bims-glumda 2025-10-26 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–10–26
seventeen papers selected by
Mott Given

Continuous Glucose Monitoring as an alternative for Cystic Fibrosis Related diabetes screening and diagnosis.
Identification of clinically meaningful automatically detected postprandial glucose excursions in individuals with type 1 diabetes using personal continuous glucose monitoring.
Overcoming underutilization of continuous glucose monitoring devices with diabetes among disparate populations.
Continuous Glucose Monitoring Metrics in Asians Without Diabetes: Differentiating Prediabetes From Normoglycemia.
The Impact of Interfering Substances on Continuous Glucose Monitors Part 3: A Review of Non-labeled Substances Influencing Continuous Glucose Monitor Readings.
Aligning Innovation With Care: Continuous Glucose Monitoring in Skilled Nursing Facilities.
Continuous Glucose Monitoring in Older People With Diabetes Mellitus and Cognitive Impairment: A Brief Review.
Continuous Glucose Monitoring to Guide Lifestyle Choices With a Focus on Nutrition in the Management of Type 2 Diabetes: A Systematic Review and Meta-Analysis.
Cost-Effectiveness Analysis of Real-Time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in People With Type 2 Diabetes Treated With Non-Intensive Insulin Therapy in South Korea.
Revolutionizing Hypoglycemia Management in Long-Term Care: Lessons Learned From a Pilot Quality Improvement Initiative Using Continuous Glucose Monitoring.
Evaluating diabetes care processes, comorbidity burden and continuous glucose monitoring utilisation in regional Australia: results from Central Queensland Hospital.
Integrating Continuous Glucose Monitoring Into Pharmacy Elective Curriculum: A Practical Learning Experience.
Sensor-Derived Glycemic Metrics in Women with Type 1 Diabetes Using Insulin Degludec Versus Other Basal Insulin Analogs During Pregnancy-A Post Hoc Analysis of the CopenFast Trial.
Association of impaired awareness of hypoglycemia and real-time continuous glucose monitoring with the occurrence and frequency of severe hypoglycemia in adults with type 1 diabetes mellitus: a real-world panel data analysis from the PR-IAH study.
Establishment of a Diabetes-Tailored Data Intelligence Platform Enhances Clinical Care, Enables Risk-Based Monitoring, and Facilitates Population-Health-Based Approaches at a Pediatric Diabetes Network.
The effects of carbohydrate-restricted diets on 24-h mean blood glucose levels measured by continuous glucose monitoring in type 2 diabetes: a hypothesis-generating meta-analysis.
Overweight and obesity in adults with type 1 diabetes: associations with glycemic control and cardiometabolic risk.

Diabetes Res Clin Pract. 2025 Oct 19. pii: S0168-8227(25)00966-0. [Epub ahead of print]229 112952

Continuous Glucose Monitoring as an alternative for Cystic Fibrosis Related diabetes screening and diagnosis.

I Aguilera García, P Vázquez Pérez, B López Plaza, M Matabuena, R M García Moreno, S Palma Milla, E Zamarrón de Lucas, M C Prados Sánchez, N González Pérez de Villar.

   BACKGROUND AND AIMS: The data regarding the capacity of HbA1c and Continuous Glucose Monitoring (CGM) to diagnose Cystic Fibrosis Related Diabetes (CFRD) are uncertain. We studied HbA1c, classical CGM indexes, and novel glucodensities CGM metrics' ability to distinguish CFRD based on Oral Glucose Tolerance Test (OGTT) results.
METHODS: We carried out a prospective observational study involving 38 patients who had had an OGTT test within the previous 6 months and who accepted wearing a CGM sensor for 14 days. Patients answered a questionnaire regarding preferences for CFRD screening.
RESULTS: Participants reported a preference for a simpler method for CFRD screening, such as HbA1c, but CGM was better accepted than OGTT. Regarding CGM metrics, time above 180 mg/dL over 6 % presented a sensitivity of 93 % (p = 0.042) and time above 140 mg/dL over 20 %, a specificity of 90 % (p = 0.032) for CFRD diagnosis. CGM metrics distinguished CFRD better than HbA1c, but glucodensities improved CGM diagnostic capacity with sensitivity and specificity over 85 %.
CONCLUSION: In this exploratory study, glucodensities show better discriminatory capacity than HbA1c and CGM classic metrics in distinguishing early mild CFRD. This study supports the need for future larger prospective studies to define the most accepted screening method for CFRD, as well as the optimal cut-off point of CGM metrics and/or glucodensities for the diagnosis of CFRD.

