Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel.
The Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Diabetes Metab Res Rev. 2021 Jan;37(1):e3355. doi: 10.1002/dmrr.3355. Epub 2020 Jul 3.
We evaluated the impact of flash continuous glucose monitoring (FCGM) on glycemic control and healthcare burden in a large real-world cohort of patients with type 1 diabetes (T1D) initiating FCGM technology.
In this retrospective cohort study, we included adults (age ≥18 years) with T1D from a large Health Maintenance Organization in Israel, who initiated FCGM during 2018. Primary outcomes included change in HbA1c ≥3 months following FCGM commencement and change in rate of internal-medicine hospitalization. Additional outcomes included changes in glucose test strip purchases, diabetes related outpatient health care visits and hospitalization for diabetic ketoacidosis (DKA) and/or severe hypoglycemia.
The study included 3490 patients, followed for a median of 14 (inter-quartile range 11-15) months after FCGM commencement. Among 2682 patients with an HbA1c measured both at baseline and ≥3 months after FCGM initiation, average HbA1c declined from 8.1% ± 1.46% to 7.9% ± 1.31% (P < .001) at first measurement and was maintained during follow up. Specifically, in those with HbA1c ≥8%, a mean decline of 0.5% (P < .001) was observed. A clinically significant HbA1c reduction of ≥0.5% was experienced by 25.5% of the patients. The rate of internal medicine hospitalization, visits to primary care, or visits to endocrine/diabetes specialists in the period following FCGM commencement vs the 6 months prior was significantly reduced (P < .001). Hospitalization for DKA and/or hypoglycemia declined as well (P = .004).
FCGM was associated with significant and durable improvement in glycemic control as well as reduced consumption of healthcare services.
我们评估了在接受瞬态连续血糖监测（FCGM）的大型真实世界 1 型糖尿病（T1D）患者队列中，FCGM 对血糖控制和医疗负担的影响。
在这项回顾性队列研究中，我们纳入了以色列一家大型健康维护组织中在 2018 年开始接受 FCGM 的成年（年龄≥18 岁）T1D 患者。主要结局包括 FCGM 开始后 3 个月内 HbA1c 的变化和内科住院率的变化。其他结局包括血糖测试条购买量、糖尿病相关门诊医疗就诊和糖尿病酮症酸中毒（DKA）和/或严重低血糖症住院率的变化。
该研究纳入了 3490 名患者，在 FCGM 开始后中位数为 14（四分位距 11-15）个月进行随访。在 2682 名基线和 FCGM 开始后≥3 个月均有 HbA1c 测量值的患者中，平均 HbA1c 从 8.1%±1.46%降至 7.9%±1.31%（P<0.001），在随访期间保持不变。具体来说，在 HbA1c≥8%的患者中，观察到平均下降 0.5%（P<0.001）。25.5%的患者经历了≥0.5%的 HbA1c 显著降低。与 FCGM 开始前 6 个月相比，FCGM 开始后内科住院率、初级保健就诊率或内分泌/糖尿病专家就诊率显著降低（P<0.001）。DKA 和/或低血糖症住院率也有所下降（P=0.004）。
FCGM 与血糖控制的显著和持久改善以及医疗服务消耗的减少相关。
