Practical Considerations for Initiating and Utilizing Flash Continuous Glucose Monitoring in Clinical Practice

Carol H. Wysham; Davida F. Kruger

Disclosures

J Endo Soc. 2021;5(9) 

In This Article

Abstract and Introduction

Abstract

Use of continuous glucose monitoring (CGM) has been shown to improve clinical outcomes in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), including improved glycemic control, better treatment adherence, and an increased understanding of their treatment regimens. Retrospective analysis of CGM data allows clinicians and patients to identify glycemic patterns that support and facilitate informed therapy adjustments. There are currently 2 types of CGM systems: real-time CGM (rtCGM) and flash CGM. The FreeStyle Libre 2 (FSL2) is the newest flash CGM system commercially available. Because the FSL2 system was only recently cleared for use in the US, many endocrinologists and diabetes specialists may be unfamiliar with the strengths, limitations, and potential of the FSL2 system. This article focuses on practical approaches and strategies for initiating and using flash CGM in endocrinology and diabetes specialty practices.

Introduction

The benefits of continuous glucose monitoring (CGM) have been demonstrated in large clinical trials[1–4] and numerous real-world, observational studies.[5–15] On the strength of this growing body of evidence, use of this CGM is recommended for most individuals with diabetes who are treated with intensive insulin regimens.[16]

CGM technology first emerged as real-time CGM (rtCGM); however, flash continuous glucose monitoring (flash CGM), another method of CGM, is being adopted by an increasing number of individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) for their daily self-management.

Large randomized controlled trials using flash CGM have demonstrated significant improvements in hypoglycemia, glycemic variability, and patient satisfaction in individuals with well-controlled T1D[3] and T2D[17] who were treated with intensive insulin therapy. Improvements in glycated hemoglobin A1c (HbA1c) and percentage of time within the target glucose range were observed in T1D[3] but not T2D[17] patients. Moreover, recent real-world observational studies have reported significant reductions in hospital admissions for severe hypoglycemia and/or diabetic ketoacidosis in large cohorts of T1D adults who used flash CGM for 12 months.[6,7] Decreased hypoglycemia frequency, reduced HbA1c, and improved quality of life among young adults with T1D treated with insulin pump therapy have also been demonstrated.[18]

The FreeStyle Libre 2 (FLS2) (Abbott Diabetes Care, Alameda, CA) is the newest flash CGM system commercially available. Unlike earlier versions of the FreeStyle Libre system, which did not offer alarms, the FSL2 offers optional alarms as an added safeguard against severe hypoglycemia and hyperglycemia. Users can select the times and situations when the alarms are operational, which can help counter "alarm fatigue" and support persistence in their system.

Because the FLS2 system was only recently cleared for use in the United States, many clinicians may be unfamiliar with the strengths, limitations, and potential of the FSL2 system in managing T1D and insulin-treated T2D patients who are treated with intensive insulin management regimens. The aim of this article is to provide practical guidance for initiating and utilizing the FSL2 system in endocrinology and diabetes specialty practices.

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