Abstract
OBJECTIVES: The objective of this systematic review and meta-analysis was to synthesize evidence from randomized controlled trials (RCTs) evaluating the use of continuous glucose monitoring (CGM) to guide lifestyle choices, particularly nutrition, in the management of T2D. METHODS: PubMed and Cochrane CENTRAL were searched from inception to June 6, 2025. Randomized controlled trials were included if their intervention involved the use of a CGM device and education or feedback intended to modify nutrition choices, either as part of a nutrition intervention or a multicomponent lifestyle intervention. Random-effects meta-analyses were performed, and certainty of evidence was rated in alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: A total of 21 RCTs involving 2734 adults in groups of interest were included, with 20 RCTs eligible for meta-analysis. Results from meta-analysis showed statistically significant improvements in HbA1c (MD: -0.46%, 95% CI: -0.71, -0.22), time in range (TIR) 70-180 mg/dL (MD: 7.18%, 95% CI: 2.77, 11.58), time above range (TAR) >180 mg/dL (MD: -7.32%, 95% CI: -12.98, -1.66), fasting glucose (MD: -7.86 mg/dL, 95% CI: -15.06, -0.65), body weight (MD: -2.06 kg, 95% CI: -3.74, -0.38), with moderate certainty of evidence, and for mean CGM glucose (MD: -11.57 mg/dL, 95% CI: -22.58, -0.56), and standard deviation (SD) glucose (MD: -4.06 mg/dL, 95% CI: -6.54, -1.58), with low certainty of evidence. No statistically significant differences were found for other outcomes, typically with low certainty of evidence. CONCLUSIONS: Findings from this systematic review and meta-analysis support the use of CGM as a tool to guide lifestyle choices with a focus on nutrition in the management of T2D, with significant benefits related to glycemia and body weight.