Increased Scanning Frequency Improves Glucose Control, Hypoglycemia Fear in T1D Using CGM

Increased scanning can decrease fear of hypoglycemia among people with type 1 diabetes using intermittently scanned continuous glucose monitoring (CGM) systems, according to the results of a new study.

An analysis of clinical data and ambulatory glucose profile reports from an outpatient clinic in Poland, results of the study indicate increased frequency of scanning with intermittently scanned CGM devices was associated with improve glycemic control and decreased fear of hypoglycemia among people with type 1 diabetes.

“For the first time, we report that higher scanning frequency is associated not only with improved glycemic indices but also with reduced fear of hypoglycemia in adults with type 1 diabetes mellitus using isCGM,” wrote investigators. “This constitutes a new argument for advising T1DM patients to undertake frequent scanning when using isCGM.”

As diabetes technology evolves, understanding of strategies to optimize potential for CGM technology has become of the utmost importance for improving diabetes management. With this in mind, a team from University Hospital in Krakow, Poland sought to assess how frequency of scanning of intermittent scanned CGM devices, specifically the FreeStyle Libre 2, might influence glycemic control and fear of hypoglycemia in people with type 1 diabetes.

Using electronic medical record data from people receiving care from the University Hospital in Krakow from October-December 2021, investigators identified 77 adult patients with type 1 diabetes with full information related to age, sex, diabetes duration, type of therapy and presence of diabetic complications for inclusion in the current study. Among this cohort, 39 received multiple daily injections of insulin and 38 were insulin pump users. The study cohort had a mean age of 34.1±10.2 years and a mean duration of diabetes of 14.7±12.0 years.

For the purpose of analysis, fear of hypoglycemia was assessed using Hypoglycemia Fear Survey II (HFS II), which investigators pointed out is a validated measure of fear of hypoglycemia in adults with type 1 diabetes and contains both a worry subscale and a separate behavior subscale. Specific glucose ranges of interest for the current study were defined as time in range of 70-180 mg/dL (3.9-10.0 mmol/L), time below 70 mg/dL (<3.9 mmol/L), and time above 180 mg/dL (>10.0 mmol/L).

Upon analysis, results indicated study participants performed a mean of 13.8±7.8 scans per day and significant correlations were observed for scanning frequency and mean glucose (r=-0.54, β=-2.1 [95% CI, -2.8 to -1.4]), glucose management index (r=-0.55, β=-0.05 [95% CI, -0.07 to -0.03]), time in target range (r=0.65, β=1.49 [95% CI, 1.09 to 1.89]), time below range of 70 mg/dL (r=-0.25, β=-0.13 [95% CI, -0.25 to -0.02]), time above 180 mg/dL (r=-0.58, β=-1.34 [95% CI, -1.77 to -0.91]), and time above 250 mg/dL (r=-0.56, β=-0.75 [95% CI, -1.00 to -0.49]).

When assessing fear of hypoglycemia, initial analysis suggested the mean total HFS II score was 34.7±16.6, with 16.1±7.2 and 18.7±12.2 scores for the behavior and worry subscales. Upon analysis, investigators observed significant correlations between scanning frequency and overall HFS II score (r=-0.25, β=-0.53 [95% CI, -1.01 to -0.05]), and with the HFS II behavior subscale (r=-0.24, β=-0.22 [95% CI, -0.43 to -0.02]), but so significant correlation was observed with the HFS II worry subscale (r=-0.19, β=-0.30 [95% CI, -0.66 to 0.05]).

“For the first time, we have found that scanning frequency is negatively correlated with FOH in adults with T1DM. We have shown that increased daily scan rates are associated with reduced fear of hypoglycemia for people with T1DM, as assessed by HFS II scores,” investigators added.

This study, “Higher scanning frequency is correlated with less fear of hypoglycemia in type 1 diabetes patients using isCGM,” was published in Frontiers in Endocrinology.