Flash Glucose Monitoring Vs Self-Monitoring in Diabetic Chronic Kidney Disease

Flash glucose monitoring (FGM) demonstrated similar effectiveness in reducing hypoglycemia in patients with diabetic chronic kidney disease (CKD) compared with self-monitoring of blood glucose (SBMG), according to late-breaking poster results presented at the American Diabetes Association Virtual 81st Scientific Sessions.

Patients with diabetes and CKD experience an increased risk of hypoglycemia by 2- to 3-fold, according to lead author Elaine Chow, PhD MBChB, who presented the results during a poster session on Friday, June 25. This is due to unmet needs in accurate clinical assessment of glycemic control from limitations of glycated hemoglobin A1c (HbA1c) as a marker and adherence to frequent SBMG. 

“[FGM] has been shown to be effective in reducing hypoglycemia in non-CKD type 1 and type 2 diabetes populations,” Chow said.

For the study, the investigators aimed to determine whether FGM was effective in reducing hypoglycemia compared with SMBG in patients with diabetes and moderate-to-advanced CKD stages G3b to 5 who are not on dialysis. The single-centered, randomized clinical trial included 94 adult patients with diabetes who had a history of symptomatic or severe hypoglycemia. Patients were randomized to either FGM (FreeStyle Libre; Abbott) or routine SMBG (CONTOUR PLUS; Ascensia Diabetes) for 16 weeks.

Both patients groups received education on hypoglycemia, ambulatory/SMBG glucose profile, and treatment review by the clinician and nurse at weeks 0, 4, 8, and 12. The investigators assessed continuous glucose monitoring (CGM) metrics, HbA1c, insulin dose, renal end points, hypoglycemia awareness, and treatment satisfaction at baseline and week 16.

The results demonstrated:

• Time below 3.9 millimoles per liter (mmol/L) was reduced by approximately half in both groups, with no significant difference between arms.
• Time greater than 3.9 mmol/L decreased significantly from 4.0% to 2.5% in the FGM group, but not in the SMBG group.
• HbA1c improved significantly across both groups.
• Fasting plasma glucose was slightly higher in the FGM group compared with SMBG at the end of the study.

One severe hypoglycemic event occurred in the FMG group in a prematurely discontinued participant, and none occurred in the SMBG group.

Chow concluded that FGM demonstrated effectiveness in reducing hypoglycemia and improving HbA1c in patients with diabetes and moderate-to-advanced CKD, but it was not significantly different from SMBG when accompanied by hypoglycemia education.

“Overall, FGM was acceptable with high sensor use; however, we do need further studies to investigate whether real-time studies with alerts would further reduce hypoglycemic episodes in this high-risk group,” she said.

Reference

Chow E, Ling J, Ng JK, Ma RC, et al. Flash glucose monitoring in the reduction of the hypoglycemia in diabetic kidney disease: A randomised controlled trial. Presented at: American Diabetes Association Virtual 81st Scientific Sessions; June 25-29, 2021; online.