It is possible in primary care to give people with type 2 diabetes “wear-and-forget” masked flash glucose monitoring to allow their healthcare providers access to accurate glucose profiles, but it is not known how effective this is, the findings of the GP-OSMOTIC study show.
“GP-OSMOTIC offers another significant piece of evidence and blends well into the overall picture, indicating that it is not easy to minimize HbA1c in type 2 diabetes with flash glucose monitoring,” Norbert Hermanns and his co-authors write in a review following the publication in The Lancet Diabetes & Endocrinology.
In the study, 149 individuals with type 2 diabetes were randomly assigned to acquire the professional-mode flash glucose monitoring device FreeStyle Libre Pro, which is worn for 14 days, after which the HCP will check it to obtain data for complete use.
At the 9-month check-up, the proportion of people actually using the flash glucose monitor dropped to 78%, and only 73% shared the results with their HCPs. Hermanns and co-authors quote this as a drawback to the pragmatic design of the study, saying that while it robustly demonstrates the feasibility of the intervention in the real world, the lower degree of control over the trial may mean that “Potentially effective approaches then lack their ability to warn and change clinical practice.” “The effectiveness of sporadic, masked flash glucose testing could not be omitted in this experiment if adherence to the research protocol had been higher,” they add.
HbA1c was significantly lower in flash tracking than the standard care population at 6 months, 8.1% versus 8.6% and the period in the goal glucose level at 12 months was significantly higher, 54.8% versus 46.9%, powered by a 9.2% average increase.
“Interpreted generously,” the commentators claim the overall findings suggest that qualified flash glucose monitoring “Could decrease HbA1c, but these effects could be very short-term.” In the absence of obvious drug improvements, they conclude that “Behavioral changes triggered by the glucose monitoring data debate could be a possible explanation.”