Keywords:  Continuous Glucose Monitoring; Cystic Fibrosis-Related Diabetes; Glucodensities; HbA1c

DOI:  https://doi.org/10.1016/j.diabres.2025.112952
Diabetes Res Clin Pract. 2025 Oct 19. pii: S0168-8227(25)00965-9. [Epub ahead of print] 112951

Identification of clinically meaningful automatically detected postprandial glucose excursions in individuals with type 1 diabetes using personal continuous glucose monitoring.

Sang Ho Park, Rosa Oh, Seohyun Kim, Seung Hee Yang, Hanna Lee, Ji Yoon Kim, So Hyun Cho, Soojin Park, Gyuri Kim, Jae Hyeon Kim, Sang-Man Jin.

   SUBJECTS: This study aimed to identify and longitudinally validate characteristics of postprandial glucose excursions detected by the Glucose Rate Increase Detector algorithm (GRID-excursions) that are associated with clinically meaningful glycemic changes in adults with type 1 diabetes.
MATERIALS AND METHODS: This prospective cohort included 287 adults using continuous glucose monitoring (CGM) for at least 90 days through the Korean National Home Care Pilot Program at Samsung Medical Center, between April 2019 and July 2024. GRID-excursions were classified by peak glucose (≥7.8, ≥10.0, ≥13.9 mmol/L) and time-to-peak intervals. Associations with time in range (TIR) were assessed cross-sectionally and validated longitudinally.
RESULTS: Higher frequency of excursions with very high peaks (≥13.9 mmol/L) showed the strongest inverse association with TIR, regardless of time-to-peak. More frequent excursions with longer time-to-peak were also linked to lower TIR. Participants with initially four or more high-peak excursions had significantly greater odds of achieving > 5 % TIR improvement after CGM education, independent of baseline HbA1c.
DISCUSSION: The frequency of GRID-excursions with very high postprandial peaks is a simple, reliable CGM-derived marker to guide targeted interventions in adults with type 1 diabetes.

Keywords:  Continuous glucose monitoring; Glucose rate increase detector algorithm; Post prandial peak glucose; Time–to–peak

DOI:  https://doi.org/10.1016/j.diabres.2025.112951
Endocr Res. 2025 Oct 24. 1-12

Overcoming underutilization of continuous glucose monitoring devices with diabetes among disparate populations.

Samar A Nasser, Dragana Lovre, Farbod Zahedi Tajrishi, Keith C Ferdinand.

   INTRODUCTION: Continuous glucose monitoring (CGM) demonstrates significant benefits in glycemic control for both type 1 and type 2 diabetes, including reductions in HbA1c, increased time-in-range, and decreased hypoglycemia.
METHODS: In this article, we review the recent American Diabetes Association guidelines recommending real-time CGM for adults with type 2 diabetes, including those not using insulin.
RESULTS: While acknowledging the documented advantages, CGM remains underutilized, with many barriers, particularly in primary care settings and among racially diverse or lower socioeconomic populations.
DISCUSSION: This review outlines positive strategies to address barriers to CGM-adoption, optimize glycemic control and thereby potentially reduce cardiovascular-kidney-metabolic complications.

Keywords:  Cardiovascular-kidney-metabolic; continuous glucose monitoring devices; diabetes; underserved

DOI:  https://doi.org/10.1080/07435800.2025.2577643
J Diabetes Sci Technol. 2025 Oct 21. 19322968251384682

Continuous Glucose Monitoring Metrics in Asians Without Diabetes: Differentiating Prediabetes From Normoglycemia.

Suresh Rama Chandran, Gerald Gui Ren Sng, Celine Yu Hui Wong, Wei Mian Ang, Daphne Gardner.

   BACKGROUND: Early detection of dysglycemia is important to delay the progression to diabetes. Continuous glucose monitoring (CGM) may offer advantages over current diagnostic methods for prediabetes. However, reference intervals for CGM metrics among Asians with normoglycemia (NG), and their differences compared with prediabetes, have not been well characterized.
METHOD: Healthy Asian adults were classified using American Diabetes Association criteria via 75-g oral glucose tolerance test and HbA1c as NG, prediabetes, or diabetes. Participants without diabetes wore a blinded CGM device. Reference intervals (2.5th and 97.5th percentiles) for NG were determined. Continuous glucose monitoring metrics were compared between NG and prediabetes using the two-sample t-test or Mann-Whitney U test as appropriate. The area under the receiver operating characteristic (AUROC) curve and the Youden Index were used to identify optimal diagnostic thresholds for prediabetes.
RESULTS: Of 160 participants, one was diagnosed with diabetes. A total of 151 individuals with adequate CGM data were analyzed, including 27 participants with prediabetes (median age 32 years, BMI 22 kg/m², HbA1c 5.4%, 36 mmol/mol). Reference intervals for NG included: mean glucose (78-106 mg/dL), TIR 70 to 180 mg/dL (69%-100%), TIR 54 to 140 mg/dL (86.4%-100%), TAR >140 mg/dL (0%-9.7%), and standard deviation (10.9-25.6 mg/dL). Among CGM metrics, TAR140 had the highest AUROC at 0.72 and an optimal threshold of 5.6%.
CONCLUSIONS: Asians with NG spend most of their time within TIR 54 to 140. TAR140 may be a useful metric for distinguishing prediabetes from NG.

