The Use of Freestyle Libre Glucose Monitoring System and Diabetes Treatment Progression in Type 2 Diabetes Mellitus: A Retrospective Cohort Study in Saudi Arabia

TL;DR

This study examines how using the FreeStyle Libre glucose monitoring system affects diabetes treatment and blood sugar control in Saudi Arabia.

Contribution

The study evaluates the impact of FreeStyle Libre on treatment intensification and HbA1c levels in T2DM patients in a real-world clinical setting.

Findings

Patients using FreeStyle Libre had higher medication intensification and insulin correction doses.

FreeStyle Libre users showed a significant reduction in HbA1c at three months but not at six months.

FreeStyle Libre users had more healthcare visits for hyperglycemia but not for hypoglycemia.

Abstract

Background

Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disease in Saudi Arabia, with a prevalence rate of approximately 25%. Traditional blood glucose monitoring methods, such as finger stick tests, provide limited insights into blood glucose measurements and fluctuations contributing to clinical inertia. The advent of continuous glucose monitoring (CGM) systems, such as the FreeStyle Libre glucose monitoring system, has transformed diabetes management by offering comprehensive exposure of glucose data to healthcare providers.

Objective

This study aims to evaluate the impact of the FreeStyle Libre glucose monitoring system on diabetes management intensification and treatment progression provided by healthcare specialists among T2DM patients in primary healthcare settings in Riyadh, Saudi Arabia.

Methods

An observational, retrospective, 24-week, two-arm study was conducted at Prince Sultan Military Medical City. The study involved 188 T2DM patients who were either using standard capillary glucose monitoring or transitioned to the FreeStyle Libre system, and it was based on clinical discretion rather than randomization. The primary outcomes were to evaluate the effect of FreeStyle Libre on treatment intensification provided by healthcare providers and changes in HbA1c levels. Data analysis included descriptive statistics and hypothesis testing using R software.

Results

Participants using the FreeStyle Libre glucose monitoring system experienced higher rates of medication intensification, and the use of insulin correction doses, and a significant reduction in median HbA1c levels was observed at three months (9.19% vs. 9.6%, p=0.047). However, at six months, the median HbA1c further reduced to 9.07%, though the difference between groups was not statistically significant. Despite these improvements, healthcare provider visits due to hyperglycemia were higher in the FreeStyle Libre group (p<0.001). There were no significant differences in hypoglycemia-related visits between the two groups (p=0.09).

Conclusion

The FreeStyle Libre glucose monitoring system was associated with increased treatment intensification and a significant reduction in HbA1c at three months compared to standard glucometers. However, by six months, the reduction in HbA1c was no longer statistically significant between groups. The increased healthcare provider visits in the FreeStyle Libre group may be attributed to heightened glucose monitoring awareness rather than the true worsening of hyperglycemia. While CGM offers advantages in diabetes management, its impact on long-term glycemic control remains uncertain. Further research is needed to confirm these findings, assess patient adherence, and evaluate the long-term effectiveness of continuous glucose monitoring in diabetes care.

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