Real-time continuous glucose monitoring in type 1 diabetes: A systematic review and individual patient data meta-analysis

Khalid Benkhadra, Fares Alahdab, Shrikant Tamhane, Zhen Wang, Larry J. Prokop, Irl B. Hirsch, Denis Raccah, Jean Pierre Riveline, Olga Kordonouri, Mohammad H Murad

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Real-time continuous glucose monitoring (RTCGM) may help in the management of individuals with type 1 diabetes mellitus (T1DM); however, the evidence supporting its use is unclear. The available meta-analyses on this topic use aggregate data which weaken inference. Objective: Individual patient data were obtained from randomized controlled trials (RCTs) to conduct a meta-analysis and synthesize evidence about the effect of RTCGM on glycosylated haemoglobin (HbA1c), hypoglycaemic events and time spent in hypoglycaemia in T1DM. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus through January 2015. We included RCTs that enrolled individuals with T1DM and compared RTCGM vs control group. A two-step regression model was used to pool individual patient data. Results: We included 11 RCTs at moderate risk of bias. Meta-analysis suggests that the use of RTCGM is associated with a statistically significant but modest reduction in HbA1c (-0·276; 95% confidence interval -0·465 to -0·087). The improvements in HbA1c were primarily seen in individuals over age 15 years. We were unable to identify a statistically significant difference in time spent in hypoglycaemia or the number of hypoglycaemic episodes although these analyses were imprecise and warrant lower confidence. There was no difference between males and females. Conclusion: RTCGM in T1DM is associated with a reduction in HbA1c primarily in individuals over 15 years of age. We were unable to identify a statistically significant difference in the time spent in hypoglycaemia or the incidence of hypoglycaemic episodes.

Original languageEnglish (US)
JournalClinical Endocrinology
DOIs
StateAccepted/In press - 2017

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Type 1 Diabetes Mellitus
Meta-Analysis
Glucose
Hypoglycemia
Hypoglycemic Agents
Randomized Controlled Trials
Glycosylated Hemoglobin A
MEDLINE
Databases
Confidence Intervals
Control Groups
Incidence

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Real-time continuous glucose monitoring in type 1 diabetes : A systematic review and individual patient data meta-analysis. / Benkhadra, Khalid; Alahdab, Fares; Tamhane, Shrikant; Wang, Zhen; Prokop, Larry J.; Hirsch, Irl B.; Raccah, Denis; Riveline, Jean Pierre; Kordonouri, Olga; Murad, Mohammad H.

In: Clinical Endocrinology, 2017.

Research output: Contribution to journalArticle

Benkhadra, Khalid ; Alahdab, Fares ; Tamhane, Shrikant ; Wang, Zhen ; Prokop, Larry J. ; Hirsch, Irl B. ; Raccah, Denis ; Riveline, Jean Pierre ; Kordonouri, Olga ; Murad, Mohammad H. / Real-time continuous glucose monitoring in type 1 diabetes : A systematic review and individual patient data meta-analysis. In: Clinical Endocrinology. 2017.
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AU - Tamhane, Shrikant

AU - Wang, Zhen

AU - Prokop, Larry J.

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AU - Raccah, Denis

AU - Riveline, Jean Pierre

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AU - Murad, Mohammad H

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N2 - Background: Real-time continuous glucose monitoring (RTCGM) may help in the management of individuals with type 1 diabetes mellitus (T1DM); however, the evidence supporting its use is unclear. The available meta-analyses on this topic use aggregate data which weaken inference. Objective: Individual patient data were obtained from randomized controlled trials (RCTs) to conduct a meta-analysis and synthesize evidence about the effect of RTCGM on glycosylated haemoglobin (HbA1c), hypoglycaemic events and time spent in hypoglycaemia in T1DM. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus through January 2015. We included RCTs that enrolled individuals with T1DM and compared RTCGM vs control group. A two-step regression model was used to pool individual patient data. Results: We included 11 RCTs at moderate risk of bias. Meta-analysis suggests that the use of RTCGM is associated with a statistically significant but modest reduction in HbA1c (-0·276; 95% confidence interval -0·465 to -0·087). The improvements in HbA1c were primarily seen in individuals over age 15 years. We were unable to identify a statistically significant difference in time spent in hypoglycaemia or the number of hypoglycaemic episodes although these analyses were imprecise and warrant lower confidence. There was no difference between males and females. Conclusion: RTCGM in T1DM is associated with a reduction in HbA1c primarily in individuals over 15 years of age. We were unable to identify a statistically significant difference in the time spent in hypoglycaemia or the incidence of hypoglycaemic episodes.

AB - Background: Real-time continuous glucose monitoring (RTCGM) may help in the management of individuals with type 1 diabetes mellitus (T1DM); however, the evidence supporting its use is unclear. The available meta-analyses on this topic use aggregate data which weaken inference. Objective: Individual patient data were obtained from randomized controlled trials (RCTs) to conduct a meta-analysis and synthesize evidence about the effect of RTCGM on glycosylated haemoglobin (HbA1c), hypoglycaemic events and time spent in hypoglycaemia in T1DM. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus through January 2015. We included RCTs that enrolled individuals with T1DM and compared RTCGM vs control group. A two-step regression model was used to pool individual patient data. Results: We included 11 RCTs at moderate risk of bias. Meta-analysis suggests that the use of RTCGM is associated with a statistically significant but modest reduction in HbA1c (-0·276; 95% confidence interval -0·465 to -0·087). The improvements in HbA1c were primarily seen in individuals over age 15 years. We were unable to identify a statistically significant difference in time spent in hypoglycaemia or the number of hypoglycaemic episodes although these analyses were imprecise and warrant lower confidence. There was no difference between males and females. Conclusion: RTCGM in T1DM is associated with a reduction in HbA1c primarily in individuals over 15 years of age. We were unable to identify a statistically significant difference in the time spent in hypoglycaemia or the incidence of hypoglycaemic episodes.

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