Dataset Information

Marked improvement in HbA_1c following commencement of flash glucose monitoring in people with type 1 diabetes.

ABSTRACT:

Aims/hypothesis

Minimal evidence supports the efficacy of flash monitoring in lowering HbA_1c. We sought to assess the impact of introducing flash monitoring in our centre.

Methods

We undertook a prospective observational study to assess change in HbA_1c in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring data and hospital admissions.

Results

Those with baseline HbA_1c ?58 mmol/mol (7.5%) achieved a median -7 mmol/mol (interquartile range [IQR] -13 to -1) (0.6% [-1.2 to -0.1]%) change in HbA_1c (p?1c <58 mmol/mol rose from 34.2% to 50.9% (p?1c across a similar timescale (p?=?0.508). Higher HbA_1c (p?1c fall of ?5 mmol/mol (0.5%). More symptomatic (OR 1.9, p?Conclusions/interpretationFlash monitoring is associated with significant improvements in HbA_1c and fewer diabetic ketoacidosis admissions. Higher rates of hypoglycaemia may relate to greater recognition of hitherto unrecognised events. Impact upon quality of life parameters was mixed but overall treatment satisfaction was overwhelmingly positive.

SUBMITTER: Tyndall V

PROVIDER: S-EPMC6647076 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Marked improvement in HbA<sub>1c</sub> following commencement of flash glucose monitoring in people with type 1 diabetes.

Tyndall Victoria V Stimson Roland H RH Zammitt Nicola N NN Ritchie Stuart A SA McKnight John A JA Dover Anna R AR Gibb Fraser W FW

Diabetologia 20190609 8

<h4>Aims/hypothesis</h4>Minimal evidence supports the efficacy of flash monitoring in lowering HbA<sub>1c</sub>. We sought to assess the impact of introducing flash monitoring in our centre.<h4>Methods</h4>We undertook a prospective observational study to assess change in HbA<sub>1c</sub> in 900 individuals with type 1 diabetes following flash monitoring (comparator group of 518 with no flash monitoring). Secondary outcomes included changes in hypoglycaemia, quality of life, flash monitoring dat ...[more]

PMID: 31177314

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Project description:BackgroundEarly-onset GDM often requires pharmacological treatment and is associated with adverse perinatal outcomes, but data is insufficient regarding the best methods to identify high-risk women requiring early GDM screening. The aim of this study was to analyze the diagnostic accuracy of HbA1c in the prediction of (1) plasma glucose concentrations > 90th percentile in an oral glucose tolerance test (OGTT) at 12-16 weeks' gestation; and (2) pharmacologically treated early- or late-onset GDM.MethodsHbA1c was measured at 8-14 weeks' gestation in a population-based cohort of 1394 Finnish women recruited for the Early Diagnosis of Diabetes in Pregnancy (EDDIE) study between 3/2013 and 12/2016. Information on maternal risk factors were collected at recruitment. Subsequently, a 2-hour 75 g OGTT was performed at 12-16 weeks' gestation (OGTT1), and if normal, repeated at 24-28 weeks' gestation (OGTT2). Early- and late-onset GDM were diagnosed using the same nationally endorsed cut-offs for fasting, 1 h- and 2 h-plasma glucose: ≥5.3, ≥ 10.0mmol/l, and/or ≥ 8.6mmol/l, respectively. In total, 52/1394 (3.7%) women required metformin or insulin treatment for GDM, including 39 women with early-onset GDM diagnosed at OGTT1 and 13 women with late-onset GDM diagnosed at OGTT2.ResultsMaternal early-pregnancy HbA1c ≥ 35mmol/mol (≥ 5.4%) was the best cut-off to predict fasting or post-load plasma glucose > 90th percentile in OGTT1, but its diagnostic accuracy was low [AUC (95% CI) 0.65 (0.62 to 0.69), sensitivity 0.55 (0.49 to 0.60) and specificity 0.67 (0.64 to 0.70)] both alone and in combination with other maternal risk factors. However, HbA1c ≥ 35mmol/mol correlated positively with plasma glucose concentrations at all time points of OGTT1 and predicted pharmacologically treated GDM diagnosed at OGTT1 or OGTT2; AUC (95% CI) 0.75 (0.68 to 0.81), sensitivity 0.75 (0.61 to 0.86), specificity 0.64 (0.61 to 0.66).ConclusionsIn our population-based cohort, early-pregnancy HbA1c ≥ 35mmol/mol was positively associated with fasting and post-load plasma glucose concentrations in an OGTT at 12-16 weeks' gestation and predicted pharmacologically-treated early- and late-onset GDM, suggesting potential utility in first-trimester identification of women at high risk of severe GDM subtypes.

Dataset Information

Marked improvement in HbA_1c following commencement of flash glucose monitoring in people with type 1 diabetes.

Aims/hypothesis

Methods

Results

Publications

Marked improvement in HbA<sub>1c</sub> following commencement of flash glucose monitoring in people with type 1 diabetes.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Marked improvement in HbA1c following commencement of flash glucose monitoring in people with type 1 diabetes.

Aims/hypothesis

Methods

Results

Publications

Marked improvement in HbA<sub>1c</sub> following commencement of flash glucose monitoring in people with type 1 diabetes.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Marked improvement in HbA_1c following commencement of flash glucose monitoring in people with type 1 diabetes.