bims-glumda 2025-10-19 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–10–19
seventeen papers selected by
Mott Given

The role of continuous glucose monitoring in the diagnosis and management of gestational diabetes mellitus.
Continuous glucose monitoring in non-insulin-dependent type-2 diabetes - rationale for CGM-NIDDM study.
The Impact of Interfering Substances on Continuous Glucose Monitors: Part 2: Marketed CGM Designs, Labeled Interfering Substances, and Design Mitigations.
The Impact of Interfering Substances on Continuous Glucose Monitors: Part 4: Continuous Glucose Monitoring Interferents: In Vivo Performance, Clinical Implications and Future Standardization.
Continuous Glucose Monitoring With Linx™ Improves Glycemic Control and Satisfaction in Youth With Type 1 Diabetes: A Real-World Observational Study.
First-trimester continuous glucose monitoring parameters in preeclamptic and normotensive patients with type 1 diabetes.
Who is using continuous glucose monitoring for type 2 diabetes management? A scoping review protocol.
Patient Experience with Continuous Glucose Monitoring During Dialysis in Type 2 Diabetes: A Qualitative Study.
DIABASE: an automatically filled single-centre registry of diabetes mellitus in the Netherlands, combining clinical data with real-world longitudinal wearable device data-a study protocol.
Exploring the interaction between ethnicity, deprivation and the use of CGM on diabetes outcomes-A study from the Association of British Clinical Diabetologists.
The GMI/HbA1c ratio does not independently predict diabetic retinopathy in adults with Type 1 Diabetes.
Diabetes Technology Accessibility in Deaf and Hard of Hearing People With Diabetes.
Swiss Diabetes and Technology recommendations.
Insights into the effective use of the Smart MDI system: Data from the first 1852 type 1 diabetes users.
Analysis of glucose metabolism outcomes 4-7 years postpartum in women with gestational diabetes mellitus using continuous glucose monitoring maternal risk factors: a Chinese cohort study.
Exploring the Association of Sleep Profiles With Plasma Glycaemic Outcomes and 24-h Interstitial Glucose Levels in Adults With Prediabetes: Findings From Chrono-DM Study.
Analysis of the correlation between glycemic variability indices and disease severity as well as inflammatory status in patients with type 2 diabetes mellitus and periodontitis.

Best Pract Res Clin Endocrinol Metab. 2025 Oct 14. pii: S1521-690X(25)00093-4. [Epub ahead of print] 102060

The role of continuous glucose monitoring in the diagnosis and management of gestational diabetes mellitus.

Hui Wei Leow, Karen Forbes, Eleanor Scott.

  Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy, traditionally diagnosed using the oral glucose tolerance test (OGTT) and managed via self-monitoring of blood glucose (SMBG). However, both methods have limitations, including poor reproducibility, discomfort, and limited ability to detect glycaemic variability. Continuous glucose monitoring (CGM) offers a promising alternative by providing 24-hour glucose profiles and identifying glycaemic excursions missed by SMBG. CGM shows potential for early detection of subclinical dysglycaemia, improved diagnostic accuracy when combined with clinical risk scores, and improved patient satisfaction. Although randomised controlled trials (RCTs) have reported mixed results regarding perinatal outcomes, CGM is associated with improved glycaemic control, reduced gestational weight gain, and high user acceptability. Nocturnal hyperglycaemia identified by CGM may predict fetal overgrowth. Integration with telemedicine may further personalise care. Further large, robust, RCTs are needed to confirm CGM's clinical value and guide its broader implementation in GDM.

Keywords:  blood glucose self-monitoring; continuous glucose monitoring; diabetes, gestational; glucose; large for gestational age; oral glucose tolerance test; pregnancy outcome

DOI:  https://doi.org/10.1016/j.beem.2025.102060
Diabetol Metab Syndr. 2025 Oct 16. 17(1): 397

Continuous glucose monitoring in non-insulin-dependent type-2 diabetes - rationale for CGM-NIDDM study.

Carolin Rädel, Andreas Wienke, Rainer U Pliquett.

  Type-2 diabetes is treated by general practitioners and diabetologists in a stepwise manner with an emphasis on lifestyle modifications. Glucose monitoring is mandatory to gauge the effect of lifestyle modifications or medical therapies in order to identify the need for therapy escalation, if treatment goals are not met. To date, three-monthly hemoglobin A1c measurements have been conducted for this purpose in the majority of non-insulin-dependent type-2 diabetes patients in Germany. Here, we review the role of continuous glucose monitoring in combination with nutrition counseling to offer a biofeedback. In addition, we present the rationale for a hypothesis-generating study that randomizes continuous glucose monitoring or no continuous glucose monitoring to the standard of nutrition counseling in individuals with prediabetes or non-insulin-dependent type-2 diabetes mellitus.

