Video Glucose Control, Quality of Life, and Health Delivery Benefits of Deploying Flash-Based CGM Across the Diabetes Population Play Pause Volume Quality 1080P 720P 576P Fullscreen Captions Transcript Chapters Slides Glucose Control, Quality of Life, and Health Delivery Benefits of Deploying Flash-Based CGM Across the Diabetes Population Overview Continue to Test Back to Symposium Thank you very much Ramsey for the presentation, lovely overview as ever about all the challenges. We have the trials going on the future, so to speak and here we are at E. S. D. 2021 are virtual meeting and thank you very much for the kind invite. So I'll for the audience members. I'll carry on what Ramsey has said. But we're going to look at a little bit of a different sort of perspective as to where we are in this present world with technology. So to move things forward, my presentation, that's me, path car and we'll be looking at the benefits of deploying the flash based continuous glucose monitoring across the diabetes population. So what do you get when you try the challenges you face? How does that all work out? So that's what we're going to try and see as we go along. So a bit of a hat tip to one of my colleagues professor pretty Children, who kindly has given me this slide after. I think one of the exercises you're done with lots of people living with Type one diabetes and you can see this is a fantastic slide which summarizes the challenges that people face dealing with Type one diabetes on a day to day basis. And I personally have always said that Type one diabetes sits on three main stools so to speak. One is your self management. Second is your peer support. And thirdly is access to train professionals now. Self management being the key because of all these things that the person has to manage A bit of an overview about the journey in uh flash glucose monitoring, so to speak, 2014, it was first released, so to speak, around the global audience. 2015, lots of people revealed to fund you had the impact trial published in 2016, 20, end of 2017. It sort of starting to get into the NHS consciousness that in 2018 there was a lot of sort of chewing and throwing. And as you can see from one of the maps of the UK at that stage, differing areas having very different ways of giving up people. So, for example, the green areas where people were quite happily or easily getting the flash glucose, some areas in red finding it very, very difficult to So that was around about March april 2018. At which point national national commitment was made around 2019 that we started the work. So sort of try and even out the field and say that where can we get two? And the fantastic thing has been with support of so many people all around. And I mentioned about the educational modules be set up along with the diabetes technology network, working with partners, for example, diabetes UK. We are now in a position where by more than half of the type one diabetes population across the whole of the country has got access to flash glucose monitoring, which is fantastic, so to speak, when it's going to talk about a tax based system that we have that everybody has it free available at the point of them getting that. So some of the studies that started coming out in the back of that, this was a marked improvement in HBO one C. Just shown by fraser gibb and his team showing the benefit of the particular. And as you can see from this study without going too much into details, you can see the pre flash glucose monitoring and the post flash glucose monitoring, Simply put the amount of people achieving an H20, less than 7.5% of 58 mm from all went up significantly and the amount of people or the percentage of people who are achieving H20 greater than 75 are not greatest control, so to speak. Certainly dropped down. So it showed the benefit of having this too. We just gave people better visualization on day to day basis as to where they sat. The higher you initial HBO and see the greater the reductions. That was an important lesson that where you're starting point was. And this again, this primary work done by gibbs at all was an excellent overview as to what this device could use or benefit the overall population. This was done of course in Scotland. Again, another finding from that particular work was the number of scans but related to your drop in the more scans you did clearly. And that was about going back to the point about the more scans you did, the better visualization you had and thereby the reduction in the HB A one C What about outcomes where you can see here the decay admissions also falling down in the six month period of time, which was extremely exciting news as we started thinking about rolling it out and one would expect that apart from the financial benefit of those DK admission, the use of glucose strips fell down from nearly 3.8 to 0.6 per day, which is significant drop in glucose strips which again translated into cost savings for the system. It always is an issue that people debate and talk about. So here is where we are as regards the freestyle liberal prescribing, I talked about the freestyle liberal type one, you know, adoption in 2019. This was the april data where we had about 10.7% of the population, a huge variation around the country. You can see from that slide where we talk about the variation which existed And we are here and I can actually confirm it become July we have data to say that we have crossed 50% which is incredibly exciting. But more importantly it's