Video Real World and Prospective Trials Supporting CGM as a Foundational Approach to Management of Diabetes Play Pause Volume Quality 1080P 720P 576P Fullscreen Captions Transcript Chapters Slides Real World and Prospective Trials Supporting CGM as a Foundational Approach to Management of Diabetes Overview Continue to Test Back to Symposium Hello everyone chairman. My name is Razia Jan. I work in leeds, United Kingdom and I'm going to talk to you today about flash based C. G. M. To optimize glitzy mia. Now this is my disclosure slide and as you're looking at it I would like to thank the organizers for inviting me to present at this symposium. Now when it comes to HB one say we all know that haier HB one C. Is associated with both higher risk of microvascular and microvascular complications. Now when we lower the HB one C we of course reduce the risk of complications but sometimes we get things that are not expected. So the court trial has shown that aggressive treatment of HB one say is associated with increased mortality. And this is because there are glycemic markers other than HB one C. There are likely to play a role in the outcome. So they just Think a little bit about HB one C. Think about the drawbacks of this classic marker. Our first of all it's an approximate measure and it's not always reliable because if you have anemia in your e miA is not reliable even in some ethnic groups. The other thing is it tells you nothing about glucose variability and it tells you nothing about hypoglycemia. And these two glycemic markers have been associated with adverse outcome. And this is why the recent guidance indicates that we need to have these other glycemic markets looked at when we are managing people with diabetes. So now we've got time in range or timing. Target an important glycemic marker hypoglycemic exposure important and glycemic variability important and we need to keep the same checked. And just to demonstrate to you the importance of hypoglycemia. Studies have shown that severe hypoglycemia actually is associated with increased cardio vascular disease. There's a 2-fold increase in cardiovascular event. The other thing about hypoglycemia that I personally find very interesting is that the effect these adverse effects of hypoglycemia or not instantaneous. So these are data from the leader trial looking at mace major adverse cardiac event, cardiovascular death and in the bottom all cause death you can see that the highest risk is usually within a month of the severe hypoglycemia. But this risk persists for up to a year after the hypoglycemic event. So when you have severe hypoglycemia the effects of the severe hypoglycemia can last for a long period of time. And it's not something that you know it's not an instantaneous effect. That's something to bear in mind in clinical practice. So what about studies of Flash C. G. M. What do they tell us? So let me start with some more cities. So a large relatively larger city. The impact trial was published now five years ago. I can't believe it's been five years showing that if you take people with type one diabetes, we've got Good control Good HB one Sale the use of the fly CGM reduces hypoglycemic exposure quite significantly. So less than 70 mg per deciliter or less than 3.9 million more per liter is reduced by more than an hour a day or 38% reduction compared with control. The control was S. MPg. Now, if you look at more significant hyperglycemia reduction is 60%. Now taking a type two diabetes population intensively treated with insulin, the reduction in hyperglycemia with the use off he flies C. G. M was almost identical. Just look at the table below the less than 70 mg per deciliter. Russian 43% and more significant hypoglycemia was reduced by 64%. So it's very effective at reducing hypoglycemia. Now when it comes to a one C you thinking has he wants the increase Now in the type one diabetes group. Actually this was they had a very good control and the HP NC did not increase despite the significant reduction in hyperglycemia, The type two diabetes group, this was a group with inadequate control. It will see fell in both study arms. But the drop was very similar and I'll show you more of the data in a moment. Okay, um something important in the type two diabetes group. People less than 65 years of age had more reduction in a one C with the use of the flash See gm. Something to bear in mind. Now what are people who are not on insulin. So we conducted a study in very high risk groups. So these are Type two diabetes individuals following myocardial infarction. Half of them were on insulin, half of them on sale finale area. Remember hypoglycemia in the older age group is even more dangerous because it can predispose to cardiac event. Now, if you look at early on day 16-30, the Flash see GM reduced hypoglycemic exposure by almost an hour in the whole group. And if you look at the people are insulin people in Suphan Algeria. The reduction was there in both groups. Of course you think was that sustained? Well actually that wasn't only sustained but it was board Pronounced at 90 days. So you can see the whole group. The reduction was more than an hour. And again you can see a reduction both in insulin treated and sell finale Yuria treated people. If anything you can argue is driven more by people who were initially on Sir phenols Korea. What about HB one C reduction have been any studies showing hBOC direction in Type two diabetes. And indeed we had studies. So this was a study over a relatively short period of time. Two months showing that with the use of fly C. G. M. You get almost 70% of people with type two diabetes on intensive insulin therapy. Reaching the dropping a one C by 5.5 million more per more versus 30% in controls. When you look if you look at the drop in air and sea by around 11 million more per more. 39% dropped it with a flash T. G. M versus 18.6 in control. And even