bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2025–11–23
thirty papers selected by
Mott Given
  1. Neonatal Outcomes and A1C Improved With Real-Time Continuous Glucose Monitoring in Pregnancy With Preexisting Type 2 Diabetes.
  2. A Clinical Review of Continuous Glucose Monitoring in the Hospital Setting.
  3. Real-world use of continuous glucose monitoring in people with type 2 diabetes and chronic kidney disease or on dialysis.
  4. Development of an HbA1c prediction model using continuous glucose monitoring metrics in pediatric type 1 diabetes: insights into average glucose and recent glycemic trends.
  5. Management of Hypoglycemia Using Continuous Glucose Monitoring During Tirzepatide Initiation or Uptitration When Used in Addition to Other Glucose-Lowering Agents.
  6. Clinical Trials in Diabetes: Examining the Value of Use of Continuous Dual Glucose-Ketone Monitoring.
  7. Expert Opinion Statement on Continuous Glucose Monitoring in Type 2 Diabetes in the Arab Gulf Region.
  8. Beyond Time in Range: Hidden Statistical Challenges of Continuous Glucose Monitoring Data in Diabetes Drug Development.
  9. Comparable performance of 1,5-anhydroglucitol and continuous glucose monitoring in detecting subclinical atherosclerosis in elderly patients with type 2 diabetes.
  10. Clinical assessment and acceptance criteria for continuous glucose monitoring (CGM) system performance: A proposed guideline by the IFCC Working Group on CGM.
  11. Clinical validation of noninvasive blood glucose measurements by midinfrared spectroscopy.
  12. The Importance of Expanding Medicare Continuous Glucose Monitoring Coverage for High-Risk Hypoglycemia.
  13. Use of continuous glucose monitoring systems in pediatric patients in the perioperative environment: Challenges and machine learning opportunities.
  14. Oral Hygiene Practices and Glucose Profiles Assessed Through Continuous Glucose Monitoring in Adults With Type 2 Diabetes.
  15. Multivendor Continuous Glucose Monitor Integration into the Electronic Health Record: Real-World Experience of an Academic Pediatric Endocrinology Clinic.
  16. Glucotypes in patients with type 2 diabetes and either diabetic kidney disease or end stage kidney disease under different anti-diabetic treatments.
  17. Disparities in Continuous Glucose Monitor Uptake Among Veterans With Diabetes Despite Universal Coverage.
  18. Impact of a Nurse Practitioner-Led Diabetes Program on Barriers to CGM Use in a Federally Qualified Health Center After Medicaid Expansion.
  19. Comment on: Agreement Between Fingerstick Blood Glucose and Continuous Glucose Monitor Measures Among Long-Term Care Facility Residents.
  20. Economic analyses of freestyle libre systems for people living with diabetes: a systematic literature review.
  21. Impact of technologies on quality of life in relation to glucose control in patients with type 1 diabetes.
  22. Clinical perspectives of new insights and tools to minimize the hypoglycaemia burden connected with type 2 diabetes pharmacotherapy.
  23. Coefficient of Variation to Assess the Reproducibility of Meal-Induced Glycemic Responses: Development of a Clustering Algorithm.
  24. Role of Continuous Dual Glucose-Ketone Monitoring in Diabetes Care.
  25. Integrating Continuous Dual Glucose-Ketone Monitoring into Clinical Practice.
  26. Switch from premixed insulin analogue to degludec-liraglutide combination: a CGM study.
  27. Reply to: Comment on: Agreement Between Fingerstick Blood Glucose and Continuous Glucose Monitor Measures Among Long-Term Care Facility Residents.
  28. The Future of Dual Glucose-Ketone Monitoring in Youth with Diabetes.
  29. Continuous Dual Glucose-Ketone Sensing Technology.
  30. Global Burden of Diabetic Ketoacidosis.
  1. Diabetes Spectr. 2025 ;38(4): 461-466
    Neonatal Outcomes and A1C Improved With Real-Time Continuous Glucose Monitoring in Pregnancy With Preexisting Type 2 Diabetes.
    Gail L Nunlee-Bland, Rochanda Mitchell, Inez V Reeves, Michal A Young.
      This study evaluated the use of real-time continuous glucose monitoring (CGM) versus blood glucose monitoring (BGM) with a glucose meter in pregnant patients with preexisting type 2 diabetes on insulin therapy. The use of CGM improved A1C and reduced infant morbidity and mortality compared with BGM alone.
    DOI:  https://doi.org/10.2337/ds25-0034
  2. touchREV Endocrinol. 2025 Oct;21(2): 5-8
    A Clinical Review of Continuous Glucose Monitoring in the Hospital Setting.
    Jennifer N Clements, Kennedy Howard, Emory Moss.
      This editorial explores the critical role of continuous glucose monitoring (CGM) in managing diabetes within hospital settings. It provides a comprehensive clinical overview of CGM technology, highlighting its advances, such as improved glucose control and reduced hypoglycaemic events. This article also delves into the challenges, including cost and integration with existing hospital systems. The editorial examines real-world applications of CGM, highlighting its potential to enhance patient outcomes and streamline diabetes care in hospitals. By addressing both the current state and prospects of CGM, this article underscores its value in advancing diabetes management and improving overall patient care in hospital settings.
    Keywords:  Continuous glucose monitors; diabetes; diabetes technology; hospital; inpatient; monitoring
    DOI:  https://doi.org/10.17925/EE.2025.21.2.3
  3. Diabet Med. 2025 Nov 18. e70174
    Real-world use of continuous glucose monitoring in people with type 2 diabetes and chronic kidney disease or on dialysis.
