Breakthrough Clinical Results
New data from Abbott's REFLECT real-world studies show that using FreeStyle Libre continuous glucose monitoring (CGM) technology is associated with a significant reduction in hospitalizations for heart complications in people with Type 1 and Type 2 diabetes. In individuals with Type 1 diabetes, the studies revealed a 78% reduction in cardiovascular disease-related hospitalizations for those with prior severe low blood sugar episodes and an 80% reduction for those with no prior history of cardiovascular disease. For those with Type 2 diabetes on insulin, a similar reduction in heart-related hospitalizations was observed. These findings suggest potential cost savings in healthcare due to reduced hospital admissions. The studies utilized data from the Swedish National Diabetes Register.
Key Highlights
- FreeStyle Libre CGM associated with a significant reduction in cardiovascular-related hospitalizations in people with Type 1 and Type 2 diabetes.
- 78% reduction in cardiovascular disease-related hospitalizations observed in Type 1 diabetes patients with prior severe hypoglycemia using Libre CGM.
- 80% reduction in cardiovascular hospitalization risk observed in Type 1 diabetes patients without prior cardiovascular disease history using Libre CGM.
- Similar reduction in heart-related hospitalizations observed in Type 2 diabetes patients on insulin using Libre technology.
Incidence and Prevalence
Global Diabetes Burden (2021):
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Prevalence:
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529 million people (95% UI 500-564) were living with diabetes worldwide.
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Age-standardized prevalence: 6.1% (5.8-6.5).
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Type 2 diabetes accounted for 96.0% (95.1-96.8) of diabetes cases and 95.4% (94.9-95.9) of diabetes DALYs.
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High BMI attributed to 52.2% (25.5-71.8) of global type 2 diabetes DALYs.
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Regional Variation:
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Highest age-standardized rates:
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Super-region: North Africa and the Middle East (9.3% [8.7-9.9]).
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Region: Oceania (12.3% [11.5-13.0]).
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Highest national age-specific prevalence: Qatar (76.1% [73.1-79.5] in individuals aged 75-79 years).
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Projections (2050):
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Over 1.31 billion (1.22-1.39) people projected to have diabetes.
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Age-standardized prevalence >10% expected in:
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North Africa and the Middle East (16.8% [16.1-17.6]).
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Latin America and Caribbean (11.3% [10.8-11.9]).
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89 countries (43.6%) projected to have an age-standardized rate >10%.
Other Estimates (2021):
- 10.5% of the world's adult population (20-79 years old) had diabetes (536.6 million people).
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Prevalence higher in:
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Urban (12.1%) vs. rural (8.3%) areas.
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High-income (11.1%) vs. low-income (5.5%) countries.
- Greatest relative increase in prevalence between 2021 and 2045 expected in middle-income countries (21.1%).
- Global diabetes-related health expenditures: 966 billion USD (projected to reach 1,054 billion USD by 2045).
Additional Information:
- The burden of diabetes is increasing worldwide, primarily due to the rise in obesity.
- Type 2 diabetes is largely preventable and potentially reversible with early identification and management.
It's important to note that these estimates come from different studies and may vary slightly due to different methodologies and data sources.
Risk Factors and Comorbidities
Diabetes Risk Factors and Comorbidities
Diabetes, particularly type 2 diabetes (T2D), is often associated with a complex interplay of risk factors and comorbidities. Here's a breakdown of some of the most prominent ones, categorized for clarity:
Top 3 Risk Factors:
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Obesity: Obesity is consistently identified as a leading risk factor for T2D. Excess weight, especially around the abdomen, contributes to insulin resistance, a key factor in T2D development.
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One study found that for each unit increase in age, there was a 7.8% increase in the odds of diabetic kidney disease, a common complication of diabetes, and that obesity was a significant comorbidity in these patients.
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Another study found that obese participants were 4.63 times more likely to have diabetes.
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Yet another study found that the risk for diabetes was increased markedly (odds ratios of 12.95) at a BMI of ≥35 kg/m2 compared with normal weight.
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Another study found obesity to be the most significant risk factor for the development of diabetes.
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Physical Inactivity: Lack of regular physical activity contributes to weight gain and reduces the body's ability to use insulin effectively, increasing T2D risk.
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One study found that physical inactivity was strongly and independently associated with diabetes and diabetes-related comorbidities.
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Another study found that physically inactive participants were 1.33 times more likely to have diabetes.
