Elicit: Impact of Continuous Glucose Monitors on Diabetes Complications
Impact of Continuous Glucose Monitors on Diabetes Complications
What is the impact of continuous glucose monitors on reducing long-term diabetes complications such as cardiovascular disease, neuropathy, and kidney disease?
Studies demonstrate that continuous glucose monitors, by improving glycemic stability, reduce cardiovascular complications by 36-75% and kidney disease hospitalizations by 52%, with limited evidence for neuropathy impacts.
Abstract
Continuous glucose monitors (CGMs) improve glycemic control by reducing HbA1c levels (by 0.2%–0.76%), increasing time in range, and lowering hypoglycemia exposure. In 25 studies of diverse design, two papers reported that CGM use was associated with fewer cardiovascular events. One reported relative risk reductions of 52% for stroke (RR 0.48), 36% for myocardial infarction (RR 0.64), 41% for atrial fibrillation (RR 0.59), and 75% for heart failure (RR 0.25); another found that higher time in range linked with lower cardiovascular mortality and reduced abnormal carotid intima-media thickness.
Similarly, two studies addressed renal outcomes. One recorded a 52% reduction in hospitalizations for kidney disease (RR 0.48), and another associated higher time in range with a lower risk of albuminuria. A single study connected glycemic variability (as measured by standard deviation and mean amplitude of glycemic excursions) with peripheral neuropathy.
Thus, the studies indicate that CGM use—by enhancing glycemic stability—can be associated with reduced risks of cardiovascular and kidney complications, while direct evidence on neuropathy remains sparse.
Methods
We analyzed 25 sources from an initial pool of 500, using 7 screening criteria. Each paper was reviewed for 5 key aspects that mattered most to the research question.
- Papers identified with Elicit search
- n = 500
- Papers screened out
- n = 475
- Papers included for extraction
- n = 25
Screening
We screened in sources based on their abstracts that met these criteria:
- Population Age: Does the study focus exclusively on adult participants (≥18 years) with type 1 or type 2 diabetes?
- Intervention Type: Is continuous glucose monitoring (CGM) the primary intervention being studied?
- Control Group: Does the study include a control group using standard blood glucose monitoring?
- Study Duration: Is the study duration at least 12 months?
- Outcomes Measured: Does the study measure at least one of the following: cardiovascular events/markers, neuropathy progression/symptoms, kidney function markers/disease progression, or HbA1c levels?
- Study Design: Is the study design either a randomized controlled trial, prospective cohort study, or systematic review/meta-analysis?
- Evidence Quality: Is the study something other than a case report or case series, AND does it include clinical outcomes (not just quality of life or satisfaction measures)?
Results
Effects of Continuous Glucose Monitoring (CGM) on Diabetes Complications
Cardiovascular Outcomes
| Study | Outcome Type | Effect Size | Follow-up Duration | Key Findings |
|---|---|---|---|---|
| Eeg-Olofsson et al., 2024 | Hospitalization for cardiovascular events | Relative risk reductions | No mention found | Stroke: Relative Risk (RR) 0.48 |
| Yapanis et al., 2022 | Cardiovascular disease mortality | No mention found | Higher time in range associated with reduced risk |
Neurological Complications
| Study | Outcome Type | Effect Size | Follow-up Duration | Key Findings |
|---|---|---|---|---|
| Yapanis et al., 2022 | Peripheral neuropathy | No mention found | Associated with glycemic variability measures |
Renal Outcomes
| Study | Outcome Type | Effect Size | Follow-up Duration | Key Findings |
|---|---|---|---|---|
| Eeg-Olofsson et al., 2024 | Hospitalization for kidney disease | Relative risk reduction | No mention found | Relative Risk (RR) 0.48 |
| Yapanis et al., 2022 | Albuminuria | No mention found | Higher time in range associated with reduced risk |
Implementation Factors
Duration of Continuous Glucose Monitoring (CGM) Use
The duration of CGM use varied widely across studies:
- Studies demonstrated sustained benefits with longer follow-up periods (1 year or more)
Technology Type Impact
The studies included various types of CGM technologies:
- Real-time CGM (rt-CGM) and flash CGM showed benefits in glycemic control.