even across the country you can see all the areas being green and that was because we had committed that at the minimal every area. 20% of the tightening population would have access to freestyle libera And we achieved 50%. So that's 2.5 times more than what the initial point was. But that is fantastic. And at the moment we're waiting for nice to make a call and hopefully the 50% will go higher up. And you you know that the whole world will be opened up to people for continues for glucose monitoring and moving away from the fingerprint vetted. Which again, you know just like the course of time it's moving on from the glucose. Uh you know the urine that we used to do to check glucose are now moving on to this particular arena. So it's just the progression of glucose monitoring and really exciting to see the UK keeping pace with this innovation as time has progressed. What about what what did it show? So thankfully the we have a fantastic specialist body organization called A. B. C. D. Associated british clinical dermatologist. And they were very helpful in helping us collect data by I. T. To from all around the region to try and see where things stood. 102 centers across the U. K. And the things that we measured for HBO one C. As you would expect hypoglycemia hospital admissions user satisfaction and diabetes related distress. What impact did having the flash glucose monitoring have. So this was published subsequently. And you can see the drop of HB A one C. Which is statistically significant across the board showing that this did what it was supposed to do on the tip. Did it reduce your HB one c. The answer is yes it did. What you also show with sort of parallel with what you saw from the Scottish data. If you had a starting point where the HBO once he was high you had even greater reduction. Which also goes back to the point about control which groups were targeting and why the maximum impact in the system going forwards. So the conclusions from that particular audit was this use of this technology showed significant improvement HBO and see trend for reduced admissions and severe hypoglycemia. Improved diabetes related distress though of course everybody wants more data which is understandable as we progress forwards. Here are some other data from across the world and you can see the impressive data collection 60 million points. And what you see is again the number of scans you do correlates to improvement. So that is important as you go along. You see the number of scans also by hour of day shows how impressive this device has been to help people self manage their diabetes. And that's an important point. As I said at the beginning we are trying to get to a system where we talk about self management peer support access to train professionals and have a think about what this device can do. Not only is this helping self management because you can check your glucose levels as many times as you wish etcetera, peer support. Very important. People using this sort of devices, more people connecting together. Talking about their readings giving each other sort of nuances and fuses to what could make things better and of course with the advent of technology and shared platforms etcetera you have the benefit of quicker access to train professionals. For example when I do my clinics most of my patients are on this device and what you do you don't necessarily have to see them. You have a shared platform. You look at the views, you talk about what can be changed all very done much more efficiently then would be for example when you're looking at let's say Well you know the finger picking style where you have three or four readings at most. Majority of people not being in that position to sort of do what we want 78 times a day. But you can see what we're now seeing. It's a huge number of testing which will be very very difficult to attain from simple glucose monitoring by fingerprint methods. So here are some also you can see the timing range of group of control measures and what it says is again the same reading the same point of view that we say look at the number of scans per day. Look at the A. One C. And look at the impact important point about the greater the scans, the improvement in the A. One C. Comes down and again it goes back to the point the more scan points you have, the more you have a better picture of what is going on with your diabetes which is what you really want to get too. So it's important that that's the message we have you have this device where you can scan yourself as many times as one please do. So that's part of the process. And I always give analogy of uh you know for example saying you saying bolts running the having forced steady picture just for pictures of the man probably gives you an idea of him just running but it stills if you see that in a bit more moving together. Like one of those flip charts that we used to have you have you know the athletes running together in tandem. Suddenly you can appreciate the skills. So I think it's the same with type one diabetes management. The greater readings you have the greater patterns you have the better understanding. You have an absolutely good evidence to back exactly that point of view. More scans you do better your results are and doesn't really matter if you can see what country you are in Germany spain France. UK italy. Same results across the board. So just to sort of go through a few other studies, what about about expanding into other areas let's say type two diabetes. We've