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      Marked improvement in HbA 1c following commencement of flash glucose monitoring in people with type 1 diabetes

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          Abstract

          Aims/hypothesis

          Minimal evidence supports the efficacy of flash monitoring in lowering HbA 1c. We sought to assess the impact of introducing flash monitoring in our centre.

          Methods

          We undertook a prospective observational study to assess change in HbA 1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.

          Results

          Those with baseline HbA 1c ≥58 mmol/mol (7.5%) achieved a median −7 mmol/mol (interquartile range [IQR] −13 to −1) (0.6% [−1.2 to −0.1]%) change in HbA 1c ( p < 0.001). The percentage achieving HbA 1c <58 mmol/mol rose from 34.2% to 50.9% ( p < 0.001). Median follow-up was 245 days (IQR 182 to 330). Individuals not using flash monitoring experienced no change in HbA 1c across a similar timescale ( p = 0.508). Higher HbA 1c ( p < 0.001), younger age at diagnosis ( p = 0.003) and lower social deprivation ( p = 0.024) were independently associated with an HbA 1c fall of ≥5 mmol/mol (0.5%). More symptomatic (OR 1.9, p < 0.001) and asymptomatic (OR 1.4, p < 0.001) hypoglycaemia was reported after flash monitoring. Following flash monitoring, regimen-related and emotional components of the diabetes distress scale improved although the proportion with elevated anxiety (OR 1.2, p = 0.028) and depression (OR 2.0, p < 0.001) scores increased. Blood glucose test strip use fell from 3.8 to 0.6 per day ( p < 0.001). Diabetic ketoacidosis admissions fell significantly following flash monitoring ( p = 0.043).

          Conclusions/interpretation

          Flash monitoring is associated with significant improvements in HbA 1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.

          Electronic supplementary material

          The online version of this article (10.1007/s00125-019-4894-1) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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          Most cited references14

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          Assessing psychosocial distress in diabetes: development of the diabetes distress scale.

          The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.
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            Real-world flash glucose monitoring patterns and associations between self-monitoring frequency and glycaemic measures: A European analysis of over 60 million glucose tests

            Randomised controlled trials demonstrate that using flash glucose monitoring improves glycaemic control but it is unclear whether this applies outside trial conditions. We investigated glucose testing patterns in users worldwide under real life settings to establish testing frequency and association with glycaemic parameters.
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              Effect of Continuous Glucose Monitoring on Glycemic Control, Acute Admissions, and Quality of Life: A Real-World Study

              Randomized controlled trials evaluating real-time continuous glucose monitoring (RT-CGM) patients with type 1 diabetes (T1D) show improved glycemic control, but limited data are available on real-world use.
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                Author and article information

                Contributors
                fraser.gibb@ed.ac.uk
                Journal
                Diabetologia
                Diabetologia
                Diabetologia
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0012-186X
                1432-0428
                9 June 2019
                9 June 2019
                2019
                : 62
                : 8
                : 1349-1356
                Affiliations
                [1 ]ISNI 0000 0004 0624 9907, GRID grid.417068.c, Edinburgh Centre for Endocrinology and Diabetes, , Western General Hospital, ; Edinburgh, UK
                [2 ]ISNI 0000 0001 0709 1919, GRID grid.418716.d, Edinburgh Centre for Endocrinology and Diabetes, , Royal Infirmary of Edinburgh, Little France Crescent, ; Edinburgh, UK
                [3 ]ISNI 0000 0004 1936 7988, GRID grid.4305.2, Centre for Cardiovascular Science, , University of Edinburgh, ; Edinburgh, EH14 4TJ UK
                Author information
                http://orcid.org/0000-0002-5576-6463
                Article
                4894
                10.1007/s00125-019-4894-1
                6647076
                31177314
                c134c4b6-0735-4a24-8dbc-f1fc72c331d2
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 24 February 2019
                : 15 April 2019
                Funding
                Funded by: University of Edinburgh
                Categories
                Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2019

                Endocrinology & Diabetes
                clinical diabetes,continuous glucose monitoring,devices,dka,hba1c,human,hypoglycaemia,psychological aspects

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