Effect of continuous glucose monitoring on glycaemic control in type 1 diabetes

Abstract

Topic Overview: Diabetes is increasing globally, and it is associated with an increased risk of morbidity. To avoid diabetes complications, individuals are required to self-manage blood glucose levels daily. Technological advances in glucose monitoring aim to reduce complications and optimise HbA1c levels. This review sought to examine whether continuous glucose monitoring (CGM) can be beneficial for individuals with Type 1 Diabetes Mellitus (T1DM) treated with Intensive Insulin Therapy (IIT). Research Question: Amongst adults with Type 1 diabetes mellitus receiving intensive insulin therapy, does continuous glucose monitoring improve HbA1c levels compared with self-monitoring blood glucose? PICO Elements: The population is adults with T1DM. The intervention under review is CGM and the comparison is SMBG. The expected outcome is improved HbA1c levels. Inclusion and exclusion criteria: Studies focused on adults with T1DM treated with either CSII or MDI. Studies were excluded if they included participants aged under 18 years of age, pregnant women and T2DM. The studies eligible for inclusion had to be written in English and published after 2010. Study Outcome: The study outcome was to be measured through HbA1c levels. Methods: A systematic search was applied to retrieve relevant studies. Synonyms were combined with search tools and limiters to create a search strategy. Various databases from EBSCO were used, such as ProQuest, PubMed, and Scopus amongst others. The PRISMA framework assisted in the selecting process of articles. The CASP tool for RCT’s guided the appraisal process. Results: The key studies consisted of six RCTs and their findings were inconsistent. Three of the studies, found a significant larger HbA1c reduction amongst participants using CGM than those using SMBG. In the other studies, the authors found a reduction in HbA1c levels for the CGM groups, however they did not find any significant HbA1c reduction in between groups. The methodological limitations identified could partly explain the inconsistencies. Conclusion: A conclusive deduction cannot be presented. However, it can be said that the evidence gathered identified the benefits of CGM in lowering HbA1c levels. The evidence presented sheds light onto the likely improved effectiveness of CGM in achieving glucose levels over SMBG, especially amongst individuals with uncontrolled blood glucose. Implications and Recommendations: Recommendations for future research includes providing more evidence regarding the role of CGM in improving glucose control amongst individuals whose HbA1c levels are lower than 7.5%. Implementation of CGM system locally requires staff awareness, training, and financial resources.