Thank you so much, Professor Keller. That was really interesting. And these are such fabulous data, aren't they really showcasing the benefits of flash glucose monitoring now? Over the next few minutes, I'm going to move our attention a bit broader around europe. Looking at the english data than some other recently published real world evidence. I'm also going to go a bit further a field looking at data from the Middle East and from India about some innovative ways of using C. G. M. And the benefits that have been reported in those groups. I'm also going to maybe focus a little bit more about other diabetes related health metrics, things like quality of life, things like diabetes distress, things like admissions to diabetes. And I think I'm going to frame that talk by thinking, let's just broaden this out and think who would benefit from flash glucose monitoring where white might we see benefits to both us people living with diabetes and the broader health care system. So I guess one of the questions we've had raised, certainly we've we've been thinking about this a lot in the UK is can we think a bit more broadly about who would benefit from flash glucose monitoring? And of course now there's widespread access to flash glucose monitoring for people living with Type one diabetes pretty much across the whole of europe. But amongst that there are little pockets where there's some inequalities around access for people with other causes of insulin deficient diabetes, in particular cystic fibrosis related diabetes or pancreatic diabetes come into that. And certainly on, although there's very little evidence in those specific areas, they're logically groups of patients who would really benefit from the frequency and the ease of glucose monitoring that you get with flash. And then if you move across to Type two diabetes, of course, across vast parts of Europe and many countries in France in Germany and in Austria. And I know that people with instant treated diabetes, type two diabetes, particularly those on intensive insulin therapy. So more than two injections have access to flash glucose monitoring. But increasingly, um, maybe there are advantages of flash glucose monitoring either continuously or intermittently in people with Type two diabetes using oral hypoglycemic agents or even those with new onset Type two diabetes. And I've certainly had anecdotal evidence of patients who have had a new diagnosis purchased flash glucose monitors. Seen their glucose excursions. And the impact of that picture has been what tipped them over the edge allowing them to make those necessary lifestyle and dietary modifications to help bring their glucose under control. Um, and that picture that seeing what happens when you have the food that you're eating, it is a real visible change. Now. A few groups have tried to look into that and use that in a organized way, but I think we really need some more evidence in that field, but it's certainly true that for some people that's a huge motivator. And then in the UK and I'm sure in other countries across the UK, there is access for high risk patients, such as those on dialysis who have a very high risk of hypoglycemia. People with learning disabilities who might not be able to manage their glucose where that glucose measurement needs to be done by a third party. Um, and again, maybe some people where they can't do fingerprint readings due to physical reasons. And I've just had someone today who had a traumatic amputation of his arm, so he only had one hand. Um, and so actually flash glucose monitoring allowed him to measures glucose where in the past he was reliant on someone else to check his, check his glucose on his finger. So when you look at different studies and let's look at the evidence based says this is a kind of a summary paper looking at all the different studies and is a meta analysis around eight PM sees present pre and post. And you can see that in almost all the studies is a drop in A one C that sustained over time. Except in those studies. You look at that blue line right at the bottom there with uh Bolander, that's the impact study where they took people with an H. P. R. And C. Already at 7%. And so there's very limited change in that what we also see and these are data from Abbott is that actually when you give people the means the number of scans they scan so frequently. Right And a few compared these data to the data I showed in my first talk at the beginning of this symposium. So in the world in the era of S. M. B. G, the average number of checks per day, even in the german diabetes database was 4 to 5. And that's higher than the numbers reported in american and UK studies. But here given freestyle library you can see the median number of scans is 14 average 16.3 with most people. The inter quartile range is 10 to 20 scans a day And you can see that there's a few scans in the day. But then these are equally balanced through the day. People are scanning if you're scanning 14 times a day, that's almost once every two hours while once every hour or a couple of hours when you're awake. And and these are data again published by Abbott in that sense, in collaboration with Abbott looking at the different countries. And this is the same in all the countries. But what you also find here is that the frequency of scans links very directly. Just in the way with sMB G. It links to glucose levels achieved. And if you look there it links two hours above 10, the more you scan, the less hours above 10, you have, the more time in range. You have, the less time below range you have and in the UK we have dinner. This is data by the National UK audit