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Review Diabetes Flash Continuous Glucose Monitoring and its IMPACT to REPLACE Blood Glucose Monitoring in the Management of Type 1 and Type 2 Diabetes Stephen M Twigg, 1 Mahmood R Kazemi, 2 and Maria E Craig 3 1. Central Clinical School, Charles Perkins Centre, Bosch Institute, The University of Sydney, Australia; 2. Abbott Diabetes Care, Alameda, California, US; 3. The Children's Hospital at Westmead, Westmead, and Charles Perkins Centre Westmead, The University of Sydney, Australia; School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia O bjective: Established methods of self-monitoring of glucose levels include capillary self-monitoring of blood glucose (SMBG) and interstitial continuous glucose monitoring (CGM). Flash CGM is a novel form of self-monitoring that provides on-demand continuous interstitial glucose profiles. The purpose of this article is to critically review the recent outcome data from randomized controlled trials that assessed the efficacy and safety of flash CGM to replace routine SMBG in diabetes management. Methods: Two recent six-month, prospective, multicenter, randomized controlled trials in type 1 (IMPACT; NCT02232698) and type 2 (REPLACE; NCT02082184) diabetes compared flash CGM with SMBG under otherwise usual care conditions. The trials did not use a prescribed treatment algorithm based on self-monitoring of glucose. Results: Both trials demonstrated that the time spent in hypoglycemia over a 24-hour period, as well as overnight, was markedly reduced by flash CGM without deterioration in glycated hemoglobin (A1C) levels. In IMPACT there was a 38% reduction in time in hypoglycemia with flash CGM versus SMBG, and in REPLACE there was a 43% reduction in time in hypoglycemia with flash CGM compared with SMBG. Moreover, patient satisfaction improved with flash CGM, usage adherence rates were high, and flash CGM was well tolerated. Conclusions: The findings from these trials suggest that improved care outcomes can be achieved when flash CGM is integrated into current established clinical care paradigms. Flash CGM provides important advantages over SMBG that are likely to be applicable to real-world care of individuals with differing forms of diabetes requiring intensive insulin treatment. Keywords Continuous glucose monitoring, diabetes, flash glucose monitoring, glycated hemoglobin, hypoglycemia, self-monitoring of blood glucose Disclosure: Stephen M Twigg is an advisory panel member and is on the speaker’s bureau for Abbott Diabetes Care, Astra Zeneca, Novo Nordisk Australia, Sanofi-Aventis, Eli Lilly and Company and Boehringer Ingelheim Pharmaceuticals. He is on the speaker’s bureau only for Takeda Pharmaceutical Company Limited, Merck Sharp & Dohme Corporation, Novartis Pharmaceuticals Corporation, and Servier. Mahmood R Kazemi is an employee of Abbott Diabetes Care. Maria E Craig is an advisory panel member for Abbott Diabetes Care, and is on the speaker's bureau for Novo Nordisk Australia, Pfizer Australia. Abbott Diabetes Care has contracted with Watermeadow Medical (UK) to manage and prepare this manuscript. Acknowledgements: The authors thank Liz Southey and Rebecca Cocking of Watermeadow Medical (UK) for assistance with the preparation of this manuscript. Editorial support was provided by Catherine Amey, Touch Medical Media and funded by Abbott. Compliance with Ethics: This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: March 6, 2017 Accepted: June 9, 2017 Citation: US Endocrinology, 2017;13(2):57–62 Corresponding Author: Stephen M Twigg, Sydney Medical School, Charles Perkins Centre (D17), Level 3 West, The University of Sydney, Sydney NSW 2006, Australia. E: Support: The publication of this article was supported by Abbott, who was given the opportunity to review the article for scientific accuracy before submission. Any resulting changes were made at the authors’ discretion. TOU CH MED ICA L MEDIA The main priorities in diabetes care include prompt recognition and minimization of hypoglycemia while optimizing glucose control and glycated hemoglobin (A1C) levels. To achieve this, individuals need accurate and clear information about their glucose levels. There are practical limits to the frequency of self-monitoring of blood glucose (SMBG) that can be performed daily, which means that testing tends to focus on pre-meal glucose levels and relies on patient motivation and compliance. 1 The intermittent snapshots of blood glucose provided by SMBG do not provide information for large parts of the day or night. Newer glucose monitoring approaches enable additional testing to be performed at regular intervals, and provide more information than would be feasible with SMBG. This includes comprehensive data on the 24-hour glucose profile; the current glucose trend (up or down); glucose variability; detection of periods of hypoglycemia and hyperglycemia; and estimated A1C. 1 Advantages and disadvantages of currently available glucose monitoring approaches Self-monitoring of blood glucose SMBG based on finger-prick testing of capillary blood using glucose test strips is generally performed at intervals throughout the day (typically four to eight times daily, depending on the individual). 2 Current guidelines for type 1 diabetes (T1D) recommend testing at a frequency to optimize diabetes control, because frequency of SMBG correlates with glycemic control. 3 The practical limitations of SMBG mean that it has a limited frequency of use, and hence it does not provide optimal information to examine glucose variability, periods of hypoglycemic or hyperglycemic risk, 57