Flash glucose monitoring became eligible for NHS funding in Scotland in 2018. The present study sought to evaluate flash usage in Scotland between 2014 and 2020, and to examine the impact of the technology on HbA1c and diabetes emergencies according to baseline age, sex, socioeconomic group, glycaemic control, insulin pump usage and education.
Using data from the Scottish Care Information – Diabetes Collaboration database, and linked to hospital and national records, a total of 14 682 individuals with type 1 diabetes were evaluated. Use of flash monitoring grew rapidly after it became eligible for funding, rising from 3.1% in 2017 to 45.9% in mid-2020. Usage varied widely by age (from 64.3% in those aged <13 years to 32.7% in those aged ≥65 years) and by socioeconomic status (54.4% vs 36.2% in the least vs most deprived postcodes).
Overall, median HbA1c decreased by 2.5 mmol/mol (0.2%) in the year following flash initiation; however, there was wide variation according to baseline HbA1c, with a median reduction of 15.5 mmol/mol in those with HbA1c over 84 mmol/mol (9.8%) at baseline compared with an increase of 1 mmol/mol in those with an initial HbA1c <54 mmol/mol (7.1%). Significant reductions in HbA1c were observed in all age groups, sexes and socioeconomic levels and regardless of insulin pump use, completion of structured diabetes education or early (self-funded) adoption of the technology. Almost all variation within these subgroups was due to the HbA1c level at baseline.
Diabetic ketoacidosis (DKA) rates fell significantly after flash initiation, both in users as a whole and within all subgroups except for adolescents. Adjusting for rates prior to initiation, the DKA event rate ratio was estimated to be 0.59 (95% CI, 0.53–0.64) in the year after flash initiation compared with up to 5 years before.
The rates of hospitalisation for severe hypoglycaemia (HSH) also decreased overall following flash initiation. The reduction was particularly high in those with a prior HSH event in the previous 5 years (rate ratio, 0.25; 95% CI, 0.20–0.32).
The authors conclude that flash glucose monitoring use in Scotland has been associated with significant improvements in HbA1c, especially in individuals with high HbA1c at baseline. They argue that the lower usage in more deprived areas is a priority to overcome, given the striking reductions in DKA seen in all socioeconomic groups.
This study was funded by Diabetes UK and the Chief Scientist Office.
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