Effect of flash glucose monitoring on glycemic control, hypoglycemia, diabetes-related distress, and resource utilization in the Association of British Clinical Diabetologists (ABCD) nationwide audit

Research output: Contribution to journalArticlepeer-review


  • Harshal Deshmukh
  • Emma G Wilmot
  • Robert Gregory
  • Dennis Barnes
  • Simon Saunders
  • Niall Furlong
  • Shafie Kamaruddin
  • Rumaisa Banatwalla
  • Roselle Herring
  • Anne Kilvert
  • Jane Patmore
  • Chris Walton
  • Robert E J Ryder
  • Thozhukat Sathyapalan

Colleges, School and Institutes

External organisations

  • Hull University Teaching Hospitals NHS Trust and University of Hull
  • University Hospitals of Derby and Burton NHS Foundation Trust, Derby.
  • Leicester General Hospital, University Hospitals Leicester NHS Trust Leicester UK
  • Tunbridge Wells Hospital, Tunbridge Wells, Kent, TN2 4QJ
  • Warrington and Halton Teaching Hospitals NHS Foundation Trust Warrington
  • St Helens and Knowsley Teaching Hospitals NHS Trust
  • Darlington Memorial Hospital
  • St Peter's Hospital
  • Royal Surrey County Hospital
  • Northampton General Hospital NHS Trust
  • Peterborough City Hospital


OBJECTIVE: The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions.

RESEARCH DESIGN AND METHODS: Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA1c following the use of FSL. Within-person variations of HbA1c were calculated using HbA1c=SD/√(n/[n-1].

RESULTS: Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (±18.8) years, 51% female, diabetes duration 16.0 (±49.9) years, and BMI of 25.2 (±16.5) kg/m2 (mean [±SD]). FSL users demonstrated a −5.2 mmol/mol change in HbA1c, reducing from 67.5 (±20.9) mmol/mol (8.3%) at baseline to 62.3 (±18.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4–7.8) months of follow-up (n = 3,182) (P < 0.0001). HbA1c reduction was greater in those with initial HbA1c ≥69.5 mmol/mol (>8.5%), reducing from 85.5 (±16.1) mmol/mol (10%) to 73.1 (±15.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (±1.8) and reduced to 2.4 (±1.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ≥4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis.

CONCLUSIONS: We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.

Bibliographic note

© 2020 by the American Diabetes Association.


Original languageEnglish
Pages (from-to)2153-2160
Number of pages8
JournalDiabetes Care
Issue number9
Early online date15 Jul 2020
Publication statusPublished - Sep 2020