Authors (including presenting author) :
Lai KPL, Tsang ML, Chan PF, Chan WY, Luk MHM
Affiliation :
Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster
Introduction :
Flash glucose monitoring (FGM) was being adopted as an alternative or adjunction to self-monitoring of blood glucose (SMBG) for patients with insulin treated diabetes. Studies showed that FGM decreased the risk of hypoglycemia and improved the glycaemic control. However, the evaluation of applicability of FGM in primary care was lacking.
Objectives :
To evaluate the clinical impacts of a 2-week FGM on the glycemic control in terms of change in HbA1c and hypoglycemic events in Chinese patients with type 2 diabetes receiving insulin treatment in a General Out-patient Clinic.
Methodology :
This was a randomized controlled study. All Chinese patients attending a Family Medicine Specialist run diabetic clinic and receiving insulin treatment from 8th June 2020 to 7th October 2020 were randomized to intervention and control group in the ratio of 1:1. Patients in the intervention group would receive a 2-week FGM monitoring. Insulin titration would be done according to the Ambulatory Glucose Profile report and SMBG in the intervention and control group respectively. All patients were assessed again after 16 weeks and the change in HbA1c and the number of hypoglycemia events were compared.
Result & Outcome :
89 subjects were recruited in the study with 45 patients being randomized to the intervention group and 44 to the control group. The control group was observed to be younger (mean age 62.4 versus 68.4 in the intervention group) and had a higher baseline HbA1c (mean HbA1c 8.0% versus 7.7% in the intervention group) after randomization due to chance effect. After intervention, the difference of mean HbA1c between the two groups were statistically not significant (8.0% in the intervention group and 8.2% in the control group). After applying FGM, patients in intervention group had significantly less multiple hypoglycaemic episodes (0% versus 16.3% in control group, p=0.01). The proportion of patients with any hypoglycaemic events was also decreased from 28.9% to 15.6% in the intervention group. There was significantly larger proportion of patients with insulin dose titrated down after applying FGM in the intervention group (48.9% versus 7.0%, p<0.01). Conclusion: While both 2 week-FGM and SMBG had a comparable effect in glycemic control in Chinese patients with type 2 diabetes and receiving insulin treatment in our study, FGM could be a very useful clinical tool to guide the titration of insulin and reduce the number of hypoglycemic episodes and serious hypoglycemic events.
