Comparing the glycaemic outcomes between real-time continuous glucose monitoring (rt-CGM) and intermittently scanned continuous glucose monitoring (isCGM) among adults and children with type 1 diabetes: A systematic review and meta-analysis of randomized controlled trials.

AIM: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the effectiveness of real-time continuous glucose monitoring (rtCGM) versus intermittently scanned continuous glucose monitoring (isCGM) on key glycaemic metrics (co-primary outcomes HbA1c and time-in-range [TIR] 70-180 mg/dL, 3.9-10.0 mmol/L) among people with type 1 diabetes (T1D). METHODS: Medline, PubMed, Scopus, Web of Science and Cochrane Central Register of clinical trials were searched. Inclusion criteria were RCTs; T1D populations of any age and insulin regimen; comparing any type of rtCGM with isCGM (only the first generation had been compared to date); and reporting the glycaemic outcomes. Glycaemic outcomes were extracted post-intervention and expressed as mean differences and 95% CIs between the two comparators. Results were pooled using a random-effect meta-analysis. The risk of bias was assessed using the Cochrane RoB2 tool. The quality of evidence was assessed by the GRADE approach. RESULTS: Five RCTs met the inclusion criteria (4 parallel and 1 crossover design; 4 with CGM use <8 weeks), involving 446 participants (354 adults; 92 children and adolescents). Overall, meta-analysis showed rtCGM compared to isCGM improved absolute TIR by +7.0% (95% CI: 5.8%-8.3%, I2 = 0%, p < 0.01) accompanied by a favorable effect on time-below-range <70 mg/dL (3.9 mmol/L) - 1.7% (95%CI: -3.0% to -0.4%; p = 0.03). No differences were seen regarding HbA1c. CONCLUSIONS: This meta-analysis highlights that for people with T1D, rtCGM confers benefits over isCGM primarily related to increased TIR, with improvements in hypo- and hyperglycaemia.

Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials.

AIMS: We aimed to conduct a systematic review and meta-analysis of randomised controlled clinical trials (RCTs) assessing separately and together the effect of the three distinct categories of continuous glucose monitoring (CGM) systems (adjunctive, non-adjunctive and intermittently-scanned CGM [isCGM]), compared with traditional capillary glucose monitoring, on HbA1c and CGM metrics. METHODS: PubMed, Web of Science, Scopus and Cochrane Central register of clinical trials were searched. Inclusion criteria were as follows: randomised controlled trials; participants with type 1 diabetes of any age and insulin regimen; investigating CGM and isCGM compared with traditional capillary glucose monitoring; and reporting glycaemic outcomes of HbA1c and/or time-in-range (TIR). Glycaemic outcomes were extracted post-intervention and expressed as mean differences and 95%CIs between treatment and comparator groups. Results were pooled using a random-effects meta-analysis. Risk of bias was assessed using the Cochrane Rob2 tool. RESULTS: This systematic review was conducted between January and April 2021; it included 22 RCTs (15 adjunctive, 5 non-adjunctive, and 2 isCGM)). The overall analysis of the pooled three categories showed a statistically significant absolute improvement in HbA1c percentage points (mean difference (95% CI): -0.22% [-0.31 to -0.14], I2  = 79%) for intervention compared with comparator and was strongest for adjunctive CGM (-0.26% [-0.36, -0.16]). Overall TIR (absolute change) increased by 5.4% (3.5 to 7.2), I2  = 71% for CGM intervention compared with comparator and was strongest with non-adjunctive CGM (6.0% [2.3, 9.7]). CONCLUSIONS: For individuals with T1D, use of CGM was beneficial for impacting glycaemic outcomes including HbA1c, TIR and time-below-range (TBR). Glycaemic improvement appeared greater for TIR for newer non-adjunctive CGM technology.

Bidirectional associations between sleep quality or quantity, and dietary intakes or eating behaviors in children 6-12 years old: a systematic review with evidence mapping.