Keywords:  Continuous glucose monitoring; Haemoglobin A1c; Non-insulin-dependent type-2 diabetes mellitus; Nutrition counseling; Prediabetes

DOI:  https://doi.org/10.1186/s13098-025-01976-2
J Diabetes Sci Technol. 2025 Oct 16. 19322968251377008

The Impact of Interfering Substances on Continuous Glucose Monitors: Part 2: Marketed CGM Designs, Labeled Interfering Substances, and Design Mitigations.

Steven John Setford.

  Presented is a series of narrative reviews that summarize published information regarding the effect or potential effect of interfering substances on the accuracy of continuous glucose monitoring (CGM) devices. While drawing together what is currently known regarding this topic, the future direction in this field and clinical implications posed by polypharmacy on CGM performance are considered. This second in a series of review articles introduces the glucose-sensing designs of commercially available continuous glucose monitors (CGMs) and describes those interfering substances currently or historically identified within manufacturer's labeling for a given CGM model. Where known, an overview of the mechanistic effects of labeled interfering substances on the corresponding CGM designs is also described, as are sensor design approaches introduced by leading manufacturers to reduce interference effects. The review also considers: the effect of interferents on market-leading minimally invasive CGMs; design changes made to limit the flux of interfering substances to the sensor's glucose-sensing element; and an appraisal of the minimally invasive implantable Senseonics Eversense system, which employs a unique synthetic glucose-recognition ligand coupled to optical signal generation, which correspondingly gives rise to a unique interference profile.

Keywords:  accuracy; continuous glucose monitor; first-generation biosensors; implantable; interfering substances; second-generation biosensors

DOI:  https://doi.org/10.1177/19322968251377008
J Diabetes Sci Technol. 2025 Oct 17. 19322968251377026

The Impact of Interfering Substances on Continuous Glucose Monitors: Part 4: Continuous Glucose Monitoring Interferents: In Vivo Performance, Clinical Implications and Future Standardization.

Steven John Setford.

  Presented is a series of narrative reviews that summarize published information regarding the effect or potential effect of interfering substances on the accuracy of continuous glucose monitoring (CGM) devices. Whilst drawing together what is currently known regarding this topic, the future direction in this field and clinical implications posed by polypharmacy on CGM performance are considered. This fourth and final in this series of articles reviews the following topics: the benefits and drawbacks of conducting interfering substance studies in vitro versus in vivo; the balance between the cost and complexity of undertaking in vitro or in vivo studies to screen for potential interferences versus the clinical relevance of the findings; clinical factors influencing interferent behavior on CGM performance (pharmacokinetics and polypharmacy considerations); the need for standardization, including consideration of the metrological traceability of CGM readings, establishment of CGM analytical performance metrics and standardized CGM assessment procedures for measuring interferents.

Keywords:  continuous glucose monitor; in vitro; in vivo; interfering substances; polypharmacy; standardization

DOI:  https://doi.org/10.1177/19322968251377026
Cureus. 2025 Sep;17(9): e91864

Continuous Glucose Monitoring With Linx™ Improves Glycemic Control and Satisfaction in Youth With Type 1 Diabetes: A Real-World Observational Study.

Abeer A Abdelmaksoud, Ayman Al Hayek, Randa Matter, Nouran Salah, Hadeer H Shahin, Ali R Reyad, Nermien M Tantawy.

