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Review
. 2019 Aug 30:10:2042018819871903.
doi: 10.1177/2042018819871903. eCollection 2019.

The road from intermittently scanned continuous glucose monitoring to hybrid closed-loop systems. Part B: results from randomized controlled trials

Francesca De Ridder  1 , Marieke den Brinker  1 , Christophe De Block  1
Affiliations
Review

The road from intermittently scanned continuous glucose monitoring to hybrid closed-loop systems. Part B: results from randomized controlled trials

Francesca De Ridder et al. Ther Adv Endocrinol Metab. .

Abstract

Background: Advances in diabetes technology have been exponential in the last few decades. With evolution in continuous glucose monitoring (CGM) systems and its progressive automation in control of insulin delivery, these advances have changed type 1 diabetes mellitus (T1DM) management. These novel technologies have the potential to improve glycated haemoglobin (HbA1c), reduce hypoglycaemic events, increase time spent in range and improve quality of life (QoL). Our aim was to evaluate the sustained effects in free-living unsupervised conditions of CGM systems (intermittently scanned and real time) and insulin delivery [from multiple daily injections, via sensor-augmented pump therapy and (predictive) low-glucose insulin suspension to hybrid closed-loop systems] on glucose control and QoL in adults and children with T1DM.

Methods: We performed a systematic review of randomized controlled trials (RCTs), using PubMed and the Cochrane library up to 30 May 2019. Inclusion of RCTs was based on type of intervention (comparing glucose-monitoring devices and insulin-delivery devices), population (nonpregnant adults and children with T1DM), follow-up (outpatient setting for at least 8 weeks) and relevant outcomes [HbA1c, time in range (TIR), time in target, time in hypoglycaemia and QoL]. Exclusion of RCTs was based on intervention (exercise, only overnight use). The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used to score the quality of the papers and for the final selection of the articles.

Results: Our search resulted in 214 articles, of which 19 were eligible. Studies on advanced use in adults and children with T1DM reported increased TIR (all 9 studies); decreased time in hypoglycaemia (13 out of 15 studies); lowered HbA1c levels (5 out of 15 studies); improved QoL (10 of 16 studies) and treatment satisfaction (7 studies).

Conclusions: Recent technologies have dramatically changed the course of T1DM. They are proving useful in controlling glycaemia in patients with T1DM, without increasing the treatment burden.

Keywords: (real-time) continuous glucose monitoring; HbA1c; hybrid closed-loop; hypoglycaemia; intermittently scanned (flash) continuous glucose monitoring; quality of life; sensor-augmented pump; time in range; type 1 diabetes.

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Conflict of interest statement

Conflict of interest statement: CDB is a consultant for Abbott, A. Menarini Diagnostics, Lilly, Medtronic, Novo Nordisk, and Roche Diagnostics.

Figures

Figure 1.
Figure 1.
Flowchart of search and study selection.
See this image and copyright information in PMC

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