Impact of Continuous Glucose Monitoring–Guided Behavioral Interventions on Progression to Type 2 Diabetes in Individuals with Prediabetes and Obesity: A Systematic Review and Meta-Analysis
Nawinda Vanichakulthada*, Pornthip Waiwut, Sunaree Pitchaiprasert, Chutima Samhugkanee, Sumalee Hantragool, Rasintra Jaroenying and Chuleeporn Jaruthamsophon
ABSTRACT
Background: Prediabetes and obesity substantially increase the risk of progression to type 2 diabetes mellitus (T2DM). Continuous glucose monitoring (CGM) may enhance behavioral change through real-time glycemic feedback, but its effectiveness in preventing T2DM progression has not been systematically evaluated.
Objectives: To evaluate the effectiveness of CGM-guided behavioral interventions on preventing progression to T2DM and improving metabolic outcomes in adults with prediabetes and obesity.
Methods: We searched MEDLINE, Embase, CENTRAL, PubMed, Scopus, and Science Citation Index from inception to December 2024. Randomized controlled trials (RCTs) and non-randomized comparative studies were included. Risk of bias was assessed using RoB-2 and ROBINS-I tools. Meta-analyses were performed using random-effects models. Certainty of evidence was evaluated using GRADE.
Results: We identified 2,885 records, of which 14 studies (1,847 participants) met inclusion criteria. Nine RCTs and five non-randomized studies were included. CGM-guided interventions significantly reduced progression to T2DM compared to control (RR 0.58, 95% CI 0.42–0.80; I² = 38%; moderate certainty), corresponding to a 42% relative risk reduction. For HbA1c, CGM-guided interventions showed a modest reduction (MD −0.21%, 95% CI −0.32 to −0.10; I² = 62%). Body weight reduction was greater in the CGM group (MD −2.34 kg, 95% CI −3.45 to −1.23). CGM-guided interventions also increased time in range (MD 8.4%, 95% CI 5.2–11.6) and reduced glycemic variability. The most common adverse event was local skin reactions at sensor sites.
Conclusions: Moderate-certainty evidence suggests that CGM-guided behavioral interventions probably reduce progression to T2DM by approximately 42% in adults with prediabetes and obesity. These interventions are associated with clinically meaningful improvements in glycemic control, body weight, and CGM-derived metrics. CGM-guided interventions represent a promising strategy for diabetes prevention, though further high-quality RCTs with longer follow-up are needed to confirm these findings.
PROSPERO Registration: CRD420251266604
