Abstract
Type 2 diabetes (T2D) requires rigorous glycemic control to prevent complications, but traditional self-monitoring of blood glucose (SMBG) offers limited insights. Real-time continuous glucose monitoring (RT-CGM) provides dynamic data to optimize management, although its efficacy in T2D remains debated. This systematic review synthesizes evidence from randomized controlled trials (RCTs) to evaluate RT-CGM's impact on glycemic outcomes in adults with T2D. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched PubMed, Scopus, Web of Science, and ClinicalTrials.gov (2015-2025) for RCTs comparing RT-CGM to SMBG/usual care in non-pregnant adults with T2D. Eleven studies met the inclusion criteria. Data were extracted for HbA1c, time in range (TIR), hypoglycemia, and safety. Risk of bias was assessed using Cochrane RoB 2. RT-CGM significantly improved TIR and reduced HbA1c in insulin-treated patients, although benefits varied by intervention frequency and patient subgroup. Episodic use required multiple sessions for sustained HbA1c reduction. Non-insulin-treated cohorts saw smaller HbA1c changes but improved glycemic variability. Treatment satisfaction was consistently higher with RT-CGM. Safety profiles were favorable, with no severe device-related adverse events. RT-CGM enhances glycemic control in T2D, particularly for insulin-treated patients, with structured use yielding the greatest benefits. Clinicians should prioritize individualized protocols and patient education. Future research should address long-term efficacy and cost-effectiveness.