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Meta-Analysis
. 2020 Jun;8(1):e001092.
doi: 10.1136/bmjdrc-2019-001092.

Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

Marco Castellana  1 , Claudia Parisi  1 , Sergio Di Molfetta  1 , Ludovico Di Gioia  1 , Annalisa Natalicchio  1 , Sebastio Perrini  1 , Angelo Cignarelli  1 , Luigi Laviola  1 , Francesco Giorgino  2
Affiliations
Meta-Analysis

Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

Marco Castellana et al. BMJ Open Diabetes Res Care. 2020 Jun.

Abstract

Introduction: Flash glucose monitoring (FGM) is a factory-calibrated sensor-based technology for the measurement of interstitial glucose. We performed a systematic review and meta-analysis to assess its efficacy and safety in patients with type 1 and type 2 diabetes.

Research design and methods: PubMed, CENTRAL, Scopus and Web of Science were searched in July 2019. Twelve studies with a follow-up longer than 8 weeks, evaluating 2173 patients on prandial insulin, multiple daily insulin injections or continuous subcutaneous insulin infusion were included. The following data were extracted: HbA1c, time in range, time above 180 mg/dL, time below 70 mg/dL, frequency of hypoglycemic events, number of self-monitoring of blood glucose (SMBG) measurements, total daily insulin dose, patient-reported outcomes, adverse events, and discontinuation rate. A comparison with SMBG was conducted.

Results: FGM use was associated with a reduction in HbA1c (-0.26% (-3 mmol/mol); p=0.002) from baseline to the last available follow-up, which correlated with HbA1c levels at baseline (-0.4% (-4 mmol/mol) for each 1.0% (11 mmol/mol) of HbA1c above 7.2% (55 mmol/mol)). Also, a decrease in time below 70 mg/dL was found (-0.60 hours/day; p=0.04). Favorable findings in patient-reported outcomes and no device-related serious adverse events were reported. When compared with SMBG, FGM was characterized by no statistically different change in HbA1c (p=0.09), with lower number of SMBG measurements per day (-3.76 n/day; p<0.001) and risk of discontinuation (relative risk=0.42; p=0.001). A limited number of studies, with a heterogeneous design and usually with a short-term follow-up and without specific training, were found.

Conclusions: The present review provides evidence for the use of FGM as an effective strategy for the management of diabetes.

Keywords: blood glucose self-monitoring; glucose monitoring; glucose monitoring technologies; insulin therapy.

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Conflict of interest statement

Competing interests: AC: Eli Lilly, Novo Nordisk, Sanofi Aventis, AstraZeneca, Bruno Farmaceutici, Roche, Alfasigma. FG: Abbott, Medtronic, Roche Diabetes Care Italy, LifeScan. LL: Abbott, Medtronic, Movi, Roche Diabetes Care Italy. SDM: Roche Diabetes Care Italy.

Figures

Figure 1
Figure 1
Flowchart of the systematic review. FGM, flash glucose monitoring.
Figure 2
Figure 2
(A) Forest plot for change in HbA1c from baseline to the last available follow-up in patients on flash glucose monitoring (FGM). (B) Forest plot for the difference in change in HbA1c from baseline to the last available follow-up in patients on FGM versus patients on self-monitoring of blood glucose (SMBG).
See this image and copyright information in PMC

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