Diabetes management with wearable continuous glucose monitoring trackers: A systematic review and meta-analysis of randomized, controlled trials
Abstract
Background: Continuous glucose monitoring (CGM) has become an essential tool in diabetes management as it provides real-time information on blood glucose levels. Present study summarizes current evidence on the clinical outcomes, glycemic control, and patient-reported outcomes of CGM compared to non-CGM strategies among the included studies with diabetes.
Methods: The systematic review was performed following the PRISMA guidelines. PubMed, Google Scholar, JAMA Network, and SpringerLink, etc. were searched for relevant research published after 2010. Included research assessed the use of CGM with non-CGM treatments, such as traditional therapy or self-monitoring of blood glucose (SMBG) for diabetics. The study's design, participant characteristics, intervention specifics, glycemic outcomes (i.e. HbA1c and duration in range), and quality of life were all included in the extracted data.
Results: Twelve studies (1916 subjects) based on randomized controlled trials and satisfied the inclusion criteria. Findings show that using a CGM is linked to notable improvements in glycemic control, as evidenced by falls in HbA1c readings when compared to non-CGM approaches. The studies had adequate heterogeneity: I² = 32%, Chi² = 16.08, and Tau² = 0.00. An impact was found in the overall effect using a random effects model, with weighted mean difference (WMD) = 0.43; CI: 0.34-0.52 (p< 0.001). To evaluate the cause of heterogeneity and publication bias, meta-regression and Egger's regression were used.
Conclusion: This study highlights the potential of CGM devices to enhance diabetes management by improving glycemic control and patient outcomes. Despite several obstacles, CGM shows promise as a substitute for conventional diabetes treatment approaches. Future studies should address these issues and assess the long-term advantages of using a CGM in more detail. This study is registered in PROSPERO (Registration ID: CRD42024518635).
1. Dias D, Paulo Silva Cunha J. Wearable health devices—vital sign monitoring, systems and technologies. Sensors. 2018 Jul 25;18(8):2414.
2. Sergel-Stringer OT, Wheeler BJ, Styles SE, Boucsein A, Lever CS, Paul RG, Sampson R, Watson A, de Bock MI. Acceptability and experiences of real-time continuous glucose monitoring in adults with type 2 diabetes using insulin: a qualitative study. Journal of Diabetes & Metabolic Disorders. 2024 Mar 5:1-9.
3. Bellido V, Aguilera E, Cardona-Hernandez R, Diaz-Soto G, González Pérez de Villar N, Picón-César MJ, Ampudia-Blasco FJ. Expert recommendations for using time-in-range and other continuous glucose monitoring metrics to achieve patient-centered glycemic control in people with diabetes. Journal of Diabetes Science and Technology. 2023 Sep;17(5):1326-36.
4. Martens T, Beck RW, Bailey R, Ruedy KJ, Calhoun P, Peters AL, Pop-Busui R, Philis-Tsimikas A, Bao S, Umpierrez G, Davis G. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized clinical trial. Jama. 2021 Jun 8;325(22):2262-72.
5. Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. Journal of diabetes science and technology. 2011 May;5(3):668-75.
6. Kataoka Y, Kitahara S, Funabashi S, Makino H, Matsubara M, Matsuo M, Omura-Ohata Y, Koezuka R, Tochiya M, Tamanaha T, Tomita T. The effect of continuous glucose monitoring-guided glycemic control on progression of coronary atherosclerosis in type 2 diabetic patients with coronary artery disease: the OPTIMAL randomized clinical trial. Journal of Diabetes and its Complications. 2023 Oct 1;37(10):108592.
7. Marigliano M, Piona C, Mancioppi V, Morotti E, Morandi A, Maffeis C. Glucose sensor with predictive alarm for hypoglycaemia: Improved glycaemic control in adolescents with type 1 diabetes. Diabetes, Obesity and Metabolism. 2024 Apr;26(4):1314-20.
8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021 Mar 29;372.
9. Mendu VV, Nair KP, Athe R. Systematic review and meta-analysis approach on vitamin A fortified foods and its effect on retinol concentration in under 10 year children. Clinical nutrition ESPEN. 2019 Apr 1;30:126-30.
