Literature Synthesis for Proposed Intervention

Literature Synthesis
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Introduction
A continuous glucose-monitoring IoT is an intelligent system gadget that assists people with diabetes conditions to seamlessly monitor the glucose levels in their blood by taking readings at randomized intervals, such as every five minutes, and transferring the data to an app where the user may access it. Medical physicians and caregivers may keep a careful eye on their patients' health with this technique. Doctors can monitor their patients' glucose levels and propose exercise, and, if necessary, medication and conduct analyses. Continuous glucose monitoring (CGM) gives the patient constant access to blood sugar readings, whether throughout the day or night. In addition, it provides information on glucose movements and speeds up the process of supplying patients with additional information to control their diabetes conditions. Without diabetes, the body systems can continuously monitor glucose levels throughout to ensure that the proper amount of insulin is created appropriately, and a CGM operates in the same way. Monitoring the glucose levels in tissue fluids using CGM relies on a glucose sensor, which is a small electrode, is implanted beneath an individual's skin (Polonsky et al., 2017). The majority of the time, it is worn in the abdomen. A needle and a sticky material that functions as an adhesive are used to implant the glucose sensor, which should be changed with a fresh sensor after a few days. The sensor is linked to a transmitter that provides data to a display device through a wireless radiofrequency. The individual will be able to see present and historical glucose level patterns, thanks to the monitor. It can alert a person before their glucose levels reach dangerously high or low levels, as well as if their levels abruptly fall or rise (Polonsky et al., 2017). 
This literature synthesis focuses on the literature identified on CGM, their significance to this DPI intervention (GCM in T1DM patients), and how it may help develop the identified DPI. The studies were collected from various databases, and they all had to meet the criteria of being specific to T1DM management. 
Problem Statement
In adult patients with type 1 diabetes mellitus (T1DM), what is the impact of continuous glucose monitoring (CGM), in comparison to standard self-monitoring of blood glucose (SMBG) levels in reducing hypoglycemic events, enhancing glycemic control, minimizing avoidable hospital readmissions or admissions, and supporting value/cost-effectiveness?
Literature Synthesis
According to Polonsky et al. (2017), Continuous Glucose Monitoring improves diabetes-specific QUALITY OF LIFE (for instance, hypoglycemic confidence and diabetic distress) in persons with T1DM, but the QUALITY OF LIFE measures are not unique to diabetes (such as the health status and well-being of the patients). The majority of QUALITY OF LIFE outcomes were linked to CGM satisfaction but not glycemic results. In 158 persons with poorly managed T1DM, the researchers used a randomized trial of Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) to compare CGM to self-monitoring of blood glucose (SMBG). Participants performed QUALITY OF LIFE measures to assess their overall well-being (WHO-5), diabetic distress (DDS), health status (EQ-5D-5L), hypoglycemic confidence (HCS), and hypoglycemic dread (worry subscale) after the study. They also filled out the CGM Customer Satisfaction Survey. Treatment group variations in QUALITY OF LIFE outcomes over time were compared using linear regression analysis. Finally, the researchers looked at the relationship between CGM satisfaction and changes in QUALITY OF LIFE and glycemic control indices. The study will help in explaining the relationship between CGM and SMBG in patients with T1DM.
The study by Feig et al. (2017) also indicated that improved newborn outcomes are linked to CGM use during pregnancy in type 1 diabetic patients, which is likely due to lower maternal hyperglycemia exposure. Therefore, all pregnant women with type 1 diabetes on intense insulin therapy should be offered CGM. This is the first study to suggest that using a CGM can improve non-glycemic health outcomes. Women between 18 and 40 years living with type 1 diabetes for at least one year and undergoing rigorous insulin therapy were recruited for the randomized controlled trial. Participants were either expectant or planning to become expectant at the time of the study. The researchers conducted two trials that ran in tandem; one for pregnant women and one for women planning to become pregnant. In both trials, the study participants were randomly allocated to either CGM with capillary glucose monitoring or capillary glucose monitoring. Insulin administration and baseline glycated hemoglobin were used to stratify the randomization (HbA1c). The study indicates the essence of CGM in pregnant women.
In a study by De Salvo et al. (2018), it is stated that regardless of insulin administration method, pediatric CGM use rose in both registries and was related with reduced mean HbA1c. In 2011, 29,007 people in the registry were 18 years old and had T1D for a year. In 2016, 29,150 people in the registry were 18 years old and had T1D for a year. Medical records were used to acquire demographic information, CGM usage, and hemoglobin A1c (HbA1c). This study will help compare the effects of insulin administration upon experiencing complications and compare it to CGM.
Kristensen et al. (2019) reported that an increase in the risks of LGA and NCO was linked to shorter time in the target range, higher mean glucose levels, and greater standard deviation. Despite using a CGM throughout the pregnancy period, daily glucose control performance was still low, and the rate of LGA recorded was significantly higher than expected. Within Sweden, the researchers studied 186 expectant patients experiencing type 1 diabetes in a cohort observational study. S.D., mean glucose, time spent in the target range, CV percentage, high and low blood glucose indices, and mean amplitude of glucose excursions were calculated using interstitial glucose measurements from 92 different CGM devices running in real-time and 94 others under intermittent observation. This study will help to affirm the essence of CGM in pregnant T1DM patients.
Raviteja et al. (2019) conducted a study to evaluate the professional CGM's therapeutic usefulness in improving glycemic control in infants with type 1 diabetes. They discovered that P-CGM might be beneficial in specific groups of T1DM patients. In infants with T1DM, including those who register high HbA1c, adding intermittent p-CGM to daily SMBG may help comprehend continuous glucose changes over days and guide treatment modulation. P-CGM is safe for use in children as young as two years. This study affirms the inclusion of CGM in every aspect of treating T1Dm patients.
Palese et al. (2016) state that from the first drop of blood that oozes out of a patient's clean hands, the emergency nurses can complete the test faster, resulting in faster results. The findings suggest that the first drop of blood is sufficient for medical decision-making in the clinical setting. However, clinicians must exercise caution when using protocols that require small values, as the first drop is more likely to register considerably low values. In addition, the study confirms the inefficiencies of the other glucose monitoring methods. Therefore, it is essential to develop a comparative analysis for this DPI intervention.
According to Baron et al. (2015), the breadth of information gathered in this study allows for a thorough examination of procedures and outcomes. According to the preliminary findings, MTH usage diminishes over time, and the participants would benefit from attending several training sessions. The researchers utilized a mixed-methods approach that included a 9-month, two-arm, parallel RCT, and exit semi-structured interviewing methods. In the beginning, three months, and nine months, quantitative data was collected. Participants' MTH transmissions and contacts with the MTH nurse during the study were also documented as additional intervention fidelity data. This observational study is also essential in comparative analysis for the DPI project.
Battelino et al. (2015) also found that conti...