    Patrick McGown, Nikoleta Papanikolaou, Jasmine El-Taraboulsi, Clemency Britton, Javeria Iqtidar, Khuram Chaudhry, Shiyan Ng, Kishan Jethwa, Jagvi Patel, Jo Reed, Monika Reddy, Lalantha Leelarathna, Andrew H Frankel, Chukwuma Uduku, Parizad Avari.
       INTRODUCTION: Continuous glucose monitoring (CGM) has become the standard of care for people with type 1 diabetes (T1D) and some people with type 2 diabetes (T2D). However, there is a lack of data regarding CGM use in people with T2D and chronic kidney disease (CKD), who are at increased risk of hypoglycaemia. We assess the use of CGM and glucose outcomes in this cohort.
    METHODS: Retrospective, observational analysis of adults on CGM attending a tertiary diabetes renal clinic between January 2023 and September 2024. People with T2D on multiple daily insulin injections (defined as 2 or more insulin injections per day) and CKD stage 3-5 (eGFR <60, on renal replacement therapy or post-renal transplant) were included. HbA1c was assessed pre- and post-initiation of CGM. CGM metrics were analysed for percentage times in ranges and other glycaemic metrics.
    RESULTS: A total of 177 adults (median (interquartile range)) aged 64.0 (56.0-71.0) years were included. Time below range (<3.9 mmol/L) was significantly reduced (median (interquartile range)) from 1.0 (0.0-2.0)% to 0.0 (0.0-1.0)% following CGM initiation (p = 0.007). Hypoglycaemia leading to an insulin dose reduction was revealed by CGM in 91/177 participants (51.4%). Median HbA1c pre- and post-CGM was 64.0 (53.0-79.0) mmol/mol (8.0, 7.0-9.4%) and 62.0 (51.8-73.0) mmol/mol (7.8, 6.9-8.8%), respectively (p < 0.001). HbA1c reduction was observed in 114/177 participants (64.4%).
    CONCLUSION: CGM use was associated with the identification of hypoglycaemia and improvements in HbA1c in people with T2D and CKD. These real-world data demonstrate the importance of CGM technology to high-risk individuals with diabetes and CKD.
    Keywords:  chronic kidney disease; continuous glucose monitoring; hypoglycaemia; type 2 diabetes
    DOI:  https://doi.org/10.1111/dme.70174
  4. Ann Pediatr Endocrinol Metab. 2025 Nov 19.
    Development of an HbA1c prediction model using continuous glucose monitoring metrics in pediatric type 1 diabetes: insights into average glucose and recent glycemic trends.
    Hakyung Lee, Mi Yang, Hwa Young Kim, Jaehyun Kim.
       Purpose: Given the limitations of glycated hemoglobin (HbA1c), continuous glucose monitoring (CGM) metrics have been proposed as complementary indicators of glycemic control. This study evaluated the association between CGM metrics and HbA1c and developed HbA1c prediction models in Korean pediatric patients with type 1 diabetes (T1D).
    Methods: We retrospectively analyzed CGM data from 85 patients aged 2-18 years using real-time CGM systems (G6 or G7, Dexcom, USA). CGM records over 12 weeks were segmented into five intervals (0-2, 0-4, 4-8, 8-12, and 0-12 weeks) prior to HbA1c measurement. Metrics included time-in-range (TIR), time-above-range (TAR), time-below-range (TBR), time-in-normoglycemia (TING), coefficient of variation (CV), and average glucose. HbA1c prediction models were constructed using ridge regression and validated in a separate test dataset.
    Results: TIR consistently showed the strongest negative association with HbA1c, while TAR and average glucose showed the strongest positive associations. Among all intervals, 0-4 week CGM data demonstrated the strongest relationship with HbA1c (all P<0.05). Average glucose achieved the best explanatory power among all metrics (R²=0.83, AIC=84.34), and prediction models incorporating average glucose and TAR yielded the lowest mean squared error (MSE=0.15) and highest R² (0.83), with robust results in the test dataset.
    Conclusion: Short-term CGM metrics, particularly average glucose during the 0-4 week preceding HbA1c testing, are strong predictors of HbA1c. These findings support the clinical utility of recent CGM data in optimizing the individualized glycemic management in pediatric patients with T1D.
    Keywords:  Continuous glucose monitoring; Glycated hemoglobin; Pediatrics; Type 1 diabetes
    DOI:  https://doi.org/10.6065/apem.2550214.107
  5. Diabetes Spectr. 2025 ;38(4): 525-528
    Management of Hypoglycemia Using Continuous Glucose Monitoring During Tirzepatide Initiation or Uptitration When Used in Addition to Other Glucose-Lowering Agents.
    Kelsey Mews, Drew Momchilovich.
      
    DOI:  https://doi.org/10.2337/ds24-0074
  6. Diabetes Technol Ther. 2025 Nov;27(S4): S44-S50
    Clinical Trials in Diabetes: Examining the Value of Use of Continuous Dual Glucose-Ketone Monitoring.
    Halis Kaan Akturk, Bruce A Perkins, Timothy C Dunn.
      Severe diabetic ketoacidosis (DKA) is a critical medical condition that often necessitates emergency treatment and hospitalization. Although DKA primarily impacts individuals with type 1 diabetes (T1D), its annual incidence among adults with T1D ranges from 4% to 8% following diagnosis. Continuous glucose monitoring (CGM) has become a standard tool for managing T1D and type 2 diabetes (T2D) in patients using insulin or aiming to improve self-management. However, advances in continuous dual glucose-ketone monitoring (DGK) technology offer new possibilities for clinical research and patient care. This article explores the potential applications of DGK in clinical research, with a focus on T1D, while also considering its broader relevance for T2D and other patient populations.
