Diabetes technology associated with reduced hospital admissions and improved blood sugar control for Blackpool patients
Research has shown that hospital admissions reduced, and blood sugar control improved for people with diabetes in Blackpool who used a blood sugar monitoring system.
Many of the 127 study participants from Blackpool Victoria Hospital, part of Blackpool Teaching Hospitals NHS Foundation Trust, also said that the FreeStyle Libre system had a significant impact on their ability to manage their diabetes and quality of life.
The study was supported by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC). Blackpool Teaching Hospitals NHS Foundation Trust is one of 6 NHS Trusts that are partners of Manchester BRC.
Diabetes is a condition that causes a person’s blood sugar (glucose) level to become too high.
Most of the patients in this study had type 1 diabetes, a lifelong condition where the body’s immune system attacks and destroys the cells that produce insulin.
In Blackpool, 9% of people have diabetes, which is among the highest rates in England and is higher than the population average of 7.5%.
Study lead Giovanni Cucinotta, Diabetes Nurse Practitioner and Research and Technology Lead at Blackpool Victoria Hospital, said: “Unmanaged diabetes is a big problem in Blackpool – it is associated with social deprivation and high rates of amputation due to raised blood sugar levels causing foot problems. To help combat this problem, we wanted to assess the service we are providing for patients in Blackpool and see if we could translate what we already know about the effectiveness of the FreeStyle Libre into our local population.
This is the first study of its kind in Blackpool and our results have shown that the technology is associated with improved blood sugar control, reduced diabetes and non-diabetes related hospital admissions and a perceived reduction in diabetes burden.
Members of the study team (L-R): Professor Frank Martin, Giovanni Cucinotta, Dr Stephen Nyangoma
Regularly checking blood sugar levels can help people living with diabetes work out when to take more medication or when to eat something. It can help them stay healthy and prevent serious diabetes complications.
These include eye problems like diabetic retinopathy, where consistently high blood sugar levels and blood pressure damage blood vessels in the eyes and can lead to sight loss.
Having raised blood sugar levels can also damage the sensation and circulation in the feet due to less blood supply. This can cause problems with the healing of cuts and sores, as wells as cramps and pain. If not treated, these can lead to foot ulcers, infections and amputations.
What is a blood sugar monitoring system?
Electronic blood sugar monitoring systems called continuous glucose monitors (CGMs) and flash monitors mean people with diabetes can check their sugar levels without doing a finger-prick blood test. These monitors should be available on the NHS to anyone with type 1 diabetes.
The FreeStyle Libre was the first flash glucose monitor that was brought onto the market and was used in this study as it provides more data to back up its efficacy, researchers say.
CGMs and flash monitors use a small sensor which a person wears on their skin during the day and night. The sensor constantly reads their blood sugar levels and is linked to their mobile phone or other device.
With a CGM, the sensor sends results to the person’s receiver or phone every few minutes. With a flash monitor, users need to scan the sensor with a reader or their phone to see the results. Following a software update, the FreeStyle Libre can now be used as a CGM as people do not need to scan it to record their blood glucose readings.
Readings and reports can be shared with healthcare professionals through LibreView, a secure cloud-based data management software, to help inform their diabetes care.
What did this study find?
In this study, researchers analysed data from patient consultation records at Blackpool Victoria Hospital, which was collected at their standard 6-week, 6-month and annual review of using the monitor. This included blood test results and data from LibreView.
Only patients who had a total sensor usage of more than 70% were included in the study to ensure data was accurate and reliable.
The findings, which were published in the Journal of Diabetes and Metabolic Disorders, showed that after 1 year of using the device, all causes of hospital admissions reduced by 59%.
Patients who had been admitted to hospital with diabetic ketoacidosis before using the sensor had no hospital admissions within a year of using it.
Diabetic ketoacidosis is a serious condition where a lack of insulin causes harmful substances called ketones to build up in the blood and must be treated in hospital quickly.
The team’s analysis also revealed a 46% reduction in reported hypoglycaemic episodes after 1 year of monitor use.
Hypoglycaemia, or a hypo, is when the blood sugar level drops too low. It can happen if a person’s balance of food, exercise and insulin is not right, and must be treated quickly to stop it getting worse.
There was also a significant reduction in patients’ HbA1c, which is the haemoglobin (a protein) in the red blood cells that has sugar attached to it, known as glycated haemoglobin. For someone with diabetes, the body cannot use the sugar properly, so more of it sticks to blood cells and builds up in the blood.
An HbA1c test shows average blood sugar levels over the last 2 to 3 months. A high HbA1c means there is too much sugar in the blood and increases the likelihood of developing diabetes complications.
To assess whether patients use the blood sugar monitoring system as recommended and whether it has an impact on different aspects of diabetes management and quality of life, they were also asked to complete an assessment and satisfaction questionnaire.
The questionnaire, which is usually administered at a follow-up visit, consisted of 8 questions including around mental health improvement and controlled anxiety about hyperglycaemia (high blood sugar).
The results suggested that the majority (62.2%) of patients considered the use of the device as having a significant impact on their quality of life and ability to control their diabetes.
A higher questionnaire score was associated with a substantial reduction in HbA1c, a significant reduction in hypoglycaemic events and reduced hospital admissions.
Professor Francis Martin, Research and Development Manager at Blackpool Teaching Hospitals NHS Foundation Trust, who was part of the study team, said:
This study demonstrates how those working in patient-facing roles can identify research opportunities to better improve care and management. We were delighted to support a nurse to undertake this research at Blackpool, focusing on a community that has a high level of social deprivation.
Giovanni Cucinotta added: “Our study has shown the benefits of a continuous glucose monitor are consistent even in a complex population such as the one in Blackpool. The study also revealed that more than one-third of monitor users reported a sensor usage of less than 70%, therefore barriers which prevent people from using it as recommended should be identified.”