Diabetes is reaching epidemic proportions and a targeted glucose control is key to prevent microvascular complications as well as long-term macrovascular disease. Self-monitoring of blood glucose (SMBG) in type 1 diabetes (T1D) is mandatory to implement safe and effective adjustments in insulin therapy in order to reduce glucose levels and prevent hypoglycemic episodes. It is known that a higher rate of glucose testing (up to 8 times/day) is associated with improved glucose control, however, long-term repeated daily glucose tests are painful, inconvenient and difficult to pursue. Continuous glucose monitoring (CGM) is an alternative to SMBG, but the use of conventional CGM has been limited by the need of repeated calibration using capillary glucose testing, relatively short sensor lifespan and high costs. The recently introduced CGM FreeStyle Libre™ (Abbott Diabetes Care, Witney, UK) flash glucose monitoring (FGM), a new generation of glucose testing device, has the advantage to be user friendly by just scanning the reader over the sensor. The FGM system does not require calibration, has a long sensor lifetime of 14 days and it's relatively affordable, explaining the widespread use of the device. The Flash Glucose Monitoring-FGM is a real-time glycemic monitoring system called "hybrid" as it is not equipped with alarms capable of alerting the patient to cut-off value for the hypo- or hyperglycemia, but allows the glycemic trend to be viewed at request.
Patients will be identified and enrolled in the Diabetes Departments of different hospitals/clinics in the Emilia Romagna region, Italy. Patients will be divided in two groups A (naive patients,) and B (patients already using the device at enrollment) and followed for 12 months. Study design is observational prospective and includes 3-months follow up visits until the 12-month final evaluation. At each visit, patient clinical data, adherence and side effects will be recorded and data download from the device will be performed.
Study Type
OBSERVATIONAL
Enrollment
350
The Flash Glucose Monitoring-FGM is a real-time glycemic monitoring system called "hybrid" will be assigned to the enrolled patients at baseline until the end of follow-up after 12 months.
Azienda Ospedaliero Universitaria
Parma, Italy
Severe hypoglycemia rate
Frequency (number) of serious episodes of hypoglycemia (as defined by the American Diabetes Association, as severe cognitive impairment requiring external assistance for recovery).
Time frame: 12 months
Severe hypoglycemia rate
Percentage (%) of patients with at least 1 episode of severe hypoglycemia.
Time frame: 12 months
Glucose control
HbA1c (mmol/mol) change from baseline.
Time frame: 12 months
Glucose control
Time in hypoglycemia (\<3.9 mmol/L) at any time of day.
Time frame: 12 months
Glucose control
Time spent with hypoglycemia (\<3.1 mmol/L) at any time of day.
Time frame: 12 months
Glucose control
Time spent with hypoglycemia (\<2.2 mmol/L) at any time of day.
Time frame: 12 months
Glucose control
Time spent within the euglycemic range (3.9 - 9.9 mmol/L) at any time of day.
Time frame: 12 months
Glucose control
Time spent with hyperglycemia (\>10 mmol/L)at any time of day.
Time frame: 12 months
Glucose control
Time spent in hyperglycemia (\>13.3 mmol/L) at any time of day.
Time frame: 12 months
Flash Glucose Monitoring treatment satisfaction
Change in Diabetes Quality Of Life- DQOL score from baseline. The original DQOL is a 60-item instrument to assess the diabetes-related QOL of participants. The instrument provides an overall scale score, as well as four subscale scores for 1) satisfaction with treatment, 2) impact of treatment, 3) worry about the future effects of diabetes, and 4) worry about social/vocational issues. Items are scored on a 5-point Likert scale and are of two general formats. One format asks about the frequency of negative impact of diabetes itself or of the diabetes treatment and provides response options from 1 (never) to 5 (all the time). The second format asks about satisfaction with treatment and quality of life and is scored from 1 (very satisfied) to 5 (very dissatisfied). Higher scores on DQOL items and subscales are, therefore, negatively valenced, indicating problem frequency or dissatisfaction.
Time frame: 12 months
Safety of the device
Number (n) of allergic patch reactions.
Time frame: 12 months
Feasibility of the device
Number (n) of untimely detachments of the device.
Time frame: 12 months
Feasibility of the device
Percentage (%) of recorded data by the device.
Time frame: 12 months
Feasibility of the device
Number (n) of device interruptions.
Time frame: 12 months
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