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Acta Diabetologica

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01-04-2021 | Insulins | Review Article

Effects of real-time continuous glucose monitoring in type 1 diabetes: a meta-analysis of randomized controlled trials

Authors: I. Dicembrini, C. Cosentino, M. Monami, E. Mannucci, L. Pala

Published in: Acta Diabetologica | Issue 4/2021

Abstract

Aims

Self-monitoring of blood glucose (SMBG) represented a major breakthrough in the treatment of type 1 diabetes. The aim of the present meta-analysis is to assess the effect of continues glucose monitoring (CGM) and flash glucose monitoring (FGM), on glycemic control in type 1 diabetes.

Materials and methods

The present analysis includes randomized clinical trials comparing CGM or FGM with SMBG, with a duration of at least 12 weeks, identified in Medline or clinicaltrials.gov. The principal endpoint was HbA1c at the end of the trial. A secondary endpoint was severe hypoglycemia. Mean and 95% confidence intervals for HbA1c and Mantel–Haenzel odds ratio [MH-OR] for severe hypoglycemia were calculated, using random effect models. A sensitivity analysis was performed using fixed effect models. In addition, the following secondary endpoints were explored, using the same methods: time in range, health-related quality of life, and treatment satisfaction. Separate analyses were performed for trials comparing CGM with SMBG, and those comparing CGM + CSII and SMBG + MDI and CGM-regulated insulin infusion system (CRIS) and CSII + SMBG.

Results

CGM was associated with a significantly lower HbA1c at endpoint in comparison with SMBG (− 0.24 [− 0.34, − 0.13]%); CGM was associated with a significantly lower risk of severe hypoglycemia than SMBG. Treatment satisfaction and quality of life were not measured, or not reported, in the majority of studies. FGM showed a significant reduction in the incidence of mild hypoglycemia and an increased treatment satisfaction, but no significant results are shown in HbA1c. CGM + CSII in comparison with SMBG + MDI was associated with a significant reduction in HbA1c. Only two trials with a duration of at least 12 weeks compared a CRIS with SMBG + CSII; HbA1c between the two treatment arms was not statistically significant (difference in means: − 0.23 [− 0.91; 0.46]%; p = 0.52).

Conclusion

GCM compared to SMBG has showed a reduction in HbA1c and severe hypoglycemia in patient with type 1 diabetes. The comparison between CGM + CSII and SMBG + MDI showed a large reduction in HbA1c; it is conceivable that the effects of CSII + CGM on glycemic control additives. The only comparison available between FGM and SMBG was conducted in patients in good control.

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Title: Effects of real-time continuous glucose monitoring in type 1 diabetes: a meta-analysis of randomized controlled trials
Authors: I. Dicembrini
C. Cosentino
M. Monami
E. Mannucci
L. Pala
Publication date: 01-04-2021
Publisher: Springer Milan
Keywords: Insulins
Hypoglycemia
Insulins
Type 1 Diabetes
Published in: Acta Diabetologica / Issue 4/2021
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-020-01589-3

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