Impact of flash glucose monitoring on glucose control and hospitalization in type 1 diabetes: A nationwide cohort study

Background We evaluated the impact of flash continuous glucose monitoring (FCGM) on glycemic control and healthcare burden in a large real-world cohort of patients with type 1 diabetes (T1D) initiating FCGM technology. Methods In this retrospective cohort study, we included adults (age >= 18 years) with T1D from a large Health Maintenance Organization in Israel, who initiated FCGM during 2018. Primary outcomes included change in HbA1c >= 3 months following FCGM commencement and change in rate of internal-medicine hospitalization. Additional outcomes included changes in glucose test strip purchases, diabetes related outpatient health care visits and hospitalization for diabetic ketoacidosis (DKA) and/or severe hypoglycemia. Results The study included 3490 patients, followed for a median of 14 (inter-quartile range 11-15) months after FCGM commencement. Among 2682 patients with an HbA1c measured both at baseline and >= 3 months after FCGM initiation, average HbA1c declined from 8.1% +/- 1.46% to 7.9% +/- 1.31% (P < .001) at first measurement and was maintained during follow up. Specifically, in those with HbA1c >= 8%, a mean decline of 0.5% (P < .001) was observed. A clinically significant HbA1c reduction of >= 0.5% was experienced by 25.5% of the patients. The rate of internal medicine hospitalization, visits to primary care, or visits to endocrine/diabetes specialists in the period following FCGM commencement vs the 6 months prior was significantly reduced (P < .001). Hospitalization for DKA and/or hypoglycemia declined as well (P= .004). Conclusions FCGM was associated with significant and durable improvement in glycemic control as well as reduced consumption of healthcare services.