bims-glumda 2026-05-17 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2026–05–17
twelve papers selected by
Mott Given

How Continuous Glucose Monitoring Reports Inform Clinical Decision-Making for Older Adults With Type 2 Diabetes: Mapping Clinical Workflow to Situation Awareness.
A Digital Diabetes Self-Management Education and Support Program Integrated With Continuous Glucose Monitoring for Type 2 Diabetes: Randomized Controlled Trial.
Prehospital identification of hypoglycemia-induced seizure using a smartphone-linked continuous glucose monitoring application.
Clinical and socioeconomic determinants of glycaemic control derived from continuous glucose monitoring in adults with type 1 diabetes.
How CGM Use in Adults With Type 2 Diabetes Leads to Glycemic Benefits: The Role of Medication and Behaviour Change.
Effectiveness of Continuous Glucose Monitoring on Glycemic and Metabolic Outcomes in Type 2 Diabetes: A Two-Year Real-World Analysis.
Advantages of Continuous and Non-Invasive Glucose Monitoring in the Geriatric Population: A Systematic Review.
Gold and Clarke Questionnaires Identify Different People With Insulin-Treated Diabetes and Impaired Awareness of Hypoglycaemia in Almost 60% of Cases: A Post Hoc Analysis From the Hypo-METRICS Study.
Building the evidence to address disparities in type 1 diabetes (BEAD-T1D): methods and design of a study examining barriers and promoters to diabetes device use in families with public insurance.
Transition from CSII to second-generation basal insulin analogues in hospitalized T2DM patients: a CGM-based study.
Personalized Medicine Interventions for Glycemic Control in Adults With Type 2 Diabetes: A Systematic Review.
Real-World Ketone Testing Patterns Among People Using FreeStyle Libre.

J Diabetes Sci Technol. 2026 May 15. 19322968261449829

How Continuous Glucose Monitoring Reports Inform Clinical Decision-Making for Older Adults With Type 2 Diabetes: Mapping Clinical Workflow to Situation Awareness.

April Savoy, Cristina Barboi, Sam Bibat, Emily Meanwell, Viral N Shah, Michael Weiner.

   BACKGROUND: Older adults with type 2 diabetes experience high risk of hypoglycemia, yet clinicians often lack actionable glucose data to guide individualized treatment decisions. This study examined how standardized continuous glucose monitoring (CGM) reports inform clinicians' decision-making using Endsley's situation awareness (SA) framework.
METHODS: We conducted semi-structured interviews. Thirty clinicians reviewed three simulated older adult type 2 diabetes cases before and after reviewing CGM reports. Data saturation was achieved, consistent with qualitative research standards. Using an SA informed framework, we analyzed the proportion of clinicians referencing specific data elements and describing changes in diagnostic reasoning and treatment decisions.
RESULTS: After CGM data review, clinicians frequently revised assessments and plans. Most clinicians (90%) incorporated time-in-range metrics, while 93% identified previously unrecognized hypoglycemia or nocturnal patterns. Continuous glucose monitoring data led 86% of clinicians to modify their original treatment plan, including deprescribing high-risk agents (eg, sulfonylureas), adjusting insulin timing or dosing, or initiating safer alternatives (eg, SGLT-2 inhibitors, GLP-1 receptor agonists). Clinicians also identified multiple barriers to treatment implementation, including cost, medication access, housing instability, and limited food security.
CONCLUSIONS: Continuous glucose monitoring data-compared with A1C alone-provided meaningful, actionable information that improved individualized treatment decisions for older adults with type 2 diabetes. Continuous glucose monitoring data enhanced clinicians' perception, comprehension, and projection across the SA continuum, fostering more confident diagnostic reasoning and safer treatment strategies. These findings inform the design of SA-based clinical decision-support tools to better integrate CGM data, address contextual barriers, and optimize management of older adults with type 2 diabetes.

Keywords:  clinical decision-making; continuous glucose monitoring; medication management; older adults; situation awareness; type 2 diabetes

DOI:  https://doi.org/10.1177/19322968261449829
J Med Internet Res. 2026 05 14. 28 e78321

A Digital Diabetes Self-Management Education and Support Program Integrated With Continuous Glucose Monitoring for Type 2 Diabetes: Randomized Controlled Trial.

