Guerci Bruno, Roussel Ronan, Levrat-Guillen Fleur, Detournay Bruno, Vicaut Eric, De Pouvourville Gérard, Emery Corinne, Riveline Jean-Pierre
Department of Endocrinology, Diabetology, and Nutrition, Brabois Adult Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France.
Institut Necker Enfants Malades (INEM), Unité INSERM U1151 INEM, IMMEDIAB Laboratory, Paris, France.
Diabetes Technol Ther. 2023 Jan;25(1):20-30. doi: 10.1089/dia.2022.0271. Epub 2022 Nov 24.
Initiation of insulin therapy in people with type 2 diabetes (T2DM) may be necessary to achieve glycemic targets but is associated with acute diabetes events (ADEs), including severe hypoglycemia (SH) or diabetic ketoacidosis (DKA). We assessed the impact of initiating FreeStyle Libre system (FSL) on hospitalizations for ADEs in people with T2DM on basal insulin only regimen±noninsulin antidiabetic drugs. A retrospective study of the French national Système National des Données de Santé reimbursement claims database (≈66 million French people) identified people with T2DM on basal insulin therapy receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. Claims data for the 12 months before, and up to 24 months after FSL initiation, were analyzed. Hospitalizations for ADEs were identified, using ICD-10 codes as main or related diagnosis, for: SH events; DKA events; comas; and hyperglycemia-related admissions. A total of 5933 people with T2DM on basal insulin therapy initiated FSL during the selection period. Of the patients, 78.9% were on basal insulin and other hypoglycemic agents. Among the 5933 patients identified, 2.01% had at least one hospitalization for any ADE in the year before FSL initiation, compared to 0.75% (1 year) and 0.60% (2 years). Reductions in ADEs were driven by 75% fewer DKA admissions, with a 44% reduction in SH admissions. These patterns of reduced ADEs persisted after 2 years, with a further 43% reduction in DKA rates. This study emphasizes the value of the FSL system in reducing ADEs in people with T2DM in France not on intensive insulin therapy and initially treated with basal-only insulin therapy.
2型糖尿病（T2DM）患者可能需要启动胰岛素治疗以实现血糖目标，但这与急性糖尿病事件（ADEs）相关，包括严重低血糖（SH）或糖尿病酮症酸中毒（DKA）。我们评估了启动FreeStyle Libre系统（FSL）对仅接受基础胰岛素治疗±非胰岛素抗糖尿病药物的T2DM患者ADEs住院情况的影响。对法国国家健康数据报销索赔数据库（约6600万法国人）进行的一项回顾性研究，确定了在2017年8月1日至2018年12月31日期间接受基础胰岛素治疗并首次报销FSL的T2DM患者。分析了FSL启动前12个月以及启动后长达24个月的索赔数据。使用国际疾病分类第十版（ICD - 10）编码作为主要或相关诊断，确定ADEs住院情况，包括：SH事件；DKA事件；昏迷；以及与高血糖相关的入院。在入选期间，共有5933例接受基础胰岛素治疗的T2DM患者启动了FSL。其中，78.9%的患者同时使用基础胰岛素和其他降糖药物。在确定的5933例患者中，2.01%在FSL启动前一年因任何ADE至少住院一次，而在启动后一年为0.75%，两年为0.60%。ADEs的减少主要是由于DKA入院减少了75%，SH入院减少了44%。这些ADEs减少的模式在2年后仍然存在，DKA发生率进一步降低了43%。本研究强调了FSL系统在降低法国未接受强化胰岛素治疗且最初仅接受基础胰岛素治疗的T2DM患者ADEs方面的价值。