CONTEXT: Although dietary advice has long been a cornerstone of a healthy lifestyle, how sleep quality and quantity may interact with dietary intake or eating behaviors remains unclear. OBJECTIVE: To consider a bidirectional relationship between sleep and diet in children aged 6-12 years via a systematic review following PRISMA guidelines. DATA SOURCES: Relevant trials and observational studies were identified by searching the PubMed, Medline, Embase, and CENTRAL databases up to June 1, 2019, without language or date restrictions and supplemented with hand searching. Recognized procedures and reporting standards were applied. DATA EXTRACTION: Data on participant characteristics, study parameters, diet measures, sleep measures, and findings of study quality assessment criteria were collected. DATA ANALYSIS: Forty-five articles involving 308 332 participants on a diverse range of topics were included. Meta-analyses were planned but were impossible to perform due to high study heterogeneity. Most studies (82%) were cross-sectional, which prevented examining directionality of the observed associations. Risk of bias was assessed for trial, cohort studies, and cross-sectional studies, using the Cochrane Risk of Bias Tool or Newcastle Ottawa Scale. RESULTS: Of 16 studies in which the effect of sleep on dietary intake was investigated, 81% (n = 13) reported a significant association. All studies (n = 8) of sugar-sweetened or caffeinated beverages reported a negative association with sleep, and in 6 of 7 studies in which eating behaviors were investigated, associations with sleep were reported. The use of objective measures of sleep and diet were scarce, with most trials and studies relying on subjective measures of sleep (68%) or diet (93%). CONCLUSION: Because most studies investigating the relationship between sleep and diet in this age group are cross-sectional, temporality could not be determined. Additional randomized controlled trials and long-term cohort studies in middle childhood, particularly those using objective rather than questionnaire measures of sleep, are required to better understand interactions between diet and sleep. SYSTEMATIC REVIEW REGISTRATION: Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).

Bidirectional associations between sleep and dietary intake in 0-5 year old children: A systematic review with evidence mapping.

We have undertaken a systematic review examining the role of diet on sleep, and sleep on diet, in children aged 0-5 y. Controlled trials and cohort or cross-sectional studies were identified with online searches of PubMed, Medline, Embase, Scopus, and CENTRAL up to 1 June 2019, and hand searching of relevant publications. Searches, extraction, and risk of bias assessments were undertaken independently by at least two researchers. Fifty articles involving 72,491 children on a diverse range of topics were eligible. All five studies that investigated the effect of sleep on diet indicated that poorer sleep (measured by a variety of indices) was associated with greater dietary energy intake or poorer diet quality. Conversely, the findings regarding how diet might influence sleep were less consistent when considering feeding practises, energy and macronutrient intake, or micronutrient and small metabolite intake. Studies were typically of short duration and relied on subjective measures of sleep (66%) or diet (88%). While we identified a clear relationship between reduced sleep and poorer diets, future studies require improved methodological reporting and support from transdisciplinary collaborations to better understand the possible role of diet on sleep. Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).

Create Our Own Kai: A Randomised Control Trial of a Cooking Intervention with Group Interview Insights into Adolescent Cooking Behaviours.

Cooking is frequently associated with a healthier diet, however few youth cooking intervention studies have used control groups or follow-ups. Additionally, although cooking is associated with better mental well-being among adolescents, this has not been examined experimentally. This randomised controlled trial investigated whether a five-day intensive holiday cooking program, followed by six weeks of weekly meal kits with Facebook support groups, affected the cooking-related outcomes, diet quality and mental well-being among adolescents, with a 12-month follow-up. Adolescents aged 12-15 years (intervention: n = 91, 60% female; control: n = 27, 78% female) completed baseline, post-intervention and 12-month follow-up anthropometric measures, and questionnaire measures of mental well-being, diet quality and cooking attitudes, self-efficacy and behaviours. The intervention group's post-intervention outcomes improved significantly more for mental well-being, diet quality, helping make dinner, cooking self-efficacy and positive cooking attitude, however body mass index (BMI) z-scores also increased. Differences were maintained at 12 months for self-efficacy only. Group interviews showed that participants' cooking behaviours were strongly influenced by family factors. Adolescent cooking interventions may have many short-term benefits, however cooking self-efficacy appears most responsive and stable over time. Effects on BMI need further investigation. Family factors influence whether and what adolescents cook post-intervention.