Ashley Berthoumieux, Jeanean B Naqvi, Sean Zion, Jenna Napoleone, Amanda McGuill, Christian J Cerrada, Hyun Jung Lee, Timothy C Dunn, David Kerr, Carolyn Bradner Jasik, Sarah Linke.

   Background: Previous research has demonstrated that the use of continuous glucose monitoring (CGM) can improve glycemic control in people with type 2 diabetes when used regularly alongside a digital diabetes self-management education and support (DSMES) program. However, to date, there is limited evidence showing the benefits of a digitally delivered DSMES program combined with real-time CGM for adults with type 2 diabetes.
Objective: The objective of this study is to evaluate the impact of a DSMES program coupled with CGM on hemoglobin A1c (HbA1c) and CGM-derived glycemic measures compared to usual care for adults with type 2 diabetes over 6 months.
Methods: Participants with type 2 diabetes and HbA1c of 8% or higher (64 mmol/mol) who were not using mealtime bolus insulin (aged 26-83 y; mean HbA1c 9.6%, SD 1.4% [mean 81.2 mmol/mol, SD 15.8 mmol/mol]) were randomly assigned to a digital DSMES+CGM integrated solution (n=51) or usual care (n=49) for 6 months. The primary outcome was HbA1c. The secondary outcomes were CGM-derived glycemic measures, including glucose management indicator, percent time in range 70 to 180 mg/dL, percent time above range (>180 mg/dL), percent time below range (<70 mg/dL), and mean glucose. Linear mixed effects models were used for intention-to-treat analyses.
Results: HbA1c was lower among the intervention group versus the usual care group at 3 months (difference=-0.7%, 95% CI -1.4% to -0.1% or difference=-8.1 mmol/mol, 95% CI -15.5 to -0.7 mmol/mol; P=.03) and at 6 months (difference=-0.6%, 95% CI -1.4% to 0.2% or difference=-6.9 mmol/mol, 95% CI -15.7 to 1.9 mmol/mol; P=.12) but only reached statistical significance at 3 months. CGM-derived glycemic measures, including glucose management indicator (difference=-0.9%, 95% CI -1.7% to -0.1%; P=.03), time in range (difference=14.6%, 95% CI 1.0% to 28.2%; P=.04), time above range (difference=-14.9%, 95% CI -29.0% to -0.9%; P=.04), and mean glucose (difference=-36.4 mg/dL, 95% CI -70.0 to -2.9 mg/dL; P=.03), also significantly improved for the intervention group versus the usual care group at 6 months.
Conclusions: The combination of digital DSMES+CGM is effective for supporting adults with type 2 diabetes in managing their condition and has the potential to reduce the risk of long-term health complications.

Keywords:  chronic disease management; continuous glucose monitoring; diabetes education; diabetes self-management education and support; digital health; time in range

DOI:  https://doi.org/10.2196/78321
Am J Emerg Med. 2026 May 10. pii: S0735-6757(26)00233-0. [Epub ahead of print]107 13-15

Prehospital identification of hypoglycemia-induced seizure using a smartphone-linked continuous glucose monitoring application.

Kenji Harada, Yuji Okazaki, Toshihisa Ichiba.

  Seizures are a common reason for emergency medical service (EMS) activation. Among various etiologies, hypoglycemia is relatively rare in prehospital settings, and blood glucose measurements at symptom onset are often unavailable. Continuous glucose monitoring (CGM) devices synchronized with smartphone applications can provide real-time or retrospective glucose data, potentially supporting prehospital clinical assessment. This case report describes a 37-year-old man with type 1 diabetes mellitus who experienced a generalized tonic-clonic seizure while shopping with his seven-year-old son. Using a smartphone application linked to the patient's CGM device, the child identified a critically low glucose level at seizure onset. Based on this information, emergency medical services were promptly contacted. Upon EMS arrival, the seizure had resolved; however, the patient remained mildly agitated. Oral carbohydrate was administered, and subsequent point-of-care testing showed improvement in blood glucose levels. On arrival at the emergency department, no focal neurological deficits were observed. Clinical findings, together with CGM data, supported a diagnosis of hypoglycemia-induced seizure. This case highlights two important aspects of both prehospital care and emergency settings. First, smartphone applications linked to CGM devices can provide valuable information regarding glucose trends during transient neurological events. Second, such applications can be effectively used even by individuals without medical training, including children, to recognize abnormal glucose patterns and facilitate appropriate emergency response. Awareness of this novel use of CGM technology may help both prehospital and hospital-based providers better interpret prehospital information.

