University Witten/Herdecke, Institute for Research in Operative Medicine, Cologne.
University of Cologne, Institute of Health Economics and Clinical Epidemiology, Cologne.
Exp Clin Endocrinol Diabetes. 2022 Jan;130(1):61-72. doi: 10.1055/a-1268-0967. Epub 2020 Dec 10.
The aim of this meta-analysis was to evaluate the impact of continuous glucose monitoring (CGM) systems on short- and long-term glycemic control in children and adolescents diagnosed with diabetes type 1.
The review was registered in PROSPERO (CRD42019135152). We partly updated a formerly published systematic review and searched several databases (Ovid MEDLINE, Embase, CENTRAL, and Clinicaltrials.gov) in May 2019. Summary measures were estimated as relative risks (RR) and standardized mean differences (SMD). The primary endpoint of our analysis was frequency of hypoglycemic events. Quality of evidence was evaluated using the GRADE approach.
Eleven studies with a total number of 818 patients were included in our review. Meta-analyses indicated a potential benefit of CGM systems regarding the relative risk of a severe hypoglycemic event (RR 0.78; 95% CI 0.29 to 2.04) and mean level of HbA1c at end of study (SMD -0.23; 95% CI -0.46 to 0.00). Certainty of evidence for effect estimates of these meta-analyses was low due to risk of selection bias and imprecision of the included studies. Qualitative analyses of the secondary outcomes of user satisfaction and long-term development of blood glucose supported these findings.
CGM systems may improve glycemic control in children and adolescents diagnosed with diabetes type 1, but the imprecision of effects is still a problem. Only a few studies examined and reported data for pediatric populations in sufficient detail. Further research is needed to clarify advantages and disadvantages of CGM systems in children and adolescents.
本荟萃分析旨在评估连续血糖监测（CGM）系统对 1 型糖尿病患儿和青少年短期和长期血糖控制的影响。
本综述已在 PROSPERO（CRD42019135152）中注册。我们部分更新了以前发表的系统评价，并于 2019 年 5 月在多个数据库（Ovid MEDLINE、Embase、CENTRAL 和 Clinicaltrials.gov）中进行了检索。汇总指标以相对风险（RR）和标准化均数差（SMD）表示。我们分析的主要终点是低血糖事件的发生频率。使用 GRADE 方法评估证据质量。
我们的综述共纳入了 11 项研究，总计 818 名患者。荟萃分析表明，CGM 系统在严重低血糖事件的相对风险（RR 0.78；95%CI 0.29 至 2.04）和研究结束时 HbA1c 的平均水平（SMD -0.23；95%CI -0.46 至 0.00）方面具有潜在获益。由于存在选择偏倚和纳入研究的不精确性，这些荟萃分析的效应估计的证据确定性较低。对用户满意度和长期血糖发展的次要结局的定性分析支持了这些发现。
CGM 系统可能改善 1 型糖尿病患儿和青少年的血糖控制，但效应的不精确性仍然是一个问题。只有少数研究足够详细地检查和报告了儿科人群的数据。需要进一步研究以阐明 CGM 系统在儿童和青少年中的优势和劣势。