Keywords:  Asians; continuous glucose monitoring; dysglycemia; normoglycemia; prediabetes

DOI:  https://doi.org/10.1177/19322968251384682
J Diabetes Sci Technol. 2025 Oct 18. 19322968251377019

The Impact of Interfering Substances on Continuous Glucose Monitors Part 3: A Review of Non-labeled Substances Influencing Continuous Glucose Monitor Readings.

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 third in a series of articles lists substances that have been found to influence readings from specific continuous glucose monitor (CGM) models. Points covered include: (1) A review of non-labeled substances that have been found, through in vivo or in vitro assessment, to influence CGM readings; (2) A consideration of substances found to influence CGM readings to an extent that warrants further investigations to determine if a clinically significant in vivo interfering effect occurs at therapeutically or nutritionally relevant levels of a substance and, as such, would require labeling by the manufacturer; and (3) the possibility of predicting if a new medication or formulation is predisposed to influencing CGM readings, based on an assessment of chemical structure or chemical classification. Evidence suggests that a more systematic approach to interference testing would be of value in determining if additional labeling is required for currently marketed CGMs. It is possible that many of the substances reported have previously been assessed by manufacturers and are within acceptance criteria such that product labeling is not required according to currently recognized definitions of interference. Nevertheless, it would be beneficial for this information to be publicly disclosed.

Keywords:  catecholamines; continuous glucose monitor; interfering substances; labeling; oxygen

DOI:  https://doi.org/10.1177/19322968251377019
J Am Geriatr Soc. 2025 Oct 22.

Aligning Innovation With Care: Continuous Glucose Monitoring in Skilled Nursing Facilities.

Hyungsoek Daniel Oh, Thaer Idrees, Theodore M Johnson.



Keywords:  blood glucose; diabetes mellitus type 2; hypoglycemia; skilled nursing facilities; technology

DOI:  https://doi.org/10.1111/jgs.70168
J Diabetes Sci Technol. 2025 Oct 20. 19322968251384992

Continuous Glucose Monitoring in Older People With Diabetes Mellitus and Cognitive Impairment: A Brief Review.

Busra Donat Ergin, Kieran Gadsby-Davis, Katharina Mattishent, Ketan Dhatariya, Anne-Marie Minihane, Michael Hornberger.

   BACKGROUND: Diabetes mellitus and dementia are common chronic diseases affecting older people in the community and in hospitals. Even though both diseases have been independently well-characterized, comorbid diabetes and dementia/cognitive impairment are much less understood. In particular, cognitive impairment can make glucose monitoring much more challenging and can more readily lead to diabetes-related emergencies such as hypoglycemia, hyperosmolar hyperglycemic state, or diabetic ketoacidosis. Based on this, improving diabetes management in the community and in the hospital settings via glucose monitoring is essential in older people with T2DM and particularly those with comorbid diabetes and dementia.
AIM: The use of continuous glucose monitoring (CGM) holds promise for greater glycemic management in older patients with diabetes and those at high risk for dementia. In this brief review, we will review the few existing studies for CGM use in the community and the hospital in this population, as well as the link between hospital admissions.
RESULTS: Existing studies show high feasibility and good adherence with using CGM among older people. In addition, diabetes technologies can improve risk factors associated with hospitalization, leading to decreased hospitalization rates. We illustrate how the current studies highlight the need for studies in the hospital in this frail population, who potentially will benefit most from CGM systems.
CONCLUSION: Although existing feasibility studies show high promise in this frail population, more data are needed on CGM for older people living with diabetes and memory problems in the hospital setting.

Keywords:  continuous glucose monitoring; dementia; diabetes mellitus; hospitalization; inpatients

DOI:  https://doi.org/10.1177/19322968251384992
J Diabetes Sci Technol. 2025 Oct 18. 19322968251384318

Continuous Glucose Monitoring to Guide Lifestyle Choices With a Focus on Nutrition in the Management of Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Raveendhara R Bannuru, Natalie J Bellini, Richard M Bergenstal, Elizabeth A Beverly, Elena A Christofides, Daniel Cox, Nicole Ehrhardt, Katherine Fazioli, Amy Hess Fischl, David Kerr, Otis W Kirksey, Ka Hei Karen Lau, Thomas W Martens, Meredith Noble, Prajakta Khare Ranade, Viral N Shah, Holly J Willis, Nuha A ElSayed.