   BACKGROUND: Children and adolescents with type 1 diabetes (T1D) often have poor glycemic control and low satisfaction with management tools, increasing risks of complications. This study evaluated the clinical efficacy and user satisfaction of a novel real-time continuous glucose monitoring (CGM) system, Linx™ (Microtech Medical (Hangzhou) Co., Ltd., Zhejiang, China), over three months in adolescents with poorly controlled T1D.
METHODS: In this single-center, single-arm, observational study, 75 children and adolescents using multiple daily injections were enrolled. Clinical outcomes (HbA1c, insulin dose, and hypoglycemia) and CGM metrics (time in range, glucose variability, and calculated Glycemia Risk Index) were assessed at baseline, 28, and 90 days. Patient satisfaction was measured at three months using the validated 44-item CGM Satisfaction (CGM-SAT) questionnaire.
RESULTS: After three months of continuous Linx™ CGM use, median HbA1c significantly decreased from 9.5% to 8.1% (absolute reduction of 1.4 percentage points; p<0.001). Time in range (%TIR70-180) increased by 10.2 percentage points, rising from 49.8% at 28 days to 60.0% at three months (p<0.001). The frequency of hypoglycemic events dropped dramatically (p<0.001). Glucose variability improved significantly, with the coefficient of variation decreasing by 2.2%, and the composite Glycemia Risk Index declined by 11.3 points (p<0.01). Patient-reported satisfaction was high, with an overall CGM-SAT score averaging 4.8 out of 5, indicating substantial perceived benefits (mean=4.9) and low reported hassles (mean=4.6).
CONCLUSIONS: The Linx™ 15-day CGM system led to marked improvements in glycemic control and safety, along with high satisfaction, in children and adolescents with poorly controlled T1D. These results support the value of factory-calibrated CGM devices in optimizing diabetes management and quality of life in this vulnerable group.

Keywords:  glycemia risk index; glycemic assessment; glycemic variability; patient satisfaction; type 1 diabetes

DOI:  https://doi.org/10.7759/cureus.91864
Diabetes Res Clin Pract. 2025 Oct 15. pii: S0168-8227(25)00958-1. [Epub ahead of print] 112944

First-trimester continuous glucose monitoring parameters in preeclamptic and normotensive patients with type 1 diabetes.

Daniel Boroń, Urszula Mantaj, Rafał Sibiak, Aleksandra Gladych-Macioszek, Paweł Gutaj, Ewa Wender-Ożegowska.

   OBJECTIVE: Preeclampsia disproportionately affects women with pregestational type 1 diabetes (T1D). This study aims to determine whether continuous glucose monitoring (CGM)-derived metrics during the first trimester predict the development of preeclampsia in pregnancies complicated by pregestational T1D, comparing their predictive capability against standard glycemic markers.
MATERIALS AND METHODS: This single-center, retrospective cohort study analyzed data from 2019 to 2023 at a tertiary center in Poland. Participants included women with T1D on sensor-augmented insulin pump (SAP) therapy, initiating monitoring by 13 weeks/6 days. Sensor mean glucose, TIR, CV%, GMI and time spent over 140, 180 and 250 mg/dL were analyzed and preeclampsia diagnosis adhered to ISSHP criteria, with data compared.
RESULTS: Of 70 women, 13 (18.6 %) developed preeclampsia. Baseline HbA1c was similar. Sensor-derived glucose metrics revealed higher first-trimester mean glucose (121.6 mg/dL vs. 112.3 mg/dL, p = 0.0012), decreased TIR 63.3% (54.3-68.46) vs 70.16 % (67.31-76.57), p = 0.03, and coefficient of variation 38.42% vs 34.29, p = 0,055 for the PE group. Good glycemic control existed in both groups during later trimesters.
CONCLUSION: Elevated first-trimester mean glucose and glucose variability could be linked with preeclampsia in T1D, in our study. Findings support CGM to refine risk models and strategies addressing early glycemic imbalances in T1D pregnancies.

Keywords:  Continuous glucose monitoring; Placental insufficiency; Preeclampsia; Pregnancy complications; Time in range; Type 1 diabetes; Vascular programming

DOI:  https://doi.org/10.1016/j.diabres.2025.112944
BMJ Open. 2025 Oct 15. 15(10): e106809

Who is using continuous glucose monitoring for type 2 diabetes management? A scoping review protocol.

Ben Kragen, Jack Resnik, Varsha G Vimalananda, Kailyn E Sitter, Alison J Leibowitz, Patricia C Underwood, Bo Kim.

   INTRODUCTION: Equitable access to healthcare technology is a major public health issue. For adults with type 2 diabetes (T2D), continuous glucose monitoring (CGM) technology can improve diabetes self-management and clinical outcomes. Even though CGM is now recommended by professional guidelines for all patients with diabetes on insulin therapy, evidence suggests that CGM is underutilised and inequitably prescribed across health systems. As CGM is an emergent technology, it is vital to understand what approaches have been studied to overcome inequities in CGM access for adults with T2D, what aspects of equitable access have yet to be addressed and what are facilitators and barriers to CGM access at the individual, facility and health system levels.
METHODS AND ANALYSIS: We will use the Joanna Briggs Institute's revised scoping review framework to conduct our analysis. The protocol is registered with Open Science Framework (https://osf.io/z2exn). We will search for peer-reviewed literature containing empirical evidence for the facilitators and barriers to equitable access to CGM technology for patients with T2D. Findings will be organised according to research objectives and the Framework for Digital Health Equity, and summarised using narrative synthesis of descriptive statistics for quantitative findings, and themes for qualitative findings. This review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews.
ETHICS AND DISSEMINATION: The findings from this review will provide valuable information and support for future research into the equitable implementation and use of CGM for patients with T2D. We will disseminate findings at conferences and publish in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER: https://osf.io/z2exn.

