Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2021; 12(11): 1908-1916
Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1908
Factors influencing the effectiveness of using flash glucose monitoring on glycemic control for type 1 diabetes in Saudi Arabia
Hala Ibrahim Alhodaib, Sama Alsulihem
Hala Ibrahim Alhodaib, Community Health Sciences Department, King Saud University, Riyadh 11564, Saudi Arabia
Sama Alsulihem, College of Medicine, King Saud University, Riyadh 11564, Saudi Arabia
Author contributions: Alsulihem S collected the patients’ clinical data; Alhodaib H wrote the manuscript; all authors conceived and designed the study and analyzed the data.
Institutional review board statement: The Institutional Review Board of King Saud University provided approval for this study, No. 19/0812/IRB.
Informed consent statement: No individual informed consent forms have been signed by participants as this study was a retrospective study, so it was not applicable.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Data sharing statement: The datasets extracted and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hala Ibrahim Alhodaib, PhD, Assistant Professor, Community Health Sciences Department, King Saud University, Prince Turki Bin Abdulaziz Alawwal Street, Riyadh 11564, Saudi Arabia.
Received: May 31, 2021
Peer-review started: May 31, 2021
First decision: July 3, 2021
Revised: July 14, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: November 15, 2021

In 2017, 35000 Saudi children and adolescents were living with a type 1 diabetes (T1D) diagnosis. Diabetic complications are minimized upon strengthened glycemic regulation. The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications. The use of flash glucose monitoring (FGM) enables better diabetes treatment and thereby improves glycemic control. Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources, resulting in improved outcomes.


To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin (HbA1c) levels/glycemic control among T1D patients.


A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed. T1D patients who began FGM between 2017 and 2019 were included.


The data included 195 T1D patients (70 males and 125 females) with a mean age of 23.6 ± 8.1 years. Among them, 152 patients used multiple daily injection and 43 used an insulin pump. The difference in HbA1c level from baseline and after using FGM was -0.60 ± 2.10, with a maximum of 4.70 and a minimum of -6.30. There was a statistically significant negative correlation between the independent variables (age, duration of diabetes, level of engagement) and HbA1c. The group with the highest HbA1c mean (9.85) was 18-years-old, while the group with the lowest HbA1c mean (7.87) was 45-years-old. Patients with a low level of engagement (less than six scans per day) had the highest HbA1c mean (9.84), whereas those with a high level of engagement (more than eight scans per day) had the lowest HbA1c mean (8.33).


With proper education, FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.

Keywords: Type 1 diabetes, Flash glucose monitoring, Continuous glucose monitoring, Hypoglycemia, Glycemic control

Core Tip: The factors influencing success of flash glucose monitoring are poorly understood in people with type 1 diabetes (T1D). Therefore, we retrospectively investigated the main predictor factors and their relationship with glycemic control/glycated hemoglobin (HbA1c) levels in 195 patients with T1D. Flash glucose monitoring resulted in a clinically significant reduction in HbA1c, and the uncontrolled group (baseline HbA1c > 9) had the highest reduction in HbA1c. Age and level of engagement were negatively associated with HbA1c. Patients in the age group (18-45 years) with a high level of engagement were more likely to experience a higher- reduction in HbA1c.