Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Type 2 Diabetes Mellitus: A Systematic Review with Meta-analysis

Abstract

Every eleventh adult has diabetes, and every third has prediabetes. Over 95% of diabetics are of type 2. It is well established that diabetes doubles the risk of heart disease and stroke apart from increasing the risk of microvascular complications. Hence, strict glycemic control is necessary. However, it increases the risk of hypoglycemia, especially in patients with longstanding diabetes. Continuous glucose monitors (CGM) use a sensor to continuously measure the glucose levels in the interstitial fluid every 10 seconds and gives out mean values every five minutes. CGMs are emerging tools in the management of type 2 diabetes. The prime objective of this review is to find out if there is enough supporting evidence, suggesting that continuous glucose monitoring is more effective than self-monitoring of blood glucose (SMBG) in type 2 diabetes. We conducted a systematic literature search in Medline (PubMed) looking for any studies addressing our objective. It is observed that there is a varying level of evidence supporting that employing a CGM can reduce glycated hemoglobin (HbA1c), hypoglycemic events, and increase patient satisfaction. However, some studies reported no significant benefits. This systematic review with meta-analysis concludes that the use of CGM in type 2 diabetes mellitus (T2DM) is beneficial, as it significantly reduces HbA1c compared to the usual method of SMBG. The pooled mean difference in HbA1c was -0.25 (-0.45, -0.06) and statistically significant (at p = 0.01) when comparing CGM to SMBG.

Remote Application and Use of Real-Time Continuous Glucose Monitoring by Adults with Type 2 Diabetes in a Virtual Diabetes Clinic

“…While persistent daily use of rtCGM is considered essential for intensive insulin management, [1][2][3][9][10][11][12][13][14] clinical trials and recent meta-analyses have reported the value of rtCGM use in individuals with T2D independent of their treatment regimen. [15][16][17][18] The realworld data included in this report add to the growing body of evidence indicating that intermittent rtCGM use with less intensive treatment regimens is associated with significant glycemic improvements, [19][20][21] creates valuable teaching opportunities 22 and is effective in promoting desired self-care behaviors. 20 Our study has some limitations.…”

Type 2 Diabetes and the Use of Real-Time Continuous Glucose Monitoring

“…A recent meta-analysis looked exclusively at RCTs specifying individuals with T2D and examined HbA1c as an outcome 38 . They identified five studies that included a total of 382 patients, and found a significant improvement in HbA1c (pooled mean difference of 0.25%) with the use of rtCGM compared to SMBG, providing additional evidence of HbA1c change with rtCGM use.…”

A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care

“…There are multiple reasons for excluding studies, which are all summarized in Supplementary Table 1 , some of the reasons are systematic review of the application of the technologies, not purely on effectiveness, systematic reviews commissioned by regulatory bodies, which did not provide all evidence, but just a full working summary and others. Finally, we included 32 full systematic reviews and/or meta-analyses for which the research quеstion was clearly defined ( 12 – 38 , 40 – 44 ). The included studies were of high quality, predominantly focusing on randomized controlled trials.…”