Association Between Continuous Glucose Monitoring - Derived Time in Range and Diabetic Kidney Disease: A Systematic Review and Meta-Analysis of current evidence

BackgroundContinuous glucose monitoring-derived time in range (TIR; glucose 70-180 mg/dL) has emerged as a complementary glycemic metric, but its association with DKD (Diabetic Kidney Disease) has not been systematically quantified. We aimed to synthesize the evidence on the association between CGM-derived TIR and DKD in adults with type 1 or type 2 diabetes by conducting a systematic review and meta-analysis of the current evidence. MethodsThis systematic review and meta-analysis adhered to PRISMA guidelines. PubMed, Embase, Cochrane CENTRAL, and Scopus were searched through March, 2026. Eligible studies were studies in adults with type 1 and type 2 diabetes that reported an association between CGM-derived TIR and any DKD outcome (albuminuria, eGFR decline, or composite nephropathy) with a quantifiable per-unit effect estimate. Random-effects meta-analysis (REML with Knapp-Hartung adjustment) pooled odds ratios per 10% TIR increment. Risk of bias was assessed using ROBINS-E and certainty of evidence using the GRADE framework. PROSPERO: CRD420261377763. ResultsEleven studies (n = 7,182; seven T2D, four T1D; ten cross-sectional, one retrospective cohort) were included. The pooled OR per 10% TIR was 0.89 (95% CI 0.84-0.95; P = 0.002; I{superscript 2} = 69.6%), and every leave-one-out iteration preserved significance (OR range 0.88-0.91; all P [≤] 0.005). In the four studies adjusting for HbA1c, the association persisted (OR 0.91, 0.86-0.97; P = 0.015) with no detectable residual heterogeneity (I{superscript 2} = 0%), indicating the signal is not fully attributable to average glycemia. ConclusionsHigher CGM-derived TIR may be associated with lower odds of DKD (OR 0.89 per 10% increment). The HbA1c-adjusted subgroup (k = 4; I{superscript 2} = 0%) provided the most internally consistent signal, though its small size limits inference. Prospective studies with standardized CGM protocols and pre-specified hard kidney endpoints are needed to establish causality.