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Another study found that physical inactivity and sedentary lifestyle were associated with T2DM in young Indian adults.
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Genetic Predisposition/Family History: A family history of diabetes significantly increases an individual's risk. While specific genes are involved, the inheritance pattern is complex and not fully understood.
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One study found that the estimated risk for the diagnosis of T2DM increases approximately by 2-4 times when a parent has the condition.
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Another study found that individuals with DM frequently have a positive familial history, and the presence of DM in both parents or solely the mother significantly amplifies genetic susceptibility.
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Another study found that family history of T2DM was the most common risk factor in a young Indian population.
Top 3 Comorbidities:
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Hypertension (High Blood Pressure): Hypertension and diabetes frequently coexist, increasing the risk of cardiovascular complications. Both conditions share some underlying mechanisms, such as endothelial dysfunction and inflammation.
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One study found that hypertension occurred in 75% of patients with T2D.
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Another study found that hypertension was the most prevalent chronic disease among participants (18.5%).
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Another study found that hypertension was the most prevalent comorbidity in lung, colorectal, gastric, breast, and thyroid cancer patients (21.9%).
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Dyslipidemia (Abnormal Blood Lipids): Dyslipidemia, characterized by elevated cholesterol and triglycerides, often accompanies diabetes, further increasing cardiovascular risk.
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One study found that 82.77% of T2DM patients had dyslipidemia.
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Another study found that dyslipidemia was the second most prevalent chronic disease among participants (8.3%).
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Another study found that dyslipidemia was a common comorbidity in young Indian adults with T2DM.
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Cardiovascular Disease (CVD): Diabetes significantly increases the risk of various CVDs, including coronary artery disease, heart failure, and stroke. This is largely due to the damaging effects of high blood sugar on blood vessels.
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One study found that CVD creates an important burden on public health systems, especially in the elderly, mainly because this group of patients frequently suffer from multiple comorbidities, including diabetes.
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Another study found that cardiovascular disease was the third most prevalent comorbidity among participants (9.7%).
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Another study found that CVD remains the leading cause of death in patients with diabetes.
It's important to note that these risk factors and comorbidities often interact and influence each other. For example, obesity can contribute to both hypertension and dyslipidemia. Managing these interconnected factors is crucial for preventing and treating diabetes and its complications.
Drug used in other indications
The provided research articles primarily focus on the use of FreeStyle Libre CGM systems in diabetes management. There is no mention of trials for other indications outside of diabetes.
However, some studies explore the use of FreeStyle Libre in specific subgroups of people with diabetes or in specific contexts, which could be considered as different intervention models:
- Hospitalized patients with type 2 diabetes: One study compared FreeStyle Libre Pro CGM with point-of-care capillary glucose testing in insulin-treated hospitalized patients. This model aims to assess the performance of CGM in an acute care setting.
- People with type 1 diabetes and suboptimal glycemic control: A randomized controlled trial investigated the impact of FreeStyle Libre 2 compared to self-monitoring of blood glucose (SMBG) in this population. This model aims to evaluate the benefits of CGM in improving glycemic control in individuals struggling with traditional methods.
- People with type 2 diabetes on basal-only insulin regimens plus SGLT-2 inhibitor and/or GLP-1 agonist: Another randomized controlled trial assessed the glycemic impact of FreeStyle Libre 3 in this specific subgroup. This model aims to determine the effectiveness of CGM in individuals with T2DM on specific medication regimens.
- Ramadan fasting in patients with type 2 diabetes and chronic kidney disease: A study used FreeStyle Libre to understand the risk of hypoglycemia during Ramadan fasting and observe glycemic control and renal function. This model explores the use of CGM in a specific cultural and religious context.
- Bionic pancreas study: A study evaluated the accuracy of FreeStyle Libre Pro alongside other CGM devices in a free-living home-use bionic pancreas study involving subjects with type 1 diabetes. This model investigates the use of CGM as part of a closed-loop system.
- Primary care settings: Several studies and reviews discuss the use and efficacy of FreeStyle Libre (including FCGM) in primary care settings for diabetes management. This model aims to integrate CGM into routine diabetes care in primary care.
- Older adults with type 2 diabetes: A study investigated the adherence to and efficacy of FreeStyle Libre Flash CGM in insulin-treated older adults. This model focuses on the use of CGM in a specific age group.
While these studies explore different intervention models within the context of diabetes, they do not represent trials for indications other than diabetes.