   OBJECTIVES: The objective of this systematic review and meta-analysis was to synthesize evidence from randomized controlled trials (RCTs) evaluating the use of continuous glucose monitoring (CGM) to guide lifestyle choices, particularly nutrition, in the management of T2D.
METHODS: PubMed and Cochrane CENTRAL were searched from inception to June 6, 2025. Randomized controlled trials were included if their intervention involved the use of a CGM device and education or feedback intended to modify nutrition choices, either as part of a nutrition intervention or a multicomponent lifestyle intervention. Random-effects meta-analyses were performed, and certainty of evidence was rated in alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: A total of 21 RCTs involving 2734 adults in groups of interest were included, with 20 RCTs eligible for meta-analysis. Results from meta-analysis showed statistically significant improvements in HbA1c (MD: -0.46%, 95% CI: -0.71, -0.22), time in range (TIR) 70-180 mg/dL (MD: 7.18%, 95% CI: 2.77, 11.58), time above range (TAR) >180 mg/dL (MD: -7.32%, 95% CI: -12.98, -1.66), fasting glucose (MD: -7.86 mg/dL, 95% CI: -15.06, -0.65), body weight (MD: -2.06 kg, 95% CI: -3.74, -0.38), with moderate certainty of evidence, and for mean CGM glucose (MD: -11.57 mg/dL, 95% CI: -22.58, -0.56), and standard deviation (SD) glucose (MD: -4.06 mg/dL, 95% CI: -6.54, -1.58), with low certainty of evidence. No statistically significant differences were found for other outcomes, typically with low certainty of evidence.
CONCLUSIONS: Findings from this systematic review and meta-analysis support the use of CGM as a tool to guide lifestyle choices with a focus on nutrition in the management of T2D, with significant benefits related to glycemia and body weight.

Keywords:  continuous glucose monitoring; lifestyle; nutrition; type 2 diabetes

DOI:  https://doi.org/10.1177/19322968251384318
J Diabetes Sci Technol. 2025 Oct 21. 19322968251382570

Cost-Effectiveness Analysis of Real-Time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in People With Type 2 Diabetes Treated With Non-Intensive Insulin Therapy in South Korea.

Ji Yoon Kim, Sabrina Ilham, Hamza Alshannaq, Richard F Pollock, Martin Field, Gregory J Norman, Sang-Man Jin, Jae Hyeon Kim.

   OBJECTIVES: There is limited evidence regarding the cost-effectiveness of real-time continuous glucose monitoring (rt-CGM) in the management of type 2 diabetes in patients receiving basal insulin regimens in South Korea. This study aimed to address this gap by analyzing the cost-effectiveness of rt-CGM when compared with self-monitoring of blood glucose.
RESEARCH DESIGN AND METHODS: The cost-effectiveness of rt-CGM was modeled using the IQVIA Core Diabetes Model from a South Korean payer perspective in a simulated cohort based on the Korea National Health and Nutrition Examination Survey. A remaining lifetime horizon (up to 50 years), and a discount rate of 4.5% per annum were adopted. The willingness-to-pay threshold was KRW 47 million per quality-adjusted life year (QALY).
RESULTS: The use of rt-CGM resulted in an increase in quality-adjusted life expectancy of 0.490 QALYs and a KRW 13.3 million increase in costs compared with self-monitoring of blood glucose. The incremental cost-utility ratio in the base case analysis was KRW 27.1 million per QALY, below the willingness-to-pay threshold of KRW 47 million.
CONCLUSIONS: rt-CGM is likely to be cost-effective versus self-monitoring of blood glucose in the management of patients with type 2 diabetes receiving basal insulin regimens in South Korea.

Keywords:  continuous glucose monitoring; general diabetes; health economics; quality of life

DOI:  https://doi.org/10.1177/19322968251382570
JMIR Diabetes. 2025 Oct 20. 10 e73485

Revolutionizing Hypoglycemia Management in Long-Term Care: Lessons Learned From a Pilot Quality Improvement Initiative Using Continuous Glucose Monitoring.

Denis O'Donnell, Sue Burns, Shirley Drever, Lisa Quesnelle, Benjamin Yuen.

