The Effectiveness of Continuous Glucose Monitoring in Patients with Type 2 Diabetes: A Systematic Review of Literature and Meta-analysis

Abstract

Background: Continuous glucose monitoring (CGM) provides glucose trend information that can be used to guide treatment and motivate patients with diabetes. Currently, the evidence on effectiveness of CGM in patients with type 2 diabetes is debatable. We aim to provide a systematic review and meta-analysis to synthesize current evidence of effectiveness of CGM in adults with type 2 diabetes.

Materials and methods: Cochrane, Embase, PubMed, and Web of Science were searched to include all studies that reported effectiveness of CGM in terms of HbA1c in adults aged 18 and older, with type 2 diabetes, on any treatment for diabetes. Heterogeneity (I²) was used to determine the variability between studies. All data were analyzed using Review Manager 5.3 software.

Results: Seven randomized controlled trials and three cohort studies, involving 1384 patients for real-time CGM (RT-CGM) and professional CGM (P-CGM) and 4902 patients for flash glucose monitoring (FGM), were included. RT-CGM and P-CGM were associated with a modest but statistically significant reduction in HbA1c of 0.20% (95% confidence interval [CI] -0.31 to -0.09) compared with control. Patients who received FGM had a nonsignificant reduction of 0.02% (95% CI -0.07 to 0.04) compared with control. The meta-analysis indicated a low heterogeneity between studies.

Conclusion: Our analysis of current evidence suggests that RT-CGM and P-CGM are effective in improving HbA1c in adults with type 2 diabetes. Due to insufficient evidence, it is premature to form conclusions on the effectiveness of FGM. Future multicenter trials accessing the effectiveness of CGM as well as safety and cost-effectiveness may be necessary.

Keywords: Ambulatory glucose profile; Continuous glucose monitoring; Diabetes mellitus; Flash glucose monitoring; Meta-analysis; Systematic review.