Keywords:  Continuous; Diabetes mellitus; Emergency medical services; Glucose monitoring; Hypoglycemia; Seizures; Type 1

DOI:  https://doi.org/10.1016/j.ajem.2026.05.021
Front Endocrinol (Lausanne). 2026 ;17 1813510

Clinical and socioeconomic determinants of glycaemic control derived from continuous glucose monitoring in adults with type 1 diabetes.

Ángel Manuel Mesa Díaz, Pablo Rodríguez de Vera Gómez, María Ruiz Rodríguez, Samuel Belmonte Lomas, Blanca Gómez Zaragoza, Eduardo Mayoral Sánchez, María Asunción Martínez Brocca.

   Aim: To identify clinical, sociodemographic and glucometric factors associated with achieving international glycaemic targets derived from intermittently scanned continuous glucose monitoring (isCGM) in adults with type 1 diabetes mellitus (T1DM) treated with multiple daily injections (MDI) in Andalusia, a region with universal access to isCGM.
Methods: A cross-sectional, population-based study was conducted using centralized electronic health records from the Andalusian Public Health System (APHS). Adults with T1DM using isCGM for ≥1 year and integrated glucometric data in Electronic Health Records in APHS in the 14 days preceding the download were included. Four glycaemic endpoints were evaluated: time in range (TIR ≥ 70%), time above range (TAR < 25%), time below range (TBR < 5%), and achievement of full AGP profile. Univariate analyses and multivariable logistic regression models were used to identify independent predictors.
Results: A total of 7,885 individuals were included. Overall, 24.8% achieved TIR ≥ 70%, 35.0% TAR < 25%, 72.9% TBR < 5%, and 12.3% met the full AGP profile. Lower HbA1c, lower glycaemic variability and a higher number of daily scans were consistently associated with achieving glycaemic targets. Older age and male sex were independent predictors of TIR ≥ 70%. Socioeconomic status showed a significant association: individuals in the intermediate-income group had higher odds of achieving TIR, TAR and full AGP criteria. No socioeconomic associations were observed for TBR < 5%.
Conclusions: In a real-world setting with universal isCGM provision, clinical, sociodemographic and glucometric determinants independently influence the achievement of glycaemic targets in adults with T1DM. Integrating advanced monitoring metrics with explicit consideration of social determinants may enhance the precision and equity of glycaemic management strategies.

Keywords:  ambulatory glucose profile; continuous glucose monitoring; glycaemic variability; socioeconomic status; time in range; type 1 diabetes

DOI:  https://doi.org/10.3389/fendo.2026.1813510
Endocrinol Diabetes Metab. 2026 May;9(3): e70236

How CGM Use in Adults With Type 2 Diabetes Leads to Glycemic Benefits: The Role of Medication and Behaviour Change.

William H Polonsky, Taylor L Clark, Emily C Soriano, Andrew Edgington, Cameron M Bennett, Amy E Fox, Thomas Grace.

INTRODUCTION: Although continuous glucose monitoring (CGM) in adults with type 2 diabetes (T2D) has known glycemic benefits, the underlying behavioural and psychosocial processes driving these outcomes remain poorly understood. We examined how CGM influences patient-reported outcomes and whether changes in those outcomes predict glycemic improvement.
RESEARCH DESIGN AND METHODS: This 6-month prospective observational study included 115 adults with T2D and elevated HbA1c who did not use fast-acting insulin and initiated CGM through a real-world program. At baseline, 3- and 6-months, HbA1c, medication use/changes and key psychosocial and self-care behaviours were assessed. Longitudinal structural equation models assessed changes over time and predictors of HbA1c reduction. Post hoc moderation analyses explored whether the effect of self-care behaviour improvements on HbA1c outcomes depended upon new medication starts at baseline.
RESULTS: HbA1c declined significantly from 9.4% (79 mmol/mol) at baseline to 7.3% (56 mmol/mol) at both 3 and 6 months (ps < 0.001). Participants reported increased diabetes engagement, reduced distress, increased physical activity, fewer missed medications and less overeating (ps < 0.001). In multivariate models, greater HbA1c reduction was independently predicted by: (1) starting a new diabetes medication in the few months before baseline (b = -1.06, p < 0.001); (2) increases in physical activity (b = -0.13, p = 0.040); and (3) improvements in medication-taking (b = 2.33, p < 0.001). Post hoc moderation analysis revealed that behaviour changes were most predictive of glycemic benefit among participants who had not started a new diabetes medication pre-baseline.
CONCLUSIONS: Real-world CGM initiation was associated with significant improvements in glycemic control, self-care behaviours and psychosocial outcomes. Behaviour change-notably, improved diet and physical activity-was a key contributor to glycemic gains, particularly among those not undergoing medication adjustments prior to CGM initiation. These findings support CGM as a catalyst for engagement and behaviour change in T2D management.

