Reply to Argento. Flash forward, with caution.
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• The authors underline that the original article intended to explore the reasons underlyingthe popularity of the FreeStyle Libre system and to provide a clinical perspective onpublished accuracy data and the impact this technology brings to UK diabetes care ratherthan providing a detailed technical comparison between the FreeStyle Libre system andthe Dexcom G5 system.
• In his comments, Dr Argento stated that possible under-reading of sensor glucose valuesby the FreeStyle Libre system in the study by Reddy et al. may explain the higher baselinehypoglycaemia rate. The authors of this Response Letter object that this may not be thecase, as baseline hypoglycaemia was assessed using the Dexcom G4 sensor with a blindedreceiver running the 505 algorithm, whilst the sensors used to assess study outcomes atthe end of the study were the FreeStyle Libre system in the Libre arm, and the Dexcom G5in the continuous glucose monitoring arm. This was a limitation of the study. So, if theFreeStyle Libre system was under-reading, this may have influenced the study outcomes.
•Two abstracts presented at the 2018 ATTD were mentioned. Kamecke et al. reported thata higher percentage of time spent in hypoglycaemia was seen with the FreeStyle Libresystem compared with the Dexcom G5. In addition, between-sensor accuracy was moreconsistent with Dexcom G5. The extension phase of the study by Reddy et al. showed afurther reduction in time spent in hypoglycaemia when participants were switched fromthe FreeStyle Libre system to the Dexcom G5 device.
•The authors agree that alarm burden could be managed; however, they disagree with thesimplistic ‘house on fire’ analogy used by Dr Argento. Evidence has shown that whilemany users find them useful, others see them as an unwelcome intrusion, attention ordistraction and will switch them off. Some found that the emotional burden of diabeteswas exacerbated by CGM use. The constant nature of CGM feedback made some anxious.
•Dr Argento suggests that FreeStyle Libre use would lead to increased HbA1c levels or timespent in hyperglycaemia. However, the IMPACT study showed that non-adjunctive use ofthe FreeStyle Libre in people with Type 1 diabetes did not increase HbA1c significantly,confirming FreeStyle Libre use reduces hypoglycaemia and improves glucose time inrange.