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Meta-Analysis
. 2022 Aug;39(8):e14854.
doi: 10.1111/dme.14854. Epub 2022 Apr 25.

Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials

Mona Elbalshy  1 , Jillian Haszard  2 , Hazel Smith  1 , Sarahmarie Kuroko  1 , Barbara Galland  1 , Nick Oliver  3 , Viral Shah  4 , Martin I de Bock  5 , Benjamin J Wheeler  1   6
Affiliations
Meta-Analysis

Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials

Mona Elbalshy et al. Diabet Med. 2022 Aug.

Abstract

Aims: We aimed to conduct a systematic review and meta-analysis of randomised controlled clinical trials (RCTs) assessing separately and together the effect of the three distinct categories of continuous glucose monitoring (CGM) systems (adjunctive, non-adjunctive and intermittently-scanned CGM [isCGM]), compared with traditional capillary glucose monitoring, on HbA1c and CGM metrics.

Methods: PubMed, Web of Science, Scopus and Cochrane Central register of clinical trials were searched. Inclusion criteria were as follows: randomised controlled trials; participants with type 1 diabetes of any age and insulin regimen; investigating CGM and isCGM compared with traditional capillary glucose monitoring; and reporting glycaemic outcomes of HbA1c and/or time-in-range (TIR). Glycaemic outcomes were extracted post-intervention and expressed as mean differences and 95%CIs between treatment and comparator groups. Results were pooled using a random-effects meta-analysis. Risk of bias was assessed using the Cochrane Rob2 tool.

Results: This systematic review was conducted between January and April 2021; it included 22 RCTs (15 adjunctive, 5 non-adjunctive, and 2 isCGM)). The overall analysis of the pooled three categories showed a statistically significant absolute improvement in HbA1c percentage points (mean difference (95% CI): -0.22% [-0.31 to -0.14], I2 = 79%) for intervention compared with comparator and was strongest for adjunctive CGM (-0.26% [-0.36, -0.16]). Overall TIR (absolute change) increased by 5.4% (3.5 to 7.2), I2 = 71% for CGM intervention compared with comparator and was strongest with non-adjunctive CGM (6.0% [2.3, 9.7]).

Conclusions: For individuals with T1D, use of CGM was beneficial for impacting glycaemic outcomes including HbA1c, TIR and time-below-range (TBR). Glycaemic improvement appeared greater for TIR for newer non-adjunctive CGM technology.

Keywords: CGM metrics; HbA1c; adjunctive CGM; continuous glucose monitoring; isCGM; non-adjunctive CGM; type 1 diabetes.

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Conflict of interest statement

BJW has previously received research funding from Dexcom, Medtronic and iSENS. NO has received research funding from Dexcom, Roche Diabetes and Medtronic Diabetes and has participated in advisory boards for Dexcom, Roche Diabetes and Medtronic Diabetes. MIdB received Research funding from: Novo Nordisk, Medtronic, Dexcom, Pfizer and Research support from Medtronic, Dexcom, SOOIL, Honoraria from Medtronic. VNS reported receiving research supports through University of Colorado from Sanofi, Novo Nordisk, Eli‐Lilly, Insulet, Dexcom, Abbott, vTv Therapeutics, JDRF and NIH. VNS’ employer also received honoraria from Dexcom, insulet, Medscape and Sanofi for speaking, consulting or being on advisory board. ME, HS, JH, BG and SK declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the recruitment process. CGM – continuous glucose monitoring; RCT – randomised controlled trail
FIGURE 2
FIGURE 2
Forest plot of meta‐analysis of continuous glucose monitoring randomised controlled trials for HbA1c by non‐adjunctive, adjunctive and intermittent scanning technologies
FIGURE 3
FIGURE 3
Forest plot of meta‐analysis of randomised controlled trails for time‐in‐range by non‐adjunctive, adjunctive and intermittent scanning technologies
FIGURE 4
FIGURE 4
Forest plot of meta‐analysis of randomised controlled trails for time‐below‐range (<3.9 mmol/L) by non‐adjunctive, adjunctive real‐time continuous glucose monitoring and intermittent scanning
See this image and copyright information in PMC

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