Continuous glucose monitoring versus self-monitoring for patients with type 1 diabetes: A systematic review and meta-analysis

Background: Patients with type 1 diabetes mellitus (T1DM) require intensive glucose monitoring to achieve optimal glycemic control and prevent complications. While self-monitoring of blood glucose (SMBG) has long been the standard approach, continuous glucose monitoring (CGM) offers real-time data and trend analysis that may enhance clinical decision-making. Objective: This study aimed to evaluate whether CGM provides superior glycemic outcomes compared with SMBG in individuals with T1DM. Materials and Methods: A systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses guidelines. Four randomized controlled trials involving T1DM patients using either CGM or SMBG were included. The primary outcome was hemoglobin A1C (HbA1c) reduction, whereas secondary outcomes included time-in-range (TIR) and hypoglycemia incidence. Metaanalysis was performed using a computer program, and leave-one-out sensitivity analysis was applied to assess the stability of the results. Results: All included studies showed effect estimates favoring CGM. The pooled analysis revealed a significant HbA1c reduction in the CGM group (mean difference [MD] = −0.50%, 95% confidence interval [CI]: −0.60 to −0.41, P < 0.001). Sensitivity analysis confirmed the consistency of these results (MD = −0.44%, 95% CI: −0.55 to −0.34). Conclusion: Although meta-analysis was not conducted for TIR or hypoglycemia, individual studies reported improvements in TIR and reduced risk of severe hypoglycemia associated with CGM use. In conclusion, CGM significantly improves HbA1c in individuals with T1DM compared with SMBG, as evidenced by consistent findings across highquality trials. Additional benefits in TIR and hypoglycemia prevention were observed, supporting CGM as a preferred tool for routine glycemic monitoring in T1DM.