Clinical and Psychological Outcomes of Flash Glucose Monitoring in Adults with Type 1 Diabetes on Multiple Daily Injections of Insulin: A Population-Based Study in Andalusia, Spain

Background: Type 1 diabetes mellitus (T1DM) is associated with a high burden of acute complications, such as severe hypoglycemia and diabetic ketoacidosis (DKA), and chronic complications, including cardiovascular events and amputations. In addition, psychological factors—particularly Fear of Hypoglycemia (FoH)—represent significant barriers to achieving optimal metabolic control and quality of life. Flash Glucose Moni-toring (FGM) has been shown to improve glycemic control and patient-reported out-comes, but its real-world impact at the population level, particularly within universal healthcare systems, remains insufficiently explored. Objectives: This doctoral thesis, presented as a compendium of publications, aimed to evaluate the clinical, economic, and psychological outcomes of the large-scale implementation of FGM in adults with T1DM treated with multiple daily injections (MDI) in Andalusia. Methods: Three complementary studies were conducted. 1. Section I analyzed population-based incidence rates of hospital admissions for acute (DKA, hypoglycemia, hyperglycemia) and chronic complications (myo-cardial infarction, stroke, amputations) before and after FGM introduction, with a specific cost analysis focused on DKA-related admissions. 2. Section II examined the effect of FGM on severe hypoglycemia requiring urgent out-of-hospital medical care, using the regional emergency services registry, and developed predictive risk models. 3. Section III assessed the psychological dimension of FGM use in a prospective cohort, focusing on FoH, quality of life, treatment satisfaction, and hypoglyce-mia unawareness. Results: • FGM implementation was associated with a 25% reduction in hospital admis-sions for acute complications and a 50% reduction in DKA-related admissions, with substantial estimated cost savings derived specifically from the reduction in DKA hospitalizations. Admissions for selected chronic complications showed a non-significant downward trend. • The incidence of severe hypoglycemia requiring extra-hospital emergency care decreased by 27 %after FGM initiation, while episodes of hypoglycemic coma fell by 36 %, with the greatest benefit observed in individuals with sensor use ? 70 %. • Psychological analyses demonstrated significant reductions in FoH, accompa-nied by improvements in treatment satisfaction and quality of life. Baseline FoH predicted the magnitude of these improvements. Conclusions: The large-scale introduction of FGM in Andalusia was associated with measurable clinical benefits, including fewer acute hospitalizations, reduced severe hy-poglycemia, and significant psychological improvements. Importantly, the cost analysis confirmed meaningful savings specifically related to DKA admissions. These findings support the role of FGM as an effective tool for optimizing diabetes care in routine clin-ical practice and highlight its potential contribution to both clinical outcomes and patient well-being within universal healthcare systems.

Author dc:creator

• Rodríguez de Vera Gómez, Pablo

Advisor dc:contributor.advisor

• Martínez Brocca, María Asunción

Statement dc:rights

• Attribution-NonCommercial-NoDerivatives 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nc-nd/4.0/

Language dc:language.iso

eng

Handle dc:identifier.uri

https://hdl.handle.net/11441/187991

OAI identifier oai:identifier

oai:idus.us.es:11441/187991