Use of continuous glucose monitoring and point-of-care glucose testing in hospitalized patients with diabetes mellitus in non-intensive care unit settings: A systematic review and meta-analysis of randomized controlled trials

Abstract

The benefits of using continuous glucose monitoring (CGM) in hospitalized patients with diabetes remain uncertain. Point-of-care (POC) glucose testing is the standard of care in this setting. We compared the effect of adding CGM to POC testing versus POC testing alone on glycemic outcomes in this population. We have searched the Cochrane Library, Embase, and MEDLINE databases and relevant conferences up to May 2024. We have included six randomized controlled trials (n = 979 patients) comparing CGM plus POC testing to POC testing alone in non-pregnant, non-critically ill hospitalized adults with diabetes. The addition of CGM improved time in range (mean difference [MD] + 7.24 %; 95 % confidence interval [CI]: +5.06, +9.42; P < 0.00001; I² = 35 %), reduced time below range < 70 mg/dL (MD: -1.23 %; 95 %CI: -2.27, -0.18; P = 0.02; I² = 64 %) and < 54 mg/dL (MD: -0.95 %; 95 %CI: -1.19, -0.70; P < 0.00001; I² = 0 %), and time above range > 250 mg/dL (MD: -3.70 %; 95 %CI: -6.10, -1.29; P = 0.003; I² = 39 %) compared to POC testing alone. We observed no statistically significant differences in glycemic variability or insulin doses. In non-critically ill, hospitalized adults with diabetes, the addition of CGM to POC testing for insulin dosing resulted in superior glycemic control and reduction of hypoglycemia compared to POC testing alone.

Keywords: Continuous glucose monitoring; Diabetes; Hospital; Meta-analysis; Point-of-care; Systematic review.