A multiple component study and pilot randomised controlled trial to explore the feasibility and effectiveness of Freestyle Libre in multiple acute settings for people living with diabetes

Abstract

Introduction
People with diabetes are more likely to be admitted to hospital and have comparatively longer stays than those without diabetes. Evidence-based interventions to reduce length of stay are needed.

Aim
To explore the feasibility and effectiveness of Freestyle Libre in a clinical setting and its implementation as a strategy in achieving blood glucose management and as a means of affecting decision-making processes and length of stay.

Methods
This thesis comprises five component studies across three acute hospitals culminating in a pilot randomised control trial, informed by the Medical Research Council’s Guidance for the Development and Evaluation of Complex Interventions.

Results
The economic analysis confirmed that length of hospital stay was significantly associated with hospitalisation costs for diabetes. Two systematic reviews identified firstly, interventions that significantly improved clinical outcomes and reduced length of hospital stay across a range of hospital-based practice. Secondly, that technology in the form of Freestyle Libre to monitor glucose has the potential to improve diabetes management and increase patient involvement in decision-making but that further research was needed. The analysis of patients’ experiences confirmed some shared decision-making but also barriers to their involvement in care. The pilot trial supports the feasibility, and effectiveness of Freestyle Libre in multiple acute settings through parameters of safety and concordance of glycaemia measures between Freestyle Libre and capillary blood glucose.

Conclusion
To inform real world practice, interventions must be developed with a full understanding of the broader context of care. Each of the component studies adds to our knowledge of hospital care and the patient experience for those with diabetes. Patient directed technology such as Freestyle Libre offers shared decision-making opportunities to optimise diabetes management. This pilot trial indicates that a full clinical trial to evaluate the impact of Freestyle Libre in acute hospitals is warranted.

Date of Award	Dec 2023
Original language	English
Supervisor	Vivien Coates (Supervisor), Claire Mc Cauley (Supervisor), Michael McCann (Supervisor), Maurice O'Kane (Supervisor) & Paddy Gillespie (Supervisor)