Alfadli Salya F, Alotaibi Yazeed S, Aqdi Maha J, Almozan Latifah A, Alzubaidi Zahra B, Altemani Hammad A, Almutairi Shaden D, Alabdullah Hussain A, Almehmadi Alaa Ahmed, Alanzi Abdulrahman L, Azzam Ahmed Y
Division of Diabetes & Endocrinology, Department of Medicine, King Abdullah Bin Abdulaziz University Hospital, Jeddah, Saudi Arabia.
College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
Metabol Open. 2025 Jul 29;27:100382. doi: 10.1016/j.metop.2025.100382. eCollection 2025 Sep.
Continuous glucose monitoring (CGM) technologies have been advancing rapidly, but evidence on their comparative effectiveness stills limited to date yet. We conducted a systematic review and meta-analysis to evaluate and investigate the impact of CGM systems on glycemic control in adults with type 1 diabetes.
We searched electronic literature databases from inception through April 30, 2025, for comparative studies investigating CGM systems with standard monitoring or different CGM technologies in adults with type 1 diabetes. Primary outcomes included HbA1c reduction, time in range (TIR), and hypoglycemia reduction. We performed random-effects meta-analyses, network meta-analysis, and subgroup analyses by baseline HbA1c and intervention duration. Evidence quality was assessed using GRADE methodology.
Twenty-seven studies with total of 2975 participants were included. CGM significantly reduced HbA1c compared to standard monitoring (mean difference: 0.38 %, 95 % CI: 0.49 to -0.27 %). TIR increased by 7.9 % (95 % CI: 5.8-10.0 %), representing 114 additional minutes daily in best range. Real-time CGM showed advantages over intermittently scanned CGM for TIR (+5.63 %, P-value<0.001) and hypoglycemia reduction (-1.28 %, P-value<0.001). Automated closed-loop systems achieved the highest ranking in network meta-analysis (SUCRA = 0.92). Benefits were greater among patients with higher baseline HbA1c (>8.5 %: 0.68 % reduction in HbA1c vs. <7.5 %: 0.24 % reduction in HbA1c, P-value = 0.009).
CGM technologies significantly improve glycemic control in adults with type 1 diabetes, with greater benefits for those with higher baseline HbA1c. Advanced systems demonstrate progressively greater improvements, with automated closed-loop systems showing the strongest evidence of effectiveness. These findings support broader implementation of CGM technologies, with selection tailored to individual patient needs.
持续葡萄糖监测（CGM）技术一直在迅速发展，但迄今为止，关于其相对有效性的证据仍然有限。我们进行了一项系统评价和荟萃分析，以评估和研究CGM系统对1型糖尿病成人患者血糖控制的影响。
我们检索了从数据库建立至2025年4月30日的电子文献数据库，以查找比较研究，这些研究调查了1型糖尿病成人患者中CGM系统与标准监测或不同CGM技术的情况。主要结局包括糖化血红蛋白（HbA1c）降低、血糖达标时间（TIR）和低血糖发生率降低。我们通过基线HbA1c和干预持续时间进行随机效应荟萃分析、网状荟萃分析和亚组分析。使用GRADE方法评估证据质量。
纳入了27项研究，共2975名参与者。与标准监测相比，CGM显著降低了HbA1c（平均差值：0.38%，95%置信区间：-0.49%至-0.27%）。TIR增加了7.9%（95%置信区间：5.8%-10.0%），相当于每天在最佳血糖范围内增加114分钟。实时CGM在TIR方面显示出优于间歇性扫描CGM的优势（增加5.63%，P值<0.001），在低血糖发生率降低方面也有优势（降低1.28%，P值<0.001）。自动闭环系统在网状荟萃分析中排名最高（累积排序曲线下面积[SUCRA]=0.92）。基线HbA1c较高的患者获益更大（HbA1c>8.5%：HbA1c降低0.68%，而HbA1c<7.5%：HbA1c降低0.24%，P值=0.009）。
CGM技术显著改善了1型糖尿病成人患者的血糖控制，对基线HbA1c较高的患者益处更大。先进的系统显示出越来越大的改善，自动闭环系统显示出最强的有效性证据。这些发现支持更广泛地应用CGM技术，并根据个体患者需求进行选择。
