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Time in Range for Multiple Technologies in Type 1 Diabetes: A Systematic Review and Network Meta-analysis
Anthony Pease1,2, Clement Lo1,2, Arul Earnest1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Diabetes Care
|July 17, 2020
Summary
Closed-loop systems significantly improve time in glucose range for type 1 diabetes management compared to other technologies. This systematic review highlights their superior efficacy in glycemic control.
Area of Science:
- Endocrinology and Metabolic Diseases
- Biomedical Engineering
- Clinical Trial Analysis
Background:
- Time in range (TIR) is a crucial metric for assessing glycemic control in diabetes management.
- Comparing different diabetes management technologies is essential for guiding effective device selection.
Purpose of the Study:
- To conduct a systematic review and network meta-analysis comparing and ranking various diabetes management technologies based on TIR.
- To provide evidence-based insights for selecting optimal diabetes management devices.
Main Methods:
- Systematic literature search across multiple databases (e.g., MEDLINE, Embase, Web of Science) up to April 2019.
- Inclusion of randomized controlled trials (RCTs) of ≥2 weeks duration in adults with type 1 diabetes.
- Extraction of data on percent time in specific glucose ranges (3.9-10.0 mmol/L, >10.0 mmol/L, <3.9 mmol/L).
Main Results:
- 14 eligible RCTs with 1,043 participants compared eight different diabetes management technologies.
- Closed-loop systems demonstrated superior performance, achieving significantly greater percent time in range compared to usual care.
- Surface Under the Cumulative Ranking curve (SUCRA) analysis indicated closed-loop systems ranked highest for time in range (98.5%) and time above range (93.5%).
Conclusions:
- Closed-loop systems appear to be the most effective approach for improving time in range among the evaluated diabetes management strategies.
- This study provides the first integrated comparison of multiple management strategies focusing on TIR, supporting the efficacy of closed-loop systems.
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