Franceschi Roberto, Micheli Francesca, Mozzillo Enza, Cauvin Vittoria, Liguori Alice, Soffiati Massimo, Giani Elisa
Pediatric Unit, S. Chiara Hospital, Trento, Italy.
Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy.
Front Pediatr. 2021 May 5;9:660173. doi: 10.3389/fped.2021.660173. eCollection 2021.
To explore the impact of real-time continuous glucose monitoring (rtCGMs) or intermittently scanned/viewed CGM (isCGM) on psychological outcomes in children and caregivers, and to grade the level of evidence. Systematic review of the literature from PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Nursing reference center, Up to date, Google Scholar, and PsycINFO databases. The studies selected used validated questionnaires for investigating the psychological outcomes. We applied GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rank the quality of a body of evidence. A total of 192 studies were identified in the initial search and after the process of evaluation 25 studies were selected as appropriate to be included in this systematic review. We found in moderate quality studies that isCGM in adolescents can improve diabetes related distress, family conflicts, fear of hypoglycemia, and quality of life, while depression, anxiety, and quality of sleep have not yet been evaluated by validated questionnaires. In moderate-high quality studies, rtCGM technology does not impact on diabetes burden, diabetes specific family conflict, and depressive symptoms. The effect on fear of hypoglycemia, sleep quality, and anxiety is still debated and RCT studies powered to find significant results in psychological outcomes are lacking. RtCGM increases satisfaction and quality of life in parents and patients wearing rtCGM. these data present an interesting point to consider when families are deciding whether or not to start CGM use, choosing between rtCGM to reach a tighter metabolic control, or isCGM which allows greater benefits on psychological outcomes.
为探讨实时连续血糖监测（rtCGMs）或间歇性扫描/查看式动态血糖监测（isCGM）对儿童及其照料者心理结局的影响，并对证据水平进行分级。对来自PubMed、Embase、Cochrane图书馆、科学网、CINAHL、护理参考中心、Up to date、谷歌学术和PsycINFO数据库的文献进行系统综述。入选的研究使用经过验证的问卷来调查心理结局。我们应用GRADE（推荐分级评估、制定与评价）对证据体的质量进行排名。在初步检索中总共识别出192项研究，经过评估过程后，选择了25项研究纳入本系统综述。我们发现在中等质量的研究中，青少年使用isCGM可以改善糖尿病相关困扰、家庭冲突、低血糖恐惧和生活质量，而抑郁、焦虑和睡眠质量尚未通过经过验证的问卷进行评估。在中高质量的研究中，rtCGM技术不会影响糖尿病负担、糖尿病特异性家庭冲突和抑郁症状。对低血糖恐惧、睡眠质量和焦虑的影响仍存在争议，且缺乏有足够能力在心理结局方面发现显著结果的随机对照试验（RCT）研究。rtCGM提高了使用rtCGM的父母和患者的满意度和生活质量。当家庭决定是否开始使用动态血糖监测、在选择rtCGM以实现更严格的代谢控制或isCGM（其在心理结局方面有更大益处）之间做出选择时，这些数据提供了一个有趣的思考点。
