Background: Real-time continuous glucose monitors (rtCGM) are associated with improved type 1 diabetes (T1D) management and quality of life but little is known on their impact on fear of hypoglycemia (FOH) . This review and meta-analysis assessed the impact of rtCGM on FOH in T1D.
Methods: Studies assessing FOH in non-pregnant adults with T1D using rtCGM compared to capillary blood glucose (CBG) or intermittently scanned CGM (isCGM) were included. Results from RCTs were pooled using a random-effects model to calculate the standardized mean difference (SMD) with 95% CI.
Results: We identified 14 original studies, with 2590 participants and lasting 8 to 26 weeks for RCTs and 16 to 52 weeks for observational studies. Ten RCTs were included in the meta-analysis. A clear trend was observed that rtCGM was associated with lower FOH (mean difference (MD) = -3.44, 95%CI [-4.02, -2.85]) with the effect size showing a significant moderate association between rtCGM and FOH reduction compared to controls (SMD= -0.52, 95%CI [-1.02, -0.02], I2= 92%) (Figure) . Observational studies (n= 4) showed a significant association between rtCGM use and lower FOH (MD = -4.10, 95%CI [-4.84, -3.36]) .
Conclusions: Compared to both isCGM and CBG; rtCGM use shows a moderate trend for lower FOH in medium-term RCTs, which was further supported by results from longer observational studies.
M.K.Talbo: None. A.Katz: None. T.Peters: None. J.Yale: Advisory Panel; Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk Canada Inc., Sanofi, Research Support; Bayer AG, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Bayer AG, Dexcom, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi. Z.Wu: Other Relationship; Eli Lilly and Company. A.Brazeau: Research Support; Eli Lilly and Company, Novo Nordisk, Sanofi.