    Keywords:  DGK; DKA; clinical research; continuous dual glucose-ketone monitoring; diabetic ketoacidosis; observational studies
    DOI:  https://doi.org/10.1177/15209156251390818
  7. J Diabetes Sci Technol. 2025 Nov 21. 19322968251393740
    Expert Opinion Statement on Continuous Glucose Monitoring in Type 2 Diabetes in the Arab Gulf Region.
    Abdulrahman Alshaikh, Abdulmohsen Bakhsh, Afaf Al-Sagheir, Ahmed El-Laboudi, Dabia Al-Mohanadi, Fatheya Al Awadi, Hussein Elbadawi, Lamya Alzubaidi, Mohammed E Al-Sofiani, Muhammad Hamed Farooqi, Raed Aldahash, Reem Alamoudi, Saud Alsifri, Mohammed Almehthel.
      The introduction of continuous glucose monitoring (CGM) has been considered a transformative monitoring tool in diabetes management. However, its adoption remains limited in the Gulf region, especially for patients with type 2 diabetes, due to cost, lack of reimbursement strategies, variability in healthcare infrastructure, and lack of trained health care providers (HCPs). The lack of regional guidelines tailored to the unique demographic, cultural, and health care needs of the Gulf population has resulted in low adoption and inconsistent use of CGM in clinical practice, leaving many patients without adequate advanced glucose monitoring options. This expert opinion statement evaluates the evidence for real-time CGM in the management of patients with type 2 diabetes and provides region-specific recommendations to guide HCPs in optimizing CGM use, improving patient outcomes, and addressing barriers to implementation in the Gulf region.
    Keywords:  expert opinion; intensive insulin therapy; real-time continuous glucose monitoring; the Gulf region; type 2 diabetes
    DOI:  https://doi.org/10.1177/19322968251393740
  8. J Diabetes Sci Technol. 2025 Nov 17. 19322968251394046
    Beyond Time in Range: Hidden Statistical Challenges of Continuous Glucose Monitoring Data in Diabetes Drug Development.
    Yoonhee Kim, Roberto Crackel, Hye Soo Cho, Wenda Tu, Yun Wang.
      
    DOI:  https://doi.org/10.1177/19322968251394046
  9. Cardiovasc Diabetol. 2025 Nov 21. 24(1): 442
    Comparable performance of 1,5-anhydroglucitol and continuous glucose monitoring in detecting subclinical atherosclerosis in elderly patients with type 2 diabetes.
    Hang Su, Jiaying Ni, Jingyi Lu, Wei Lu, Wei Zhu, Yufei Wang, Xiaojing Ma, Danfeng Peng, Jian Zhou.
       BACKGROUND: The comparison between conventional glycemic markers and continuous glucose monitoring (CGM) in relation to adverse outcomes in the elderly with type 2 diabetes remains unclear. We aimed to assess associations of 1,5-anhydroglucitol (1,5-AG) and CGM metrics with carotid intima-media thickness (CIMT) as a surrogate of cardiovascular disease.
    METHODS: The study included 2509 adults aged ≥ 60 years with type 2 diabetes. CIMT was measured by high-resolution ultrasonography, with abnormal CIMT defined as a mean thickness of ≥ 1.0 mm. Time in range (TIR), mean sensor glucose (MSG), time above range (TAR, > 10.0 mmol/L), standard deviation (SD), and coefficient of variation (CV) were calculated from CGM data.
    RESULTS: The median serum 1,5-AG was 3.9 (2.0, 8.0) μg/mL, and the prevalence of abnormal CIMT was 44.2% (n = 1,109). The prevalence of abnormal CIMT decreased across ascending 1,5-AG categories (P for trend < 0.01). In the fully adjusted model, each 1-standard deviation decrease in 1,5-AG conferred 10% higher odds of abnormal CIMT. Compared with 1,5-AG ≥ 10.0 μg/mL, 1,5-AG < 6.0 μg/mL was associated with an odds ratio of 1.25 (95% CI 1.00-1.55) for abnormal CIMT. Among CGM metrics, TIR, MSG, and TAR > 10.0, but not CV or SD, were significantly associated with abnormal CIMT. The C-statistics for 1,5-AG in predicting abnormal CIMT were comparable to those for TIR, MSG, and TAR >10.0 (all P > 0.05).
    CONCLUSIONS: In older adults with type 2 diabetes, 1,5-AG demonstrated a performance comparable to CGM for detecting abnormal CIMT, supporting its potential as a clinical biomarker for identifying subclinical atherosclerosis.
    Keywords:  1,5-Anhydroglucitol; Cardiovascular disease; Carotid intima-media thickness; Continuous glucose monitoring; Elderly; Type 2 diabetes
    DOI:  https://doi.org/10.1186/s12933-025-02993-1
  10. Clin Chim Acta. 2025 Nov 16. pii: S0009-8981(25)00607-2. [Epub ahead of print] 120728
    Clinical assessment and acceptance criteria for continuous glucose monitoring (CGM) system performance: A proposed guideline by the IFCC Working Group on CGM.
    Working Group on Continuous Glucose Monitoring of the IFCC Scientific Division
      Continuous glucose monitoring (CGM) systems are essential tools for modern diabetes care. However, the assessment of their analytical performance has been hindered by a lack of standardization. This poses challenges for the field, as the choice of study procedures and evaluation methods can influence the observed performance, further complicating the comparisons between CGM systems and confounding the interpretation and use of CGM metrics as research outcomes. To address this issue, the Working Group on CGM of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has developed a comprehensive guideline for the clinical assessment of CGM systems. The guideline defines requirements for study design and procedures, characteristics of comparator measurements, minimum requirements for accuracy, and performance characterization.