talked a lot about type one diabetes in the U. K. It is specifically reserved for type one diabetes at the present moment of time. So in some groups of people for example if we're learning disability, your diabetes type doesn't matter. You still get access to this device. But in type one diabetes you can see the results between which which you can have a look as the benefit. It has the 12 months prior the blue 12 months after the freestyle. Ibra. Look at the drop in the DK's, the hypoglycemia, comas etcetera. Now when you translate that to type two diabetes again, let's not forget there is a significant number of type two diabetes patients on insulin especially if you try and mimic the type one diabetes. Picture people in basil bullets again not small numbers. So it's important note that they also do have benefits which are really needs to be looked into a wider thing. And hopefully we are asking nice as mentioned to look into these particular areas. So hopefully we'll get to some idea where we I end up with this particular group as well. So here are some real world evidence from the Belgian data and you can see once again, you know the city of hypoglycemia the you know the absenteeism there is a drop across the board. It just improves how you live with your type one diabetes. And I always say type one diabetes is incessant. It's always there with you can't get rid of it and you can't you can't you know you so many things variables as that slide showed. Anything you can do to help your cultural life better. Anything you can do to try and make it a little bit more understandable that you can deal with it either with support from professional or appear or from your own knowledge can only make things better. Here are some position statements that now diabetes UK have worked with NHS England as well as the as well as the technology network and you can see this pathway being created at the diagnosis whereby the pump comes in. How do you plug it in with a flash glucose monitoring where there's continuous glucose monitoring set in And then of course the eventual Holy Grail of getting the pump and the noninvasive device connected. That future looks extremely bright at the present moment for three or four commercial options at the moment in the market and hopefully they will expand further. So you try and get to a position a type one diabetes always has access at whatever point they are to a non invasive way of glucose monitoring. And if that doesn't help their lives and you have better access to pumps and then pumps that talk to those devices to make it more into a loop. So exciting times ahead. And you know, great to see that evolution as we go along. So some summary just to summarize widespread use of flash glucose monitoring has certainly improved diabetes control. It has improved time in range, reduced his time in hypoglycemia, reduced DK reduced severe hypos, reduced diabetes distress and he probably will struggle to find anything that takes the box on all fronts. And I think the biggest uh feedback you have is from people living with type one diabetes who say that and I think it's important to recognize that and there'll be very few people who would say that if given the choice would rather prick their fingers rather than scan themselves. That is not even a debates quality of life is the metric we should all attain to getting better. And I think, you know, we spend a lot of time understandably and things like amputations and heart attacks with diabetes but we forget that the basic core behind reducing amputations or for example, reducing retinopathy bleeds is related to improving quality of life. And I think if we with these devices, if we improve quality of life, the rest very much fall in place. But it requires a large amount of work from people with diabetes and it is important bear that in mind. It's not just a device that sits on its own and does all the work for you. It is just a tool to help you manage your diabetes better. So you need that interaction. You need that engagement peer support comes in play there as does as does especially supporters mentioned, but it is very, very important. You do have that level of engagement as well. And hopefully the simplified diabetes tech pathway will help us support patients to live complication free. So, good progression as we're going along, we have moved forward. We have a population level, you know, roll out of this technology very good evidence of benefit and I'll probably finished with this particular evidence which has recently been published during the time of the pandemic. We've assessed during the both the waves in the UK and what we have found is an N type one diabetes where the majority and the bulk of the freestyle libre has been used. The decay rates have actually dropped. Now that may be due to better self management people be more at home, but surely one of the understandings is that the use of these self management tools has helped people because you do not see the replicating type two diabetes where actually the admissions with DK have gone up. So that's an important point to bear in mind as to what this device might have also helped people with in these difficult times. So I leave it there and thank you extremely to all the organizers for the invite and hopefully you find that of use Published September 20, 2021 Created by Related Presenters Partha Kar, FRCP Consultant in Diabetes & EndocrinologyPortsmouth Hospitals NHS TrustNational Clinical Director, DiabetesNHS England
