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; Jillian Haszard; Hazel Smith; Sarahmarie Kuroko; Barbara Galland; Nick Oliver; Viral Shah; Martin I de Bock; Benjamin J Wheeler

doi:10.1111/dme.14854

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

Diabet Med. 2022 Aug;39(8):e14854. doi: 10.1111/dme.14854. Epub 2022 Apr 25.

Authors

Mona Elbalshy¹, Jillian Haszard², Hazel Smith¹, Sarahmarie Kuroko¹, Barbara Galland¹, Nick Oliver³, Viral Shah⁴, Martin I de Bock⁵, Benjamin J Wheeler^{1

6}

Affiliations

¹ Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
² Division of Sciences, University of Otago, New Zealand, Dunedin, New Zealand.
³ Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, UK.
⁴ Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁵ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
⁶ Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand.

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.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose / analysis
Blood Glucose Self-Monitoring / methods
Diabetes Mellitus, Type 1* / drug therapy
Glycated Hemoglobin / analysis
Glycemic Control
Humans
Hypoglycemic Agents / therapeutic use
Randomized Controlled Trials as Topic
Technology

Substances

Blood Glucose
Glycated Hemoglobin A
Hypoglycemic Agents