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study shows flash glucose monitoring reduces risk for diabetes patients

the results of the frontier study showed that flash glucose monitoring use by ontarians living with diabetes reduces the risk of developing acute adverse diabetes-related events.

by karen hawthorne

sep 25 2024
read time 7 minute read
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instead of having to prick your finger to get a blood sample every time you want to check your glucose, the flash glucose monitor is a small device you attach to your arm or stomach that senses how much glucose is in the fluid under your skin. getty images
when you have diabetes, either type 1 or type 2, there can be a lot of worry over low blood sugar. it happens when the glucose in your blood is lower than the standard range because you may not have eaten enough, for example, exercised too strenuously or taken too much diabetes medication like insulin to keep your blood sugar in a healthy range. even stress can have this effect.
glucose is the primary energy source for your body, so when it drops low, you could feel shaky, dizzy and even nauseous. if it continues without treatment, it can bring on confusion, loss of coordination, slurred speech or worse, like seizures or blacking out. the formal term for the condition is hypoglycemia.
if you’re living with diabetes, you’re likely all too familiar with this.
“it’s an awful thing for a patient to experience,” says dr. stewart harris, a leading research scientist and clinician in diabetes care. “because they feel terrible. they’re scared, they’re fearful about their dosing of their insulin, about whether they can go to sleep safely. their spouse is worried about them if they’ve ever had a severe event – which is far more common than most health providers are aware of because patients don’t tell their doctors about it, because they’re worried if they do, it may have consequences. they may lose their driver’s licence. so it is a terrible thing for people to live through.”

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in hypoglycemia, you need immediate treatment to quickly get your blood glucose level back up with a high-sugar drink like apple juice, food like a small banana or medication. the condition can be as minor as a slight inconvenience or as serious as a life-threatening emergency. that’s why it’s important to boost blood sugar before it becomes problematic. unfortunately, harris says hypoglycemia is often dismissed by healthcare providers as something people with diabetes just have to live with, which shouldn’t be the case.

harris has seen the impact of hypoglycemia on his patients for years. he’s the lead physician and medical director at the primary care diabetes support program at st. joseph’s health care in london, ont. he founded the clinic in 2007 to offer diabetes care for disenfranchised and marginalized populations, after doing extensive work on diabetes in northern ontario where he coordinated care for 30 fly-in first nations reserves. indigenous canadians have a high incidence of diabetes, with almost 20 per cent of people on reserves living with the disease , which pushed him forward in his work. he was also appointed to the order of canada for his contributions to the development of strategies to manage and reduce diabetes in indigenous communities and other vulnerable populations.

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now harris, and colleagues alexandria ratzki-leewing, an expert in real-world epidemiology of diabetes at western university and the university of maryland in baltimore, as well as dr. remi rabasa-lhoret of université de montréal, are leading research in game-changing technology for patients to reduce hypoglycemia in their diabetes management. the aim is to help empower them with a tool that can improve their quality of life and reduce the burden of diabetes on healthcare services.

consider that 9.4 per cent of the canadian population currently lives with diabetes, and the national cost of treating diabetes soared from $14 billion in 2008 to just under $30 billion in 2019, according to diabetes canada .

the tool is a flash glucose monitor system. the beauty of the wearable technology is that it measures minute-by-minute glucose readings with optional alarms that alert people to low and high glucose levels. instead of having to prick your finger to get a blood sample every time you want to check your glucose – the traditional way for decades – the flash glucose monitor is a small device you attach to your arm or stomach that senses how much glucose is in the fluid under your skin. a reader or receiver (or your smartphone) shows the results and records them for analysis and sharing with your healthcare provider.