   Unlabelled: Despite efforts to raise glycemic targets and reduce modifiable risk factors, hypoglycemia continues to impact a large number of long-term care (LTC) residents living with diabetes mellitus and remains one of the leading causes of hospitalization in this cohort. Effective, sustainable practice strategies to monitor and maintain glycemic control in LTC are lacking. We describe the stepwise approach used by 2 LTC homes that switched from traditional fingerstick testing to a continuous glucose monitoring (CGM) system as part of a quality improvement initiative to reduce nursing workload and address hypoglycemia. This was an exploratory pilot project. A working group was established at each of the 2 participating LTC homes, including representatives from management and direct care staff. Kickoff meetings were held with key direct care staff to discuss the limitations of current monitoring practices and potential solutions. The following interventions were agreed upon and implemented by the working groups: (1) the initiation of structured glucose monitoring for residents using CGM (FreeStyle Libre 2), requiring scanning of sensors 4 times per day; (2) provision of staff education and training on CGM by a diabetes expert; and (3) scheduling of interdisciplinary rounds as needed to optimize diabetes management. System changes were gradually introduced in a stepwise manner over a 3-month period (intervention phase), during which the LTC homes progressed from traditional fingerstick testing to point-of-care sensor readings and then to full use of the CGM software platform. Hypoglycemia was defined as a glucose reading of ≤4 mmol/L. Glucose readings were collected from 38 residents living with diabetes mellitus and receiving insulin in the 6 months before the start of the intervention phase (baseline evaluation) and in the 6 months after the end of the intervention phase (post-launch evaluation). All hypoglycemic readings detected by a sensor at a point-of-care test were validated using a fingerstick test. Nursing workload associated with glucose testing was assessed in an anonymous survey of nursing staff at baseline and after the launch. The approach resulted in a 40% reduction in nursing time required to complete a glucose reading (from 5.1 min per test at baseline to 3.1 min per test at the post-launch evaluation). The frequency of glucose monitoring increased from a total of 19,438 glucose readings in the baseline evaluation to 35,971 point-of-care sensor scans in the post-launch evaluation. The number of detected hypoglycemic events increased 12-fold, from 88 in the baseline evaluation to 1049 in the post-launch evaluation. Hypoglycemic events continue to impact a large number of LTC residents living with diabetes mellitus. CGM can improve the detection of hypoglycemic events while decreasing nursing workload. A gradual transition to CGM can help overcome underlying barriers and concerns and ensure a sustainable approach.

Keywords:  continuous glucose monitoring; detection; diabetes; hypoglycemia; long-term care; nursing

DOI:  https://doi.org/10.2196/73485
Intern Med J. 2025 Oct 25.

Evaluating diabetes care processes, comorbidity burden and continuous glucose monitoring utilisation in regional Australia: results from Central Queensland Hospital.

Arushi Rana, Aatif Syed, Amal Rauf, Rajat Gupta, Francesca Lim, Akash Konantambigi, Belinda Weich, Majid-Al Abbood, Marion Hayward, Usman Malabu, Vasant Shenoy, Harshal Deshmukh.

   BACKGROUND AND AIMS: Real-world adherence to guideline-recommended diabetes care in regional Australia is poorly described. This study aimed to evaluate adherence to diabetes care processes, comorbidity burden and continuous glucose monitoring (CGM) metrics among individuals with type 1 diabetes (T1D) attending a regional hospital in Central Queensland, Australia.
RESEARCH DESIGN AND METHODS: A retrospective audit of 175 patients with T1D was conducted using electronic medical records. Data on demographics, care process adherence, comorbidities and CGM metrics were analysed. A gradient boosting machine (GBM) model assessed factors influencing glycaemic control.
RESULTS: The cohort had a mean age of 40.4 years and a diabetes duration of 18.5 years. Most were Caucasian (92.5%), with 7.5% identifying as First Nations Australians. Obesity prevalence was 32%, and 17.9% of patients were current smokers. Mean hemoglobin A1c was 8.51%, indicating suboptimal glycaemic control. Adherence to screening protocols varied: blood pressure monitoring (79.8%), lipid profile screening (68.8%), kidney function assessment (89.7%), retinopathy screening (43.8%) and foot examinations (28.4%). CGM usage was high (77.8%), with an average of 14 scans per day. CGM metrics showed a mean time in range of 42.9%, time above range of 54.2% and a glucose management indicator of 7.99%. The GBM model identified body mass index as the strongest modifiable factor influencing glycaemic control.
CONCLUSIONS: Despite high CGM adoption, glycaemic control remains suboptimal and significant gaps exist in essential care processes, particularly retinal and foot screenings. These findings highlight the need for targeted interventions to improve diabetes management in regional Australian settings.

Keywords:  CGM; Type 1 Diabetes; care‐processes; regional Australia

DOI:  https://doi.org/10.1111/imj.70234
J Pharm Technol. 2025 Oct 17. 87551225251379742

Integrating Continuous Glucose Monitoring Into Pharmacy Elective Curriculum: A Practical Learning Experience.

