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Implementation of flash glucose monitoring in four paediatric diabetes clinics : controlled before and after study to produce real world evidence of patient benefit
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Kandiyali, Rebecca, Taylor, Hazel, Thomas, Elizabeth, Cullen, Freyja, Hollingworth, William, Ingram, Jenny, Kenward, Charlie, West, Nicol, McGregor, David, Smith, Becky and Hamilton-Shield, Julian (2023) Implementation of flash glucose monitoring in four paediatric diabetes clinics : controlled before and after study to produce real world evidence of patient benefit. BMJ Open Diabetes & Research Care, 11 . e003561. doi:10.1136/bmjdrc-2023-003561
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Official URL: https://doi.org/10.1136/bmjdrc-2023-003561
Abstract
Aims: To assess the real-world evidence for flash glucose monitoring (Abbott FreeStyle Libre) for children with type 1 diabetes in terms of glucose control, secondary healthcare resources and costs.
Research design and methods: We conducted a controlled before and after study (approximately 12 months before and after) using routinely collected health record data on children who start using flash monitors and a control population of children with self-monitoring of blood glucose (SMBG). Our population-based sample of eligible individuals using flash monitoring (n=114) and controls (n=80) aged between 4 and 18 years was drawn from four paediatric diabetes clinics (secondary care) in the South West England. Outcome measures included: glycated hemoglobin (HbA1c), frequency of BG tests; frequency of sensor scans; time in recommended glucose range; short-term complications (hypoglycemia, diabetic ketoacidosis and related illness resulting in investigation) and secondary care costs.
Results: After adjustment for age, time since diagnosis, deprivation and the test modality (point of care or laboratory), the mean HbA1c reading for controls was 61.2 (mmol/mol) for the period before and 63.9 after. For individuals using flash monitoring, the adjusted mean HbA1c reading was 64.6 for the period before implementation and 63.8 after. Rates of short-term complications were low across all groups in the study. Whereas the ‘after’ flash monitoring group had substantially higher incremental costs (+£703 vs the flash monitoring ‘before’ comparison and +£841 vs contemporaneous SMBG controls), these cost differences were driven by primary care prescribing (sensor costs).
Conclusions: There was some indication that flash monitoring might help young people improve the control of their diabetes but for our sample, the difference between finger-prick testing and flash monitoring was not clinically significant (HbA1c improvement <5 mmol/mol). Given the pace of technological change within diabetes, research efforts should now facilitate the real-time analysis of long-term routine data on flash and continuous glucose monitors.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RJ Pediatrics |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Blood glucose monitoring, Diabetes -- Treatment, Diabetes in children, Diabetic children , Biosensors | ||||||
Journal or Publication Title: | BMJ Open Diabetes & Research Care | ||||||
Publisher: | BMJ Publishing Group Ltd. | ||||||
Official Date: | 28 August 2023 | ||||||
Dates: |
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Volume: | 11 | ||||||
Article Number: | e003561 | ||||||
DOI: | 10.1136/bmjdrc-2023-003561 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 3 August 2023 | ||||||
Date of first compliant Open Access: | 9 October 2023 | ||||||
RIOXX Funder/Project Grant: |
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