The incidence rate of type 1 diabetes mellitus (T1DM) is increasing worldwide. Patients with TIDM are at greater risk for long-term complications, which are the major cause of death in this population. Therefore, it is imperative to optimize glycemic control in an attempt to prevent these untoward sequelae. However, there are gaps in the current level of knowledge regarding the efficiency of continuous glucose monitoring (CGM) versus self-monitoring of blood glucose (SBMG) in patients with T1DM.

To help fill in these gaps, investigators conducted a systematic review and meta-analysis of randomized, controlled trials on CGM and SBMG to determine how effective CGM is compared to SBMG in maintaining glycemic control in T1DM.

Using a 3-step search strategy, researchers retrieved data from CINAHL, the Cochrane Library, Embase, PubMed, Scopus, Centre Watch, clinicaltrials.gov, CENTRAL, ISRCTN registry, WHO ICTRP, grey literature (ProQuest dissertations, Theses Global), diabetes-related specialist databases (American Diabetes Association, International Journal of Diabetes and Clinical Research), and reference lists from the above resources.

Randomized, SBMG-controlled studies that enrolled nonpregnant patients with T1DM who were on intensive insulin therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion and those who utilized individual/caregiver-led CGM systems were included in this study. The studies also had to provide information on post-intervention hemoglobin A1c (HbA1c) levels, severe hypoglycemic events, and diabetic ketoacidosis (DKA) events as outcomes. The primary outcome was post-intervention HbA1c level. Secondary outcomes included post-intervention severe hypoglycemia and DKA events.

A total of 22 studies involving 2,188 patients were included in this study. All studies reported on the primary outcome, whereas 13 studies reported on post-intervention severe hypoglycemia and 14 studies provided information on DKA events.

Investigators found that those who used CGM had significantly lower HbA1c levels (mean difference -2.46 mmol/mol, P = .0005). However, there was substantial heterogeneity in the data provided (I2 = 72%). There was no difference between CGM and SBGM in preventing severe hypoglycemic events (relative risk [RR] = 0.61 [95% CI, 0.33-1.15], P = .13) or for reducing DKA events (RR = 1.06 [95% CI, 0.49-2.32, P = .88); the former (but not latter) finding was associated with substantial heterogeneity (I2 = 50%).

Subgroup analysis found that patients with TIDM who benefited the most from CGM were those with a mean baseline HbA1c level of greater than 8% (>64 mmol/mol). CGM did not significantly decrease HbA1c in patients with TIDM who had mean baseline levels below this level.

The study also examined the type of CGM system utilized (i.e., whether it was a professional CGM, real-time CGM, or intermittent scanning CGM) and found this did not significantly modify the effectiveness of CGM. Study duration and duration of diabetes also did not affect the results of this study.

This study provides useful information for pharmacists who manage patients with T1DM who utilize CGM. It can help them determine which patients may benefit most as well as explain limitations of this technology.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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