DOI: https://doi.org/10.1002/edm2.70236
J Diabetes Sci Technol. 2026 May 11. 19322968261447256

Effectiveness of Continuous Glucose Monitoring on Glycemic and Metabolic Outcomes in Type 2 Diabetes: A Two-Year Real-World Analysis.

Ayman Al Hayek, Wael M Al Zahrani, Haifa F Alotaibi, Mohammed A Al Dawish.

   BACKGROUND: To evaluate whether sustained use of continuous glucose monitoring (CGM) is associated with long-term patterns in glycemic control, safety indicators, and health care utilization among adults with type 2 diabetes (T2D) in routine clinical care.
METHOD: A two-year retrospective chart review was conducted at a tertiary care center in Saudi Arabia. Adults with T2D who initiated second-generation CGM (FreeStyle Libre 2) and maintained use for 24 months were included. Glycemic, metabolic, and clinical outcomes were assessed at baseline, 12 months (T12), and 24 months (T24).
RESULTS: Among 222 adults (mean age 48.7 years; 48.2% female), sustained CGM use was associated with improvements across multiple glycemic parameters. Glycated hemoglobin (HbA1c) declined from 8.2% at baseline to 7.8% at T24, accompanied by reductions in mean glucose, self-monitoring of blood glucose frequency, glycemia risk indices, and glucose variability. %TIR70-180 increased, time spent in hyperglycemia decreased, and time below range remained low throughout follow-up. Directionally similar glycemic improvements were observed across subgroups, including individuals with obesity, those treated with oral agents only, and those receiving insulin-based regimens. Beyond glycemic outcomes, body weight decreased by approximately 2 kg over 24 months. Diabetes-related emergency department visits declined from five participants (2.3%) at T0 to two (0.9%) at T12 and one (0.5%) at T24.
CONCLUSIONS: Two-year use of CGM in routine care was associated with favorable trends in glycemic control, glycemic stability, self-monitoring behavior, and health care utilization. Long-term CGM integration may be feasible and potentially beneficial across diverse T2D populations, although prospective studies are needed to clarify the causal effects.

Keywords:  blood glucose self-monitoring; continuous glucose monitoring; diabetes mellitus; glycemic control; type 2

DOI:  https://doi.org/10.1177/19322968261447256
J Clin Med. 2026 Apr 22. pii: 3194. [Epub ahead of print]15(9):

Advantages of Continuous and Non-Invasive Glucose Monitoring in the Geriatric Population: A Systematic Review.

Eric Oliviu Coșovanu, Andrei Szilagyi, Alexandra Szilagyi, Elena Teona Coșovanu, Luiza Elena Corneanu, Mara Sînziana Sîngeap, Bogdan Ionel Tamba, Lucian Hrițcu, Ovidiu Rusalim Petriș.

