Effect of flash glucose monitoring on glycemic control, hypoglycemia, diabetes-related distress, and resource utilization in the Association of British Clinical Diabetologists (ABCD) nationwide audit
Open accessAbstract
OBJECTIVE: The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions. RESEARCH DESIGN AND METHODS: Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA1c following the use of FSL. Within-person variations of HbA1c were calculated using . RESULTS: Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (±18.8) years, 51% female, diabetes duration 16.0 (±49.9) years, and BMI of 25.2 (±16.5) kg/m2 (mean [±SD]). FSL users demonstrated a −5.2 mmol/mol change in HbA1c, reducing from 67.5 (±20.9) mmol/mol (8.3%) at baseline to 62.3 (±18.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4–7.8) months of follow-up (n = 3,182) (P < 0.0001). HbA1c reduction was greater in those with initial HbA1c ≥69.5 mmol/mol (>8.5%), reducing from 85.5 (±16.1) mmol/mol (10%) to 73.1 (±15.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (±1.8) and reduced to 2.4 (±1.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ≥4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis. CONCLUSIONS: We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.
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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 [75]
Continuous glucose monitoring improves glycemic control and reduces the risk of severe and nonsevere hypoglycemia.
“Continuous glucose monitoring (CGM) has been shown to improve glycemic control and self-monitoring, as well as to reduce the risk of hypoglycemia.”
From Importance of FDA-integrated continuous glucose monitors to ensure accuracy of continuous glucose monitoring (2025) · cites this paper as [8]
CGM supports people with diabetes to optimize therapy, diet, and activity, facilitating improved HbA1c, increased time in target range 70-180 mg/dL, reduced time below range <70 mg/dL, and improved Glycemia Risk Index scores.
“In fact, CGM supports people with DM to optimize their therapy, diet, and activity, facilitating improved HbA1c, increased time in target range of 70 to 180 mg/dL, reduced time below range (<70 mg/dL), and improved Glycemia Risk Index scores.5-11”
From Importance of FDA-integrated continuous glucose monitors to ensure accuracy of continuous glucose monitoring (2025) · cites this paper as [8]
Publicly available accuracy data from observational and randomized clinical trials supporting some non-iCGM-approved entrants include small sample sizes and/or very few data points in the critical range of <70 mg/dL, more stable patients, and no glucose and insulin challenges, and data may not have been published in peer-reviewed journals.
“For example, publicly available accuracy data from both observational and randomized clinical trials supporting some non-iCGM-approved entrants include small sample sizes and/or very few data points in the critical range of <70 mg/dL, more stable patients, and no glucose and insulin challenges, and data may not have been published in peer-reviewed journals.8,11,20-24,35,36,39-48”
From Importance of FDA-integrated continuous glucose monitors to ensure accuracy of continuous glucose monitoring (2025) · cites this paper as [8]
Individuals on a variety of insulin treatment plans can benefit from CGM with improved glucose control, decreased hypoglycemia, and enhanced self-efficacy.
“Individuals on a variety of insulin treatment plans can benefit from CGM with improved glucose control, decreased hypoglycemia, and enhanced self-efficacy (Section 7, “Diabetes Technology”) (1).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [1]
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Self-citation
- Authors
- Deshmukh, H., Wilmot, E. G., Gregory, R., Barnes, D., Narendran, P., Saunders, S., Furlong, N., Kamaruddin, S., Banatwalla, R., Herring, R., Kilvert, A., Patmore, J., Walton, C., Ryder, R. E. J., & Sathyapalan, T.
- Affiliations
- University of Hull (GB)
- University Hospitals of Derby and Burton NHS Foundation Trust (GB)
- Leicester General Hospital (GB)
- Tunbridge Wells Hospital (GB)
- Queen Elizabeth Hospital Birmingham (GB)
- Warrington and Halton Teaching Hospitals NHS Foundation Trust (GB)
- Mersey and West Lancashire Teaching Hospitals NHS Trust (GB)
- Darlington Memorial Hospital (GB)
- St Peter's Hospital (GB)
- Royal Surrey County Hospital (GB)
- Northampton General Hospital (GB)
- Birmingham City Hospital (GB)
- Corresponding author
- Sathyapalan, Thozhukat
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2020-07-15
- Volume
- 43
- Issue
- 9
- Pages
- 2153-2160
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC7440900
- OpenAlex
- W3043197730
- Cited by
- 175
- References
- 20
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 33 · 2023: 35 · 2022: 51 · 2021: 22 · 2020: 5
- FWCI
- 21.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion)
- Repository@Hull (Worktribe) (University of Hull) (acceptedVersion, other-oa)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- Abbott Laboratories
- 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
- flash glucose monitoring, FreeStyle Libre, type 1 diabetes, glycemic control, HbA1c reduction, hypoglycemia, hypoglycemia unawareness, diabetes distress, hospitalization, resource utilization (health care), real-world evidence, National Health Service, patient-reported outcomes, diabetes self-management
- MeSH terms
- Psychological Distress, Glycemic Control, Adult, Blood Glucose, Diabetes Mellitus, Female, United Kingdom, Health Resources, Glycated Hemoglobin, Hospitalization, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Male, Middle Aged, Patient Acceptance of Health Care, State Medicine, Stress, Psychological, Blood Glucose Self-Monitoring, Diabetic Ketoacidosis, Clinical Audit, Young Adult
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