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Continuous Glucose Monitoring Shows Potential to Improving Clinical Outcomes in Type 2 Diabetes
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Key Takeaways
- CGM demonstrates significant reductions in hemoglobin A1c compared to self-monitoring or usual care, with effect sizes ranging from −0.74% to −0.20%.
- Glycemic variability improvements were noted with CGM, showing increased time in range and decreased time above range, but no significant change in time below range.
However, the effects on patient-reported outcomes were inconclusive when compared with self-monitoring blood glucose or the usual care.
Continuous glucose monitoring (CGM) demonstrates the potential for better clinical outcomes compared with self-monitoring of blood glucose or usual care, according to results of an umbrella review published in Archives of Public Health. There is moderate grade of evidence to support these findings, however the effect on patient-reported outcomes were inconclusive.1
Continuous Glucose Monitoring, Diabetes, Type 2 Diabetes | Image Credit: © Yistocking | stock.adobe.com
According to the CDC, approximately 38 million Americans have diabetes, which is equivalent to about 1 in 10 people. Approximately 90% to 95% of individuals have type 2 diabetes (T2D). It most often develops in individuals 45 and older, but there has been a growing trend in children, adolescents, and young adults. T2D has many risk factors, including prediabetes, overweight, being 45 years and older, family history of diabetes, lack of physical activity, and ethnicity and race.2
CGMs have decreased the need for self-reporting glucose levels as wearable devices that record blood glucose over time. CGM devices include a sensor, transmitter, and some type of insulin pump or receiver, which is often a smartphone app. According to the Cleveland Clinic, patients should still have fingerstick meters and unexpired supplies on hand in case the CGM falls off unexpectedly or fails. Recently, some CGMs have been approved for OTC use, so cost, which has been a barrier to access, is becoming lower for patients.3
In the current study, investigators conducted an umbrella review of systemic reviews regarding CGMs for patients with T2D in order to consolidate the most contemporaneous evidence for the effectiveness of the device in reducing hemoglobin A1c and improving glycemic variability. They also wanted to compare the device with other outcomes, such as patient-reported outcomes, for patients using CGMs and self-monitoring of blood glucose or the usual care.1
Investigators searched 7 databases starting June 28, 2024, and bibliographies were hand-searched to identify any other studies. The population was limited to adults with T2D who either received or did not receive insulin. The primary outcome included mean difference or standardized mean difference changes in both end point and pre-to-post change in hemoglobin A1c values, time in range, time above range, time below range, and patient-reported outcomes for both CGM and self-monitoring/usual care groups. Two investigators independently reviewed each systemic review for risk of bias. In total, 989 studies were screened with 51 studies retrieved for evaluation and an additional 13 from citation and key word searching. A total of 33 articles were excluded, leaving 31 in the study.1
In total, 2 were health technology assessments, 9 were systemic reviews without a meta-analysis, and 20 were systemic reviews with a meta-analysis. The publication dates ranged from 2011 to 2024. Nineteen of the systemic reviews had outcomes regarding hemoglobin A1c, with 15 showing a significant improvement in blood glucose levels with CMGs compared with the usual care. Effect sizes ranged between −0.74% and −0.20%.1
In a meta-analysis of 34 primary studies, investigators noted that results of the pooled 11,494 patients showed that CGM use was significantly associated with greater reductions in hemoglobin A1c compared with self-monitoring or usual care. However, 28 of the studies included randomized controlled trials, which showed a high risk of bias.1
For glycemic variability, 14 studies with a pooled 1452 individuals showed that those using CGMs were significantly associated with greater pre-post time in range increases compared with self-measured/usual care. Further, in a pooled analysis of 1113 individuals, CGMs had a greater decrease in pre-post time above range. However, in 14 studies of 1254 individuals the time below range showed no significant differences for CGM and self-monitored/usual care in pre-post time above range change.Investigators concluded that further studies should be utilized to further expand on these results, including exploring patient outcomes and acceptability of CGM use.1