    Keywords:  Accuracy requirements; Comparator measurements; Continuous glucose monitoring; Performance assessment; Standardization; Study procedures; Traceability
    DOI:  https://doi.org/10.1016/j.cca.2025.120728
  11. Commun Med (Lond). 2025 Nov 15.
    Clinical validation of noninvasive blood glucose measurements by midinfrared spectroscopy.
    Michael Kaluza, Sergius Janik, Thorsten Lubinski, Mattia Saita, Peter Lachmann, Luca Canini, Valentino Lepro, Werner Mäntele.
       BACKGROUND: Non-invasive glucose monitoring (NIGM) is considered the holy grail of diabetes technology. Currently, diabetes is predominantly managed based on finger pricking and analysis of a drop of blood with test strips fitting into a glucometer. This invasive, painful and uncomfortable procedure is one of the reasons for insufficient diabetes management. Sensors for continuous glucose monitoring (CGM) in interstitial fluid (ISF) using a subcutaneous microscopic filament present a minimally invasive alternative. Worldwide, there is intense research and development for a true non-invasive glucose measurement.
    METHODS: DiaMonTech has demonstrated a NIGM technology that targets glucose in ISF. An infrared beam from a quantum cascade laser excites glucose molecules at wavelengths between 8 and 12 µm, where glucose has specific fingerprint absorbance. Absorption results in a small amount of heat in the skin, which can be detected on the surface using a photothermal deflection technique. This procedure is painless, harmless, and does not require consumables.
    RESULTS: We report here a single-center clinical test with 36 individuals (clinicaltrials.gov ID: NCT06088615). The accuracy of the NIGM device was evaluated in two subsequent sessions per individual, with different amounts of calibration data. Four different algorithms were tested for data analysis. The accuracy for the best algorithm, expressed as Mean Absolute Relative Difference was 20.7 % and 19.6 % for the two sessions.
    CONCLUSIONS: This is equivalent to the performance of early CGM systems cleared by the FDA for adjunctive use by people with diabetes. It demonstrates that glucose can be reliably measured with this non-invasive technology and opens new perspectives for a better management of diabetes.
    DOI:  https://doi.org/10.1038/s43856-025-01241-7
  12. Diabetes Technol Ther. 2025 Nov 21.
    The Importance of Expanding Medicare Continuous Glucose Monitoring Coverage for High-Risk Hypoglycemia.
    Mary Elizabeth Patti, Grazia Aleppo, Davida Kruger, Carol J Levy, Jesse Bushman, Guillermo Umpierrez, Rodolfo J Galindo, Gregory P Forlenza, Anders L Carlson, Janet B McGill.
      Medicare's current coverage policy for continuous glucose monitoring (CGM) restricts their use to people with diabetes. This restriction is based on an older National Coverage Determination (NCD 40.2) that limits blood glucose testing to people with diabetes. The CGM coverage policy also requires that CGM be used only in accordance with an Food and Drug Administration (FDA) indication for its use. However, the law, regulation, and subregulatory guidance do not require such a restriction. Multiple conditions unrelated to diabetes are associated with risk of hypoglycemic events, such as postbariatric and other upper gastrointestinal surgery, glycogen storage diseases, kidney and liver failure, neuroendocrine tumors that secrete insulin, other forms of tumor-associated hyperinsulinism, and autoimmune conditions. To avoid life-threatening hypoglycemic events, these patients need access to CGM to monitor their glucose levels. Thus, the Centers for Medicare & Medicaid Services should rescind NCD 40.2. The durable medical equipment Medicare administrative contractors (MACs) responsible for establishing CGM coverage policy should remove the requirement that CGM be used only in accordance with an FDA indication for its use. This would allow the MACs to extend coverage for CGM to populations at high risk for hypoglycemia, as the evidence supports such an approach.
    Keywords:  CGM; CMS; Centers for Medicare & Medicaid Services; bariatric surgery; continuous glucose monitoring; insurance coverage; severe hypoglycemia
    DOI:  https://doi.org/10.1177/15209156251396120
  13. World J Clin Pediatr. 2025 Dec 09. 14(4): 107127
    Use of continuous glucose monitoring systems in pediatric patients in the perioperative environment: Challenges and machine learning opportunities.
    Tara Doherty, Ashley Kelley, Elizabeth Kim, Irim Salik.
      Pediatric type 1 diabetes (T1D) is a lifelong condition requiring meticulous glucose management to prevent acute and chronic complications. Conventional management of diabetic patients does not allow for continuous monitoring of glucose trends, and can place patients at risk for hypo- and hyperglycemia. Continuous glucose monitors (CGMs) have emerged as a mainstay for pediatric diabetic care and are continuing to advance treatment by providing real-time blood glucose (BG) data, with trend analysis aided by machine learning (ML) algorithms. These predictive analytics serve to prevent against dangerous BG variations in the perioperative environment for fasted children undergoing surgical stress. Integration of CGM data into electronic health records (EHR) is essential, as it establishes a foundation for future technologic interfaces with artificial intelligence (AI). Challenges in perioperative CGM implementation include equitable device access, protection of patient privacy and data accuracy, ensuring institution of standardized protocols, and financing the cumbersome healthcare costs associated with staff training and technology platforms. This paper advocates for implementation of CGM data into the EHR utilizing multiple facets of AI/ML algorithms.
    Keywords:  Artificial intelligence; Continuous glucose monitor; Continuous glucose monitoring system; Electronic health records; Type 1 diabetes mellitus
    DOI:  https://doi.org/10.5409/wjcp.v14.i4.107127
  14. Diabetes Spectr. 2025 ;38(4): 441-448
    Oral Hygiene Practices and Glucose Profiles Assessed Through Continuous Glucose Monitoring in Adults With Type 2 Diabetes.