Aia Gamal Eldin, Anna Nogid.

  Background: Pharmacists play a vital role in diabetes education, including continuous glucose monitors (CGMs). However, formal CGM training within pharmacy education remains limited. To address this, a CGM wear activity using the FreeStyle Libre 3 system was integrated into a third-year (P3) pharmacy elective. Objective: To evaluate how a week-long educational CGM wear experience affects P3 students' knowledge and confidence in using CGMs and influences their empathy toward patients with diabetes. Methods: This was a prospective, single-center study. Students enrolled in the course attended a lecture on CGMs and were invited to wear a FreeStyle Libre 3 sensor for 1 week. During the sensor-wear period, students completed daily tasks simulating the management of a patient with diabetes. Preactivity and postactivity surveys were administered to evaluate changes in knowledge (9 items), confidence (5 items), and empathy (6 items) related to CGMs and diabetes care. Change in knowledge was assessed using a paired t test while change in confidence and empathy were assessed using Wilcoxon signed-rank test. Results: Seventeen students participated in the wear experience, completed the presurvey and postsurvey, and were included in the analysis. Statistically significant increases were noted in the knowledge assessment scores (54.4% vs 70%, P < 0.005), all self-reported confidence items (P < 0.05), and 2 empathy items related to wearing the CGM sensor (P < 0.05). Students reported being woken up by the alarms as the biggest challenge. Conclusions: Following this week-long CGM wear activity, students demonstrated improved knowledge, confidence, and empathy related to CGMs and diabetes care.

Keywords:  clinical practice; diabetes; standards of practice; teaching/training; type 2

DOI:  https://doi.org/10.1177/87551225251379742
Womens Health Rep (New Rochelle). 2025 ;6(1): 825-835

Sensor-Derived Glycemic Metrics in Women with Type 1 Diabetes Using Insulin Degludec Versus Other Basal Insulin Analogs During Pregnancy-A Post Hoc Analysis of the CopenFast Trial.

Julie C Søholm, Sidse K Nørgaard, Kirsten Nørgaard, Tine D Clausen, Peter Damm, Elisabeth R Mathiesen, Lene Ringholm.

   Aim: To explore sensor-derived glycemic metrics during pregnancy in women with type 1 diabetes using insulin degludec or other basal insulin analogs.
Methods: A post hoc analysis of 87 pregnant women with type 1 diabetes using intermittently scanned continuous glucose monitoring and multiple daily injections, including basal insulin analogs in the CopenFast trial. Glycemic metrics, including mean sensor glucose, time in range (TIRp, 3.5-7.8 mmol/L), and time below range in pregnancy (TBRp, <3.5 mmol/L), were assessed from periconception to 37 completed weeks.
Results: In total, 58 women used degludec and 29 women used other basal insulin analogs. At baseline (median = 9.5 gestational weeks, interquartile range = 9.0-11.0), hemoglobin A1c was 50 ± 9 versus 46 ± 6 (p = 0.04) mmol/mol, and diabetes duration was 16 (10-21) versus 9 (4-19) years (p = 0.35). The use of faster-acting insulin aspart and insulin aspart was equally distributed in the two groups. Glycemic metrics were comparable throughout pregnancy for 24 hours in both groups. During nighttime, mean sensor glucose was higher and TIRp was lower in women using degludec compared with women using other basal insulin analogs, while TBRp was above treatment targets in both groups throughout pregnancy. Severe hypoglycemia occurred in 1 (2%) versus 5 (17%) (p = 0.01). Birthweight standard deviation score was 1.5 ± 1.2 versus 0.8 ± 1.1 (p = 0.01).
Conclusions: In this post hoc analysis, pregnant women with type 1 diabetes using degludec achieved lower nighttime TIRp, experienced less severe hypoglycemia, and delivered infants who were heavier and thereby had less appropriate size compared with women using other basal insulin analogs.

Keywords:  basal insulin analog; continuous glucose monitoring; hypoglycemia; pregnancy; type 1 diabetes

DOI:  https://doi.org/10.1177/26884844251378015
Diabetol Int. 2025 Oct;16(4): 770-778

Association of impaired awareness of hypoglycemia and real-time continuous glucose monitoring with the occurrence and frequency of severe hypoglycemia in adults with type 1 diabetes mellitus: a real-world panel data analysis from the PR-IAH study.

Naoki Sakane, Ken Kato, Sonyun Hata, Erika Nishimura, Rika Araki, Kunichi Kouyama, Masako Hatao, Yuka Matoba, Yuichi Matsushita, Masayuki Domichi, Akiko Suganuma, Seiko Sakane, Takashi Murata.

