HbA1c and hypoglycaemia outcomes for people with type 1 diabetes due to the introduction of a single-day structured education programme and flash glucose monitoring


  • Gillian Garden Royal Surrey County Hospital
  • David W Hunt
  • Karen Mackie Royal Surrey County Hospital
  • Beverly Tuthill Royal Surrey County Hospital
  • Helen Griffith Royal Surrey County Hospital
  • David L Russell-Jones Royal Surrey County Hospital
  • Roselle Herring Royal Surrey County Hospital




education, self-management, type 1 diabetes


People with type 1 diabetes who met NHS England funding criteria attended an accredited, intensive one-day structured education programme and completed the online FreeStyle Libre Academy training module followed by a 30-minute healthcare professional face-to-face practical training session. HbA1c, Gold hypoglycaemia score and Diabetes Distress Screening score were documented before commencement of the intervention and at 6 months. 213 people with type 1 diabetes (52% men; average age 48 years (range 18–87)) completed the 6-month intervention. Overall mean HbA1c reduced by 6 mmol/mol (0.5%) from 62±14 mmol/mol (7.8%) to 56±12 mmol/mol (7.3%) (p<0.0001). Subgroup analysis of participants with a baseline HbA1c ≥54 mmol/mol (7.1%) revealed a more dramatic reduction of 10 mmol/mol (0.9%) from 69±12 mmol/mol (8.5%) to 59±11 mmol/mol (7.6%). No deterioration was demonstrated for people with HbA1c <54 mmol/mol (7.1%). 143 people (75%) reported a reduction in hypoglycaemia episodes and 162 (85%) reported a reduction in time spent in the hypoglycaemic range. There was significant improvement in the Gold score (p<0.0001) and Diabetes Distress Screening score (p=0.0001). Rates of hospital admissions, paramedic call-outs and third-party assistance were reduced. The combination of a one-day intensive structured education programme alongside flash glucose monitoring initiation provides a pragmatic, cost-effective and easily implemented intervention with positive clinical outcomes at 6 months.


Lind M, Polonsky W, Hirsch I, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 2017;317(4):379–87. https://doi.org/10.1001/jama.2016.19976

Heinemann L, Freckmann G, Ehrmann D, et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet 2018;391(10128):1367–7. https://doi.org/10.1016/S0140-6736(18)30297-6

NHS. NHS England flash glucose monitoring guidelines for CCGs. March 2019. https://www.england.nhs.uk/blog/nhs-england-flash-glucose-monitoring-guidelines-for-ccgs/

Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kroger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 2016; 388(10057):2254–63. https://doi.org/10.1016/S0140-6736(16)31535-5

Deshmukh H, Wilmot EG, Gregory R, et al. Effect of flash glucose monitoring on glycaemic control, hypoglycaemia, diabetes-related distress and resource utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit. Diabetes Care 2020;43:2153–60. https://doi.org/10.2337/dc20-0738

Abbott. FreeStyle. https://progress.freestylediabetes.co.uk

Association of British Clinical Diabetologists. FreeStyle Libre Nationwide Audit. http://www.diabetologists-abcd.org.uk/n3/FreeStyle_Libre_Audit.htm

DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002;325:746. https://doi.org/10.1136/bmj.325.7367.746

Ehrmann D, Bergis-Jurgan N, Haak T, et al. Comparison of the efficacy of a diabetes education programme for type 1 diabetes (PRIMAS) in a randomised controlled trial setting and the effectiveness in a routine care setting: results of a comparative effectiveness study. PLOS One 2016; 11(1):e0147581. https://doi.org/10.1371/journal.pone.0147581

National Institute for Health and Care Excellence (NICE). Type 1 diabetes in adults: diagnosis and management. Clinical Guideline NG17. 2015. https://www.nice.org.uk/guidance/ng17

Schachinger H, Hegar K, Hermanns N, et al. Randomized controlled clinical trial of blood glucose awareness training (BGAT III) in Switzerland and Germany. J Behav Med 2005;28(6):587–94. https://doi.org/10.1007/s10865-005-9026-3

Cox DJ, Kovatchev B, Koev D, et al. Hypoglycemia anticipation, awareness and treatment training (HAATT) reduces occurrence of severe hypoglycemia among adults with type 1 diabetes mellitus. Int J Behav Med 2004;11(4):212–8. https://doi.org/10.1207/s15327558ijbm1104_4

Rossi MC, Nicolucci A, Di Bartolo P, et al. Diabetes Interactive Diary: a new telemedicine system enabling flexible diet and insulin therapy while improving quality of life: an open-label, international, multicentre, randomized study. Diabetes Care 2010;33(1):109–15. https://doi.org/10.2337/dc09-1327

Hermanns N, Kulzer B, Kubiak T, Krichbaum M, Haak T. The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes. Diabetes Metab Res Rev 2007;23(7):528–38. https://doi.org/10.1002/dmrr.710

NHS Digital. National Diabetes Audit Report 1, Care Processes and Treatment Targets, 2016–17. https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/national-diabetes-audit-report-1-care-processes-and-treatment-targets-2016-17






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