led by Emma, Will Mark. And you can see here in 10,000 patients, we've got a five million miles from all drop in HB A one C And if we divide that up, not only a drop in HBO and see. But these are the real benefits on the health care system. You've got a more than a 50% reduction in diabetic ketoacidosis reductions in admission with hyperglycemia. Big reductions in paramedic call outs and episodes of severe hyperglycemia. And then on the side you also have reductions in diabetes distress. So as people can measure more as that uncertainty about what's happening with their glucose reduces their diabetes distress calms down as their glucose control improves their feeling of being overwhelmed or failing with the diabetes reduces. And that's a real benefit and impact of this freestyle libre and people. The gold score for those of you not familiar is a measure of hyperglycemia awareness. And again, this is interesting showing a marginal improvement in gold score. I'll beat this is within the kind of normal range And that's just the UK data. There's an even bigger study recently published by from the French group where they've got people with type one and type two diabetes. And again here, I think one of the big They showed the similar glucose reductions as we've seen in other studies. But I think the big message here from this paper was within 12 months. These huge 56% reduction in D. K. A 50% reduction overall admissions and in type two diabetes reductions in DK hyperglycemia and a 40% reduction in total admissions. It's really interesting for me to see how It's really interesting for me to see how consistent this is across both Taiwan and type two diabetes. Really reinforcing these big real world evidence studies showing the benefits of frequency of glucose monitoring and the ability to remotely assess glucose readings on in year outcomes within year benefits the long term benefits in terms of reductions in a one c will surely be seen by their countries as well. Again, just moving across in that same in that same study, you can see that um there's reduced uh hospitalization for complications across the group and then people using freestyle area. It didn't matter how often they were measuring beforehand. You've got the same benefit across the across the whole groups. Very similar data from Belgium and it's it's almost looking at the same results in Belgium, interestingly, the HB one C reduction as you can see no reduction in those people under seven or between seven and 8%. Big reduction in those people who have very high H. B. And C. But again, that same sort of benefit in terms of admissions for severe hypos. And an interesting this paper, they measured absenteeism which dropped by 50% interestingly, we saw in the UK study the diabetes distress scale showed a reduction in distress, but in the Belgian said there was no reduction in paid, which is another questionnaire used for diabetes distress. And it's interesting to think whether this is because of the differences in the what the question has pick up. Also, interesting, interesting in this study was the fact that the fear of hyperglycemia didn't reduce so much the worry of what people did. But the incident of hypoglycemia did reduce And moving on to Sweden again in the Swedish group with much more widespread improvements and probably a lower baseline when people started. Uh, so better glucose control. At the start of library, there are the smallish but sustained improvement in glucose control. Again, it was greatest in those who started higher, but there was just 21% reduction in severe hyperglycemia across across these big numbers, as you can see across the bottom, moving a bit further fueled in areas which are newer to to these therapies and where maybe the overall health care system is less well organized and in Type two diabetes here, this is a paper from Saudi published recently. You can see there there was a 20.3 drop in HBO and see Consistent as we've seen in the other studies. A 50% reduction in hyperglycemia and an increase in monitoring of glucose in these people with type two diabetes were saying six readings a day. So not not the 14 and 16 that we see in type one diabetes, but that's probably appropriate given the fact that most people Type two diabetes have far more because of their C peptide have more stable glucose. So the need for that frequency is much lower. So if we then pull together the kind of patient reported outcome benefits. This is just a table adapted from a recent publication where you looked at the different studies down the side and they've used either the diabetes treatment satisfaction questionnaire, the DTs. Q. Or diabetes distress scale. To those are the most common ones. And you can see then most of those studies there's a there's a improvement in the patient reported outcomes. The interesting one is this paper by Tyndall. It'll which showed which used the hospital anxiety and depression scale. And and this just pick up on the fact that we are seeing in a small group of people. There is an increased anxiety around the glucose readings. Um this increased pressure because they're seeing glucose reading continuously about there are patients ability to deal with those minor excursions uh you know, and feelings. And I think while the overall picture is a reduction in diabetes distress, we need to be aware of these few people where there's a where the increased date and the demands of that puts on having to manage your diabetes can upset equilibrium in some people in terms of qualitative analysis, um you know, this is the biggest response this now means I do test. So you know, the fact that