Abstract

Background: The Middle East and North Africa (MENA) region faces a severe cardiometabolic burden, prompting primary care networks to integrate digital health solutions. This systematic review and meta-analysis evaluates the real-world effectiveness of continuous glucose monitoring (CGM) and wearable biosensors versus standard care for adult Type 2 Diabetes Mellitus (T2DM) management in Middle Eastern primary care settings, incorporating a revised, strictly filtered data pool.
Methods: A PRISMA-compliant systematic search was executed across PubMed, Embase, Scopus, and the Saudi Digital Library for literature published between January 2020 and May 2026. The study protocol was prospectively registered on the Open Science Framework (OSF) registries (osf.io/uf39m). Eligible primary studies included clinical cohorts and trials evaluating adult T2DM patients managed with continuous biosensors in regional ambulatory settings. Secondary review and consensus documents were restricted to narrative synthesis. Quantitative pooling utilized a random-effects inverse-variance model restricted to original clinical data.
Results: Two primary clinical data sources encompassing a pooled sample of n = 1,440 patients were eligible for quantitative synthesis, supplemented by secondary regional consensus and review registries. In a large multi-center institutional registry (n = 1,252), intermittently scanned CGM (isCGM) integration demonstrated an absolute mean reduction in HbA1c of -1.47% at 6 months (p < 0.0001) and -1.85% at 12 months. However, in a smaller controlled cohort (n = 188), the between-group mean difference at 6 months was modest and statistically non-significant (-0.53%, 95% CI: [-1.12, 0.06]) due to rapid treatment intensification within the standard care branch. Pooled random-effects synthesis across primary clinical lines demonstrated a trend favoring CGM, though marked by substantial statistical heterogeneity (I2 = 74.3%, p = 0.003). Within-group tracking showed a reduction in emergency events, but these metrics lack control for regression to the mean. Narrative analysis identified critical regional compliance barriers (41% to 46% adherence declines) linked to a lack of cultural tailoring during Ramadan fasting and financial reimbursement bottlenecks.
Conclusion: The deployment of CGM technologies in Middle Eastern primary care settings supports glycemic optimization, particularly in poorly controlled baseline cohorts. However, the current evidence base is limited by observational designs and statistical heterogeneity. Widespread implementation requires culturally tailored algorithms and robust public reimbursement frameworks.

Key words: Continuous Glucose Monitoring, Wearable Biosensors, Type 2 Diabetes, Primary Health Care, Middle East, Telemedicine.