Background The use Flash Glucose Monitoring (FGM) is considered a useful technology for self-management of type 1 diabetes mellitus (T1DM).
Patients will be required to meet specific criteria for initiation of FGM as per the National Institute of Clinical Excellence (NICE- NG 18) guidelines. Patients would also be required to meet specific measures of improvement in diabetic control for continuation of FGM under the National Health Service (NHS) funded services. These include completing regular scanning of sensor, sensor use time of more than 70%, improvement in baseline HbA1c and reduction in diabetes related hospital attendances or admissions.
Objectives To review the compliance and effectiveness of FGM use amongst paediatric patients with T1DM, within our service.
Methods This was a retrospective audit. A total of 46 patients were commenced on FGM between April 2019 and April 2020.
We collected and analysed the data, focusing on the percentage time of sensor use, number of scans per day, HbA1c at 0,1,3,6,9 and 12 months and the average number of diabetes related hospital attendances or admissions per year before and after starting FGM.
Results Forty-six patients were started on FGM due to poor glucose monitoring, persistently high HbA1c and frequent hypoglycaemic episodes. The mean age of these children at the start of FGM was 12.8 years.
Of the total 46 patients, 28 (61%) continued using FGM while the remaining 18 discontinued FGM. The reasons for discontinuing included primary skin conditions affecting adhesiveness of device (2 patients), changing to continuous glucose monitoring system (6 patients), non-engagement in the technology (2 patients) and personal choice (8 patients).
Out of these 28 patients, 18 (64.3%) patients had sensor usage time of more than 70% and 8 (28.6%) did more than 8 scans per day. On commencing FGM (0 months), the HbA1c of these 28 children ranged between 6.2 and 11.2 mmol/mol (mean= 8.8). At 12 months, this was between 5.8 to 11.8 mmol/mol (mean= 8.3), demonstrating a 0.5 mmol/mol reduction in the mean. A One-tailed Mann-Whitney U-test indicates that the HbA1c at 12 months is less than at 0 months, U= 279, p= 0.07. While this may not be statistically significant, we have demonstrated that after commencing FGM, 19 (67.9%) patients’ serial HbA1c displayed a downward trend, and 11 patients (39.2%) had a reduction in diabetes related hospital attendances per year, with both criteria being met by 8 (28.5%) patients.
Conclusions Our results demonstrate that FGM helps improve diabetes management and outcomes. The treating diabetes teams should continue to support patients in the use of advanced technology through regular follow-up, and empower patients and carers towards diabetes self-management, thereby improving outcomes.
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