    Kayo Harada, Yasutaka Maeda, Dan Sekiguchi, Atsushi Ishikado, Mayu Hayashi Suzuki, Ayumi Tamura, Masae Minami.
       OBJECTIVE: Taking into account the potential link between oral hygiene and glycemic management in individuals with type 2 diabetes, this study aimed to investigate the relationship between oral hygiene practices, namely, tooth brushing, interdental cleaning, dental visits, and remaining teeth, and glycemic variability measured by continuous glucose monitoring (CGM) in people with type 2 diabetes, with a particular focus on the role of inflammation.
    RESEARCH DESIGN AND METHODS: This cross-sectional study included 104 adults with type 2 diabetes visiting an internal medicine clinic. Questionnaires were used to collect data on oral hygiene practices, dental visit frequency, and the number of remaining teeth. Blood and urine samples were obtained, and CGM was performed for 2 weeks. The relationship between oral hygiene practices and diabetes management indicators, as well as inflammation markers, was analyzed.
    RESULTS: The frequency of tooth brushing was negatively correlated with BMI, inflammation-related markers such as high-sensitivity C-reactive protein and tumor necrosis factor-α, and urine albumin-to-creatinine ratio. Interdental cleaning three or more times per week compared with less frequent cleaning was associated with lower fasting blood glucose, lower A1C, and improve CGM-related metrics, including greater time in range (TIR), lower glucose management indicator (GMI), and lower time above range. In logistic regression analysis, interdental cleaning showed associations with achieving TIR and GMI goals, even after adjusting for background factors and inflammatory markers.
    CONCLUSION: This study highlights the crucial role of oral hygiene practices in type 2 diabetes. Regular dental visits and effective oral self-care are paramount for promoting optimal oral health and managing diabetes.
    DOI:  https://doi.org/10.2337/ds25-0015
  15. Diabetes Technol Ther. 2025 Nov 21.
    Multivendor Continuous Glucose Monitor Integration into the Electronic Health Record: Real-World Experience of an Academic Pediatric Endocrinology Clinic.
    Michelle I Knopp, Rachel Leonard, Wayne Geers, Siobhan Tellez, Bill Vidonish, Gajanthan Muthuvel, Bliss Magella, Nana-Hawa Yayah Jones, Juan Espinoza, Sarah D Corathers.
      Background: The rapid advancement of diabetes technology, including continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery systems, has revolutionized diabetes management. However, current care delivery paradigms have not kept pace, prolonging suboptimal health outcomes for youth with type 1 diabetes (T1D). A significant obstacle is the siloed nature of clinical data. This article explores integrating CGM data for multiple vendors into electronic health records (EHRs) to unify diabetes data in health care practices. Methods: This article describes the integration of diabetes device data, following Integration of Continuous Glucose Monitoring Data into the Electronic Health Record (iCoDE) specifications, in the EHR at an urban, tertiary, academic pediatric medical center serving approximately 500,000 pediatric lives in Southwest Ohio. The Diabetes Center provides specialized interdisciplinary care for about 2200 patients with diabetes, with an average of 200+ new onset cases/year. This project is part of the Cincinnati Children's Diabetes Clinic Initiative (ConnecT1D), funded by the Helmsley Charitable Trust, aiming to reorient diabetes care from quarterly visits to continuous, proactive care. Results: By evaluating 6 key factors for integration (data sources types, clinical workflows, level of integration, visualizations, sustainable account management, and optimization), we successfully achieved structural interoperability of CGM device data for 3 vendor platforms into the results section of the EHR using HL7 v2.x. Discussion: We present practical tips to optimize the integration experience: identify the problem, mobilize resources, negotiate contracts early, evaluate and optimize the workflow, celebrate early wins, prepare for (inevitable) stumbling blocks, keep asking questions, implement change management techniques, and evaluate integration acceptance, iterate, and monitor. Conclusion: While beneficial for patients and clinical workflows, integration of vendor CGM data into the EHR currently requires significant resources. Challenges remain in optimizing workflows, mapping data, and vendor variability. Ongoing monitoring, maintenance, and optimization are necessary as technology and workflows evolve.
    Keywords:  HL7; continuous glucose monitors; electronic health record; health care data; integration; standards
    DOI:  https://doi.org/10.1177/15209156251395034
  16. BMC Endocr Disord. 2025 Nov 21.
    Glucotypes in patients with type 2 diabetes and either diabetic kidney disease or end stage kidney disease under different anti-diabetic treatments.
    Yu-Yun Chou, Feng-Hsuan Liu, Chia-Hung Lin.
       BACKGROUND: The profile of glycemic changes in diabetic kidney disease (DKD) remains unclear. Therefore, we aimed to evaluate glucotypes in patients with type 2 diabetes and end stage kidney disease (ESKD) and those with DKD through continuous glucose monitoring (CGM).
    METHODS: We analyzed ambulatory glucose profiles. The primary outcome was time in range (TIR) and the secondary outcomes included hypoglycemia and glucose variability.
    RESULTS: Twenty-one patients with ESKD and 42 patients with DKD were enrolled after matching for age and gender. There was no significant difference in TIR between the ESKD and DKD groups. However, patients with ESKD exhibited higher standard deviation (SD), and nocturnal glucose levels compared to those with DKD. For different dialysis treatments, patients undergoing peritoneal dialysis (PD) had higher continuous overlapping net glycemic action (CONGA), J-Index, high blood glucose index (HBGI), glycemic risk assessment in diabetes equation (GRADE), and M-value than those undergoing HD. Additionally, higher all day glycemic values were observed in the PD group. Patients with ESKD on premixed insulin therapy had higher standard deviation of sensor glucose across 24 h and lower nocturnal glucose levels compared with those on Multiple daily injection (MDI).
