Continuous glucose monitoring versus self-monitoring of blood glucose in the management of cystic fibrosis related diabetes: A systematic review and meta-analysis

Background: Treatment of cystic fibrosis related diabetes (CFRD) can improve outcomes and use of con-tinuous glucose monitoring (CGM) can positively impact glycemic control. We conducted a systematic review to assess current evidence on CGM compared to self-monitoring of blood glucose (SMBG) in the management of CFRD to determine its effect on glycemic, pulmonary, non-pulmonary and quality of life outcomes.Methods: Using pre-defined selection criteria, we searched MEDLINE, Embase, CENTRAL, Evidence-Based Medicine Reviews, grey literature and six relevant journals for studies using CGM and/or SMBG in CFRD with greater than 6 weeks of follow-up and reported change in HbA1c. The primary outcome was weighted mean difference (WMD) in plasma HbA1c between CGM and SMBG groups. Secondary out-comes included exploring interrelationships between CGM metrics and effects on disease-specific pul-monary, non-pulmonary and quality of life outcomes.Results: A total of 1671 references were retrieved, 862 studies screened and 124 full-texts assessed for eligibility. No studies directly compared CGM to SMBG. A meta-analysis of seventeen studies of 416 indi-viduals (CGM = 138, SMBG = 278) found CGM group had 4.1 mmol/mol (95% CI-7.9 to-0.30, p = 0.034) lower HbA1c compared to SMBG group. Most studies demonstrated moderate-to-high risk of bias. Publi-cation bias was also present. Heterogeneity was high and meta-regression identified duration of follow-up in SMBG group as main contributor.Conclusion: Our findings suggest use of CGM may be associated with improved glycemic control com-pared to SMBG in CFRD, however evidence of benefit on pulmonary, non-pulmonary and psychosocial outcomes are lacking.(c) 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.