Continuous glucose monitoring versus self-monitoring of blood glucose in the management of cystic fibrosis related diabetes: A systematic review and meta-analysis

Background: Treatment of cystic fibrosis related diabetes (CFRD) can improve outcomes and use of con-tinuous glucose monitoring (CGM) can positively impact glycemic control. We conducted a systematic review to assess current evidence on CGM compared to self-monitoring of blood glucose (SMBG) in the management of CFRD to determine its effect on glycemic, pulmonary, non-pulmonary and quality of life outcomes.Methods: Using pre-defined selection criteria, we searched MEDLINE, Embase, CENTRAL, Evidence-Based Medicine Reviews, grey literature and six relevant journals for studies using CGM and/or SMBG in CFRD with greater than 6 weeks of follow-up and reported change in HbA1c. The primary outcome was weighted mean difference (WMD) in plasma HbA1c between CGM and SMBG groups. Secondary out-comes included exploring interrelationships between CGM metrics and effects on disease-specific pul-monary, non-pulmonary and quality of life outcomes.Results: A total of 1671 references were retrieved, 862 studies screened and 124 full-texts assessed for eligibility. No studies directly compared CGM to SMBG. A meta-analysis of seventeen studies of 416 indi-viduals (CGM = 138, SMBG = 278) found CGM group had 4.1 mmol/mol (95% CI-7.9 to-0.30, p = 0.034) lower HbA1c compared to SMBG group. Most studies demonstrated moderate-to-high risk of bias. Publi-cation bias was also present. Heterogeneity was high and meta-regression identified duration of follow-up in SMBG group as main contributor.Conclusion: Our findings suggest use of CGM may be associated with improved glycemic control com-pared to SMBG in CFRD, however evidence of benefit on pulmonary, non-pulmonary and psychosocial outcomes are lacking.(c) 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Automated summary

This systematic review found that the use of continuous glucose monitoring (CGM) may be associated with improved glycemic control in cystic fibrosis-related diabetes (CFRD) compared to self-monitoring of blood glucose (SMBG). However, there is limited evidence on the impact of CGM on pulmonary, non-pulmonary, and quality of life outcomes in CFRD.