Glucose Monitor System Cuts Hospitalizations for DKA

Ketoacidosis rates were slashed with initiation of a continuous glucose monitor, a French study found.

Among people who started on the FreeStyle Libre system, annual rates of diabetic ketoacidosis dropped by 52% and 47% for those with type 1 diabetes and type 2 diabetes, respectively, reported Ronan Roussel MD, PhD, of Bichat Hospital in Paris.

Not including diabetic comas, incidence of hospitalization for ketoacidosis events dropped from 5.46 per 100 patients to 2.59 per 100, Roussel explained during a presentation at the American Diabetes Association (ADA) virtual meeting.

And ketoacidosis hospitalization rates dropped from 1.70 per 100 patients over the year down to only 0.90 among those with type 2 diabetes.

“It is plausible that the use of the FreeStyle Libre system allowed — due to its convenience — people to detect and limit persistent hyperglycemia and subsequently limit the occurrence of ketoacidosis,” Roussel pointed out.

When broken down by the average daily number of strips used for self-monitoring of blood glucose prior to using the system, two groups appeared to benefit most from the switch: those with very low and very high rates of self-monitoring.

Specifically, the biggest decline in hospitalization for ketoacidosis was seen among those who used an average of zero strips a day, as well as five or more strips a day:

• Zero strips a day: 60% decline in ketoacidosis in T1D; 51% decline in T2D
• 1-3 strips: 28% decline in T1D; 39% decline in T2D
• 4-5 strips: 41% decline in T1D; 43% decline in T2D
• 5+ strips: 59% decline in T1D; 52% decline in T2D

Citing other recently published data, Roussel said his group took on this study due to the growing body of literature showing an uptick in both rates of diabetic ketoacidosis and occurrences of hyperglycemic hyperosmolar state in people with either type 1 or type 2 diabetes.

“This is a clinical issue, but also increased burden of hospitalization is associated with significant healthcare utilization and expenditure in several countries,” he said.

The longitudinal, retrospective cohort study included data on over 33,000 individuals with type 1 diabetes and nearly 41,000 people with type 2 diabetes from a French reimbursement claim database. Rates of diabetic ketoacidosis were determined using ICD-10 codes. Index date was defined as the first reimbursement for the FreeStyle Libre system, either for the sensor or the reader, and compared ketoacidosis rates for the year prior and the year following. About 88% of these patients were treated with multiple daily injections or continuous subcutaneous insulin infusions.

Approved in the U.S. in September 2017, Abbott’s FreeStyle Libre Flash Glucose Monitoring System was the first system that doesn’t require fingerstick calibration when monitoring blood glucose. In July 2018, a 14-day flash glucose monitoring system replaced the original system that only allowed wear of the sensor on the back of the upper arm for ten days.

Looking separately at the type of insulin therapy utilized by the patient, improvements were seen across the board after initiation of the system. The number of patients with diabetic ketoacidosis dropped from 2.89% down to 1.32% among multiple daily injection users, and dropped from 2.58% to 1.8% for those receiving continuous subcutaneous insulin infusions.

Roussel also pointed out a few limitations of this study: patients could have undergone “enhanced self-care” after they started on the new device, such as diabetes education and more focused face-time with their healthcare provider during initial device prescription. The study also didn’t account for more specific clinical data such HbA1c levels.

This research comes on the heels of the FDA’s clearance this week of Abbott’s FreeStyle Libre 2 as an integrated continuous glucose monitor, indicated for use in children as young as four. Similarly worn for up to 14-days, this new system touts itself as the only integrated continuous glucose monitoring system currently available, meaning it can be interoperable with other devices, that also allows for customizable and optional real-time glucose alarms.