Keywords:  Diabetes Mellitus, Type 2; Digital Technology; Health Equity; Health Services Accessibility; Wearable Electronic Devices

DOI:  https://doi.org/10.1136/bmjopen-2025-106809
J Clin Med. 2025 Sep 30. pii: 6943. [Epub ahead of print]14(19):

Patient Experience with Continuous Glucose Monitoring During Dialysis in Type 2 Diabetes: A Qualitative Study.

Miguel Angel Cuevas-Budhart, Dante Atzin Juncos Ríos, Maricruz Ponce Villavicencio, Marcela Ávila Diaz, María Begoña Ilabaca Avendaño, Maricela Beatriz Rocha-Carrillo, Ramón Paniagua.

  Objective: To explore the lived experiences of type 2 diabetes mellitus (T2DM) patients undergoing peritoneal dialysis (PD) or hemodialysis (HD) using continuous glucose monitoring (CGM). Research Design and Methods: A qualitative phenomenological study was conducted with 50 adult T2DM patients on PD or HD who used CGM for at least 14 days. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis framework was applied to identify major themes regarding insulin management, CGM utilization, and emotional and social dimensions. Results: Four main themes emerged, each with multiple subthemes. PD patients emphasized enhanced autonomy and frequent insulin adjustments due to dialysate glucose absorption. Conversely, HD patients reported severe post-dialysis fatigue, emotional distress, and limited social engagement often associated with intra-dialytic hypoglycemia. CGM was valued by 85% of participants for improving metabolic awareness and self-management. However, 15% reported barriers such as device cost and technical difficulties. The insights clearly distinguish the differential impact of dialysis modality on daily glucose control and patient well-being. Conclusions: These findings underscore the critical need for patient-centered care incorporating access to CGM and tailored insulin regimens. Equitable implementation of CGM in dialysis settings could significantly enhance glycemic control, emotional resilience, and overall quality of life.

Keywords:  blood glucose control; chronic kidney disease; continuous glucose monitoring; diabetes management; dialysis; patient experience; qualitative research

DOI:  https://doi.org/10.3390/jcm14196943
BMJ Open. 2025 Oct 13. 15(10): e096888

DIABASE: an automatically filled single-centre registry of diabetes mellitus in the Netherlands, combining clinical data with real-world longitudinal wearable device data-a study protocol.

Thomas Urgert, Kilian Derk Rinse Kappert, Anouk Veldhuis, Jeroen Geerdink, Bernard Johannes Frederik van Beijnum, Gozewijn Dirk Laverman.

   INTRODUCTION: Advancements in technology for treating diabetes mellitus (DM) are progressing rapidly. With the growing availability and use of continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion (CSII), glucose regulation is improved in individuals with DM, which will lead to less long-term complications and reduce the overall disease burden on patients with DM. Collecting vast amount of biomedical data, these devices combined with clinical outcome data provide more insight into the development and treatment of the disease. The objective of the DIABASE initiative is to collect and examine real-world data from medical devices and clinical practice in a registry.
METHODS AND ANALYSIS: The ongoing study is structured as an observational study registry. Clinical data and real-world data from diabetes wearable devices, such as CGM and CSII, are aggregated in the database. Clinical data is automatically extracted from the hospital's electronic health record. Data from wearables is periodically collected manually from the various online data platforms for sharing and automatically added to the database.
ETHICS AND DISSEMINATION: This study is exempted from ethics approval by the Medical Research Ethics Committees United (MEC-U) since participants are not subject to procedures and are not required to follow rules of behaviour (approval ID: AW23.009/W20.197). The execution of this study has been approved by the board of the study site Hospital Group Twente (ZGT) (ZGT20-40). Results will be shared through scientific meetings and publications and through articles for the general public.
TRIAL REGISTRATION NUMBER: NCT05584293; Pre-results.

Keywords:  DIABETES & ENDOCRINOLOGY; Observational Study; REGISTRIES

DOI:  https://doi.org/10.1136/bmjopen-2024-096888
Diabetes Obes Metab. 2025 Oct 17.

