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. 2021 Mar 16:12:636959.
doi: 10.3389/fendo.2021.636959. eCollection 2021.

A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care

Maria Kamusheva  1 , Konstantin Tachkov  1 , Maria Dimitrova  1 , Zornitsa Mitkova  1 , Gema García-Sáez  2   3 , M Elena Hernando  2   3 , Wim Goettsch  4   5 , Guenka Petrova  1
Affiliations

A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care

Maria Kamusheva et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: Diabetes monitoring systems (DMS) are a possible approach for regular control of glucose levels in patients with Type 1 or 2 diabetes in order to improve therapeutic outcomes or to identify and modify inappropriate patient behaviors in a timely manner. Despite the significant number of studies observing the DMS, no collective evidence is available about the effect of all devices.

Goal: To review and consolidate evidences from multiple systematic reviews on the diabetes monitoring systems and the outcomes achieved.

Materials and methods: Internet-based search in PubMed, EMBASE, and Cochrane was performed to identify all studies relevant to the research question. The data regarding type of intervention, type of diabetes mellitus, type of study, change in clinical parameter(s), or another relevant outcome were extracted and summarized.

Results: Thirty-three out of 1,495 initially identified studies, involving more than 44,100 patients with Type 1, Type 2, or gestational diabetes for real-time or retrospective Continuous Glucose Monitoring (CGMS), Sensor Augmented Pump Therapy (SAPT), Self-monitoring Blood Glucose (SMBG), Continuous subcutaneous insulin infusion (CSII), Flash Glucose Monitoring (FGM), Closed-loop systems and telemonitoring, were included. Most of the studies observed small nominal effectiveness of DMS. In total 11 systematic reviews and 15 meta-analyses, with most focusing on patients with Type 1 diabetes (10 and 6, respectively), reported a reduction in glycated hemoglobin (HbA1c) levels from 0.17 to 0.70% after use of DMS.

Conclusion: Current systematic review of already published systematic reviews and meta-analyses suggests that no statistically significant difference exists between the values of HbA1c as a result of application of any type of DMS. The changes in HbA1c values, number and frequency of hypoglycemic episodes, and time in glucose range are the most valuable for assessing the appropriateness and effectiveness of DMS. Future more comprehensive studies assessing the effectiveness, cost-effectiveness, and comparative effectiveness of DMS are needed to stratify them for the most suitable diabetes patients' subgroups.

Keywords: diabetes; diabetes monitoring systems; glucose control; personalized approach; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Classification of diabetes monitoring technologies.
Figure 2
Figure 2
PRISMA 2009 Flow Diagram.
Figure 3
Figure 3
Number of studies presented by type of intervention and type of diabetes.
Figure 4
Figure 4
Number of studies presented by type of intervention and type of studies. SMBG, Self-monitoring Blood Glucose; CGM, Continuous Glucose Monitoring; MA, Meta-Analysis; SAPT, Sensor Augmented Pump Therapy; SR, Sytematic review.
See this image and copyright information in PMC

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