The effectiveness of continuous glucose monitoring for type 1 diabetic adolescents using continuous subcutaneous insulin infusion pumps: a systematic review

Background Type 1 diabetes is a common childhood pediatric disease characterized by autoimmune destruction of insulin producing &bgr;eta‐cells in the pancreas.1 Effective measurement and control of blood glucose levels is critical for the health and wellbeing of adolescents with type 1 diabetes. Adolescents using continuous subcutaneous insulin pumps are able to perform continuous glucose monitoring. However, evidence is unclear if this improves effectiveness when compared to self‐glucose monitoring alone. This review aims to establish the optimal care of an adolescent with type 1 diabetes mellitus to maintain glycemic control and to avoid hypoglycemia. Objectives The review question is: are metabolic outcomes improved in outpatient adolescents with type 1 diabetes on a continuous subcutaneous insulin infusion pump when continuous glucose monitoring is used, compared to self‐glucose monitoring alone? Inclusion criteria Types of participants This review included studies of adolescent patients, aged 12 to 18 years, in the outpatient setting with type 1 diabetes mellitus utilizing a continuous subcutaneous insulin infusion pump. Type of intervention This review included studies which evaluated continuous glucose monitoring, as compared to self‐glucose monitoring alone, in adolescents utilizing a continuous subcutaneous insulin infusion pump. Types of outcomes This review included studies examining the following outcome measures: number of hypoglycemic episodes (glucose < 70mg/dL) and hemoglobin A1C level. Types of studies This review included randomized controlled trials, quasi‐experimental studies were considered only in the absence of randomized controlled trials. Search strategy The search strategy included studies published between 2002 and 2012 in, or translated into, English. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity utilizing standardized critical appraisal instrument from the Joanna Briggs Institute. Data extraction Data was extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI). Data synthesis Quantitative papers were pooled by statistical meta‐analysis using JBI‐MAStARI. A fixed effect model for continuous data was utilized to express weighted mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed statistically using the standard Chi‐square. Results There is no statistical or clinically significant difference in levels of hemoglobin A1C in adolescents on continuous subcutaneous insulin infusion pumps utilizing continuous glucose monitoring devices as compared to those utilizing self‐glucose monitoring alone. Conclusions From the findings of this review, the utilization of a continuous glucose‐monitoring device in conjunction with an insulin pump does not improve hemoglobin A1C levels when compared with self‐glucose monitoring in adolescent patients with type 1 diabetes. Implication for practice There is no evidence that suggests continuous glucose‐monitoring is the best method of glycemic control for adolescents on an insulin pump. Implication for research Further research needs to be considered in regard to continuous glucose‐monitoring effectives in the adolescent population, specifically a well‐designed study with larger sample size and particular attention to age as well as time from diagnosis.