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Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data

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Pickup, J. C., Freeman, S. C., Sutton, A. J.·2011·BMJ
DOI 10.1136/bmj.d3805PMC PMC3131116
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Abstract

OBJECTIVE: To determine the clinical effectiveness of real time continuous glucose monitoring compared with self monitoring of blood glucose in type 1 diabetes. DESIGN: Meta-analysis of randomised controlled trials. DATA SOURCES: Cochrane database for randomised controlled trials, Ovid Medline, Embase, Google Scholar, lists of papers supplied by manufacturers of continuous glucose monitors, and cited literature in retrieved articles. Studies reviewed Randomised controlled trials of two or more months' duration in men and non-pregnant women with type 1 diabetes that compared real time continuous glucose monitoring with self monitoring of blood glucose and where insulin delivery was the same in both arms. Analysis Two step meta-analysis of individual patient data with the primary outcome of final glycated haemoglobin (HbA(1c)) percentage and area under the curve of hypoglycaemia (glucose concentration <3.9 mmol/L) during either treatment, followed by one step metaregression exploring patient level determinants of HbA(1c) and hypoglycaemia. RESULTS: Six trials were identified, consisting of 449 patients randomised to continuous glucose monitoring and 443 to self monitoring of blood glucose. The overall mean difference in HbA(1c) for continuous glucose monitoring versus self monitoring of blood glucose was -0.30% (95% confidence interval -0.43% to -0.17%) (-3.0, -4.3 to -1.7 mmol/mol). A best fit regression model of determinants of final HbA(1c) showed that for every one day increase of sensor usage per week the effect of continuous glucose monitoring versus self monitoring of blood glucose increased by 0.150% (95% credibility interval -0.194% to -0.106%) (1.5, -1.9 to -1.1 mmol/mol) and every 1% (10 mmol/mol) increase in baseline HbA(1c) increased the effect by 0.126% (-0.257% to 0.0007%) (1.3, -2.6 to 0.0 mmol/mol). The model estimates that, for example, a patient using the sensor continuously would experience a reduction in HbA(1c) of about 0.9% (9 mmol/mol) when the baseline HbA(1c) is 10% (86 mmol/mol). The overall reduction in area under the curve of hypoglycaemia was -0.28 (-0.46 to -0.09), corresponding to a reduction in median exposure to hypoglycaemia of 23% for continuous glucose monitoring compared with self monitoring of blood glucose. In a best fit regression model, baseline area under the curve of hypoglycaemia was only weakly related to the effect of continuous glucose monitoring compared with self monitoring of blood glucose on hypoglycaemia outcome, and sensor usage was unrelated to hypoglycaemia at outcome. CONCLUSIONS: Continuous glucose monitoring was associated with a significant reduction in HbA(1c) percentage, which was greatest in those with the highest HbA(1c) at baseline and who most frequently used the sensors. Exposure to hypoglycaemia was also reduced during continuous glucose monitoring. The most cost effective or appropriate use of continuous glucose monitoring is likely to be when targeted at people with type 1 diabetes who have continued poor control during intensified insulin therapy and who frequently use continuous glucose monitoring.

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  • Whether CSII is better, overall, than multiple daily injection for management of type 1 diabetes is debated, since outcomes reported in studies have varied substantially.

    “However, whether CSII is better, overall, than multiple daily injection for management of type 1 diabetes is debated, since outcomes reported in studies have varied substantially.90”

    From Type 1 diabetes (2014) · cites this paper as [90]

    The Methods (page unavailable) say the analysis compared continuous glucose monitoring with self-monitoring and excluded trials in which insulin treatment differed between arms. The Results’ Study characteristics (page unavailable) list CSII and multiple daily injections as delivery methods, but do not assess whether CSII is better or report variability in outcomes from that comparison. I searched for a discussion of conflicting CSII-versus-injection results and found none in our copy. (LLM, conf=0.76)

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Authors
Pickup, J. C., Freeman, S. C., & Sutton, A. J.
Affiliations
  • Guy's Hospital (GB)
  • University of Leicester (GB)
Corresponding author
Pickup, J. C.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2011-07-07
Volume
343
Issue
jul07 1
Pages
d3805-d3805
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.d3805
PMC
PMC3131116
OpenAlex
W1995972413
Cited by
541
References
6
Citations by year
2026: 13 · 2025: 13 · 2024: 18 · 2023: 16 · 2022: 30 · 2021: 38 · 2020: 51 · 2019: 51 · 2018: 45 · 2017: 48 · 2016: 41 · 2015: 42 · 2014: 41 · 2013: 43 · 2012: 40
FWCI
6.03
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
Funders
Engineering and Physical Sciences Research Council
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 1 diabetes, continuous glucose monitoring, self-monitoring of blood glucose, HbA1c, hypoglycemia, glycemic control, meta-regression, insulin delivery, diabetes technology, cost-effectiveness
MeSH terms
Adult, Blood Glucose, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male, Blood Glucose Self-Monitoring, Randomized Controlled Trials as Topic, Treatment Outcome, Young Adult

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