Impact of real-time continuous glucose monitoring on glycaemic control in adults with type 2 diabetes: systematic review and meta-analysis

Abstract

Objective: To evaluate the effectiveness of real-time continuous glucose monitoring compared with self-monitoring of blood glucose in adults with type 2 diabetes, focusing on glycaemic control, cardiometabolic outcomes, and patient-centred measures. Methods: Randomised controlled trials published in English with study intervention period ≥12 weeks, which compared real-time continuous glucose monitoring with self-monitoring of blood glucose in adults with type 2 diabetes were included in this systematic review. Analyses were conducted using Review Manager version 9.6. Risk of bias was evaluated using the Cochrane risk-of-bias tool. The Grading of Recommendations Assessment, Development and Evaluations approach was used to assess certainty of evidence. Data Sources: The search was conducted across PubMed, CINAHL, Web of Science, the Cochrane Library databases and ClinicalTrials.gov from inception to July 2025. Results: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eleven studies which compared real-time continuous glucose monitoring (n=437) with self-monitoring of blood glucose (n=352) were included. Real-time continuous glucose monitoring use was associated with a significant reduction in HbA1c (mean difference=−0.20%), improved time-in-range (mean difference=7.41%), reduced time-above-range (mean difference=6.93%) and reduced time-below-range (mean difference=0.26%). Glucose variability was significantly lower (mean difference=-1.06%) and users demonstrated greater improvements in readiness for diabetes self-management (standardised mean difference=0.69). No significant differences were observed in cardiometabolic or psychosocial outcomes. Conclusion: Real-time continuous glucose monitoring improves glycaemic control and self-management capacity compared with self-monitoring of blood glucose in adults with type 2 diabetes. These findings support the integration of real-time continuous glucose monitoring into routine clinical care, particularly for individuals requiring intensive glucose monitoring and tailored self-care support. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42025625444.