    CONCLUSIONS: Patients with ESKD exhibited higher glucose variability and nocturnal glucose levels compared with those with DKD. Patients receiving PD showed higher glycemic variability and glucose levels compared with those undergoing HD.
    Keywords:  Continuous glucose monitoring; Diabetes; Diabetic kidney disease
    DOI:  https://doi.org/10.1186/s12902-025-02108-7
  17. Diabetes Care. 2025 Dec 01. 48(12): e183
    Disparities in Continuous Glucose Monitor Uptake Among Veterans With Diabetes Despite Universal Coverage.
    Pedro Leonel Rojas, Sarah Nadeem.
      
    DOI:  https://doi.org/10.2337/dc25-2244
  18. J Diabetes Res. 2025 ;2025 5724236
    Impact of a Nurse Practitioner-Led Diabetes Program on Barriers to CGM Use in a Federally Qualified Health Center After Medicaid Expansion.
    Ligaya Docena Scarlett, Walter Solorzano, Katayoun Khoshbin, Giuliana Perini Villanueva, Kathyana Santiago Mangual, Marielle Tavares, Cynthia Santana, Bryan Escobar, Joseph Borrell, Beatrice Brumley, Tannaz Moin, Estelle Everett.
       Objective: Continuous glucose monitors (CGMs) enhance diabetes management, but disparities exist, particularly among underserved populations in federally qualified health centers (FQHCs). In 2022, a California Medicaid policy change expanded CGM coverage, providing an opportunity to better evaluate barriers to CGM use within primary care in an FQHC.
    Methods: We used 2022-2023 electronic health record (EHR) data to identify adults with diabetes managed on insulin within a nurse practitioner-led diabetes program in primary care. Patients were categorized as current, former, or never CGM users. We used summary statistics, chi-squared, and Bartlett's tests to assess unadjusted group differences and multivariate logistic regression to identify factors associated with former or never use. All patients were invited to complete a survey on CGM facilitators and barriers.
    Results: Among 275 eligible patients, 109 (40%) were current CGM users, 31 (11%) former users, and 135 (49%) never users. Discussions on CGM occurred in 45% of never users, who were more likely to have non-Medicaid insurance, fewer than five clinic visits (OR 3.69, 95% CI: 1.94-6.99), and a lower baseline A1C (OR 0.67, 95% CI: 0.52-0.86). No demographic or clinical factors were associated with former CGM use. Among survey respondents (n = 124), the desire to reduce finger-pricks motivated CGM use, while device burden and inconvenience contributed to discontinuation or refusal.
    Conclusions: Medicaid policy expansion reduced major structural barriers to CGM use, yet some patient-related barriers persisted. Team-based care models integrating health educators and advanced practice providers can successfully support CGM access and sustained use in underserved populations.
    Keywords:  CGM; FQHC; continuous glucose monitoring; federally qualified healthcare centers
    DOI:  https://doi.org/10.1155/jdr/5724236
  19. J Am Geriatr Soc. 2025 Nov 19.
    Comment on: Agreement Between Fingerstick Blood Glucose and Continuous Glucose Monitor Measures Among Long-Term Care Facility Residents.
    Xiaohong Song.
      
    DOI:  https://doi.org/10.1111/jgs.70204
  20. Cost Eff Resour Alloc. 2025 Nov 19. 23(1): 67
    Economic analyses of freestyle libre systems for people living with diabetes: a systematic literature review.
    Gerard de Pouvourville, Jack Timmons, Fleur Levrat-Guillen, Anthony Zara, Yeesha Poon.
      
    Keywords:  Continuous glucose monitoring; Cost effectiveness; Economic evaluation; FreeStyle Libre; Systematic literature review; Type 1 diabetes mellitus; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.1186/s12962-025-00673-1
  21. J Diabetes Complications. 2025 Nov 08. pii: S1056-8727(25)00268-5. [Epub ahead of print]40(1): 109215
    Impact of technologies on quality of life in relation to glucose control in patients with type 1 diabetes.
    Silvia Irina Briganti, Oreste Lanza, Valerio Renzelli, Giuseppe Campagna, Daria Maggi, Massimiliano Caprio, Silvia Manfrini, Rocky Strollo.
       AIM: To assess the effect of insulin delivery and glucose monitoring technologies on quality of life in relation with glucose control in adults with type 1 diabetes (T1D).
    METHODS: This cross-sectional study included 69 adults with T1D (mean age 39.3 ± 12.1 years; 44.9 % females): 36 on multiple daily insulin injections (MDI) and 33 on continuous subcutaneous insulin infusion (CSII). Patient-reported outcomes were assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ), Diabetes-Specific Quality of Life Scale (DSQOLS), and SF-36. Glucose control was evaluated using HbA1c and CGM metrics.
    RESULTS: Individuals in the CSII group reported higher treatment-related satisfaction (p = 0.004), and better disease acceptance (p = 0.004) compared with individuals on MDI, despite similar age, sex or disease duration (p > 0.34). Time in range (TIR) resulted higher in the CSII group than in the MDI group (p = 0.02), while time below range (TBR) resulted higher in the MDI group compared to CSII (p = 0.03). Individuals reporting high satisfaction scores demonstrated better glucose control metrics compared to those with lower satisfaction levels. The association between satisfaction and TIR was relevant, even after adjusting for treatment modality (p = 0.0003).
    CONCLUSIONS: Technology may improve quality of life over MDI treatment. Improvement in glucose control may partially account for this effect.
    Keywords:  Continuous glucose monitoring; Continuous subcutaneous insulin infusion; Glucose control; Insulin therapy; Quality of life; Time in range; Treatment satisfaction; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.jdiacomp.2025.109215
  22. Cardiovasc Diabetol. 2025 Nov 21. 24(1): 441
    Clinical perspectives of new insights and tools to minimize the hypoglycaemia burden connected with type 2 diabetes pharmacotherapy.