   Background: Patients with long-standing type 1 diabetes mellitus (T1DM) often experience severe hypoglycemia (SH); however, the protective and risk factors that influence its occurrence and frequency in the era of advanced diabetes technology remain unclear. This study aimed to investigate the association of impaired awareness of hypoglycemia (IAH) and real-time continuous glucose monitoring (rtCGM) with the incidence and frequency of SH in adults with T1DM.
Methods: This prospective, observational study recruited 311 adults with T1DM (mean age: 50.6 ± 14.7 years; male: 37.9%; diabetes duration: 17.9 ± 11.3 years; mean HbA1c: 7.7 ± 1.0%) from seven diabetes centers across Japan. All participants were aged ≥ 20 years and had been diagnosed with type 1 diabetes for at least 1 year. The primary outcomes were the incidence and frequency of SH, defined as an episode of hypoglycemia necessitating assistance from others. Logistic and Poisson fixed- or random-effects models were selected using the Hausman test and were applied to analyze the data. Data are presented as coefficients with 95% confidence intervals (CIs).
Results: The prevalence of SH was 5.4 (95% CI 3.6-7.7)/100 person-years during the 2-year follow-up period. The logit random-effects model for predicting the occurrence of SH revealed that diabetic peripheral neuropathy (DPN) tended to be associated with an increased risk (coefficient: 2.01, 95% CI - 0.02 to 4.04; P = 0.053), whereas IAH (coefficient: 1.08, 95% CI 0.49 to 1.66; P < 0.001) exhibited a significant association with an increased risk. rtCGM (coefficient: - 1.75, 95% CI - 2.49 to - 1.00; P < 0.001) was associated with a reduced risk. The Poisson random-effects model for predicting the frequency of SH revealed that DPN and the IAH score (coefficient: 0.21, 95% CI 0.06 to 0.35; P = 0.006) exhibited positive associations with an increased frequency of SH, whereas rtCGM (coefficient: - 1.60, 95% CI - 2.84 to - 0.37; P = 0.011) was associated with a reduced frequency of SH.
Conclusion: This panel data analysis demonstrated that IAH was associated with an increased incidence and frequency of SH, whereas rtCGM was associated with a decreased incidence and frequency of SH.
Trial registration: University Hospital Medical Information Network (UMIN) Center: UMIN000039475), approval date: February 13, 2020.

Keywords:  Continuous glucose monitoring; Hypoglycemia unawareness; Severe hypoglycemia; Type 1 diabetes mellitus

DOI:  https://doi.org/10.1007/s13340-025-00846-6
J Diabetes Sci Technol. 2025 Oct 18. 19322968251367776

Establishment of a Diabetes-Tailored Data Intelligence Platform Enhances Clinical Care, Enables Risk-Based Monitoring, and Facilitates Population-Health-Based Approaches at a Pediatric Diabetes Network.

Brent Lockee, Craig A Vandervelden, Daniel R Tilden, Kelsey Panfil, Erin M Tallon, Emily DeWit, Katie Noland, David D Williams, Harpreet Gill, Susana R Patton, Priya Prahalad, Juan Espinoza, Amey Waghmode, Mitchell Barnes, Mark A Clements.

   BACKGROUND: Patient-generated health data (PGHD) represents an opportunity to customize care, particularly in type 1 diabetes (T1D) care where continuous glucose monitor (CGM) and insulin pump usage continues to rise. Previous solutions to integrating CGM data into the electronic health record (EHR) have been limited in their ability to integrate data from multiple sources, ensure data fidelity, integrate data from multiple data streams, and rapidly adapt to changes in data output from numerous vendors. We developed a novel data infrastructure contained outside of the EHR to provide an alternative approach to PGHD integration, enable diabetes centers to identify and predict risk, and to facilitate research and quality improvement.
METHODS: We identified three key capabilities: ingesting and storing a wide variety of data, refining raw data into actionable insights, and visualizing and reporting to decision makers. To meet these requirements, we built a data intelligence platform we coined the diabetes data dock (D-data dock) in the Microsoft Azure cloud platform.
RESULTS: The D-data dock houses approximately 100 million CGM measurements, one million clinical events and insulin bolus records, and a near complete EHR record covering approximately 3000 patients per year from 2016 to 2023. We provide case studies detailing how the D-data dock allows timely monitoring of CGM data, enables novel study designs, and powers machine-learning-informed supplemental care interventions.
CONCLUSIONS: The D-data dock is a novel approach to harnessing disparate data streams to improve patient care, enable timely interventions, and drive innovation to improve the lives and care of people with T1D.

