AIMS

Hybrid closed-loop (HCL) systems have become the standard of care for type-1 diabetes patients. However, they require exact carbohydrate counting (ECC), which can be complex. We conducted a meta-analysis to assess whether simplified meal announcement (SMA) is inferior to ECC by comparing the percentage of time spent in the time in range (TIR) 3.9 to 10 mmol/l.

MATERIALS AND METHODS

PubMed, EMBASE, and Cochrane Central database were searched for randomized controlled trials (RCTs) that compared ECC to SMA and reported the outcomes of (1) percentage of 3.9 to 10 mmol/l glucose level time; (2) percentage of 3.9 to 7.8 mmol/l glucose level time; (3) total daily insulin units (TDI) per kg; and (4) coefficient of variation (CV) of glucose (%). Heterogeneity was examined with statistics. A random-effect generic inverse variance (GIV) method was applied to all analyses.

RESULTS

We included 4 RCTs (three of them crossover) with 137 patients, of whom 118 underwent SMA. Follow-up ranged from 2 weeks to 12 months. The pooled mean difference (MD) of percentage of time spent in TIR was -3.28 [-6.00, -0.56], indicating lower proportion with SMA. Two studies reported the percentage of TIR of 3.9 to 7.8 mmol/l, with a pooled effect size MD of -3.36 [-5.80, -0.92]). The pooled MD in TDI units per kg was 0.00 [-0.05, 0.05], and CV of glucose was 0.60 [0.02, 1.18]).

CONCLUSIONS

Simplified meal announcement may be considered as an alternative to ECC, but further research is needed to confirm its broader applicability.