Exploring the interaction between ethnicity, deprivation and the use of CGM on diabetes outcomes-A study from the Association of British Clinical Diabetologists.

Harshal Deshmukh, Emma G Wilmot, Emmanuel Ssemmondo, Dennis Barnes, Neil Walker, Chris Walton, Robert E J Ryder, Thozhukat Sathyapalan.

   AIMS: Ethnic and socioeconomic disparities in diabetes outcomes persist despite widespread adoption of technologies such as continuous glucose monitoring (CGM). We examined the independent and interactive effects of ethnicity and area-level deprivation on baseline glycaemic control and CGM effectiveness in a large UK diabetes cohort.
MATERIALS AND METHODS: This retrospective observational study used data from the Association of British Clinical Diabetologists (ABCD) national audit, including 18,139 adults with type 1 or type 2 diabetes initiating FreeStyle Libre. Ethnicity was categorised into White, Black, Indian, Pakistani/Bangladeshi, and Mixed/Other groups. Deprivation was assessed using hospital-level Index of Multiple Deprivation (IMD) rankings. Baseline and follow-up HbA1c and diabetes distress scores (DDS) were analysed. Linear regression assessed associations between predictors and HbA1c, and interaction effects were evaluated using both regression and Gradient Boosting Machine (GBM) models, with Friedman's H-statistic quantifying interaction strength.
RESULTS: Compared to White individuals, Black participants had significantly higher baseline HbA1c (β = 6.19, SE = 1.87, p < 0.001), while Indian participants had lower levels (β = -3.50, SE = 1.37, p = 0.01). Compared to those in low deprivation areas, baseline HbA1c was significantly higher in high (β = 3.38, p < 0.001), moderate (β = 2.90, p < 0.001), and very high (β = 4.54, p < 0.001) deprivation categories. The interaction between ethnicity and deprivation was not statistically significant (p > 0.05); GBM analysis supported this with a low H-statistic of 0.088. CGM use resulted in significant HbA1c reductions across all IMD groups, most notably in very high deprivation areas (-8.54%, p < 0.001). Reduction was similar across ethnicities (all p = 1.0).
CONCLUSIONS: Ethnicity and deprivation independently influence glycaemic control. However, CGM yields equitable HbA1c improvements across all subgroups.

Keywords:  continuous glucose monitoring (CGM); database research; observational study; real‐world evidence

DOI:  https://doi.org/10.1111/dom.70206
Sci Rep. 2025 Oct 14. 15(1): 35825

The GMI/HbA1c ratio does not independently predict diabetic retinopathy in adults with Type 1 Diabetes.

Carolina Sager-La Ganga, Jose Alfonso Arranz-Martin, Jessica Jiménez-Díaz, Iñigo Hernando-Alday, Victor Navas-Moreno, Maria Del Mar Fandiño García, Gisela Liz Román Gómez, Jon Garai Hierro, Luis Eduardo Lander Lobariñas, Purificación Martinez de Icaya, Miguel Antonio Sampedro-Nuñez, Mónica Marazuela Azpiroz, Fernando Sebastian-Valles.

  The discordance between glycated haemoglobin (HbA1c) and the glucose management indicator (GMI) has been proposed as a marker of vascular risk in diabetes. This study evaluated whether the GMI/ HbA1c ratio independently predicts diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) using continuous glucose monitoring. We conducted a multicenter cross-sectional study involving 1,070 adults using flash glucose monitoring. Participants were stratified as high glycators (ratio < 0.9) or non-high glycators based on the GMI/HbA1c ratio. DR status was assessed by ophthalmologic evaluation. Multivariable logistic regression and 1:1 propensity score matching were used to assess independent associations with DR, adjusting for age, sex, diabetes duration, smoking, hypertension, LDL cholesterol, BMI and insulin dose. While high glycators had a higher crude DR prevalence (31.3% vs. 23.1%, p = 0.020), the GMI/HbA1c ratio was not independently associated with DR in adjusted models (OR 1.19; 95% CI: 0.34-4.15; p = 0.785) or in the matched cohort (OR 1.23; 95% CI: 0.76-1.99; p = 0.391). Absolute HbA1c remained the strongest glycemic predictor. These findings suggest that the GMI/HbA1c ratio may aid in interpreting discordant glycemic profiles, serving as a contextual tool in clinical practice, but it lacks independent prognostic value for DR.