the frontier study

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harris and his colleagues conducted a first of its kind canadian study, called the frontier study, of flash glucose monitoring with data from the institute for clinical evaluation sciences and real-world practice data, for more than 45,000 ontarians diagnosed with type 1 or type 2 diabetes who met specific criteria. the results, presented at the international american diabetes association conference this june, were undeniable. flash glucose monitoring use by ontarians living with diabetes reduces the risk of developing acute adverse diabetes-related events.
as mentioned, the adverse events are more than constant worry and fear but include severe hypoglycemia and diabetes ketoacidosis, where lack of insulin can cause the potentially fatal release of ketones that make your blood acidic. these situations usually require hospital-based treatment.
with more public funding and access to flash glucose monitoring systems, canadians living with diabetes, and the healthcare system, stand to benefit.
studies around the world have shown the benefits of technology on diabetes management, harris notes, but every healthcare system is unique. having powerful canadian data “that demonstrate at a population level and at a system level, the impact and utilization of just this simple technology in people who have access to it” hasn’t been achieved until now.

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“i can sit with a patient and look at their numbers in 10 seconds instead of hoping that they brought their logbook in which may or may not have recorded their numbers and only gives you a specific moment in time what that sugar was when they took it,” harris explains. “whereas the sensor technology allows you to see 24/7 the last three months and the patterns, so providers can understand what the issues are and where we need to intervene with therapies, but also for the patient. they understand how to have better control, how to reduce their risk for lows and how to prevent hypoglycemia and severe hypoglycemia in the future.”
the frontier study investigated two measures: glycated hemoglobin, or hba1c levels, that indicate the average of a person’s glucose levels over two to three months, and healthcare resource utilization of er visits and hospitalizations. hba1c levels were recorded 12 months before using flash glucose monitoring and at the end of the 24-month follow-up. then er visits and hospitalization data were reviewed from 12 months prior to the sensor use and during the last 12 months of follow-up.
here’s the wakeup call for health providers and policymakers: hba1c levels improved by 0.6 per cent for those under age 66 and 0.3 per cent for people age 66 and over, no matter their diabetes type or treatment. as well, er visits dropped by 15 per cent for those under 66 and nine per cent for people 66 and over. overall hospitalizations dropped respectively by 11 per cent and nine per cent.

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“what was fantastic to see was that these outcomes and the benefit of these devices was also found for individuals over 65,” says ratzki-leewing, who is assistant professor in gerontology at the university of maryland. the results confirm the potential for flash glucose monitoring in the older population at high risk of diabetes complications. they also challenge some of the implicit biases people may have about technology use in older adults.
she points out how serious hypoglycemia can actually be, leading to sudden death or disability from stroke. and if hypoglycemia events happen repeatedly, “the effect can lead to a clinical syndrome referred to as impaired awareness of hypoglycemia, where in essence an individual loses their ability to detect the onset of symptoms. and when this happens, they don’t have essentially those cues to adjust their behaviour and act on an incipient low.”
the pattern increases the risk for hypoglycemia.
“so it’s this weird cycle of defective counter regulation in the body,” she says, adding hypoglycemia recurrence has been associated with premature mortality, higher work absenteeism, and the rising cost of the hypoglycemia event itself and managing it. “the long-term consequences of this are massive.”

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the other side of the problem is that people generally don’t like experiencing hypoglycemia, and some people will do anything to avoid it, including intentionally keeping their blood glucose levels high just so they won’t have to worry. it helps them cope. but if high blood glucose levels, or hyperglycemia, persist, it too can lead to serious complications, including eye problems, kidney damage, nerve damage, and cardiovascular disease.
“i hope that the results of studies like this also awaken clinicians to the benefit of these devices and to say, ‘hey, you know what, let’s just offer this to as many people as we can,’” says ratzki-leewing. “there’s great coverage in ontario and across canada.”
the frontier study will have more to deliver following this first “data crunch,” adds harris. “we have a large database to work with.” the aim is to have the study published in the next six months to reach more practitioners, including family doctors, who have patients with diabetes.
the takeaway? as harris emphasizes, flash glucose monitoring is “something you should be using at every opportunity in all of your patients with diabetes.”
karen hawthorne
karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto as a freelancer, and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

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