Type of publication:
Conference abstract
Author(s):
*Nayak D.; *Williams K.; Iqbal N.; *Sathiaraj S.; *Jha N.;
Citation:
Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 241), 2025. Date of Publication: 01 Jun 2025.
Abstract:
Introduction: Meta-Analysis to address and bridge the gap in current NHS Guidelines on the Use of Continuous Glucose Monitors (CGM) in Type 1 and Type 2 Diabetes with Significant Retinopathy The current NHS England guidelines allow the use of CGM for patients with Type 1 diabetes who meet certain criteria such as: Frequent episodes of severe hypoglycaemia or hypoglycaemia unawareness. Frequent hospital admissions for hypoglycaemia. Pregnant women with Type 1 diabetes. Children and young people with Type 1 diabetes who may benefit from continuous monitoring. Type 2 diabetes patients may also be eligible for CGM, particularly those who have difficulty managing their blood glucose or are on insulin therapy, though this may require a referral to a specialist. Method(s): This meta-analysis includes randomised controlled trials (RCTs), cohort studies, and observational studies from 2015 to 2023 involving T1DM and T2DM patients with significant retinopathy. A total of 12 studies were selected, with sample of 1200 participants (600 T1DM and 600 T2DM). Data focused on three key outcome measures: Visual outcomes: Retinopathy progression and visual acuity changes. Glycaemic control: HbA1c levels, time in range, glucose variability. Lifestyle changes: Dietary adherence, physical activity, and quality of life Inclusion Criteria Adults with T1DM or T2DM and significant retinopathy as determined by ophthalmological examination. CGM use as part of diabetes management. Result(s): The studies included a mix of RCTs (5 studies) and cohort studies (7 studies), totalling 1200 participants, with an average age of 58 years and diabetes duration of 15 years. The mean baseline HbA1c across studies was 8.3%. Retinopathy Progression: CGM was associated with a 30% reduction in the risk of retinopathy progression compared to conventional blood glucose monitoring (p =0.02). This reduction was particularly significant in patients with moderate to severe retinopathy, supporting previous findings from the Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS), which demonstrated that tight glycaemic control slows retinopathy progression in T1DM and T2DM patients (DCCT Research Group, 1993; UKPDS Group, 1998). Visual Acuity: Those with HbA1c levels below 7% showed a trend toward stabilization or slight improvement in visual acuity (p =0.08), suggesting that effective glycaemic management through CGM may help preserve vision in individuals with DR (Wong et al., 2016). Retinal Imaging: Retinal imaging revealed improvements in retinal microvascular health in 18% of CGM users, compared to only 8% in the control group (p =0.05), supporting the hypothesis that tighter glucose control helps prevent further retinal damage (Simo et al., 2014). Glycaemic Control: HbA1c: The use of CGM resulted in a significant reduction in HbA1c (mean reduction of 0.9%), improving glycaemic control (Heinemann et al., 2015). Time in Range: CGM users spent 71% of the day within the target glucose range (70-180 mg/dL) compared to 55% in the control group (p < 0.001), aligning with findings from other studies indicating that CGM increases time in target range and reduces glucose variability (Bergenstal et al., 2018). Glucose Variability: CGM users showed a 14% reduction in glucose variability (measured by standard deviation), highlighting the role of CGM in minimizing glycaemic fluctuations (p =0.03)(Rodriguez et al., 2017). Lifestyle Changes: Dietary Habits: Patients using CGM reported better dietary adherence, with 65% following recommended dietary guidelines, compared to 52% in the control group (p =0.01). This is consistent with evidence that CGM promotes better diabetes self-management by providing real-time feedback on the effects of food on blood glucose levels (Vigersky et al., 2012). Physical Activity: CGM users increased their weekly physical activity by 22%, compared to 12% in those using SMBG (p =0.04). Quality of Life: Patients using CGM reported improved quality of life, including reduced anxiety about hypoglycaemia and better diabetes management (p =0.03), supporting findings that CGM can positively impact mental well-being (Bergenstal et al., 2018). Conclusion(s): The meta-analysis suggests extended CGM use, ophthalmologist collaboration and patient education.
DOI: 10.1038/s41433-025-03831-0
