INTRODUCTION: Frequent scanning of FreeStyle Libre (FSL) flash glucose monitoring sensors is known to be important whilst wearing an active sensor, but adherence to sensor reapplication is also critical to effective glucose monitoring. We report novel measures of adherence for users of the FSL system and their association with improvements in metrics of glucose control. METHODS: Anonymous data were extracted for 1600 FSL users in the Czech Republic with ≥ 36 completed sensors from October 22, 2018 to December 31, 2021. "Experience" was defined by the number of sensors used (1-36 sensors). "Adherence" was defined by time between the end of one sensor and the start of the next (gap time). User adherence was analyzed for four experience levels after initiating FLASH; Start (sensors 1-3); Early (sensors 4-6); Middle (sensors 19-21); End (sensors 34-36). Users were split into two adherence levels based on mean gap time during Start period, "low" (> 24 h, n = 723) and "high" (≤ 8 h, n = 877). RESULTS: Low-adherence users reduced their sensor gap times significantly: 38.5% applied a new sensor within 24 h during sensors 4-6, rising to 65.0% by sensors 34-36 (p < 0.001). Improved adherence was associated with increased %TIR (time in range; mean + 2.4%; p < 0.001), reduced %TAR (time above range; mean - 3.1%; p < 0.001), and reduced glucose coefficient of variation (CV; mean - 1.7%; p < 0.001). CONCLUSIONS: With experience, FSL users became more adherent in sensor reapplication, with associated increases in %TIR, and reductions in %TAR and glucose variability.

3rd Department of Internal Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Abbott Diabetes Care Alameda CA USA

Department of Internal Medicine and Center for Molecular Medicine and Genetics Wayne State University School of Medicine Detroit MI USA

Grunberger Diabetes Institute Bloomfield Hills MI USA

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Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA. 2017;317:371–378. doi: 10.1001/jama.2016.19975. PubMed DOI

Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections. Ann Intern Med. 2017;167:365–374. doi: 10.7326/M16-2855. PubMed DOI

Deshmukh H, Wilmot EG, Gregory R, et al. 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. Diabetes Care. 2020;43:2153–2160. doi: 10.2337/dc20-0738. PubMed DOI PMC

Wilmot EG, Leelarathna L, Evans ML, Neupane S, Rayman G, Lumley S. FLASH-UK randomised controlled trial. Diabetes UK Professional Conference 2022; 2022.

Bailey T, Bode BW, Christiansen MP, Klaff LJ, Alva S. The performance and usability of a factory-calibrated flash glucose monitoring system. Diabetes Technol Ther. 2015;17(11):787–794. doi: 10.1089/dia.2014.0378. PubMed DOI PMC

Alva S, Bailey T, Brazg R, et al. Accuracy of a 14-day factory-calibrated continuous glucose monitoring system with advanced algorithm in pediatric and adult population with diabetes. J Diabetes Sci Technol. 2020;16(1):70–77. doi: 10.1177/1932296820958754. PubMed DOI PMC

Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593–1603. doi: 10.2337/dci19-0028. PubMed DOI PMC

Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40:1631–1640. doi: 10.2337/dc17-1600. PubMed DOI PMC

Beyond A1c Writing Group Need for regulatory change to incorporate beyond A1C glycemic metrics. Diabetes Care. 2018;41:e92–e94. doi: 10.2337/dci18-0010. PubMed DOI

Dunn TC, Xu Y, Hayter G, Ajjan RA. Real-world flash glucose monitoring patterns and associations between self-monitoring frequency and glycaemic measures: a European analysis of over 60 million glucose tests. Diabetes Res Clin Pract. 2018;137:37–46. doi: 10.1016/j.diabres.2017.12.015. PubMed DOI

Eldor R, Roitman E, Merzon E, Toledano Y, Alves C, Tsur A. Flash glucose monitoring in Israel: understanding real-world associations between self-monitoring frequency and metrics of glycemic control. Endocr Pract. 2022;28(5):472–478. doi: 10.1016/j.eprac.2022.02.004. PubMed DOI

Lameijer A, Lommerde N, Dunn TC, et al. Flash glucose monitoring in the Netherlands: increased monitoring frequency is associated with improvement of glycemic parameters. Diabetes Res Clin Pract. 2021;177:108897. doi: 10.1016/j.diabres.2021.108897. PubMed DOI

Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388:2254–2263. doi: 10.1016/S0140-6736(16)31535-5. PubMed DOI