Continuous Glucose Monitoring in Non-ICU Hospitalized Adults with Type 2 Diabetes: A Systematic Review.

Background

Continuous glucose monitoring (CGM) may overcome the limitations of intermittent point-of-care (POC) testing by providing real-time glucose trends and reducing treatment delays. This study aimed to evaluate the efficacy of CGM versus POC capillary testing in improving glycemic control among hospitalized non-Intensive Care Unit (non-ICU) adults with type 2 diabetes mellitus (T2DM).

Methods

We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed for randomized controlled trials published in English or Spanish that compared CGM with POC testing in hospitalized non-ICU adults ≥ 18 years old with T2DM and assessed risk of bias using the Cochrane RoB2 tool. The primary outcome was time in range (TIR). Secondary outcomes included time below range (TBR), time above range (TAR), mean glucose (MG), and glycemic variability (GV).

Results

Seven randomized controlled trials (RCTs) including 1106 patients were analyzed. CGM significantly improved TIR (mean difference [MD] +8.15%; 95% confidence interval [CI]: +5.76, +10.55; p < 0.001) and reduced TAR > 180 mg/dL (MD -7.11%; 95% CI: -9.43, -4.78; p < 0.001) and TAR > 250 mg/dL (MD -3.96%; 95% CI: -5.29, -2.62; p < 0.001) compared with POC testing. MG also decreased with CGM (MD -11.27 mg/dL; 95% CI: -14.74, -7.81; p < 0.001). A modest reduction in TBR <70 mg/dL was observed (MD -0.29%; p < 0.001), whereas no significant differences were found for TBR < 54 mg/dL or GV.

Conclusions

CGM improves inpatient glycemic control in non-ICU adults with type 2 diabetes, demonstrating advantages over POC testing across multiple randomized trials. However, further multicenter research is needed to clarify workflow implications, cost-effectiveness, and optimal implementation strategies.