Endocrinol Diabetes Metab. 2022 Feb 4:e00324. doi: 10.1002/edm2.324. Online ahead of print.
ABSTRACT
INTRODUCTION: To determine the impact of real-time continuous glucose monitoring (RT-CGM) in conjunction with ‘Open loop’- continuous subcutaneous insulin infusion (CSII) as compared to conventional multiple daily injections (MDI) in type 1 diabetes.
METHODS: We explored the COCHRANE database, MEDLINE, WEB OF SCIENCE, GOOGLE SCHOLARS, PUBMED, EMBASE, and cited literature in articles retrieved (2010-2021) for all randomized controlled trials and real-world trials of more than 6 months duration in patients with type 1 diabetes that compared RT-CGM+CSII vs RT- CGM+MDI. A total of 1645 publications have been identified; however, only 3 trials fulfilled our inclusion criteria with a total number of 150 patients (72 patients using RT-CGM+CSII and 78 patients on RT-CGM+MDI). A Systematic Review and Meta-analysis were carried out.
RESULTS: No statistically significant reduction in HbA1c was found on comparing RT-CGM+CSII vs RT- CGM + MDI, with p-value = .75. Likewise, impact on TIR, weight and insulin usage was found to be statistically insignificant with p-value of 0.15, 0.75 and 0.20 respectively. There was an overall homogeneity between the 3 trials in respect to all previous variables with I2 being 0%.
CONCLUSIONS: Real-time continuous glucose monitors in conjunction with MDI open-loop CSII had a similar impact on HbA1c, weight, insulin usage and TIR. In addition, RT-CGM when combined with CSII was associated with higher costs and reduced quality of life, hence RT- CGM+MDI can be considered as a cheaper, safer yet equivalent substitute.
REVIEW REGISTRATION: This study was registered in PROSPERO (International prospective register of systematic reviews). Registration Name: RT-CGM in conjunction with CSII vs MDI in optimizing glycaemic control in T1DM: a systematic review. Registration No: CRD42021255333. Accessible at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255333. Amendments: Few amendments to the above-mentioned registration were made: (1) Title (Meta-analysis was added). (2) Prof. Gleeson was added as an author. (3) Real-world trials were included. (4) Outcomes required in studies as per our inclusion criteria amended to include at least 1 outcome. (5) Bias risk was assessed by the CASP tool.
PMID:35118826 | DOI:10.1002/edm2.324