  Background: The global aging population faces an increasing prevalence of type 2 diabetes mellitus (T2DM), often complicated by frailty, cognitive decline, and impaired manual dexterity. These factors make glucose self-monitoring particularly challenging. Minimally invasive glucose monitoring methods, particularly continuous glucose monitoring (CGM) as well as emerging non-invasive glucose monitoring technologies offer potential solutions, but remain insufficiently evaluated in older adults. Objective: To systematically review and synthesize available evidence on the advantages of continuous glucose monitoring (CGM) and non-invasive glucose monitoring methods in older adults aged ≥65 years, focusing on clinical efficacy, usability, adherence, and existing knowledge gaps. Methods: A systematic literature search was conducted across PubMed, Scopus, and Web of Science, including studies from 2020 to 2025. Eligible studies included participants aged ≥65 years and evaluated the clinical performance of CGM or other minimally invasive or non-invasive glucose monitoring technologies. The PRISMA framework guided screening and selection. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Due to substantial heterogeneity among study designs and reported outcomes, a narrative synthesis approach was adopted. Results: A total of 426 records were identified, of which 13 met the predefined eligibility criteria after full-text screening. After risk of bias assessment, one study was excluded, resulting in 12 studies included in the final synthesis. No eligible studies evaluating completely non-invasive glucose monitoring technologies were identified, highlighting a significant research gap in this area specifically for older adults. CGM was associated with improved glycemic control, reduced hypoglycemia, and increased time in range among older adults. Usability was generally high, particularly with newer, user-friendly devices. Conclusions: CGM is associated with improved glycemic outcomes and favorable usability in adults aged ≥65 years. However, a significant gap exists in research on non-invasive glucose monitoring technologies in this population. Future studies should address the accuracy, feasibility, and usability of non-invasive glucose monitoring devices, while accounting for the physiological and behavioral complexities associated with aging.

Keywords:  continuous glucose monitoring (CGM); diabetes mellitus; glycemic control; hypoglycemia; non-invasive glucose monitoring; older adults; time in range (TIR)

DOI:  https://doi.org/10.3390/jcm15093194
Diabetes Obes Metab. 2026 May 11.

Gold and Clarke Questionnaires Identify Different People With Insulin-Treated Diabetes and Impaired Awareness of Hypoglycaemia in Almost 60% of Cases: A Post Hoc Analysis From the Hypo-METRICS Study.

Hypo‐RESOLVE consortium

   AIMS: Gold and Clarke questionnaires are used to identify impaired awareness of hypoglycaemia (IAH) and severe hypoglycaemic event (SHE) risk in people with diabetes (pwD). We explored their overlap, including Clarke's Hypoglycaemia Awareness Status (Clarke-HAS) subfactor, and subsection differences in SHE incidence (Gold, Clarke, overlap).
MATERIALS AND METHODS: This post hoc analysis of the Hypo-METRICS study recruited pwD on insulin (type 1: T1D; type 2: T2D) with ≥ 1 hypoglycaemic event in the previous 3 months. IAH was defined as Gold ≥ 4, Clarke ≥ 4, Clarke-HAS ≥ 2.
RESULTS: Gold and Clarke were completed by 232 pwT1D and 285 pwT2D (age: 47 vs. 62 years, p < 0.001; HbA1c: 56 mmol/mol (7.3%) vs. 57 mmol/mol (7.4%), p = 0.03). IAH prevalence in T1D vs. T2D was 21% vs. 26% (p = 0.1), 14% vs. 18% (p = 0.2), and 41% vs. 48% (p = 0.2) according to Gold, Clarke and Clarke-HAS. The overlap between Gold ≥ 4, Clarke ≥ 4 was 40% (T1D: 45%; T2D: 37%); between Gold ≥ 4, Clarke-HAS ≥ 2 it was 45% (T1D: 43%; T2D: 47%). The overlap between Gold ≥ 4, Clarke ≥ 4 was 41% vs. 39% in CGM vs. non-CGM users (T1D: 50% vs. 35%; T2D: 32% vs. 40%); between Gold ≥ 4, Clarke-HAS ≥ 2 it was 39% vs. 53% (T1D: 38% vs. 54%; T2D: 40% vs. 53%). In the IAH sample, SHE rate was lower in people found with IAH by Gold vs. Clarke, 9% vs. 53%, and in those assessed by Gold-Clarke overlap vs. Clarke, 20% vs. 53% (all p < 0.001).
CONCLUSIONS: Gold and Clarke show moderate consistency (37%-54%) in identifying IAH in insulin-treated diabetes, with/without CGM use, each associated with different SHE rates, indicating the two questionnaires measure different, independent aspects of IAH.

Keywords:  continuous glucose monitoring (CGM); hypoglycaemia; type 1 diabetes; type 2 diabetes

DOI:  https://doi.org/10.1111/dom.70869
Front Endocrinol (Lausanne). 2026 ;17 1815131

Building the evidence to address disparities in type 1 diabetes (BEAD-T1D): methods and design of a study examining barriers and promoters to diabetes device use in families with public insurance.

