Results of a systematic review and meta-analysis detail the reduction in fear of hypoglycemia and general improvement in satisfaction associated with use of continuous glucose monitoring in patients with type 1 diabetes.
New research from a systematic review and meta-analysis of nearly a dozen studies is providing an overview of the impact continuous glucose monitoring (CGM) can have on the emotional well-being of patients with type 1 diabetes.
Performed by a group of investigators from organizations based in Warsaw, Poland, results of the study detail a reduction in fear of over complications, including hypoglycemia, and general improvement in satisfaction as a result of CGM use among patients with type 1 diabetes.
“To our best knowledge, this is the first quantitative meta‑analysis of adults exclusively with T1DM, which provides further evidence for the ability of CGM systems to reduce the fear of hypoglycemia and improve emotional well‑being,” wrote investigators.
With patients with type 1 diabetes among the patient groups standing to benefit most from CGM use, the current study was led by Robert Olszewski, PhD, DSc, of the Institute of Fundamental Technological Research at the Polish Academy of Sciences, to assess the impact of CGM use on quality of life compared to convention self-monitoring of blood glucose. The study was designed as a systematic review and meta-analysis of relevant publications within the MEDLINE/PubMed, Cochrane Library/Embase, CINAHL, Scopus, Web of Science, and ProQuest databases.
Additional inclusion criteria required studies of interest to be randomized clinical trials and survey studies comparing markings of emotional well-being, including health-related quality of life and fear of hypoglycemia, in patients with type 1 diabetes. To be included in the systematic review and meta-analysis, studies needed to include participants at least 18 years or older considered to have type 1 diabetes with an HbA1c level of 7.5% or greater and using any type of CGM system or conventional self-monitoring of blood glucose.
Outcomes of interest for the study were measures of emotional well-being, including diabetes‑specific or generic measures of well-being, and changes in HbA1c level. Investigators noted they were unable to assess secondary outcomes such as diabetic complications, citing difficulty comparing data as data from each study were presented differently.
A total of 11 studies, including a cohort of 1228 patients with type 1 diabetes, were included in the study. Upon analysis, results suggested use of CGM was associated with a reduction of hypoglycemia fear using the Worry subscale of the Hypoglycemia Fear Survey (Cohen d=–0.24 [95% CI, -0.41 to -0.07]; mean difference, –3.15 [95% CI, –5.48 to -0.82]). Investigators pointed out an outcome analysis of studies using the Diabetes Treatment Satisfaction Questionnaire showed Cohen d of 0.23 (95% CI, -0.18 to 0.63).
Additionally, results indicated the overall value of Cohen d equaled -0.24 (95% CI, -0.57 to 0.09), which indicates a lack of effect of CGM on improving HbA1c levels. Investigators did note the reduction of HbA1c levels was significantly greater among CGM users when excluding a study from calculations (Cohen d=-0.33 [95% CI, -0.66 to 0.00]; P=.047).
“This is the first quantitative meta‑analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over self-monitoring of blood glucose in adults with T1DM and improve HbA1c levels,” wrote investigators.
This study, “Impact of continuous glucose monitoring on improving emotional well‑being among adults with type 1 diabetes mellitus: a systematic review and meta‑analysis,” was published in the Polish Archives of Internal Medicine.