Efetividade da tecnologia flash para monitorização e controle glicêmico de pacientes com Diabetes Mellitus tipo I

Abstract

Introduction: Strict and early control of blood glucose with intensive insulin therapy is essential to reduce chronic complications of the disease. One of the great advances in technology for the treatment of diabetes was the development of the technique for reading interstitial glucose and its correlation with capillary blood glucose (GC). Flash glucose monitoring technology was introduced into the technological arsenal for therapeutic guidance of diabetes, having as one of its main advantages the fact that it does not require calibration with capillary blood glucose (GC) and has a lower cost when compared to traditional CGM, associated with the insulin pump. The aim of this study was to evaluate the effectiveness of the Flash device in patients with DM1, followed up at a tertiary referral service at a university hospital. Methods: Prospective open-label cohort study, with non-probabilistic sampling, consisting of 30 patients with a previous diagnosis of DM1, treated at the Endocrinology Outpatient Clinic of the Gaffrée and Guinle University Hospital in Rio de Janeiro (HUGG), from May to August 2019. Protocol no. 94672518.0.0000.5258 was approved[1] by the local Research Ethics Committee. Patients with DM1, with at least one year of disease; aged over 18 years; who were instructed to perform capillary blood glucose tests before main meals and at bedtime, with glucometers with the possibility of downloading data (Accu chek Active®) and who agreed to use the FSL sensor for a period of 28 days were included. Individuals with T1DM, pregnant women and serious medical conditions were excluded. Inferential statistics were applied to evaluate the effectiveness of the FSL system in glycemic control, considering the outcome variables: time on target (TA), hypoglycemia and level 2 hyperglycemia. To assess whether there was a significant variation in the measurements of the Accu chek 360® system in relation to the FSL, the Wilcoxon test was used for numerical data and the corrected McNemar test for categorical data. Results: Data from 24 patients were analyzed. The comparative analysis between the glycemia measurements achieved with LIBRE® total (A+B), in relation to Accu chek 360®, observed a significant increase in the number of glucose assessments (3:(3-5) with Accu chek 360® versus 13:(8-9) with LI-BRE®), significant increase in the percentage of glycemia in the target (70-180mg/dl), (43% with Accu chek 360® versus 65% with LIBRE®), and in the percentage of level 2 hypoglycemia (250 mg/dL) with LIBRE® (total, A and B) compared to Accu chek 360®; and a significant decrease in the percentage of patients with target (<54 mg/dL) achieved with LIBRE® (total, 1 and 2) compared to Accu chek 360®. No significant variation was observed between LIBRE® B and Accu chek 360®. Discussion and conclusions: In real-world studies, increased glucose scanning with the LIBRE® sensor was associated with increased time to target blood glucose and decreased time to hyperglycemia and hypoglycemia (5). When comparing groups with higher scanning frequencies with those with lower frequencies, both the studies by Dunn et al. (6) and those by Gomez-Peralta et al. (7) and Jangam et al. (8) found that a greater number of readings is significantly associated with lower HbA1c levels, less time spent in hypoglycemia/hyperglycemia, and more time spent in the target range. A higher monitoring frequency is related to better glycemic control, as demonstrated in a study in which increased monitoring frequency was associated with improved HbA1c (9). The goal recommended by the 2019 International Consensus on Time in Target for clinically significant hypoglycemia (blood glucose < 54 mg/dL in less than 1% of measurements performed in 24 hours) was not achieved with the use of the two systems evaluated, with the proportion of hypoglycemia being higher with the use of FSL (Accu chek 360® 2% versus LIBRE® 5%). However, LIBRE® showed some benefits in maintaining blood glucose in the target range.