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Quality of life and glucose control after 1 year of nationwide reimbursement of intermittently scanned continuous glucose monitoring in adults living with type 1 diabetes (FUTURE): a prospective observational real-world cohort study

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Charleer, Sara, De Block, Christophe, Van Huffel, Liesbeth, Broos, Ben, Fieuws, Steffen, Nobels, Frank, Mathieu, Chantal, Gillard, Pieter·2020·Diabetes Care
DOI 10.2337/dc19-1610
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Abstract

OBJECTIVE: In 2016, nationwide reimbursement of intermittently scanned continuous glucose monitoring (isCGM) for people living with type 1 diabetes treated in specialist diabetes centers was introduced in Belgium. We undertook a 12-month prospective observational multicenter real-world study to investigate impact of isCGM on quality of life and glycemic control. RESEARCH DESIGN AND METHODS: Between July 2016 and July 2018, 1,913 adults with type 1 diabetes were consecutively recruited in three specialist diabetes centers. Demographic, metabolic, and quality of life data were collected at baseline, 6 months, and 12 months of standardized clinical follow-up. The primary end point was evolution of quality of life from baseline to 12 months. Secondary outcome measures were, among others, change in HbA1c, time spent in different glycemic ranges, occurrence of acute diabetes complications, and work absenteeism. RESULTS: General and diabetes-specific quality of life was high at baseline and remained stable, whereas treatment satisfaction improved (P < 0.0001). Admissions for severe hypoglycemia and/or ketoacidosis were rare in the year before study (n = 63 out of 1,913; 3.3%), but decreased further to 2.2% (n = 37 out of 1,711; P = 0.031). During the study, fewer people reported severe hypoglycemic events (n = 280 out of 1,913 [14.6%] vs. n = 134 out of 1,711 [7.8%]; P < 0.0001) or hypoglycemic comas (n = 52 out of 1,913 [2.7%] vs. n = 18 out of 1,711 [1.1%]; P = 0.001) while maintaining HbA1c levels. Fewer people were absent from work (n = 111 out of 1,913 [5.8%] vs. n = 49 out of 1,711 [2.9%]; P < 0.0001). Time spent in hypoglycemia significantly decreased in parallel with less time in range and more time in hyperglycemia. Eleven percent (n = 210) of participants experienced skin reactions, leading to stopping of isCGM in 22 participants (1%). CONCLUSIONS: Nationwide unrestricted reimbursement of isCGM in people with type 1 diabetes treated in specialist diabetes centers results in higher treatment satisfaction, less severe hypoglycemia, and less work absenteeism, while maintaining quality of life and HbA1c.

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  • Benefits of CGM in T1D include reductions in A1C, fewer severe hypoglycemia events in children and adults, increased time in range, and significant reductions in hospitalizations for severe hypoglycemia and DKA.

    “Benefits of CGM in this population include reductions in A1C, fewer severe hypoglycemia events in children and adults, increased TIR, as well as significant reductions in hospitalizations for severe hypoglycemia and DKA.156,162–168”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [163]

    The Results (p. 1) report significantly fewer severe hypoglycemic events and fewer admissions for severe hypoglycemia and/or ketoacidosis among adults using intermittently scanned CGM. They also report maintained HbA1c and less time in range, not the claimed improvements in those measures. The study enrolled adults; its introduction (p. 2) mentions earlier pediatric studies but does not establish the claimed reduction in severe events among children. (LLM, conf=0.90)

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  • In adults with type 1 diabetes who wear intermittently scanned CGM, hypoglycemia improves.

    “and hypoglycemia (41,43,75,78,79).”

    From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [79]

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Research works printed but not linked: 4

  1. [15]15. Ish-Shalom M, Wainstein J, Raz I, Mosenzon O. Improvement in glucose control in dif fi cult-tocontrol patients with diabetes using a novel fl ash glucosemonitoringdevice.JDiabetesSciTechnol 2016;10:1412 -1413
  2. [32]32. Baysal N, Cameron F, Buckingham BA, et al.; InHomeClosed-LoopStudyGroup(IHCL).Anovel method to detect pressure-induced sensor attenuations (PISA) in an arti fi cial pancreas. J Diabetes Sci Technol 2014;8:1091 -1096
  3. [36]36. Rawlings AM, Sharrett AR, Albert MS, et al. The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairmentanddementia:theARICstudy.Diabetes Care 2019;42:1248 -1254
  4. [40]40. Herman A, Aerts O, Baeck M, et al. Allergic contact dermatitis caused by isobornyl acrylate in Freestyle Ò Libre, a newly introduced glucose sensor. Contact Dermatitis 2017;77: 367 -373

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Authors
Charleer, S., De Block, C., Van Huffel, L., Broos, B., Fieuws, S., Nobels, F., Mathieu, C., & Gillard, P.
Affiliations
  • KU Leuven (BE)
  • Department of Endocrinology, Diabetology and Metabolism, University of Antwerp–Antwerp University Hospital, Antwerp, Belgium
  • Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
  • University of Antwerp (BE)
  • Hasselt University (BE)
  • Onze Lieve Vrouwziekenhuis Hospital (BE)
Corresponding author
Gillard, Pieter
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2019-12-16
Volume
43
Issue
2
Pages
389-397
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc19-1610
OpenAlex
W2996110789
Semantic Scholar
2e600084d19dd2a0b57fc70dd35b7c24af1d7db8
Cited by
261
References
41
Citations by year
2026: 12 · 2025: 28 · 2024: 40 · 2023: 47 · 2022: 57 · 2021: 58 · 2020: 19
FWCI
27.19
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor, 35 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • Document Server@UHasselt (UHasselt) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 1 diabetes, intermittently scanned continuous glucose monitoring, quality of life, glycemic control, HbA1c, hypoglycemia, diabetic ketoacidosis, absenteeism, treatment satisfaction, health insurance reimbursement, real-world outcomes, adults with diabetes, Belgium, hypoglycemic coma
MeSH terms
Adult, Age Factors, Belgium, Blood Glucose, Diabetes Mellitus, Type 1, Equipment and Supplies, Female, Hospitalization, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Insurance, Health, Reimbursement, Male, Middle Aged, Prospective Studies, Quality of Life, Blood Glucose Self-Monitoring, Cohort Studies

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