Benjamin John Wheeler

Aim To conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) comparing the effectiveness of real‐time continuous glucose monitoring (rtCGM) versus intermittently scanned continuous glucose monitoring (isCGM) on key glycaemic metrics (co‐primary outcomes HbA1c and time‐in‐range [TIR] 70–180 mg/dL, 3.9–10.0 mmol/L) among people with type 1 diabetes (T1D). Methods Medline, PubMed, Scopus, Web of Science and Cochrane Central Register of clinical trials were searched. Inclusion criteria were RCTs; T1D populations of any age and insulin regimen; comparing any type of rtCGM with isCGM (only the first generation had been compared to date); and reporting the glycaemic outcomes. Glycaemic outcomes were extracted post‐intervention and expressed as mean differences and 95% CIs between the two comparators. Results were pooled using a random‐effect meta‐analysis. The risk of bias was assessed using the Cochrane RoB2 tool. The quality of evidence was assessed by the GRADE approach. Results Five RCTs met the inclusion criteria (4 parallel and 1 crossover design; 4 with CGM use <8 weeks), involving 446 participants (354 adults; 92 children and adolescents). Overall, meta‐analysis showed rtCGM compared to isCGM improved absolute TIR by +7.0% (95% CI: 5.8%–8.3%, I 2 = 0%, p < 0.01) accompanied by a favorable effect on time‐below‐range <70 mg/dL (3.9 mmol/L) – 1.7% (95%CI: −3.0% to −0.4%; p = 0.03). No differences were seen regarding HbA1c. Conclusions This meta‐analysis highlights that for people with T1D, rtCGM confers benefits over isCGM primarily related to increased TIR, with improvements in hypo‐ and hyperglycaemia.