Keywords:  Continuous glucose monitoring; Diabetic retinopathy; Glucose management indicator; Glycation index; HbA1c; Type 1 Diabetes

DOI:  https://doi.org/10.1038/s41598-025-19705-0
J Diabetes Res. 2025 ;2025 9944722

Diabetes Technology Accessibility in Deaf and Hard of Hearing People With Diabetes.

Michelle L Litchman, Karissa Mirus, Lorne Farovitch, Andrew Bray, Nancy A Allen, Catherine Elmore.

Background: Deaf and hard of hearing (DHH) populations face higher rates of diabetes and systemic barriers accessing diabetes technology. Effective use of diabetes technology relies on sensory (e.g., visual and audible) input and interpretation by the user. This study evaluates the accessibility of continuous glucose monitoring systems (CGMs) and insulin pumps for DHH individuals.
Methods: A 2-h focus group was conducted to comprehensively evaluate the accessibility of two CGM and six insulin pumps in a sample of DHH individuals during an interactive, hands-on session. Participants used an investigator-developed 6-point Likert-like scale to score audible, haptic, and visual alarm features for each device and provided additional qualitative feedback that was captured. Observational field notes and team debriefing notes were analyzed using a thematic qualitative approach.
Results: Nine diverse DHH participants living with diabetes consistently scored all devices as poor across each alarm feature. Median scores for audible, haptic and visual alarms for CGM were 2, 2.6, and 1.2 and for insulin pumps were 0.5, 2, and 0.7, respectively. The overall qualitative theme was that the evaluated diabetes technology devices were not designed to be accessible for DHH individuals. Participants noted that CGM and insulin pump companies fell short in providing audible, haptic, and visual alarms and provided several important recommendations.
Conclusion: This study highlights the importance of diabetes technology companies including the creative and diverse perspectives of DHH people in diabetes technology design and testing to optimize accessibility. This inclusive approach fosters innovation by integrating universal design principles that can ultimately enhance the experience for all users.

DOI: https://doi.org/10.1155/jdr/9944722
Swiss Med Wkly. 2025 Oct 03. 155 4632

Swiss Diabetes and Technology recommendations.

Giacomo Gastaldi, Lia Bally, Marie-Anne Burckhardt, Elena Gamarra, Michael Hauschild, Daniel Konrad, Roger Lehmann, Camillo Piazza, Marie-Alice Savet, Valérie Schwitzgebel, Anne Wojtusciszyn, Markus Laimer.

Technological advancements have significantly reshaped diabetes care. Diabetes and technology now encompass the hardware, devices and software required to treat diabetes mellitus. In Switzerland, these technologies are being increasingly adopted, especially by people living with type 1 diabetes, where continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems are considered standards of care. This document provides a comprehensive overview of all diabetes-related technologies currently available in Switzerland. It details their technical specifications, indications for use across diverse populations, compatibility, reimbursement regulations and practical guidance for implementation. Recommendations extend to special populations: children and adolescents, pregnant women, older adults, and people with type 2 diabetes or other specific diabetes types (e.g. maturity-onset diabetes of the young [MODY] or pancreatogenic diabetes). In youth with type 1 diabetes, early adoption of continuous glucose monitoring and automated insulin delivery systems is strongly encouraged and is supported by the Swiss Society of Paediatric Endocrinology and Diabetology. During pregnancy, achieving and maintaining strict glycaemic targets is crucial for reducing pregnancy-related complications. Continuous glucose monitoring and automated insulin delivery improve glycaemic metrics and neonatal outcomes. In older adults, technologies can reduce hypoglycaemia risk and simplify management. For people with type 2 diabetes, continuous glucose monitoring and insulin pumps have shown benefits in glycaemic control, with growing evidence supporting the use of automated insulin delivery systems. The document also highlights the expanding role of telemedicine and remote monitoring. While offering greater accessibility and patient-centred care, these tools raise challenges in terms of digital literacy, interoperability and data protection. Finally, the integration of diabetes and technology into diabetes care requires structured education. Diabetes self-management education and support programmes such as Functional Insulin Therapy (FIT) are essential to help people acquire the knowledge and skills necessary to manage insulin therapy and use diabetes technology effectively and safely. Overall, these recommendations aim to support effective and equitable use of diabetes technology throughout Switzerland and to guide healthcare providers, patients and policymakers towards improving diabetes outcomes.

DOI: https://doi.org/10.57187/s.4632
Diabet Med. 2025 Oct 13. e70161

Insights into the effective use of the Smart MDI system: Data from the first 1852 type 1 diabetes users.