    Eberhard Standl, Antonio Ceriello, Darren K McGuire, Oliver Schnell, Rury R Holman.
      
    Keywords:  Bi-directional association; Cardiovascular events; Continuous glucose monitoring; Hypoglycaemia; Phenotype at dual risk; Type 2 diabetes pharmacotherapy
    DOI:  https://doi.org/10.1186/s12933-025-02959-3
  23. JMIR Diabetes. 2025 Nov 20. 10 e68821
    Coefficient of Variation to Assess the Reproducibility of Meal-Induced Glycemic Responses: Development of a Clustering Algorithm.
    Nicole Lubasinski, Hood Thabit, Paul W Nutter, David Petrescu, Simon Harper.
       Background: Managing type 1 diabetes (T1D) requires maintaining target blood glucose levels through precise diet and insulin dosing. Predicting postprandial glycemic responses (PPGRs) based solely on carbohydrate content is limited by factors such as meal composition, individual physiology, and lifestyle. Continuous glucose monitors provide insights into these responses, revealing significant individual variability. The statistical clustering method proposed here balances the number of clusters formed and the glycemic variability of the PPGRs within each cluster to offer a clustering technique on which treatment decisions could be based.
    Objective: This study aims to develop and evaluate a PPGR clustering method that identifies reproducible meal-specific glucose patterns in people with type 1 diabetes.
    Methods: Blood glucose data from the OhioT1DM dataset were used to assess clustering of PPGR based on the coefficient of variability (CV) of glucose. Clustering was performed using statistical clustering, with each PPGR isolated into 48 data points per event. A CV threshold of <36% was used to define clinically similar clusters. This aimed to cluster PPGRs with minimal glycemic variability. The approach aims to enhance precision in analyzing postprandial glycemic dynamics, assessing cluster cohesion via standard deviation and CV within meal categories.
    Results: The analysis revealed a reproducible set of PPGR clusters specific to meal types and individuals (mean [SD], 2.4 [1.8] for breakfast, 2.7 [0.9] for lunch, and 3.1 [1.0] for dinner), with the number of clusters varying across participants and meals in the dataset. Carbohydrate intake alone did not affect cluster formation, suggesting a complex relationship between meal composition and PPGR variability. However, certain individuals showed significant associations between carbohydrate intake and cluster formation for specific meals.
    Conclusions: The meal-based glycemic clustering algorithm provides a promising framework for predicting PPGRs in people with type 1 diabetes, independent of carbohydrate intake. It emphasizes the need for personalized prediction models to optimize time in range and enhance diabetes management. Efforts to refine treatment strategies are crucial in reducing T1D-related complications.
    Keywords:  PPGR clusters; bolus targeting solution; meal-based PPGR clustering algorithm; postprandial glycemic response (PPGRs); reproducibility; type 1 diabetes (T1D)
    DOI:  https://doi.org/10.2196/68821
  24. Diabetes Technol Ther. 2025 Nov;27(S4): S1-S5
    Role of Continuous Dual Glucose-Ketone Monitoring in Diabetes Care.
    Satish K Garg, Christopher G Parkin.
      
    Keywords:  CGM; DGK; continuous dual glucose–ketone monitoring; hyperglycemia; hypoglycemia; insulin pump
    DOI:  https://doi.org/10.1177/15209156251369529
  25. Diabetes Technol Ther. 2025 Nov;27(S4): S32-S35
    Integrating Continuous Dual Glucose-Ketone Monitoring into Clinical Practice.
    Eden Miller, Kevin Miller, Richard M Bergenstal.
      Diabetic ketoacidosis (DKA) is a life-threatening diabetes emergency associated with mortality and severe morbidities in individuals with diabetes. DKA mainly presents with significant hyperglycemia (>250 mg/dL); however, with the increasing use of sodium-glucose transporter 2 inhibitors, we are seeing an increase in euglycemic DKA (euDKA) in both type 1 diabetes and type 2 diabetes. Although severe DKA generally requires emergency department services or inpatient hospitalization, clinicians can play an important role in helping patients prevent DKA by providing comprehensive education to their patients regarding early identification of elevated ketone states and intervention for improvement in ketone production, thus potentially preventing the severity of DKA. Although ketone monitoring is recommended for all patients at risk for developing DKA or euDKA, current ketone monitoring methods have significant limitations. Abbott Diabetes Care (Alameda, CA) is developing a dual monitoring system that continuously measures interstitial glucose and β-hydroxybutyrate using a single sensor. This article discusses how continuous dual glucose-ketone monitoring can be integrated into primary care practice when it becomes available.
    Keywords:  DKA; continuous dual glucose-ketone monitoring; diabetic ketoacidosis; ketone
    DOI:  https://doi.org/10.1177/15209156251392900
  26. Front Endocrinol (Lausanne). 2025 ;16 1715800
    Switch from premixed insulin analogue to degludec-liraglutide combination: a CGM study.
    Nika Aleksandra Kravos Tramšek, Andrijana Koceva, Mitja Krajnc.
       Introduction: Basal insulin with glucagon-like peptide-1 receptor agonist could be preferred over premixed insulin for intensification in type 2 diabetes due to better glycemic control, lower hypoglycemia risk, and favorable effects on body weight. Comparative data on premixed insulin and the combination of degludec and liraglutide (iDegLira) are limited.