Lauren E Figg, Ricardo Medina Peñaranda, Daniel Garfias Silva, Sarah Hanes, Gary M Shaw, Lisa J Chamberlain, Diana Naranjo, Jennifer K Raymond, David M Maahs, Korey K Hood, Ananta Addala.

  Continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems have led to improved outcomes in type 1 diabetes (T1D). Diabetes technology use in minoritized populations is 50% lower than more privileged groups. Tailored, multi-factorial interventions are needed to address disparities and improve technology uptake in minoritized youth with T1D. The Building the Evidence to Address Disparities in Type 1 Diabetes (BEAD-T1D) Study assesses drivers of disparities in CGM and AID use in youth with T1D and public insurance to develop an intervention to increase uptake of diabetes technology. This manuscript describes the rationale, design, and protocols of the study. BEAD-T1D is a prospective, mixed-methods study grounded in the social-ecological model informed by sequential triangulation. Study Aim 1 constructs an evidence base of barriers and promoters to CGM and AID use in youth with T1D and public insurance to formulate and test a pilot intervention to increase device uptake in minoritized populations. Study Aim 2 constructs an evidence base of barriers and promoters to recommending devices to youth with T1D and public insurance to formulate and test a pilot intervention for healthcare providers to increase recommendations of devices. The primary outcome is diabetes technology acceptance analyzed via descriptive statistics and univariate analyses to inform the systematic building of a multivariable model. BEAD-T1D lays the groundwork for future efforts to reduce disparities in the uptake and continued use of diabetes technology in marginalized populations. Interventions effective in increasing the uptake and continued use of diabetes technology in youth with T1D and public insurance are necessary to mitigate disparities.

Keywords:  automated insulin delivery; clinical trials; continuous glucose monitoring; diabetes technology; health equity; type 1 diabetes; underrepresented populations

DOI:  https://doi.org/10.3389/fendo.2026.1815131
BMC Endocr Disord. 2026 May 09.

Transition from CSII to second-generation basal insulin analogues in hospitalized T2DM patients: a CGM-based study.

Ruiqing Dong, Hui Liu, Lifan Gu, Qiange Zhao, Chenwen Luo, Ting Zhang, Xuna Kou, Yuanna Hu, Bingyin Shi, Hui Guo, Wei Qiang.

   BACKGROUND: The optimal approach for transitioning hospitalized patients with type 2 diabetes (T2DM) from continuous subcutaneous insulin infusion (CSII) to second-generation basal insulin analogues remains unclear. This exploratory study aimed to: (1) evaluate whether a smooth transition from CSII to each second‑generation basal insulin analogue (insulin degludec [IDeg] or insulin glargine U300 [IGlar U300]) could be achieved; (2) compare post‑transition glycemic outcomes between IDeg and IGlar U300; and (3) identify patient characteristics associated with transition outcomes.
METHODS: This single-center retrospective analysis included 135 hospitalized adults with T2DM who received CSII therapy upon admission and were transitioned to basal insulin analogues before discharge (IDeg, n = 77; IGlar U300, n = 58). Among these, 90 patients (IDeg: 50; IGlar U300: 40) were insulin-naive at admission. Glycemic outcomes were assessed using continuous glucose monitoring metrics.
RESULTS: Within‑group comparisons showed significant improvements from CSII to post‑transition in both groups: time in range increased from 56.4% to 73.0% in the IDeg group (P < 0.001) and from 58.3% to 73.6% in the IGlar U300 group (P < 0.001). Between‑group comparisons after transition revealed comparable profiles between IDeg and IGlar U300 across key metrics: overall control (time in range: 73.0% vs. 73.6%, P = 0.912), glycemic variability (coefficient of variation: 29.8% vs. 29.2%, P = 0.629), and hypoglycemia risk (time below range: 0.8% vs. 0.5%, P = 0.915). IDeg demonstrated lower fasting glucose variability (coefficient of variation of fasting glucose: 23.8% vs. 28.3%, P = 0.024) and a later nocturnal glucose nadir. Lower body mass index correlated strongly with poorer post-transition outcomes, coinciding with more frequent use of multiple daily injection regimens in these patients (36.1% vs. 6.3%, P < 0.001). Lower serum albumin consistently associated with greater glycemic variability.
CONCLUSIONS: Transition from CSII to either IDeg or IGlar U300 is effective and safe. IDeg may provide greater fasting glucose stability. Transition success requires personalized discharge planning based on BMI and albumin levels.
CLINICAL TRIAL NUMBER: Not applicable.

