Flash glucose monitoring in type 2 diabetes managed with basal insulin in the USA: a retrospective real-world chart review study and meta-analysis

Introduction Evidence supporting use of continuous glucose monitoring in type 2 diabetes treated with basal insulin is unclear. This real-world study aimed to assess the impact on glycated hemoglobin (HbA1c) of flash glucose monitoring use in adults with type 2 diabetes managed with basal insulin. Research design and methods Medical records were reviewed for adult individuals with type 2 diabetes using basal insulin for >= 1 year with or without additional antihyperglycemic medication, HbA1c 8.0%-12.0% prior to FreeStyle Libre Flash Glucose Monitoring use for >= 90 days and an HbA1c measurement recorded between 90 and 194 days after device use. Exclusion criteria included utilization of bolus insulin. Meta-analysis data are from the current study (USA) and a similar Canadian cohort. Results Medical record analysis (n=100) from 8 USA study sites showed significant HbA1c decrease of 1.4%+/- 1.3%, from 9.4%+/- 1.0% at baseline to 8.0%+/- 1.2% after device use, p<0.0001 (mean +/- SD). Meta-analysis of medical records from USA and Canada sites (n=191) showed HbA1c significantly decreased by 1.1%+/- 0.14% (mean +/- SE), from baseline 9.2%+/- 1.0% to 8.1%+/- 1.1%, p <= 0.0001, with moderate to high heterogeneity between sites (Q=43.9, I-2=74.9, p<0.0001) explained by differences in baseline HbA1c between sites. The HbA1c improvement in both groups was observed by age group, body mass index, duration of insulin use and sex at birth. Conclusions In a real-world retrospective USA study and a meta-analysis of a larger USA and Canada cohort, HbA1c significantly reduced in basal insulin-treated type 2 diabetes, without bolus insulin initiation and following the commencement of flash glucose monitoring technology.