particular self-management) of other health conditions. The first lesson is that reducing the individual burden of lifestyle behavioural interventions may allow substantially larger changes. It is so much easier to scan a subcutaneous sensor with your phone than to obtain and measure a fingerprick blood sample. Similarly, it would be much easier to follow a healthy diet if the majority of manufactured foods are formulated according to healthy nutritional profiles, and if unhealthy profile foods are not placed at supermarket checkouts or advertised intensely by your traditional or social media channels. Secondly is the concept of ‘agency’. Individuals are more motivated to make changes if they are empowered to make choices and take actions. Rather than following a fixed protocol of diet and insulin dosing, the intervention group received information and instruction on how to use scanned glucose level data to make changes to their treatment and lifestyles.
Of course we do not (yet!) have such sensors to monitor daily changes in thyroid function, 17 hydroxy progesterone, or biomarkers of sufficiency of glucocorticoid or mineralocorticoid replacement. But the more we educate and help our patients to understand and contribute to chronic disease management, the more we will see patient engagement and concordance with their treatments.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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