Keywords:  continuous glucose monitor; data integration; data intelligence platform; machine learning; patient generated health data; population health

DOI:  https://doi.org/10.1177/19322968251367776
Front Nutr. 2025 ;12 1670022

The effects of carbohydrate-restricted diets on 24-h mean blood glucose levels measured by continuous glucose monitoring in type 2 diabetes: a hypothesis-generating meta-analysis.

Chou Wang, Aizhen Pei.

   Purpose: To conduct a hypothesis-generating meta-analysis exploring trends in 24-h mean blood glucose via CGM in T2DM patients on carbohydrate-restricted diets (CRDs), to inform future trial design and intervention duration.
Methods: This study applied predefined inclusion and exclusion criteria and systematically searched five major databases-PubMed, Web of Science, Embase, Cochrane Library, and EBSCOhost-from their inception to May 16, 2025. The methodological quality of the selected studies was assessed in accordance with the Cochrane Handbook (version 5.1). Statistical analyses, including effect size estimation and sensitivity testing, were conducted using STATA version 18. Bias evaluation was performed using Review Manager version 5.4. Exploratory trend analyses were carried out using Microsoft Excel 2019.
Results: A total of 1,322 articles were retrieved, and after four rounds of screening, seven studies involving 301 participants (mean age 58.1 ± 8.64 years) were included in the meta-analysis. Results showed that CRDs significantly improved 24-h mean blood glucose in patients with T2DM (d = -0.51, 95% CI: -0.88 to -0.14, p < 0.05), with exploratory trend analysis suggesting a positive correlation between intervention duration and the magnitude of 24-h mean blood glucose reduction.
Conclusion: CRDs may improve 24-h MBG in patients with T2DM, with exploratory trend analysis suggesting greater benefits with longer intervention durations. However, due to the limited number and relatively short duration of included studies, further high-quality randomized controlled trials with longer durations (≥1 year) are warranted to evaluate the differential effects of short-term and long-term CRDs on glycemic outcomes in patients with T2DM.
Systematic review registration: CRD420251069702, https://www.crd.york.ac.uk/PROSPERO/.

Keywords:  carbohydrate-restricted diets; continuous glucose monitor; low carbohydrate diets; meta-analysis; type 2 diabetes

DOI:  https://doi.org/10.3389/fnut.2025.1670022
J Diabetes Metab Disord. 2025 Dec;24(2): 240

Overweight and obesity in adults with type 1 diabetes: associations with glycemic control and cardiometabolic risk.

Joana Lagoa, Ana Rita Leite, Patrícia Ferreira, Inês Meira, João Menino, Ana Margarida Lopes, Mariana Lourenço, Beatriz Viveiros, Maria João Barbosa, Sílvia Santos Monteiro, Celestino Neves, Joana Queirós, João Sérgio Neves.

   Purpose: An often-overlooked issue in type 1 diabetes' (T1D) management is the growing prevalence of overweight and obesity, as well as the control of accompanying cardiometabolic risk factors. This cross-sectional study investigates associations of body mass index (BMI) and waist circumference (WC) with glycemic control and other cardiometabolic risk factors in adults with T1D.
Methods: Patients followed in the Insulin Pump Clinic at a tertiary hospital were selected. Data from clinical records and continuous glucose monitoring-derived parameters were retrospectively documented, from 2022 to 2024. Associations of BMI and WC categories with cardiometabolic risk factors were assessed using linear regression models. Restricted cubic splines analyses were performed to assess for nonlinear associations.
Results: Of the 388 patients included, 32.3% were overweight and 13.7% had obesity. A U-shaped relationship was observed between BMI and glycated hemoglobin (HbA1c), with lower and higher BMI associated with increased HbA1c (p for non-linearity = 0.005). A higher time in range was found in the increased WC group (53.1 ± 18.4% vs. 59.8 ± 14.6%, p = 0.036). Patients with obesity had higher systolic (p = 0.013) and diastolic blood pressure (BP) (p = 0.001), non-high-density lipoprotein (HDL) cholesterol (p = 0.022) and triglycerides (p = 0.001) values, when compared to lower BMI categories. Patients with increased WC also presented higher systolic (p = 0.038) and diastolic BP (p = 0.015), non-HDL (p = 0.010) and triglycerides (p < 0.001) values, compared to those with normal WC.
Conclusion: In adults with T1D, BMI and WC showed stronger associations with BP and lipid profile than glycemic control, underscoring the importance of comprehensive cardiovascular risk assessment and targeted therapeutic strategies in this population.
Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-025-01718-1.

Keywords:  Cardiometabolic risk.; Continuous glucose monitoring; Glycemic control; Obesity; Type 1 diabetes

DOI:  https://doi.org/10.1007/s40200-025-01718-1