we were talking to people saying that you need to measure glucose more often. Um and people struggling to that whole um procedure of stopping what they're doing, getting their equipment out, stabbing their finger drop. And even though the machine might take five seconds, that process means have to stop what they're doing. And this system just integrates blood glucose monitoring into people's lives. It's giving them independence. It's given them confidence to do things that I do things I never, in a million years would have done unless there was someone with me. It's made me a happier person. I'm not having to do stab yourself with needles is amazing. Helping in that ripple effect. Not only the person with diabetes but their husband. I'm happier if they're happy with their diabetes better. That makes it so much better for the people as we call it. People affected by diabetes. Um And again reduction hyperglycemia helps control because people aren't reducing their insulin and it takes a while for different people to adapt their mindset. Um to the fact that I don't have to cut my instant now because I might go hyper in five hours. I can scan as often as I need to and see where I am and I can be a bit more bold with my treatment decisions. Um Help get my glucose into control and then I want to take us even further east um and look at you know in an even different healthcare setting. The benefits of library and in India for those of you don't know um the library device that's available there is a library pro device. And so this was a really really interesting paper where they took 105 participants and they would start the sensor and then halfway through the patient would come back to clinic, they would download the seven days of data and institute a treatment change and then review the patient a week later and do a final review and see what was happening. And you can see here in that two week period when the patient is using blind at C. G. M. So for the seven days it's blinded. They come they see the data and make a data driven treatment decision. Then you can see there's a drop in daily average glucose from 191 Milligram per desolated down to 137 mg podesta. Leader Time above target range drops dramatically from 52 to 18 time below. Target drops from 5.7 to 1.5 and time in target range goes from 40 to 80 a doubling of time. And target buy in that data driven approach allows the right treatment decision and helps the physician um convinced if you like or support that patient to make the right treatment decisions. Um a wider study of 5000 patients with diabetes who have nature payments of over 7%. Again from India where 2.5 1000 people using freestyle Libya were matched with a similar number of people in the same clinics who are not using freestyle liberate And this was in seven clinics in India. And you can see using that approach of using the blinded data intervening and then checking again and then looking at the HBO and see a later time point. You can see there's a .5% drop in HBO and see in those using library compared to no change in the controls. And so I think some of these kind of slightly innovative ways of using the data are suggesting how we can spread out the use of lee brand, the benefits of library maybe even into nontraditional groups. People are not using insulin. I've talked a little bit earlier on about the impact of liberal view on on communication and on on the interaction between the person living with diabetes and us and how we can see things and you know, we have to be balanced about the benefits. Yes. Now, instead of spending a half day um taking time off work, sitting in my waiting room for an hour, seeing me for 20 minutes and going away, we can log in, we can discuss the data and the person can do this from their home, their living room, their office um from the shopping mall wherever they are, looking at the data on their phone, having that video consultation, it's really changed the way we consult. There has been a negative impact to I've had patients being a bit anxious. Now doctor you can see everything I do when I had that big ice cream on saturday and there was a spike in my glucose. You can see it. Um I've had people describe it to me as I feel naked of all say, well you know we're looking at the big picture, it doesn't matter what happens, but the better data we have, the better support we can give you. It also changed the way I approach my clinic and this is just a screen shot of me lining up people in my clinic by their average glucose. And you can see here we have some people who have got quite a lot of challenges and their average million moles are between 15 and 20 there do not doing that many scans. Um and that means I can target these people. And certainly in my service we used this function of lead review to target our resources towards those people who need it the most. Rather than having the standard, we just see whoever turns up. We knew that we had to target people who are struggling the most during this pandemic and lee review allowed us to do that. So in summary, I think we've now got widespread real world evidence from most European countries and even further a field about the benefits of flash glucose monitoring in a variety of settings. I think we've now got really strong evidence in type one diabetes and insulin treated type two diabetes. And there are areas where there's emerging data now around pregnancy, around The educational benefits in new onset Type one diabetes or tablet. True to type one diabetes. And I think we're learning and seeing novel ways of using these data as educational tools. Thank you.
Related Presenters
