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

被引:49
作者
Benkhadra, Khalid [1 ,2 ]
Alahdab, Fares [1 ,2 ]
Tamhane, Shrikant [3 ]
Wang, Zhen [1 ]
Prokop, Larry J. [4 ]
Hirsch, Irl B. [5 ]
Raccah, Denis [6 ]
Riveline, Jean-Pierre [7 ]
Kordonouri, Olga [8 ]
Murad, Mohammad Hassan [1 ,2 ]
机构
[1] Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN USA
[2] Mayo Clin, Div Prevent Med, 200 First St SW, Rochester, MN 55905 USA
[3] Mayo Clin, Div Endocrinol Diabet & Nutr, Rochester, MN USA
[4] Mayo Clin, Lib Publ Serv, Rochester, MN USA
[5] Univ Washington, Med Ctr Roosevelt, Seattle, WA 98195 USA
[6] Univ Hosp St Marguerite, Marseille, France
[7] Hop Paris, Lariboisiere Hosp, Paris, France
[8] Childrens Hosp AUF DER BULT, Hannover, Germany
关键词
MULTIPLE DAILY INJECTIONS; GLYCEMIC CONTROL; HEMOGLOBIN A1C; PUMP THERAPY; INSULIN PUMP; MELLITUS; MULTICENTER; CHILDREN; TRENDS; HYPOGLYCEMIA;
D O I
10.1111/cen.13290
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundReal-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. ObjectiveIndividual 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. MethodsWe 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. ResultsWe 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 (-0276; 95% confidence interval -0465 to -0087). 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. ConclusionRTCGM 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.
引用
收藏
页码:354 / 360
页数:7
相关论文
共 34 条
[1]  
[Anonymous], DIABETES FORECAST
[2]   Reduction in hemoglobin A1c with real-time continuous glucose monitoring: Results from a 12-week observational study [J].
Bailey, Timothy S. ;
Zisser, Howard C. ;
Garg, Satish K. .
DIABETES TECHNOLOGY & THERAPEUTICS, 2007, 9 (03) :203-210
[3]   The effect of continuous subcutaneous glucose monitoring (CGMS) versus intermittent whole blood finger-stick glucose monitoring (SBGM) on hemoglobin A1c (HBA1c) levels in Type I diabetic patients: A systematic review [J].
Chetty, V. T. ;
Almulla, A. ;
Odueyungbo, A. ;
Thabane, L. .
DIABETES RESEARCH AND CLINICAL PRACTICE, 2008, 81 (01) :79-87
[4]   The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control [J].
Chico, A ;
Vidal-Ríos, P ;
Subirà, M ;
Novials, A .
DIABETES CARE, 2003, 26 (04) :1153-1157
[5]   17-Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta-analysis [J].
Combs, C. A. ;
Schuit, E. ;
Caritis, S. N. ;
Lim, A. C. ;
Garite, T. J. ;
Maurel, K. ;
Rouse, D. ;
Thom, E. ;
Tita, A. T. ;
Mol, B. W. J. .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2016, 123 (05) :682-690
[6]  
DCCT Res Grp, 1991, AM J MED, V90, P450, DOI 10.1016/0002-9343(91)80085-Z
[7]   Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring [J].
Deis, Dorothee ;
Bolinder, Jan ;
Riveline, Jean-Pierre ;
Battelino, Tadej ;
Bosi, Emanuele ;
Tubiana-Rufi, Nadia ;
Kerr, David ;
Phillip, Moshe .
DIABETES CARE, 2006, 29 (12) :2730-2732
[8]   Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study [J].
Eton, David T. ;
Ramalho de Oliveira, Djenane ;
Egginton, Jason S. ;
Ridgeway, Jennifer L. ;
Odell, Laura ;
May, Carl R. ;
Montori, Victor M. .
PATIENT-RELATED OUTCOME MEASURES, 2012, 3 :39-49
[9]  
Floyd Baraka, 2012, J Diabetes Sci Technol, V6, P1094
[10]  
Gandhi Gunjan Y, 2011, J Diabetes Sci Technol, V5, P952