Tekarli Mustafa, Turner Kyle, Witt Daniel
University of Utah College of Pharmacy.
Department of Pharmacotherapy, University of Utah College of Pharmacy.
Innov Pharm. 2021 Jun 10;12(3). doi: 10.24926/iip.v12i3.3977. eCollection 2021.
Randomized controlled trials have investigated the effect of continuous glucose monitors on hemoglobin A1C; however, more evidence is needed to justify their use and expand insurance coverage. Additionally, there are few published studies investigating the A1C lowering effect of flash glucose monitors (FGMs) in broad diabetes populations with varying insulin requirements. This analysis aimed to help fill this gap in medical literature and help clinicians evaluate costs/benefits when considering FGMs for their patients with diabetes. To determine the association between FGM use and A1C reduction in patients with type 1 or type 2 diabetes mellitus regardless of insulin dependence. Pharmacy dispensing records were used to identify patients for inclusion. Patients who received a FGM from a University of Utah pharmacy between July 7, 2018 and July 7, 2020 were included. Patients who did not receive at least an 84-day supply of FGM sensors or did not have a baseline or follow-up A1C were excluded. Baseline and follow-up A1Cs, defined as A1Cs that are within one year before and 3-12 months after the FGM dispense date, were collected for each patient. New diabetes medications within a six-month window of the initial FGM dispense date were also recorded. Outcome variables were collected before and after patients received their first FGM (pre-FGM vs. post-FGM, respectively). The primary outcome was the difference between baseline and follow-up A1C for each patient. Secondary outcomes were the difference in baseline and follow-up A1C for various clinical subgroups within the overall sample. Descriptive statistics were used to summarize baseline characteristics and outcome data. Paired Student's t-tests were used to evaluate outcome differences (α=0.05). Fifty-seven patients (50.8% male; mean age: 49 years) were included. For the primary outcome, the average baseline and follow-up A1Cs were 9.33% and 8.32%, respectively for a difference of -1.01% ([95%CI -1.31:-0.72]; p<0.0001). The use of FGMs is associated with decreases in A1C within a cohort of patients at one health system. Further effort to determine impact of FGM on clinical and economic outcomes is warranted.
随机对照试验研究了持续血糖监测仪对糖化血红蛋白（A1C）的影响；然而，仍需要更多证据来证明其使用的合理性并扩大保险覆盖范围。此外，很少有已发表的研究调查闪光血糖监测仪（FGM）在胰岛素需求各异的广大糖尿病患者群体中降低A1C的效果。本分析旨在填补医学文献中的这一空白，并帮助临床医生在考虑为糖尿病患者使用FGM时评估成本/效益。以确定1型或2型糖尿病患者（无论是否依赖胰岛素）使用FGM与A1C降低之间的关联。利用药房配药记录来确定纳入的患者。纳入2018年7月7日至2020年7月7日期间从犹他大学药房领取FGM的患者。未领取至少84天用量的FGM传感器或没有基线或随访A1C的患者被排除。为每位患者收集基线和随访A1C，定义为FGM配药日期前一年内和配药后3至12个月内的A1C。还记录了初始FGM配药日期后六个月内的新糖尿病药物。在患者接受首次FGM之前和之后（分别为FGM前和FGM后）收集结果变量。主要结局是每位患者基线和随访A1C之间的差异。次要结局是总体样本中各个临床亚组基线和随访A1C的差异。使用描述性统计来总结基线特征和结果数据。采用配对学生t检验来评估结果差异（α=0.05）。纳入了57名患者（男性占50.8%；平均年龄：49岁）。对于主要结局，平均基线和随访A1C分别为9.33%和8.32%，差异为-1.01%（[95%置信区间-1.31：-0.72]；p<0.0001）。在一个医疗系统的患者队列中，使用FGM与A1C降低相关。有必要进一步努力确定FGM对临床和经济结局的影响。
