Impact of technology on glycaemic control in type 2 diabetes: A meta‐analysis of randomized trials on continuous glucose monitoring and continuous subcutaneous insulin infusion

Abstract

Aim To conduct a meta‐analysis to assess the effect of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and the combination of the two, on glycaemic control in type 2 diabetes. Materials and methods The analysis included randomized clinical trials comparing CSII with multiple daily injections (MDI) in people with type 2 diabetes, as well as studies comparing CGM or flash glucose monitoring (FGM) with self‐monitoring of blood glucose (SMBG), with a duration of at least 12 weeks, identified in Medline or http://clinicaltrials.gov. The principal endpoint was glycated haemoglobin (HbA1c) at the end of the trial. Mean and 95% confidence intervals (CIs) for HbA1c and Mantel–Haenzel odds ratios for severe hypoglycaemia were calculated, using random‐effect models. Results The retrieved trials showed a significant heterogeneity (I2 = 90%). The difference in HbA1c between CSII and MDI was not statistically significant (−0.26% [95% CI –0.74;0.22]; P = .29). The difference in endpoint HbA1c between CGM and SMBG was marginally significant (−0.24 [95% CI –0.49;0.00]; P = .05), and CGM was possibly associated with a lower hypoglycaemic risk. Only one trial explored the effect of FGM, as compared with SMBG, on HbA1c in type 2 diabetes, finding no difference across groups (at study end: 8.4% ± 0.8% vs 8.3% ± 1.1% with FGM and SMBG, respectively). Conversely, FGM was associated with an improvement in quality of life and with a lower incidence of hypoglycaemic events. The small number of retrieved trials indicates that the results should be interpreted with caution. Conclusions The analysis showed that CSII, CGM and FGM provide only small benefits compared with MDI (on either HbA1c, hypoglycaemic risk or quality of life) in insulin‐treated people with type 2 diabetes.

Insulin Pump Therapy for Patients With Type 2 Diabetes Mellitus: Evidence, Current Barriers, and New Technologies

“…Some reviews could not detect beneficial effects of CSII therapy for patients with T2DM 7 or concluded similar outcomes of CSII and MDI. [8][9][10][11] Other reviews, however, reported better glycemic control in people with long-standing diabetes and poor glycemic control at baseline through CSII compared with MDI. [12][13][14] Since most trials do not show a consistent body of evidence, this conclusion mainly refers to the results of the OpT2mise study.…”

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“…Similarly, the HypoDE trial showed that, in comparison to usual care, the use of Dexcom‐based CGM resulted in a significant reduction in hypoglycemic events in patients with impaired hypoglycemia‐awareness and a history of severe hypoglycemia 20 . Several meta‐analyses of RCTs in patients with type 1 and 2 diabetes have shown that CGM provides greater reduction in HbA1c values with less hypoglycemia as compared with usual care 21,22 …”

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“…9 A meta-analysis of five studies identified no difference in A1C reduction between CSII and MDI among patients with T2DM. 10 In another meta-analysis of five studies, there was a marginal reduction in A1C and insulin requirements in patients with T2DM who were managed with CSII, compared with MDI. 11 In addition, there was no difference in weight among patients receiving CSII or MDI.…”