Important drop in rate of acute diabetes complications in people with type 1 or type 2 diabetes after initiation of flash glucose monitoring in France: the RELIEF study

Roussel, Ronan; Riveline, Jean-Pierre; Vicaut, Eric; de Pouvourville, Gérard; Detournay, Bruno; Emery, Corinne; Levrat-Guillen, Fleur; Guerci, Bruno

doi:10.2337/dc20-1690

Cited by 173Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Important drop in rate of acute diabetes complications in people with type 1 or type 2 diabetes after initiation of flash glucose monitoring in France: the RELIEF study

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Roussel, Ronan, Riveline, Jean-Pierre, Vicaut, Eric, de Pouvourville, Gérard, Detournay, Bruno, Emery, Corinne, Levrat-Guillen, Fleur, Guerci, Bruno·2021·Diabetes Care

DOI 10.2337/dc20-1690PMC PMC8247513

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Abstract

OBJECTIVE: The RELIEF study assessed rates of hospitalization for acute diabetes complications in France before and after initiation of the FreeStyle Libre system. RESEARCH DESIGN AND METHODS: A total of 74,011 patients with type 1 diabetes or type 2 diabetes who initiated the FreeStyle Libre system were identified from the French national claims database with use of ICD-10 codes, from hospitalizations with diabetes as a contributing diagnosis, or the prescription of insulin. Patients were subclassified based on self-monitoring of blood glucose (SMBG) strip acquisition prior to starting FreeStyle Libre. Hospitalizations for diabetic ketoacidosis (DKA), severe hypoglycemia, diabetes-related coma, and hyperglycemia were recorded for the 12 months before and after initiation. RESULTS: Hospitalizations for acute diabetes complications fell in type 1 diabetes (−49.0%) and in type 2 diabetes (−39.4%) following FreeStyle Libre initiation. DKA fell in type 1 diabetes (−56.2%) and in type 2 diabetes (−52.1%), as did diabetes-related comas in type 1 diabetes (−39.6%) and in type 2 diabetes (−31.9%). Hospitalizations for hypoglycemia and hyperglycemia decreased in type 2 diabetes (−10.8% and −26.5%, respectively). Before initiation, hospitalizations were most marked for people noncompliant with SMBG and for those with highest acquisition of SMBG, which fell by 54.0% and 51.2%, respectively, following FreeStyle Libre initiation. Persistence with FreeStyle Libre at 12 months was at 98.1%. CONCLUSIONS: This large retrospective study on hospitalizations for acute diabetes complications shows that a significantly lower incidence of admissions for DKA and for diabetes-related coma is associated with use of flash glucose monitoring. This study has significant implications for patient-centered diabetes care and potentially for long-term health economic outcomes.

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Use of CGM may prevent emergency department visits and hospital admission in people with type 1 and type 2 diabetes.
“recent studies have shown that use of CGM may prevent emergency department visits and hospital admission in people with type 1 and type 2 diabetes”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [198]
The Results section, “Impact of Starting the FreeStyle Libre System on Rates of Hospitalization for Acute Diabetes Complications” (page not provided), reports fewer hospitalizations after flash CGM initiation in people with both type 1 and type 2 diabetes. The study assessed hospitalizations, not emergency department visits separately, so it does not support that part of the claim. (LLM, conf=0.88)
Experimental — accuracy not yet measured
In adults with type 1 or type 2 diabetes, intermittently scanned CGM reduces acute diabetes complications such as diabetic ketoacidosis, severe hypoglycemia or diabetes-related coma, and hospitalizations for hypoglycemia and hyperglycemia.
“Reductions in acute diabetes complications, such as diabetic ketoacidosis (DKA), episodes of severe hypoglycemia or diabetes-related coma, and hospitalizations for hypoglycemia and hyperglycemia, have been observed in adults with type 1 or type 2 diabetes (43,78,80)”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [80]

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69-OR: Freestyle Libre System Use Is Associated with Reduction in Inpatient and Outpatient Emergency Acute Diabetes Events and All-Cause Hospitalizations in Patients with Type 2 Diabetes
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The Impact of the FreeStyle LibreTM Flash Glucose Monitoring System on Glycemic Control in Patients with Diabetes; Observational Multicenter 15-Months Study
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Important Decrease in Hospitalizations for Acute Diabetes Events Following FreeStyle Libre System Initiation in People with Type 2 Diabetes on Basal Insulin Therapy in France
Guerci, B., Roussel, R., Levrat‐Guillen, F., Detournay, B., Vicaut, É., de Pouvourville, G., Emery, C., & Riveline, J. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2022.0271 · Cited by 72 · see citing works
Self-citation

Authors: Roussel, R., Riveline, J.-P., Vicaut, E., de Pouvourville, G., Detournay, B., Emery, C., Levrat-Guillen, F., & Guerci, B.
Affiliations: Inserm (FR)
Clinical Research Unit, Fernand Vidal Hospital, Paris, France
Department of Economics, ESSEC Business School, Cergy-Pontoise, France
Cemka-Eval (France) (FR)
Abbott Laboratories, Maidenhead, Berkshire, U.K.
Université de Lorraine (FR)
Corresponding author: Roussel, Ronan
ORCID: Roussel, Ronan
Riveline, Jean-Pierre
Detournay, Bruno
Emery, Corinne
Guerci, Bruno
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2021-04-20
Volume: 44
Issue: 6
Pages: 1368-1376
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc20-1690
PMC: PMC8247513
OpenAlex: W3152935002
Cited by: 173
References: 25
Citations by year: 2026: 25 · 2025: 48 · 2024: 39 · 2023: 27 · 2022: 24 · 2021: 10
FWCI: 18.64
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.diabetesjournals.org/content/license (vor)
Locations: Diabetes Care (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
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, type 2 diabetes, diabetic ketoacidosis, hypoglycemia, hyperglycemia, hospitalization rates, self-monitoring of blood glucose
MeSH terms: Blood Glucose, Diabetes Mellitus, Type 2, Humans, Retrospective Studies, Blood Glucose Self-Monitoring, Diabetic Ketoacidosis

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Important drop in rate of acute diabetes complications in people with type 1 or type 2 diabetes after initiation of flash glucose monitoring in France: the RELIEF study

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