Flash glucose monitoring  

Meeting unmet needs in diabetes management 

Limitations of self-monitoring of blood glucose (SMBG) 

A major obstacle to glucose monitoring is the pain and hassle of finger pricks.1,2*† Patients do not test as often as they should, and many do not achieve optimal glycemic control.3-7

Only 1/3 adhere to the frequency of SMBG recommended by their HCP1
2/3 skip SMBG because it is invasive to their lives2
>3/4 using insulin do not achieve their A1C target of <7%8 
1/2 of Canadians with diabetes do not achieve their A1C target of ≤7%9

Infrequent glucose testing leads to insufficient glucose data for diabetes treatment decisions1,2 

Look beyond the number 

Flash glucose monitoring is more than just a single glucose value at a single point in time, helping you fill in the gaps.  

Four patients with the same A1C (7.6-7.7%) can have very different glucose variability.10 Flash glucose monitoring provides a complete glucose profile and allows you to look beyond A1C for the real story behind your patients’ glucose results. 

FreeStyle Libre reports provide better insights for more informed diabetes management decisions

The FreeStyle Libre family of products measures interstitial fluid (ISF) glucose 

Interstitial glucose vs. blood glucose

 

 

 

Blood glucose vs. ISF glucose 

The FreeStyle Libre family of products is designed to replace blood glucose monitoring in the self-management of diabetes11,12§

According to the 2018 Diabetes Canada Clinical Practice Guidelines, flash glucose monitoring can inform treatment decisions:13‡ 

  • Short-term insulin dosing decisions 

  • Long-term treatment modifications and titrations 

""

A1C has limitations 

A1C reflects average glucose over the last 2-3 months; it does not show glycemic excursions of hyper- and hypoglycemia.14  

Ambulatory Glucose Profiles (AGPs) reveal glucose trends and patterns

at a glance and help identify when patients are out of target range.15

Time in Range helps you quickly assess patients’ glucose and contextualize A1C 

   Decrease

            Time above range

   Increase

            Time in range

   Decrease

            Time below range

The primary goal for effective and safe glucose control is to increase time in range while reducing time below range.16

""

International consensus recommendations set clear targets for time in range14¶

Recommended time in range for all non-pregnant adults with T1D or T2D14

The consensus data recommend that patients with T1D or T2D spend >70% of their time in range (3.9-10.0 mmol/L).14

For age <25 years: If A1C is 7.5%, time in range target is 60%. For older/high risk: >50% of time/day in target range (3.9-10.0 mmol/L).

""

Increased time in range improves patient outcomes 

T1D=type 1 diabetes; T2D=type 2 diabetes.

* FreeStyle Libre users: A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or if hypoglycemia or impending hypoglycemia is reported by the FreeStyle LibreLink app or when symptoms do not match the app readings.

† FreeStyle Libre 2 users: Finger pricks are required if your glucose readings and alarms do not match symptoms or expectations. 

‡ Treatment decisions should not be based on real-time sensor glucose readings alone but instead should consider all the information on the results screen.

§ Data collected from the FreeStyle Libre System. FreeStyle Libre 2 has the same features as the FreeStyle Libre System, with the addition of optional real-time glucose alarms. Study data are applicable to both products.

¶ The international consensus report has been endorsed by the American Diabetes Association, American Association of Clinical Endocrinologists, American Association of Diabetes Educators, European Association for the Study of Diabetes, Foundation of European Nurses in Diabetes, International Society for Pediatric and Adolescent Diabetes, JDRF, and Pediatric Endocrine Society.

** Includes percentage of values >13.9 mmol/L.

†† Includes percentage of values <3.0 mmol/L.

 

References:

1. Vincze G, et al. Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes. Diabetes Educ 2004;30(1):112-25.

2. Wagner J, et al. Invasiveness as a barrier to self-monitoring of blood glucose in diabetes. Diabetes Technol Ther 2005;7(4):612-19.

3. Schnell O, et al. Consensus statement on self-monitoring of blood glucose in diabetes. A European perspective. Diabetes, Stoffwechsel und Herz 2009;18(4):285-89.

4. Lee WC, et al. Frequency of blood glucose testing among insulin-treated diabetes mellitus patients in the United Kingdom. J Med Econ 2014;17(3):167-75.

5. National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. Last updated July 2016.

6. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. Last updated August 2019. 

7. American Diabetes Association. Standards of medical care in diabetes, 2014. Diabetes Care 2014;37(Suppl 1):S14-80.

8. Foster N, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther 2019;21(2):66-72.

9. Leiter LA, et al. Type 2 diabetes mellitus management in Canada: is it improving? Can J Diabetes 2013;37(2):82-89.

10.  Dunn TC, et al. Development of the likelihood of low glucose (LLG) algorithm for evaluating risk of hypoglycemia: A new approach for using continuous glucose data to guide therapeutic decision making. J Diabetes Sci Technol 2014;8(4):720-30.

11. Bolinder J, et al. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 2016;388(10057):2254-63.

12. Haak T, et al. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther 2017;8(1):55-73.

13. Berard LD, et al. Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada: monitoring glycemic control. Can J Diabetes 2018;42(suppl 1):S47-53.

14. Battelino T, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 2019;42(8):1593-603.

15. Wright E Jr, Manivannan S. Ambulatory glucose profiling. J Fam Pract 2015;64(12):S44-47.

16. Rebrin K, Steil GM. Can interstitial glucose assessment replace blood glucose measurements? Diabetes Technol Ther 2000;2(3):461-72. 

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The FreeStyle Libre flash glucose monitoring system is indicated for measuring interstitial fluid glucose levels in adults aged 18 years and older with diabetes mellitus. Always read and follow the label/insert. 

The FreeStyle Libre 2 flash glucose monitoring system is indicated for measuring interstitial fluid glucose levels in people aged 4 years and older with diabetes mellitus. Always read and follow the label/insert.