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 through December 2024. RCTs and non-randomized comparative studies were included.
Risk of bias was assessed using RoB-2 and ROBINS-I tools. Meta-analyses used random-effects models. Evidence certainty was evaluated using GRADE.
Results: Fourteen studies (1,847 participants) met inclusion criteria. CGM-guided interventions significantly reduced T2DM progression (RR 0.58, 95% CI 0.42–0.80; I²=38%; moderate certainty), representing 42% relative risk reduction. HbA1c showed modest reduction (MD
−0.21%, 95% CI −0.32 to −0.10). Body weight reduction was greater in CGM groups (MD
−2.34 kg, 95% CI −3.45 to −1.23). Time in range increased by 8.4% with reduced glycemic variability.
Conclusion: Moderate-certainty evidence suggests CGM-guided behavioral interventions reduce T2DM progression by approximately 42% in adults with prediabetes and obesity, with clinically meaningful improvements in glycemic control and body weight.