Andrea Laurenzi, Shannon N Edd, Peter Adolfsson, Fabio Di Piazza, Benedikt Voelker, Glen Im, Tim van den Heuvel, Ohad Cohen.

   AIMS: The study analysed real-world data of people with type 1 diabetes (PWT1D) using the Smart Multiple Daily Insulin (MDI) system with the aim of assessing associations between user interaction behaviours and parameters of glycaemic control to provide educational insights for optimal system use.
METHODS: A retrospective cohort analysis was conducted using data from 1852 PWT1D users of the Smart MDI system across 21 countries. The system comprises the InPen™ insulin injector, Simplera™ CGM, and the InPen™ phone application. Users were included if they had at least 10 days of InPen and CGM data. Glycaemic outcomes were correlated with user interaction, focusing on responses to missed dose alerts (MDA) and correct high glucose alerts (CHGA).
RESULTS: The mean time in range (TIR) was 55.7%, with users responding with a bolus dose to 49.3% of MDA and 46.6% of CHGA. However, those users who responded within 1 h to over 75% of alerts with a bolus dose achieved higher TIRs of 67.2% (MDA) and 71.5% (CHGA). Prompt responses (within 10 min) showed greater TIR. The study highlighted significant associations between alert responsiveness and better glycaemic outcomes without increased hypoglycaemia risk.
CONCLUSIONS: User engagement with the Smart MDI system is crucial for optimal glycaemic outcomes. The study underscores the need for structured education on system use and alert responses. While causality cannot be confirmed, the findings suggest that proactive user interactions contribute to meeting glycaemic targets. Further research is needed to explore these relationships and enhance educational strategies.

Keywords:  continuous glucose monitoring; glycaemic control; retrospective studies; smart insulin pen; subcutaneous injections; time in range; type 1 diabetes

DOI:  https://doi.org/10.1111/dme.70161
Front Endocrinol (Lausanne). 2025 ;16 1596717

Analysis of glucose metabolism outcomes 4-7 years postpartum in women with gestational diabetes mellitus using continuous glucose monitoring maternal risk factors: a Chinese cohort study.

Dan Zhao, Ning Yuan, Xin Zhao, Jianbin Sun, Xiumei Xu, Xiaomei Zhang.

   Background: This study investigates glucose metabolism outcomes and glycemic variability in women with gestational diabetes mellitus (GDM) 4-7 years postpartum. It also identifies maternal risk factors for glucose metabolism abnormalities (GMA) to support early prevention strategies.
Methods: A bidirectional cohort study was conducted with 60 women with GDM and 60 without GDM, recruited from Peking University International Hospital between 2017 and 2019. Participants underwent oral glucose tolerance tests at 4-7 years postpartum and were categorized into GMA and normal glucose tolerance groups. Continuous glucose monitoring assessed glycemic variability, and logistic regression identified early pregnancy risk factors for postpartum GMA.
Results: (1) Women with a history of GDM have a higher incidence of GMA 4-7 years postpartum (p< 0.001). (2) They also showed increased cardiovascular risk factors 4-7 years postpartum, including diastolic blood pressure, body fat ratio, and interleukin-6 (p<0.05). (3) Blood glucose variability is significantly higher in all participants with a history of GDM, even in the normal glucose tolerance group. (4) Independent early pregnancy predictors of postpartum GMA included pre-pregnancy body mass index (BMI), the triglyceride-glucose index, and a history of GDM (AUC = 0.870, 95% CI: 0.808-0.931).
Conclusions: Women with a history of GDM are at a higher risk of GMA and glycemic variability 4-7 years postpartum. Pre-pregnancy BMI, the triglyceride-glucose index, and GDM history are strong predictors of postpartum GMA, highlighting the need for early intervention.Clinical trial registration: China Clinical Trials Registry, identifier ChiCTR2300067592.

Keywords:  continuous glucose monitoring; gestational diabetes mellitus; glycemic variability; postpartum period; risk factors

DOI:  https://doi.org/10.3389/fendo.2025.1596717
J Sleep Res. 2025 Oct 14. e70218

Exploring the Association of Sleep Profiles With Plasma Glycaemic Outcomes and 24-h Interstitial Glucose Levels in Adults With Prediabetes: Findings From Chrono-DM Study.

Guey Yong Chong, Satvinder Kaur, Ruzita Abd Talib, See Ling Loy, Hui Yin Tan, Rosmiza Binti Abdullah, Hanisah Binti Mahmud, Woan Yie Siah, Chee Cheong Kee, Hui Chin Koo.

