Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls – published online 27/03/2021

David Nathanson, Ann-Marie Svensson, Mervete Miftaraj, Stefan Franzén, Jan Bolinder, Katarina Eeg-Olofsson

The increasing use of glucose-sensor technologies makes it difficult to design long-term randomised controlled trials with conventional self-monitoring of blood glucose (SMBG) as a comparator. Instead, the evidence regarding the effectiveness of flash glucose monitoring (FM) is largely derived from observational data lacking well-matched non-FM-using control participants. In this issue, Nathanson et al (https://doi.org/10.1007/s00125-021-05437-z) used data from the Swedish National Diabetes Registry (NDR) to investigate long-term changes in glucose control after initiation of FM in comparison with conventional SMBG. The authors also assessed the efficacy of FM in alleviating the incidence of severe hypoglycaemic events. Nathanson and colleagues identified all adults with type 1 diabetes using FM for 2 years, as well as continuous glucose monitoring (CGM)/FM-naive individuals. Propensity scores and inverse probability of treatment weighting were used to balance the groups. The analyses showed a small and lasting decrease in HbA_1c in FM users compared with control individuals and a 21% reduction in severe hypoglycaemic events. The authors conclude that FM is associated with improvements in HbA_1c and alleviation of severe hypoglycaemia, which supports the use of FM in adults with type 1 diabetes. However, the long-term clinical significance of the modest lowering of HbA_1c achieved by FM use remains to be elucidated.

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