Available online 16 March 2024, 108723

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The main findings were the increase in time of use and the decrease in time below range.

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We didn't find significant changes in TIR.

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The differences in TIR were significant in those patients with poor glycemic control.

Abstract

In Spain, from October 10th, 2023, the FreeStyle Libre 2 system offers the possibility to automatically changed from isCGM to rtCGM with a system update. Our study aimed to evaluate the glucometric before and after that date. We didn't find significant changes in TIR, however time of use increased and TBR decreased.

Section snippetsBackground

Real-time continuous glucose monitoring (rtCGM) or intermittently scanned continuous glucose monitoring (isCGM) should be offered for diabetes management in people living with diabetes mellitus (PLWDM) on multiple daily injections (MDI) who can use the devices safely (either by themselves or with a caregiver).1 The use of isCGM with optional alerts and alarms compared with blood glucose monitoring (BGM) improves glycemic control,2 quality of life and satisfaction.3 In adults with type 1

Methods

We performed a cross-sectional and longitudinal/retrospective, observational, and multicenter (four hospitals in Castilla-La Mancha) study. The protocol was approved by the Ethics Committee of the Complejo Hospitalario Universitario de Albacete, Spain (reference: 2023-087). All PLWDM users of Free-Style Libre 2 and the LibreLink application, connected to the Libreview platform, with a usage time ≥ 70 % before, 4 weeks, and 16 weeks after the date of the update possibility were included in the

Results

A total of 652 PLWDM on MDI (80.3 % type 1 diabetes; 15.8 % type 2 diabetes, and 3.9 % other types of diabetes) meeting inclusion criteria were analyzed (46.01 % women, age 48.23 ± 16.01 years). Time of use was 90.85 ± 7.04 % with 100 % ≥ 70 % and 10.51 ± 5.87 scans per day, 191 (29.29 %) had TIR > 70 %, and 122 (18.71 %) had TIR > 70 % + TBR < 4 % + CV ≤ 36 % before the date of the update possibility. TIR was 61.32 ± 17.30 % before, and 62.04 ± 17.16 % and 60.55 ± 17.95 %, 4 weeks and 16 weeks

Discussion

To our knowledge, this is the first study that evaluates the glucometric parameters in PLWDM users of the Free-Style Libre 2 system before and after the update possibility to rtMCG from a cohort based on a public health system. The main findings of our study were the increase in time of use and the decrease in time below range. The improvement observed in the time below range is small (3.62 ± 4.16 % VS 3.30 ± 4.06 % after 4 weeks, and 3.06 ± 3.69 % after 16 weeks from the update possibility).

Conclusion

In conclusion, the update possibility to real-time glucose readings in PLWDM using Free-Style Libre 2 was associated with an increase in time of use and a decrease in time below range. Achieving good control in PLWDM on MDI is difficult and strategies aimed at increasing time of use of CGM may lead to better glycemic control and greater efficiency of this technological tool for self-management of the disease.

Funding statement

Without supporting.

CRediT authorship contribution statement

Pedro J. Pinés-Corrales: Writing – review & editing, Writing – original draft, Validation, Supervision, Methodology, Investigation, Formal analysis, Conceptualization. María Carmen López-García: Writing – review & editing, Writing – original draft, Investigation. Alberto Sanz-Velasco: Writing – review & editing, Writing – original draft, Investigation. Antonio J. Moya-Moya: Writing – review & editing, Writing – original draft, Investigation. César Gonzalvo Díaz: Writing – review & editing,

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal interests' relationship that could have appeared to influence the work reported in this paper.

Acknowledgments

We thank the participants patients.

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