Flash Glucose Monitoring in Clinical Management of Patients with Type 1 Diabetes Mellitus
Objective of the Paper: To describe the potential of flash glucose monitoring (FGM) by reviewing data in the literature and the authors’ own clinical observations.
Key Points: Diabetes mellitus (DM) remains a challenging issue. Continuous glycemic monitoring is the main factor in getting the course of this disease under control. The most common method is self-monitoring using a glucose meter. This has, however, a number of disadvantages, the greatest of which is its failure to detect episodes of latent hypoglycemia and assess actual daily blood glucose level fluctuations. Therefore, continuous glycemic monitoring is becoming increasingly popular in clinical practice. This method helps in providing DM patients with treatments that are tailored as much as possible to specific patient characteristics and adjusting these interventions when necessary. Fairly recently, FGM has been introduced into clinical practice. A number of studies conducted over the past years, which were designed to compare the effectiveness of FGM and conventional blood glucose self-monitoring using glucose meters, and to evaluate glycated hemoglobin levels, showed that FGM is a more effective option. This paper describes three clinical cases of type 1 DM to illustrate the effectiveness of FGM.
Conclusion: Analysis of FGM data obtained from three patients clearly demonstrates the advantages of this method in clinical practice. It should be noted, however, that in order to maintain positive results over time, FGM should be used continuously.
Contribution: Demidova, T.Yu. — study design, approval of the manuscript for publication; Titova, V.V. — collection and the flash monitoring data analysis; Neudakhina, V.O. — thematic publications reviewing, assistance in writing the final manuscript.
Conflict of interest: The authors declare that they do not have any conflict of interests.
T.Yu. Demidova — N.I. Pirogov Russian National Research Medical University (a Federal State Autonomous Educational Institution of Higher Education), Russian Ministry of Health; 4 Shkulev St., Bldg. 1, Moscow, Russian Federation 109263. eLIBRARY.RU SPIN: 9600-9796. ORCID: https://orcid.org/0000-0001-6385-540X. Scopus Author ID: 7003771623. E-mail: email@example.com
V.V. Titova (Corresponding author) — N.I. Pirogov Russian National Research Medical University (a Federal State Autonomous Educational Institution of Higher Education), Russian Ministry of Health; 4 Shkulev St., Bldg. 1, Moscow, Russian Federation 109263. eLIBRARY.RU SPIN: 7864-2910. E-mail: firstname.lastname@example.org
V.O. Neudakhina — N.I. Pirogov Russian National Research Medical University (a Federal State Autonomous Educational Institution of Higher Education), Russian Ministry of Health; 4 Shkulev St., Bldg. 1, Moscow, Russian Federation 109263. ORCID: https://orcid.org/0000-0003-0809-0429. E-mail: NeudakhinaVeronika@yandex.ru
Fig. 1. Male patient 1 glucose profile characteristics
Fig. 2. Male patient 1 daily diary
Fig. 3. Male patient 2 24-h glucose profiles
Fig. 4. Male patient 2 glucose profile characteristics
Fig. 5. Female patient 3 24-h glucose profiles
Fig 6: Female patient 3 glucose profile characteristics
- National Institute of Diabetes and Digestive and Kidney Diseases. Sickle cell trait and other hemoglobinopathies and diabetes (for providers), 2014. URL: https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/diabetes/sickle-cell-trait-hemoglobinopathies-diabetes
- Bry L., Chen P. C., Sacks D.B. Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin. Clin. Chem. 2001; 47(2): 153–63.
- Makhlina E.S., Kapliyeva M.P., Navmenova Ya.L., Savasteyeva I.G. Complex assessment of compensation in diabetes mellitus type 1 according to the results of continuous glucose monitoring. Health and Ecology Problems. 2016; 3(49): 118–22. (in Russian)
- Karter A.J., Ackerson L.M., Darbinian J.A., D’Agostino R.B., Ferrara A., Liu J. et al. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am. J. Med. 2001; 111(1): 1–9. DOI: 10.1016/s0002-9343(01)00742-2
- Kilpatrick E.S., Rigby A.S., Atkin S.L. Mean blood glucose compared with HbA1c in the prediction of cardiovascular disease in patients with type 1 diabetes. Diabetologia. 2008; 51(2): 365–71. DOI: 10.1007/s00125-007-0883-x
- Lin C.C., Li C.I., Yang S.Y., Liu C.S., Chen C.C., Fuh M.M. et al. Variation of fasting plasma glucose: a predictor of mortality in patients with type 2 diabetes. Am. J. Med. 2012; 125(4): 416.e9–18. DOI: 10.1016/j.amjmed.2011.07.027
- Tarasov Yu.V., Philippov Yu.I., Borisova E.K., Fedorova E.A., Mayorov A.Yu., Shestakova M.V. Continuous glucose monitoring technologies: state of the art and future perspectives in view of artificial pancreas. Endocrinology Problems. 2015; 61(4): 54–72. (in Russuan). DOI: 10.14341/probl201561454-72
- Gil-Ibáñez M.T., Aispuru G.R. Cost-effectiveness analysis of glycaemic control of a glucose monitoring system (FreeStyle Libre®) for patients with type 1 diabetes in primary health care of Burgos. Enferm. Clin. 2020; 30(2): 82–8. DOI: 10.1016/j.enfcli.2019.07.011
- Leelarathna L., Wilmot E.G. Flash forward: a review of flash glucose monitoring. Diabetic Med. 2018; 35(4): 472–82. DOI: 10.1111/dme.13584
- Pintus D., Ng S.M. Freestyle libre flash glucose monitoring improves patient quality of life measures in children with Type 1 diabetes mellitus (T1DM) with appropriate provision of education and support by healthcare professionals. Diabetes Metab. Syndr. 2019; 13(5): 2923–6. DOI: 10.1016/j.dsx.2019.07.054
- Al Hayek A.A., Robert A.A., Al Dawish M.A. Differences of FreeStyle Libre flash glucose monitoring system and finger pricks on clinical characteristics and glucose monitoring satisfactions in type 1 diabetes using insulin pump. Clin. Med. Insights Endocrinol. Diabetes. 2019; 12: 117955141986110. DOI: 10.1177/1179551419861102
- Demidova T.Yu., Ushanova F.O. Modern technologies for continuous monitoring of glycemia: developing opportunities for check-up and control. Rus. Med. J. 2018; 11(II): 86–90. (in Russian)
- Pashkova E.Yu., Ametov A.S., Demidov N.A. Clinical significance of continuous glucose monitoring in diabetic patients on insulin therapy. Endocrinology: News. Views. Education. 2018; 1(22): 50–7. (in Russian). DOI: 10.24411/2304-9529-2018-00005