    Methods: We conducted a 24-week single-arm prospective study to evaluate the impact of iDegLira compared to premixed insulin on the regulation of diabetes and glucovariability using continuous glucose monitoring (CGM), HbA1c, and anthropometric measurements. A total of 37 participants with type 2 diabetes (20 male and 17 female, aged 70.2 ± 10.0 years with BMI 31.0 (28.0-34.0) kg/m2 and duration of diabetes for 15.2 ± 7.7 years) were switched from premixed insulin treatment to iDegLira. The primary outcome was the change in HbA1c. Secondary outcomes included change in time in range (TIR) from baseline to 6 months, change in time below range (TBR), change in nocturnal hypoglycemia, glucovariability, insulin dose and body weight.
    Results: We observed improved glycemic control on iDegLira with improvement of average fasting glucose (6.92 ± 1.64 vs. 8.25 ± 2.2 mmol/l; p<0.031), HbA1c (7.10 ± 0.7% vs. 7.39 ± 0.7% p=0.045) and TIR (71.2 ± 17.2% vs. 64.3 ± 18.0; p=0.027). These results were accompanied by a nearly halved total daily insulin dose (-21 units/day, p<0.001) and a modest reduction of body weight.
    Discussion: iDegLira improved glycemic control, resulting in a lower HbA1c and higher TIR, alongside beneficial effects on body weight and total daily insulin doses. While numerical reductions in hypoglycemia did not reach statistical significance, treatment was not associated with an increased risk of hypoglycemia. iDegLira can be an efficient and safe treatment option, providing simplified treatment with improved glycemic control.
    Keywords:  CGM targets; GLP-1 analogue; IDegLira; continuous glucose monitoring (CGM); diabetes mellitus; premixed insulin
    DOI:  https://doi.org/10.3389/fendo.2025.1715800
  27. J Am Geriatr Soc. 2025 Nov 19.
    Reply to: Comment on: Agreement Between Fingerstick Blood Glucose and Continuous Glucose Monitor Measures Among Long-Term Care Facility Residents.
    Marzan A Khan, Medha N Munshi, Christine Slyne, Nina R Joyce, Andrew R Zullo.
      
    DOI:  https://doi.org/10.1111/jgs.70202
  28. Diabetes Technol Ther. 2025 Nov;27(S4): S36-S43
    The Future of Dual Glucose-Ketone Monitoring in Youth with Diabetes.
    Jennifer L Sherr, Erin C Cobry.
      Diabetic ketoacidosis (DKA) is the most common acute complication and leading cause of mortality in children and adolescents with diabetes. While DKA is mainly seen in type 1 diabetes, youth with type 2 diabetes, especially adolescents, are also susceptible to this condition. As a standard of care, individuals at risk for DKA and their caregivers are provided with instructions for preventing and managing ketone development. However, the use of urine ketone or blood ketone monitoring is often suboptimal. Abbott Diabetes Care (Alameda, CA) is developing a dual monitoring system that continuously measures interstitial glucose and β-hydroxybutyrate using a single continuous dual glucose-ketone (DGK) sensor. The use of continuous ketone monitors in the pediatric population has the potential to improve at-home monitoring and early initiation of intervention with rising ketone levels prior to severe DKA requiring hospitalization. This article reviews the importance of ketone testing, examines current testing options, and discusses how DGK, a novel testing technology, can reduce the occurrence of DKA in children and adolescents who are living with diabetes.
    Keywords:  DKA; diabetic ketoacidosis; dual continuous glucose–ketone monitoring; pediatrics; type 1 diabetes; type 2 diabetes
    DOI:  https://doi.org/10.1177/15209156251370944
  29. Diabetes Technol Ther. 2025 Nov;27(S4): S20-S24
    Continuous Dual Glucose-Ketone Sensing Technology.
    Udo Hoss, Shridhara Alva, Heather Pryor, Zoe Welsh, Benjamin Feldman.
      Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes. Although individuals who are at risk for DKA are advised to monitor ketone levels, adherence to monitoring is suboptimal. Continuous ketone monitoring is an emerging technology with the potential to address many of the limitations of current monitoring methods. Abbott Diabetes Care (Alameda, CA) has developed a continuous dual glucose-ketone sensor that measures both interstitial glucose and ketone levels simultaneously, transmitting the information in a continuous stream of data to users. However, one of the challenges in this effort was developing a sensor that can be factory-calibrated to ensure accuracy, safety, and user convenience. This article describes processes realizing factory calibration for the ketone sensor component.
    Keywords:  continuous ketone monitoring; dual glucose–ketone sensor; ketone
    DOI:  https://doi.org/10.1177/15209156251390820
  30. Diabetes Technol Ther. 2025 Nov;27(S4): S6-S13
    Global Burden of Diabetic Ketoacidosis.
    Viswanathan Mohan, Kenneth Lee.
      Diabetic ketoacidosis (DKA) is a critical medical emergency, with an estimated annual incidence of 4%-8% among adults with type 1 diabetes (T1D). Up to 80% of children/adolescents <15 years of age present with DKA at the time they are diagnosed with T1D. Although DKA occurs less frequently in individuals with type 2 diabetes, there has been a rise in DKA incidence in this population due to increasing use of sodium-glucose cotransporter 2 inhibitors (SGLT-2i), in which DKA often presents with only moderately elevated glucose. This is referred to as euglycemic DKA (euDKA). While DKA is traditionally linked to T1D, it also constitutes a serious clinical concern in other diabetes phenotypes, such as pregnancy and ketosis-prone diabetes. This article provides an overview of the global burden of DKA, recent advancements in ketone monitoring technologies, and the complexities surrounding diabetes classification. Furthermore, it highlights the development of a continuous dual glucose-ketone sensor and its potential applications in the clinical management of individuals at risk for DKA.
    Keywords:  DKA; continuous dual glucose–ketone monitoring; diabetic ketoacidosis; epidemiology; global; prevalence
    DOI:  https://doi.org/10.1177/15209156251390828
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