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Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials
Abstract
Background Continuous glucose monitoring (CGM) provides important information to aid in achieving glycemic targets in people with diabetes. Purpose We performed a meta-analysis of randomized controlled trials (RCTs) comparing CGM with usual care for parameters of glycemic control in both type 1 and type 2 diabetes. Data sources Many electronic databases were searched for articles published from inception until 30 June 2019. Study selection We selected RCTs that assessed both changes in HbA 1c and time in target range (TIR), together with time below range (TBR), time above range (TAR), and glucose variability expressed as coefficient of variation (CV). Data extraction Data were extracted from each trial by two investigators. Data synthesis All results were analyzed by a random effects model to calculate the weighted mean difference (WMD) with the 95% CI. We identified 15 RCTs, lasting 12-36 weeks and involving 2,461 patients. Compared with the usual care (overall data), CGM was associated with modest reduction in HbA 1c (WMD -0.17%, 95% CI -0.29 to -0.06, I 2 = 96.2%), increase in TIR (WMD 70.74 min, 95% CI 46.73-94.76, I 2 = 66.3%), and lower TAR, TBR, and CV, with heterogeneity between studies. The increase in TIR was significant and robust independently of diabetes type, method of insulin delivery, and reason for CGM use. In preplanned subgroup analyses, real-time CGM led to the higher improvement in mean HbA 1c (WMD -0.23%, 95% CI -0.36 to -0.10, P P Limitations Heterogene…
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“The glycemic management of T1DM has increasingly focused beyond HbA1c alone to include metrics such as TIR, hypoglycemia exposure, and glycemic variability, which reflect day-to-day glucose control and its impact on patients' lives.”
From Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: A systematic review and meta-analysis (2025) · cites this paper as [42]
In the citing paper
“Similar results have been found in trials comparing intermittently scanned (flash) monitoring with capillary blood glucose monitoring.18,19”
From Blood glucose monitoring devices: current considerations (2023) · cites this paper as [18]
In the citing paper
“In pivotal trials, glycated haemoglobin concentrations typically decreased by 0.4–0.6%, the time in target range (3.9–10 mmol/L) increased by 60–100 minutes/day, and the time below target range decreased by 10–45 minutes/day.18”
From Blood glucose monitoring devices: current considerations (2023) · cites this paper as [18]
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Metadata
- Authors
- Maiorino, M. I., Signoriello, S., Maio, A., Chiodini, P., Bellastella, G., Scappaticcio, L., Longo, M., Giugliano, D., & Esposito, K.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Maiorino, Maria Ida
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2020-04-13
- Volume
- 43
- Issue
- 5
- Pages
- 1146-1156
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W3017384252
- Cited by
- 364
- References
- 45
- Citations by year
- 2026: 45 · 2025: 76 · 2024: 75 · 2023: 59 · 2022: 53 · 2021: 37 · 2020: 19
- FWCI
- 6.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- continuous glucose monitoring, glycemic control, HbA1c, time in range, time below range, time above range, glycemic variability, coefficient of variation, type 1 diabetes, type 2 diabetes, sensor-augmented pump, flash glucose monitoring, real-time CGM, usual care comparison, insulin delivery method, hypoglycemia, hyperglycemia
- MeSH terms
- Glycemic Control, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Insulin, Male, Time Factors, Blood Glucose Self-Monitoring, Randomized Controlled Trials as Topic, Databases, Factual, Outcome Assessment, Health Care, Benchmarking
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