10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine. 2009 Aug 18;151(4):W-65.
11. Joanna Briggs Institute. Joanna briggs institute critical appraisal checklist for studies reporting prevalence data. Adelaide: JBI Libr Syst Rev. 2017;2017:1.
12. Athe R, Rao MV, Nair KM. Impact of iron-fortified foods on Hb concentration in children (< 10 years): a systematic review and meta-analysis of randomized controlled trials. Public Health Nutrition. 2014 Mar;17(3):579-86.
13. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed‐effect and random‐effects models for meta‐analysis. Research synthesis methods. 2010 Apr;1(2):97-111.
14. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. bmj. 1997 Sep 13;315(7109):629-34.
15. Athe R, Rao Mendu VV, Nair Krishnapillai M. A meta-analysis combining parallel and cross-over randomized controlled trials to assess impact of iodine fortified foods on urinary iodine concentration among children. Asia Pacific journal of clinical nutrition. 2015 Sep;24(3):496-503.
16. Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes care. 2011 Apr 1;34(4):795-800.
17. Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, Joyce C, Peoples T, Perkins BA, Welsh JB, Willi SM. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. New England Journal of Medicine. 2010 Jul 22;363(4):311-20.
18. Lee YB, Kim M, Kim JH. Glycemia according to the use of continuous glucose monitoring among adults with type 1 diabetes mellitus in Korea: a real-world study. Diabetes & metabolism journal. 2023 Mar 6;47(3):405-14.
19. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. Journal of diabetes science and technology. 2017 Nov;11(6):1138-46.
20. Laffel LM, Kanapka LG, Beck RW, Bergamo K, Clements MA, Criego A, DeSalvo DJ, Goland R, Hood K, Liljenquist D, Messer LH. Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial. Jama. 2020 Jun 16;323(23):2388-96.
21. Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, Schwarz E, Ólafsdóttir AF, Frid A, Wedel H, Ahlén E. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. Jama. 2017 Jan 24;317(4):379-87.
22. Price DA, Deng Q, Kipnes M, Beck SE. Episodic real-time CGM use in adults with type 2 diabetes: results of a pilot randomized controlled trial. Diabetes Therapy. 2021 Jul;12(7):2089-99.
23. Riveline JP, Schaepelynck P, Chaillous L, Renard E, Sola-Gazagnes A, Penfornis A, Tubiana-Rufi N, Sulmont V, Catargi B, Lukas C, Radermecker RP. Assessment of patient-led or physician-driven continuous glucose monitoring in patients with poorly controlled type 1 diabetes using basal-bolus insulin regimens: a 1-year multicenter study. Diabetes Care. 2012 May 1;35(5):965-71.
24. Beck RW, Riddlesworth TD, Ruedy K, Ahmann A, Haller S, Kruger D, McGill JB, Polonsky W, Price D, Aronoff S, Aronson R. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Annals of internal medicine. 2017 Sep 19;167(6):365-74.
25. Wan W, Skandari MR, Minc A, Nathan AG, Winn A, Zarei P, O’Grady M, Huang ES. Cost-effectiveness of continuous glucose monitoring for adults with type 1 diabetes compared with self-monitoring of blood glucose: the DIAMOND randomized trial. Diabetes care. 2018 Jun 1;41(6):1227-34.
26. Rao M, DePue JD, Dunsiger S, Elsayed M, Nu'usolia O, McGarvey ST. Peer reviewed: Long-term impact of a community health worker intervention on diabetes control in american samoa. Preventing chronic disease. 2015;12.
27. Parkin CG, Graham C, Smolskis J. Continuous glucose monitoring use in type 1 diabetes: longitudinal analysis demonstrates meaningful improvements in HbA1c and reductions in health care utilization. Journal of diabetes science and technology. 2017 May;11(3):522-8.
| Files | ||
| Issue | Vol 11 No 1 (2025): . | |
| Section | Articles | |
| Keywords | ||
| Diabetes management Continuous glucose monitoring (CGM) Glycemic control HbA1c Systematic review Meta-analysis. | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
