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DUKPC Digest Day 3: New findings on Flash and updates on type 2 and fatty livers

a close up photo of a Flash monitor (A small white circle) on a man's upper arm, which he is scanning with a reader device

On day 3 of Diabetes UK's Professional Conference (DUKPC), we heard about:

  • findings from our clinical trial comparing finger-prick testing to Flash glucose monitoring
  • the links between type 2 diabetes and non-alcoholic fatty liver disease. 

Life-changing benefits of Flash blood glucose monitoring

Funded by us, Dr Lalantha Leelarathna and his team at The University of Manchester led a clinical trial to learn if second-generation Flash technology is better and more cost-effective than traditional finger-prick testing at helping people with type 1 diabetes manage their condition.

The results show that the technology not only helps improve blood sugar levels in people with type 1 diabetes, but also has a positive effect on their quality of life. The findings help make the case for more people having access to this life changing technology, particularly because the device has been found to be cost-effective for the NHS, by enabling safer blood sugar levels and, in turn, reducing the risk of devastating diabetes complications.

The trial involved 156 people with type 1 diabetes who had above-target blood sugar levels. For 24 weeks, half of the participants monitored their blood sugar with Flash and the other half continued using finger prick testing.

Flash involves a small sensor that sits just underneath the skin and continuously measures glucose in the fluid that surrounds the body’s cells. To get a reading, you can painlessly swipe a reader or smartphone over the sensor to see what blood sugars levels are doing minute by minute. The device will also alert people when their levels are going too low or too high.

Improved blood sugar levels

At the start of the study both groups had similar blood sugar levels (assessed by an HbA1c blood test).

After 24 weeks, those participants who used Flash had reduced their HbA1c from an average of 71.6 mmol/mol to 62.7 mmol/mol - a reduction of 8.49 mmol/mol. Lowering HbA1c by this amount can decrease the risk of developing diabetes complications in the future by up to 40%. In comparison, those in the finger prick group had reduced their HbA1c on average by only 2.2 mmol/mol by the end of the study.  

In addition, those using the Flash technology spent an extra 2 hours a day with their blood sugar levels in the target range and 80% less time with dangerously low blood sugar levels.

The researchers further discovered that Flash had a positive impact on quality of life. Participants in the Flash group reported they were happier with their diabetes treatment and that using the technology reduced the day-to-day burden and emotional strain of living with the often-relentless condition.

Value for money

Crucially, the researchers also assessed the long-term cost-effectiveness of the two approaches, by estimating the cost of using the two different blood sugar monitoring systems and their benefits to a person’s physical health and quality of life.

While Flash was found to be slightly more expensive than finger-pricking over a lifetime, it was shown to be highly cost-effective. This is because Flash was predicted to help people with type 1 diabetes stay healthier for longer, meaning the extra costs to the NHS would be justified.

Flash glucose monitoring technology was first made available through the NHS in 2017. Currently, about half of people living with type 1 diabetes are prescribed Flash on the NHS. At the end of 2021, the National Institute of Health and Care Excellence consulted on new guidelines which proposed recommending Flash for all people with type 1 diabetes.

 

Dr Elizabeth Robertson, Director of Research at Diabetes UK, which funded the study, said:

We want as many people as possible to have access to innovative diabetes technologies. This study confirms the radical improvements Flash can bring to the lives of people living with type 1 diabetes, helping them to reduce their blood glucose levels – protecting against short and long-term diabetes complications – and removing some of the relentless burden of managing the condition. 

“By demonstrating the benefits to people living with type 1 diabetes and the value for money to the NHS – which currently spends 10% of its budget on diabetes care – we hope these results encourage healthcare professionals and people with type 1 diabetes to consider flash glucose monitoring as a cost-effective and life-improving intervention.

Dr Lalantha Leelarathna, Diabetes UK-funded researcher at University of Manchester, said:

Ability to monitor glucose without painful finger-sticks is life-changing for many people living with type 1 diabetes. With the use of second-generation Flash technology, we found significant improvements in average glucose levels and a reduction in both high and low glucose levels, helping people to spend more time with normal glucose levels thereby reducing their risk of long-term diabetes related complications. This intervention was highly cost-effective and led to a high level of treatment satisfaction. We call for universal funding of this life-changing technology for all people living with type 1 diabetes.”

Type 2 diabetes and fatty liver disease

A build-up of fat in the liver that isn’t related to excess alcohol consumption is known as non-alcoholic fatty liver disease (NAFLD). NAFLD is most common in people living with obesity or overweight and can lead to severe liver damage. 

At DUKPC, Professor Chris Byrne, a Professor of Endocrinology and Metabolism at the University of Southampton, gave the prestigious Banting Memorial Lecture all about the links between NAFLD and type 2 diabetes.  

Rising rates 

When NAFLD was first described in the 1980s it was uncommon, but nowadays up to 70% of people living with type 2 diabetes are estimated to have NAFLD. But it can be difficult to spot - sometimes being described as a silent condition - and people with type 2 diabetes often remain undiagnosed.  

Professor Byrne described the relationship between NAFLD and type 2 diabetes as a “vicious spiral”, where one condition affects the other and vice versa. Over the last few years, she and others have published evidence showing that NAFLD increases the risk of type 2 diabetes more than two-fold. And having type 2 diabetes may then accelerate the progression of NAFLD towards more serious liver damage.   

Treatment and prevention 

The good news is if it’s caught early and treated, the damaging effects of NAFLD on the body are usually preventable. Professor Bryne spoke to the audience of healthcare professionals about the importance of raising awareness of the condition so it can be spotted and treated earlier.   

GLP-1 receptor agonists, a type 2 diabetes medication, has been found to be effective at treating NAFLD. And our DiRECT trial has shown that weight loss through diet is very effective at helping people with type 2 diabetes to lose liver fat.  

We know that if you have diabetes there are huge benefits to losing weight if you're carrying extra weight. It can help with blood sugar control, reduce the risk of complications, like heart attack and stroke, and for some could even mean going into remission. Professor Bryne’s lecture has highlighted a lesser-known potential benefit to weight loss, helping to stop progression of NAFLD or even prevent it from developing in the first place. 

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