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Time in Range for Multiple Technologies in Type 1 Diabetes: A Systematic Review and Network Meta-analysis

机译：1型糖尿病患者的多种技术的时间范围：系统审查和网络元分析

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BACKGROUND Time in range is a key glycemic metric, and comparisons of management technologies for this outcome are critical to guide device selection. PURPOSE We conducted a systematic review and network meta-analysis to compare and rank technologies for time in glycemic ranges. DATA SOURCES We searched Evidenced-Based Medicine Reviews, CINAHL, Embase, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PROSPERO, PsycInfo, PubMed, and Web of Science until 24 April 2019. STUDY SELECTION We included randomized controlled trials >= 2 weeks' duration comparing technologies for management of type 1 diabetes in adults (>= 18 years of age), excluding pregnant women. DATA EXTRACTION Data were extracted using a predefined template. Outcomes were percent time with sensor glucose levels 3.9-10.0 mmol/L (70-180 mg/dL), >10.0 mmol/L (180 mg/dL), and <3.9 mmol/L (70 mg/dL). DATA SYNTHESIS We identified 16,772 publications, of which 14 eligible studies compared eight technologies comprising 1,043 participants. Closed-loop systems led to greater percent time in range than any other management strategy, and mean percent time in range was 17.85 (95% predictive interval 7.56-28.14) longer than with usual care of multiple daily injections with capillary glucose testing. Closed-loop systems ranked best for percent time in range or above range with use of Surface Under the Cumulative RAnking curve (SUCRA) (98.5% and 93.5%, respectively). Closed-loop systems also ranked highly for time below range (SUCRA 62.2%). LIMITATIONS Overall risk of bias ratings were moderate for all outcomes. Certainty of evidence was very low. CONCLUSIONS In the first integrated comparison of multiple management strategies considering time in range, we found that the efficacy of closed-loop systems appeared better than all other approaches.
机译：背景技术范围内是一个关键的血糖度量，并且对此结果的管理技术的比较对于指导设备选择至关重要。目的，我们进行了系统审查和网络元分析，以比较和排名在血糖范围内的时间。数据来源我们搜索了基于证明的医学评论，CINAHL，EMBASE，MEDLINE，MEDLINE和其他非索引引文，PROSPERO，PSYCINFO，PURCHINGO和Science Web，直到2019年4月24日。学习选择我们包括随机对照试验> = 2周龄持续时间比较成人1型糖尿病患者的技术（> = 18岁），不包括孕妇。使用预定义模板提取数据提取数据。结果是百分比，传感器血糖水平3.9-10.0mmol / L（70-180mg / dl），> 10.0mmol / L（180mg / dl）和<3.9mmol / L（70mg / d1）。数据综合我们确定了16,772个出版物，其中14项合格研究比较了包括1,043名参与者的八种技术。闭环系统的范围比任何其他管理策略更大的时间百分比，平均值范围为17.85（95％预测间隔7.56-28.14），而不是通常护理毛细血管葡萄糖测试。闭环系统在累积排名曲线（SUCRA）下使用表面（分别为98.5％和93.5％），在范围内或高于范围内排名最佳。闭环系统也在高度范围内排名（Sucra 62.2％）。限制偏差额定值的总体风险适中，适合所有结果。证据的确定性非常低。结论在考虑范围内的多种管理策略的第一次综合比较中，我们发现闭环系统的功效比所有其他方法更好。

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