medwireNews: Real time continuous glucose monitoring (RTCGM) is associated with a modest but significant reduction in glycosylated hemoglobin (HbA1c) in patients with type 1 diabetes, but only if they are over 15 years of age, meta-analysis data show.
The review, conducted by Mohammad Hassan Murad (Mayo Clinic, Rochester, Minnesota, USA) and colleagues, included data from 11 randomized controlled trials with 1530 patients published up to January 2015.
The researchers found that the use of RTCGM was associated with a significant 0.276 mmol/L reduction in HbA1c at follow-up, compared with baseline.
However, when they stratified the patients by age (≤12, 13–15, >15 years) they found that the reduction was only significant in those over 15 years old. These patients experienced a 0.356 mmol/L fall in HbA1c from baseline to follow-up.
There was also no significant reduction in time spent in hypoglycemia (<3.3 mmol/L) or in the number of hypoglycemic events (<3.9 mmol/L) from baseline to follow-up across all age groups.
And subgroup analysis by gender showed no significant differences for any of the outcomes studied.
Murad and team report in Clinical Endocrinology that the trials they included had a moderate risk of bias due to unclear reporting of allocation concealment, outcome assessors not being blinded, and funding coming from industry sources in most cases.
They also note that data on several important covariates such as body mass index, education level, adherence to wearing the device, diabetes duration, and insulin delivery system (pump vs multiple daily injections) were missing.
“Knowing the differential effect in patients with such characteristics would have been very informative to practice and would facilitate patient selection for RTCGM,” they write.
The authors conclude: “RTCGM use in [type 1 diabetes] patients seems beneficial; although evidence is lacking in children <15 years old.
“It is plausible that the lack of effect in younger children is due to the fact that the primary goal of monitoring in these patients may have been the avoidance of hypoglycaemia.”
They add that “parents of preschool children have high parental stress scores and often have challenges managing children’s meals and nutrition; which is another possible explanation for lack of efficacy in younger children.”
By Laura Cowen
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