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Triangle of Diabetes Care

The 3 key areas for improving diabetes management

The Triangle of Diabetes Care is an emerging treatment strategy that is centred around three diabetes management targets, reaching all three can help improve outcomes for patients with Type 1 and Type 2 diabetes. When used with the FreeStyle Libre systems,* you can help your patients hit targets in all three areas using the glucose data from their sensor to inform your treatment plan. 

What is the Triangle of Diabetes Care?

The Triangle of Diabetes Care acknowledges that improving your patients' HbA1c is important, but it also emphasises a need to minimise hypoglycaemia and limit glucose variability.

Ideally, all three targets should be achieved but might not always be possible. Sensor-based glucose monitoring with the FreeStyle Libre portfolio can support you and your patients in achieving these goals.

The three goals of the Triangle of Diabetes Care for better diabetes management are: better manage overall glucose levels (HbA1c), minimise hypoglycaemia, limit glucose variability.

The Triangle of Diabetes Care was developed by Professor Ramzi Ajjan, Professor of Metabolic Medicine and Consultant in Diabetes and Endocrinology at Leeds University and Leeds Teaching Hospitals Trust6.

Triangle of Diabetes Care: better overall glucose levels, minimise hypoglycaemia and limit glucose variability.

Improve overall glucose levels (HbA1c)

HbA1c is an accepted measure of overall glucose control over the past three months and illustrates how a person with diabetes has been managing their treatment regime.

More regular glucose monitoring with the FreeStyle Libre system can help patients achieve better long term diabetes control.

Real-world analysis of data collected from over 50,831 readers and 279,446 sensors around the world shows that the estimated HbA1c decreased as scanning frequency increased. When the scan frequency increased from 4.4 to 48.1 scans/day, the estimated HbA1c decreased from 64 to 50 mmol/mol7

Point one of the Triangle of Diabetes Care: Better manage overall glucose levels (HBA1c).

Minimise hypoglycaemia

Hypoglycaemia is a common issue for those living with type 1 diabetes. Even people with type 2 diabetes who use insulin or insulin-stimulating drugs can suffer from hypoglycaemia.

The FreeStyle Libre system has proven to help reduce hypoglycaemia

The FreeStyle Libre system has trend arrows to show your patients where their glucose values ​​are heading, which means that before the patient gets a hypoglycaemic value, they can take appropriate measures.

Current time in range consensus recommends that patients spend <4% of time <3.9 mmol/L, including <1% of time <3.0 mmol/L. This applies to adults with type 1 and type 2 diabetes who are not pregnant, elderly or in a risk group3.

In clinical trials for people with type 1 and type 2 diabetes, the FreeStyle Libre group significantly reduced the time their glucose levels were in hypoglycemia (<3.9 mmol/L) by 38% and 43%, respectively, compared to SMBG the group.8,9

Point two of the Triangle of Diabetes Care: Minimise Hypoglycaemia.

 

Limit glucose variability

Even if your patient’s HbA1c is on target, they may have been experiencing daily swings between high and low glucose levels or significant day-to-day glucose variability.

Avoiding glucose excursions and minimising the size of these daily swings are important for improving your patient’s overall health and management of their diabetes.4 

In fact, Analyzed data from the DCCT study showed that changes in a patient's average glucose values were a better independent variable for cardiovascular disease than HbA1c.44

Point three of the Triangle of Diabetes Care: Limit glucose variability.

FreeStyle Libre Portfolio & The Triangle of Diabetes Care

The FreeStyle Libre portfolio empowers patients to hit targets on each of the three sides of the Triangle of Diabetes Care and improve their overall glucose control. Even if one goal cannot be reached, an improvement of one or both of the other goals will have a positive effect on the overall health of your patients.

Additional Resources

Webinars

We offer various on-demand webinars for Healthcare Professionals including a spotlight on hypoglycaemia.

EXPLORE WEBINARS

Educational, Training & Case Studies

See more of our educational material, trainings and case studies.

SEE MORE

Time in range

An important metric that goes beyond HbA1c. Discover how time in the target range can provide useful information for you and your patients.

LEARN MORE

References & Disclaimers

SMBG=self-monitored blood glucose

* FreeStyle Libre systems refers to the FreeStyle Libre 2 and FreeStyle Libre 3 systems

3. Battelino, T. Diabetes Care (2019): https://doi.org/10.2337/dci19-0028

4. Ceriello A. et al, Lancet Diabetes Endocrinol 2019 : http://dx.doi.org/10.1016/S2213-8587(18)30136-0

6. Rayman G. Glycaemic control, glucose variability and the Triangle of Diabetes Care. Br J Diabetes 2016;16(Suppl1):S3-S6. http://dx.doi.org/10.15277/bjd.2016.070

7. Dunn, T., et al. Real-world flash glucose monitoring patterns and associations between self-monitoring frequency and glycaemic measures: A European analysis of over 60 million glucose tests. Diabetes Research and Clinical Practice; 137(2018) 37-46

8. Haak, Thomas., et al. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, openlabel randomized controlled trial. DiabetesTherapy 8.1 (2017): 55–73.

9. Jan Bolinder, Ramiro Antuna, Petronella Geelhoed-Duijvestjin, Jens Kröger, Raimund Weitgasser. “Novel Glucose-Sensing Technology and Hypoglycaemia in Type 1 Diabetes: a Multicentre, Non-Masked, Randomised Controlled Trial.” Lancet 388, no. 10057 (2016): 2254–2263. https://doi.org/10.1016/S0140-6736(16)31535-5.

44. Kilpatrick ES et al Diabetologia 2008; 51: 365-371.

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