in people who are not only insulin therapy? Flash? See Gm was associated with a significant drop in A one C. Compared with S. M. B. G. As you can see in this study. And that was a study conducted in japanese population. So putting all the studies in type two diabetes together. What is shown here, red is the intervention which is the flashy Gm. Blue is the control and the dark areas is the drop in H. B. O. N. C. So in replace six months of intensive insulin therapy, The drop in each with a one C. was similar. And to study arms, three million more per more in your in the study that I showed you earlier two months study intensive insulin. The drop was more significant with the flash Gm. The wider study this is the non insulin ah patients. And again, the drop was most significant with the Flash C. G. M. And it liberates this is the post my patients post my accordion function patients. Half on some finale or a a half an insulin. There was a significant drop in here and see both study arms, but no difference between the two study arms. But then, even if you have no difference between the two study arms, you get a significant reduction in hyperglycemia with the use of fly CGs. So the Flash C. G. M reduces HBO on C plus minus reduces your hypo glycemic exposure so you can say and all reduces hypoglycemic explosion. So these were the R. C. T. S. What about real world studies? These are observation studies. So this is a study conducted in Scotland Intact one diabetes patients. And they compared pre flash with post flash uh HBO and see as you can see a lot more people reached the target A one C. Of less than 58 million more per mole after the use of flash glucose monitoring. And generally the drop in A one C. Was around four million more per more. Of course the drop was bigger. If you're starting A one C. Was higher and the drop was smaller it was You're starting a one c. was small. What about this? A. B. C. D. Audit in the E. B. C. D. Audit and other observation study. Look at the numbers more than 3000 patients. You can see the drop in A one C. With the use of the Flash see GM was 5.2 million more per more. And this is over a medium follow up of around 7.5 months In time. two diabetes again, observational studies smaller numbers But they show you this is over 3-6 months. You get to drop an e. one c. of 10 million more per more. And if you take if you analyze studies together. R. C. T. S observational studies. Type one and type two diabetes patients. You get a drop in a one C. Of no 10.55% of all around six million more per more dropping A one C. So the details are pretty consistent showing you that drop. Now the other thing to remember is the non glycemic outcomes which are really important. So if you look at the relief study again observation study in type one and type two, the taipan in red type two in blue you can see massive reduction in DK diabetic ketoacidosis. And yes you can get diabetic ketoacidosis in type two diabetes. So the percentage reduction was similar in type one and type two coma was reduced quite a lot and hospital admissions reduced by 40 to 50% in both Type one and type two. And if you look at a more recent study you can see here that In type two diabetes patients who are treated with insulin Emergencies, impatient or our patient emergencies were reduced after flash glucose monitoring by a massive 61%. So you're getting a reduction in A one C. And your reduction hypoglycemia and the reduction in hard clinical outcomes as well. Other things to consider and please do not underestimate this is prinze patient related outcome measures. How do patients feel? So the majority of studies show improvement in patient related outcome measures and and to me that's really an important message here better understanding of diabetes by patients and more meaningful interaction with a health care professional because the moment you start showing the patient the glycemic data, a lot of them tell me ah now we understand what's happening with our diabetes and you can have that meaningful discussion and you and particularly with you know in the UK we had a lot of our clinics done remotely. So when you discuss things remotely is so nice to have those glycemic data that you can access and also helps to identify the problem and the diagnosis. And let me demonstrate to you what I mean by that. So, this is one of my patients who have seen earlier this year, as you can see it's got Target range 95%, fantastic hypoglycemia only at 2% really very good control. Some of you may wonder has he got diabetes? He indeed has diabetes is daily in certain requirements are quite respectable, 64-78 units a day. But look at this another patient from earlier this year and this was a referral from outside our region. And when you start looking at it, the timing target is in the 50s, the hypoglycemia is 11%. And look at the dealings of requirements quite low and you think is this patient in the honeymoon period? Is this patient have, does this patient have type one diabetes? And actually this was a patient more than eight years post diagnosis and it turns out that doesn't have type one diabetes, having different type of diabetes. And actually the continuous glucose monitoring helped us to make that diagnosis. So to conclude randomized controlled trials and observational studies show that flash. See GM optimized like eczema in both Type one and type two diabetes, It reduces HB one C and all reduces hypoglycemic exposure. Also, it appears to improve quality of life measures in people with diabetes, and therefore, I think I see GM is a helpful tool to optimize licinia and improve well being of our patients. Thank you very much for your attention. Published September 20, 2021 Created by Related Presenters Ramzi Ajjan, MD, PhD Professor of Metabolic MedicineConsultant in Diabetes and EndocrinologyUniversity of Leeds and Leeds Teaching Hospitals TrustLeeds, United Kingdom
