title: Real-time continuous glucose monitoring in type 1 diabetes: a systematic review and individual patient data meta-analysis.
abstract: BACKGROUND
  Real-time continuous glucose monitoring (RTCGM) may help in the management of individuals with type 1 diabetes mellitus (T1DM); however, the evidence supporting its use is unclear. The available meta-analyses on this topic use aggregate data which weaken inference.
  
  
  OBJECTIVE
  Individual patient data were obtained from randomized controlled trials (RCTs) to conduct a meta-analysis and synthesize evidence about the effect of RTCGM on glycosylated haemoglobin (HbA1c), hypoglycaemic events and time spent in hypoglycaemia in T1DM.
  
  
  METHODS
  We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus through January 2015. We included RCTs that enrolled individuals with T1DM and compared RTCGM vs control group. A two-step regression model was used to pool individual patient data.
  
  
  RESULTS
  We included 11 RCTs at moderate risk of bias. Meta-analysis suggests that the use of RTCGM is associated with a statistically significant but modest reduction in HbA1c (-0·276; 95% confidence interval -0·465 to -0·087). The improvements in HbA1c were primarily seen in individuals over age 15 years. We were unable to identify a statistically significant difference in time spent in hypoglycaemia or the number of hypoglycaemic episodes although these analyses were imprecise and warrant lower confidence. There was no difference between males and females.
  
  
  CONCLUSIONS
  RTCGM in T1DM is associated with a reduction in HbA1c primarily in individuals over 15 years of age. We were unable to identify a statistically significant difference in the time spent in hypoglycaemia or the incidence of hypoglycaemic episodes.
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Benkhadra
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Fares
authors.initials: F
authors.lastname: Alahdab
authors.affiliation: Division of Endocrinology, Diabetes and Nutrition, Rochester, MN, USA.
authors.forename: Shrikant
authors.initials: S
authors.lastname: Tamhane
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Library Public Services, Mayo Clinic, Rochester, MN, USA.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: University of Washington Med Ctr-Roosevelt, Seattle, WA, USA.
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
authors.affiliation: University Hospital Sainte Marguerite, Marseille, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Raccah
authors.affiliation: Hôpitaux de Paris, Lariboisière Hospital, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Riveline
authors.affiliation: Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Kordonouri
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin