Utility of Real-Time and Retrospective Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Ida, Satoshi; Kaneko, Ryutaro; Murata, Kazuya

doi:10.1155/2019/4684815

Cited by 65 publications

(64 citation statements)

References 34 publications

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“…The results of the present study are similar to those of a recent meta‐analysis which also included restrospective CGM and observational studies . Conversely, a meta‐analysis that only included randomized trials estimated an effect of real‐time CGM on HbA1c greater than that assessed in the present analysis; however, this latter analysis included one trial in which CGM was used intermittently for a short time, and it did not include another trial that was published after the end of the study search . Available data are insufficient, however, to draw clear conclusions on the effect of CGM on hypoglycaemic risk and on quality of life; notably, no increase in hypoglycaemic risk was observed despite a reduction in HbA1c.…”

Section: Discussionsupporting

confidence: 71%

“…A recent meta‐analysis of patient‐level data from controlled trials on CSII, as compared to MDI, in type 2 diabetes showed a small but statistically significant reduction in HbA1c . Two further meta‐analyses of study‐level data showed a more relevant effect of real‐time CGM on glycaemic control in people with type 2 diabetes, in comparison with traditional self‐monitoring of blood glucose (SMBG); however, one of those two meta‐analyses also included observational studies, and both considered retrospective CGM, together with real‐time CGM.…”

Section: Introductionmentioning

confidence: 99%

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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

Dicembrini

Mannucci

Monami

et al. 2019

Diabetes Obesity Metabolism

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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.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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

Dicembrini

Mannucci

Monami

et al. 2019

Diabetes Obesity Metabolism

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“…Future studies will want to confirm that better workup and diagnosis resulted in better glucose control, although there already is substantial evidence that this is the case in other settings. 17,18 Another limitation is that this study did not look at specialist referrals. We recognize that an alternative to the PCP changing the therapy would be to send the patient to a diabetes specialist.…”

Section: Discussionmentioning

confidence: 99%

Variation in Diabetes Management: A National Assessment of Primary Care Providers

Peabody

Belen²,

Dahlen³

et al. 2019

J Diabetes Sci Technol

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Background: Glucose control is monitored primarily through ordering HbA1c levels, which is problematic in patients with glycemic variability. Herein, we report on the management of these patients by board-certified primary care providers (PCPs) in the United States. Methods: We measured provider practice in a representative sample of 156 PCPs. All providers cared for simulated patients with diabetes presenting with symptoms of glycemic variability. Provider responses were reviewed by trained clinicians against evidence-based care standards and accepted standard of care protocols. Results: Care varied widely—overall quality of care averaged 51.3%±10.6%—with providers performing just over half the evidence-based practices necessary for their cases. More worryingly, provider identified the underlying etiology of the poor glycemic control only 36.3% of the time. HbA1c was routinely ordered in 91.3% of all cases but often (59.5%) inappropriately. Ordering other tests of glycemic control (done in 15% of cases) led to significant increases in identifying the etiology of the hyperglycemia. Correctly modifying their patient’s treatment was more likely to occur if doctors first identified the underlying etiology (65.9% vs 49.0%, P<0.001). We conservatively estimated a US $65/patient/visit in unnecessary testing and US $389 annually in additional care costs when the etiology was missed, translating potentially into millions of dollars of wasteful spending. Conclusion: Despite established evidence that HbA1c misses short-term changes in diabetes, we found PCPs consistently ordered HbA1c, rarely using other available blood tests. However, if the factors leading to poor glycemic control were recognized, PCPs were more likely to correctly alter their patient’s hypoglycemic therapy.

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“…However, it has only searched three databases so that it may not include all relevant studies. Besides, it did not compare different types of CGM devices [16].…”

Section: Introductionmentioning

confidence: 99%

Comparing effects of continuous glucose monitoring systems (CGMs) and self-monitoring of blood glucose (SMBG) amongst adults with type 2 diabetes mellitus: a systematic review protocol

et al. 2020

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Background: Continuous glucose monitorings (CGMs) have been used to manage diabetes with reasonable glucose control amongst patients with type 2 diabetes (T2D) in recent decades. CGMs measure interstitial fluid glucose levels to provide information about glucose levels, which identify fluctuation that would not have been identified with conventional self-monitoring. Self-monitoring of blood glucose (SMBG) is a classical tool to measure glycaemic changes. However, the effectiveness of glucose control, hypoglycemia, weight change, quality of life and user satisfaction, are needed to evaluate and compare CGMs and SMBG amongst adults with T2D.

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Utility of Real-Time and Retrospective Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Cited by 65 publications

References 34 publications

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

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

Variation in Diabetes Management: A National Assessment of Primary Care Providers

Comparing effects of continuous glucose monitoring systems (CGMs) and self-monitoring of blood glucose (SMBG) amongst adults with type 2 diabetes mellitus: a systematic review protocol

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