Systematic Review of the Effects of Continuous Glucose Monitoring on Metabolic Control in Children and Adolescents with Type 1 Diabetes

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Rigorous metabolic control helps delay long-term health complications in children with type 1 diabetes (T1D). Continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) provides valuable information regarding blood glucose levels that is not available with self-monitoring of blood glucose (SMBG) alone. To critically appraise the research evidence on metabolic control in children diagnosed with T1D using CGM. Published studies evaluating metabolic control in children with T1D where CGM was used were evaluated. Electronic searches were conducted in MEDLINE, EMBASE, Health and Psychosocial Instruments, and Ovid Healthstar. The articles were reviewed and assessed for methodological quality. Of the 1427 published articles on CGM, only 18 met the inclusion criteria and were included in the analysis. The review yielded 9 randomized controlled trials (RCTs) and 9 non-randomized controlled trials. The studies included 1424 children and adolescents with T1D ranging in age from 1 to 19 years with a diabetes duration ranging from 0.2 to 15 years, with 75% of children using CSII for diabetes management. Improvements in HbA1c were found in only 6 studies, of which only 3 were significant improvements. The remaining 15 studies did not reveal significant improvements in HbA1c between groups (n=8) or between the first and second time point (n=7). There are the beginnings of an evidence base indicating that CGM may lead to improved metabolic control compared to SMBG alone in children with T1D. However, future studies using a more rigorous study design (RCT) are required to build on this evidence base.