Keywords:  Continuous glucose monitoring; Continuous subcutaneous insulin infusion; Glycemic variability; Insulin degludec; Insulin glargine U300; Type 2 diabetes mellitus

DOI:  https://doi.org/10.1186/s12902-026-02291-1
Cureus. 2026 Apr;18(4): e106693

Personalized Medicine Interventions for Glycemic Control in Adults With Type 2 Diabetes: A Systematic Review.

Hadeil Elfadil Ahmed Abdelgader, Shimaa Ali Hassan Hamed, Hamza Abubaker Abdin Sidahmed, Ahmed-Lamin Gehani, Abdulwahhab Al-Shaikhli, Amani Edris Uthman Ali, Hiba Merghani Abdalkareem Hajali, Elkhansaa A Elsamani, Asim Ahmed.

  Type 2 diabetes mellitus (T2DM) is a heterogeneous condition in which patients differ markedly in glycemic patterns, treatment responses, and self-management capacity, limiting the effectiveness of uniform care models. Personalized medicine aims to tailor diabetes management using patient-specific data, behaviors, and risk profiles, but the clinical impact of different personalization strategies remains variable. A comprehensive search of major biomedical databases was conducted to identify eligible studies evaluating individualized interventions in adults with T2DM, and 27 studies were included. Evidence was synthesized narratively due to clinical and methodological heterogeneity. Across the included studies, personalized approaches were generally associated with improved glycemic control compared with usual care, although the magnitude and consistency of benefit varied by intervention type and implementation intensity. Larger and more durable improvements were most often observed in interventions that combined objective patient data with actionable care pathways, particularly in high-risk populations or during periods of therapeutic change. These findings suggest that personalization may improve glycemic outcomes in certain settings, although the certainty of evidence remains limited due to study heterogeneity and variations in design and quality.

Keywords:  continuous glucose monitoring; digital health; glycemic control; personalized medicine; type2 diabetes mellitus

DOI:  https://doi.org/10.7759/cureus.106693
Diabetes Technol Ther. 2026 May 11. 15209156261446059

Real-World Ketone Testing Patterns Among People Using FreeStyle Libre.

Richard M Bergenstal, Naunihal Virdi, Farhan Quadri, Casey C Curl, Samia Rahman.

   OBJECTIVE: Ketone testing behavior in relation to glucose control is not well characterized. We aimed to describe ketone testing patterns and assess glucose control among individuals using a FreeStyle Libre (FSL) reader and blood ketone test strips in a real-world dataset of over 2.5 million ketone readings.
RESEARCH DESIGN AND METHODS: Historical glucose and ketone data from September 2014 to September 2024 were analyzed. As data are recorded for individual readers, the analysis is performed by readers. Ketone excursions were categorized by initial ketone level: ≤0.5, 0.6-1.4, 1.5-2.9, and ≥3.0 mmol/L. Glucose concentrations were evaluated 24 h before and after the initial ketone test. Ketone test frequency and concentrations within 72 h post-test were also assessed.
RESULTS: A total of 92.4% of readers never recorded a ketone test, and only 5% of readers performed a ketone test when glucose exceeded 250 mg/dL. Users with ketone levels ≥3.0 mmol/L had higher glucose concentrations in the 24 h preceding the ketone test. Among those with ketones ≥1.5 mmol/L, ketone testing was typically delayed by 5-8 h after glucose surpassed 250 mg/dL, and retesting ketones within 24-72 h was rare.
CONCLUSIONS: Most readers did not demonstrate adherence to standard-of-care recommendations for ketone monitoring and infrequently recheck ketones after elevated readings. Incorporation of continuous ketone monitoring into FSL would address limitations with current ketone testing methodologies and adherence to ketone monitoring guidelines.

Keywords:  FreeStyle Libre; diabetic ketoacidosis; glucose monitoring; ketone monitoring; real-world data

DOI:  https://doi.org/10.1177/15209156261446059