  Sleep profiles, including chronotype, sleep duration and sleep-wake time, may affect glycaemic outcomes. However, their associations with plasma glycaemic outcomes and 24-h interstitial glucose levels in individuals with prediabetes remains ambiguous. This study aimed to examine the association between sleep profiles and glycaemic outcomes in adults with prediabetes. Chronotype was assessed using the Malay-translated Munich Chronotype Questionnaire. Glycaemic outcomes, including fasting plasma glucose (FPG), 2-h postprandial glucose (2hPPG), glycated haemoglobin (HbA1c) levels and 24-h glucose profiles derived from seven-day continuous glucose monitoring (CGM). Generalised linear models and generalised estimating equations were used and adjusting for potential confounders. A total of 120 participants (mean age: 54 ± 15 years) were categorised as morning (18.4%), intermediate (60.8%) or evening (20.8%) chronotypes. Evening chronotypes demonstrated greater weekday-weekend discrepancy in awake time (0.7 h [±1.1 h]), indicating higher social jet lag. Each additional hour of jet lag in awake time was associated with a 0.28 mmol/L reduction in 2hPPG levels (95% CI: -0.49, -0.08), reflecting compensatory catch-up sleep on weekends. Longer sleep time was positively associated more time spent within the target glucose range (3.9-7.8 mmol/L) (β: 0.58, 95% CI: 0.06, 1.10), while evening chronotype showed higher 24-h mean glucose levels (β: 0.65 mmol/L, 95% CI: 0.22, 1.12). Evening chronotype and shorter sleep duration were associated with adverse glycaemic outcomes, while the unexpected inverse association between awake-time jet lag and 2hPPG may reflect short-term catch-up sleep rather than a protective effect. These findings highlight the importance of addressing sleep regularity in lifestyle interventions for prediabetes management.

Keywords:  chronotype; continuous glucose monitor; glucose; prediabetes; sleep

DOI:  https://doi.org/10.1111/jsr.70218
Clin Oral Investig. 2025 Oct 14. 29(11): 508

Analysis of the correlation between glycemic variability indices and disease severity as well as inflammatory status in patients with type 2 diabetes mellitus and periodontitis.

Long Zhang, Yike Ding, Baorong Zhang, Xuegang Hu.

   BACKGROUND: The interaction between type 2 diabetes mellitus (T2DM) and periodontitis is a growing research focus, with glycemic variability potentially playing a critical role in the pathophysiology and severity of periodontal disease in T2DM patients. This study aims to evaluate the association between glycemic variability, inflammatory markers, and the occurrence and severity of periodontitis in patients with T2DM.
METHODS: A retrospective case-control study included 296 T2DM patients admitted between February 2020 and November 2023. Patients were screened based on demographic and clinical criteria, segregating into non-periodontitis (n = 83) and periodontitis (n = 213) groups. Periodontal status was categorized using American Academy of Periodontology guidelines into non-severe (n = 131) and severe (n = 82) groups. Glycemic variability indices including average blood glucose, coefficient of variation (CV), standard deviation (SD), and mean amplitude of glycemic excursions (MAGE) were measured using continuous glucose monitoring systems. Inflammatory markers, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), were quantified in gingival crevicular fluid (GCF) using enzyme-linked immunosorbent assay. Statistical analyses included multivariate logistic regression and correlation analyses.
RESULTS: Increased glycemic variability was significantly correlated with the presence and severity of periodontitis (P < 0.05). T2DM patients with periodontitis exhibited higher levels of inflammatory markers IL-1, IL-6, and TNF-α. Multivariate logistic regression identified SD (OR = 2.046, 95% CI: 1.324-3.162), CV (OR = 1.054, 95% CI: 1.008-1.102), and MAGE (OR = 1.368, 95% CI: 1.097-1.706) as significant predictors for periodontitis occurrence in T2DM patients. IL-6 and TNF-α showed strong interrelationships and correlations with glycemic indices.
CONCLUSION: Glycemic variability significantly influences the occurrence and severity of periodontitis in T2DM patients. This relationship is mediated through enhanced inflammatory responses, suggesting potential pathways linking glycemic instability to periodontal deterioration. The findings underscore the importance of glycemic control in managing periodontal health in T2DM, proposing glycemic variability as a target for therapeutic interventions to mitigate the risk and progression of periodontitis.

Keywords:  Blood glucose variability coefficient; Inflammatory factors; Periodontitis; Type 2 diabetes mellitus

DOI:  https://doi.org/10.1007/s00784-025-06609-6