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. 2021 Nov 29;11(11):CD013755.
doi: 10.1002/14651858.CD013755.pub2.

Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes

Aileen Toner  1 , Anna McCloy  2 , Paula Dyce  3 , Dilip Nazareth  4   5 , Freddy Frost  4   5
Affiliations

Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes

Aileen Toner et al. Cochrane Database Syst Rev. .

Abstract

Background: Cystic fibrosis (CF) is one of the most common life-shortening autosomal-recessive genetic conditions with around 100,000 people affected globally. CF mainly affects the respiratory system, but cystic fibrosis-related diabetes (CFRD) is a common extrapulmonary co-morbidity and causes excess morbidity and mortality in this population. Continuous glucose monitoring systems (CGMS) are a relatively new technology and, as yet, the impact of these on the monitoring and subsequent management of CFRD remains undetermined.

Objectives: To establish the impact of insulin therapy guided by continuous glucose monitoring compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD.

Search methods: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 23 September 2021. We also searched the reference lists of relevant articles and reviews and online trials registries. Date of last search: 23 September 2021.

Selection criteria: Randomised controlled studies comparing insulin regimens led by data from CGMS (including real-time or retrospective data, or both) with insulin regimens guided by abnormal blood glucose measurements collected through other means of glycaemic data collection in people with CFRD. Studies with a cross-over design, even with a washout period between intervention arms, are not eligible for inclusion due to the potential long-term impact of each of the interventions and the potential to compromise the outcomes of the second intervention.

Data collection and analysis: No studies were included in the review, meaning that no data were available to be collected for analysis.

Main results: Review authors screened 14 studies at the full-text stage against the review's inclusion criteria. Consequently, seven were excluded due to the study type being ineligible (not randomised), two studies were excluded due to their cross-over design, and two studies was excluded since the intervention used was not eligible and one was a literature review. One study in participants hospitalised for a pulmonary exacerbation is ongoing. Investigators are comparing insulin dosing via insulin pump with blood sugar monitoring by a CGMS to conventional diabetes management with daily insulin injections (or on an insulin pump if already on an insulin pump in the outpatient setting) and capillary blood glucose monitoring. The participants in the control arm will wear a blinded continuous glucose monitoring system for outcome assessment. In addition to this, one further study is still awaiting classification, and will be screened to determine whether it is eligible for inclusion, or is to be excluded, in an update of this review.

Authors' conclusions: No studies were included in the review, indicating that there is currently insufficient evidence to determine the impact of insulin therapy guided by CGMS compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD, nor on potential adverse effects of continuous glucose monitoring in this context. Randomised controlled studies are needed to generate evidence on the efficacy and safety of continuous glucose monitoring in people with CFRD. There is one relevant ongoing study that may be eligible for inclusion in a future update of this Cochrane Review, and whose results may help answer the review question.

Trial registration: ClinicalTrials.gov NCT03939065.

PubMed Disclaimer

Conflict of interest statement

All authors: none known.

Figures

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1
Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD013755

References

References to studies excluded from this review

EUCTR2004‐005019‐28‐GB {published data only}
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Guilbert 2018 {published data only}
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Hagan 2020 {published data only}
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Jackson 2017 {published data only}
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NCT04533646 {published data only}
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Rahman 2020 {published data only}
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Sherwood 2020 {published data only}
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References to studies awaiting assessment

NCT03258853 {published data only}
    1. NCT03258853. Feasibility of outpatient closed loop control with the iLet bionic pancreas in cystic fibrosis related diabetes. clinicaltrials.gov/ct2/show/NCT03258853 (date first posted 23 August 2017).

References to ongoing studies

NCT03939065 {unpublished data only}
    1. NCT03939065. Sensor Augmented Pump (SAP) Therapy for Inpatient CFRD Management. clinicaltrials.gov/ct2/show/NCT03939065 (first posted 06 May 2019).

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References to other published versions of this review

Toner 2020
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