Comparison of continuous glucose monitoring to reference standard oral glucose tolerance test for the detection of dysglycemia in cystic Fibrosis: A systematic review

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM
Shanal Kumar , Michael Pallin , Georgia Soldatos , Helena Teede
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引用次数: 2

Abstract

Aims

Increasing evidence for benefit of early detection of cystic fibrosis related diabetes (CFRD) coupled with limitations of current diagnostic investigations has led to interest and utilisation of continuous glucose monitoring (CGM). We conducted a systematic review to assess current evidence on CGM compared to reference standard oral glucose tolerance test for the detection of dysglycemia in people with cystic fibrosis without confirmed diabetes.

Methods

MEDLINE, Embase, CENTRAL, Evidence-Based Medicine Reviews, grey literature and six relevant journals were searched for studies published after year 2000. Studies reporting contemporaneous CGM metrics and oral glucose tolerance test results were included. Outcomes on oral glucose tolerance tests were categorised into a) normal, b) abnormal (indeterminate and impaired) or c) diabetic as defined by American Diabetes Association criteria. CGM outcomes were defined as hyperglycemia (≥1 peak sensor glucose ≥ 200 mg/dL), dysglycemia (≥1 peak sensor glucose ≥ 140–199 mg/dL) or normoglycemia (all sensor glucose peaks < 140 mg/dL). CGM hyperglycemia in people with normal or abnormal glucose tolerances was used to define an arbitrary CGM-diagnosis of diabetes. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias. Primary outcome was relative risk of an arbitrary CGM-diagnosis of diabetes compared to the oral glucose tolerance test.

Results

We identified 1277 publications, of which 19 studies were eligible comprising total of 416 individuals with contemporaneous CGM and oral glucose tolerance test results. Relative risk of an arbitrary CGM-diagnosis of diabetes compared to oral glucose tolerance test was 2.92. Studies analysed were highly heterogenous, prone to bias and inadequately assessed longitudinal associations between CGM and relevant disease-specific sequela.

Conclusions

A single reading > 200 mg/dL on CGM is not appropriate for the diagnosis of CFRD. Prospective studies correlating CGM metrics to disease-specific outcomes are needed to determine appropriate cut-points.

Abstract Image

Abstract Image

连续血糖监测与参考标准口服糖耐量试验检测囊性纤维化患者血糖异常的比较:系统综述
越来越多的证据表明,早期发现囊性纤维化相关糖尿病(CFRD)是有益的,加上当前诊断调查的局限性,导致了对连续血糖监测(CGM)的兴趣和利用。我们进行了一项系统综述,以评估CGM与参考标准口服葡萄糖耐量试验在未确诊糖尿病的囊性纤维化患者中检测血糖异常的现有证据。方法检索medline、Embase、CENTRAL、循证医学评论、灰色文献和6种相关期刊2000年以后发表的研究。包括报告同期CGM指标和口服葡萄糖耐量试验结果的研究。根据美国糖尿病协会的标准,口服葡萄糖耐量试验的结果分为a)正常,b)异常(不确定和受损)或c)糖尿病。CGM结果被定义为高血糖(≥1个传感器血糖峰值≥200 mg/dL)、血糖异常(≥1个传感器血糖峰值≥140-199 mg/dL)或血糖正常(所有传感器血糖峰值<140 mg / dL)。葡萄糖耐量正常或异常的人的CGM高血糖被用来定义糖尿病的任意CGM诊断。使用诊断准确性研究质量评估工具评估偏倚风险。主要结局是与口服葡萄糖耐量试验相比,任意cgm诊断糖尿病的相对风险。结果:我们确定了1277篇出版物,其中19项研究符合条件,共包括416名同时具有CGM和口服葡萄糖耐量试验结果的个体。与口服糖耐量试验相比,任意cgm诊断糖尿病的相对风险为2.92。所分析的研究具有高度异质性,容易产生偏倚,且对CGM与相关疾病特异性后遗症之间的纵向关联评估不充分。结论:单读>CGM上200 mg/dL不适合诊断CFRD。需要将CGM指标与疾病特异性结果相关联的前瞻性研究来确定适当的切入点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.10
自引率
0.00%
发文量
24
审稿时长
16 weeks
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