bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2026–05–31
sixteen papers selected by
Mott Given
  1. Evaluating the role of pharmacist intervention in improving continuous glucose monitor access for patients with uncontrolled diabetes at an FQHC.
  2. Continuous glucose monitoring to support the diagnosis of MODY: A multicenter cross-sectional and prospective study.
  3. Evidence-based recommendations for the use of continuous glucose monitoring in type 2 diabetes: the Italian guidelines.
  4. Accuracy of a Continuous Glucose Monitoring System Under Hyperglycemic Challenge in Chinese Hospitalized Patients With Diabetes.
  5. Adopters and discontinuers: Mapping the diabetes device adoption journeys of adults with type 1 diabetes after continuous glucose monitoring uptake.
  6. The glucose monitoring comparison in primary care study (GluCoCare): Study design, methods, recruitment success, and baseline characteristics of study participants.
  7. A Machine Learning Framework to Quantify Postprandial Glucose Responses in Gestational Diabetes.
  8. Association Between Therapeutic Inertia and Future Hypoglycemia Among Patients with Type 2 Diabetes.
  9. Association between time in range and incident early diabetic kidney disease in patients with type 2 diabetes: a retrospective cohort study.
  10. Does Continuous Glucose Monitoring Improve Glycemic Control and Quality of Life Among Adults With Type 2 Diabetes in Primary Care Settings? A Systematic Review and Meta-Analysis.
  11. Association of Continuous Glucose Monitoring with Glycaemic, Distress, and Quality of Life Outcomes in Insulin-Treated Type 2 Diabetes: A 12-Month Prospective Study.
  12. Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study.
  13. Insulin-to-carbohydrate ratio intensification during Ramadan in young people using advanced hybrid closed-loop therapy: A prospective quasi-experimental pilot study.
  14. Associations between body composition and glycemic control: an exploratory analysis of bioelectrical impedance parameters in adolescents with type 1 diabetes.
  15. Continuous glucose monitoring metrics based clustering in people living with type 1 diabetes identifies phenotypes associated with higher inflammation, metabolic dysfunction-associated steatotic liver disease risk, and lower insulin sensitivity.
  16. Increased Glycation Ratio and Risk of Complications in Latent Autoimmune Diabetes in Adults Compared With Type 1 Diabetes Onset before 30 Years: A Cohort Study.
  1. Am J Health Syst Pharm. 2026 May 28. pii: zxag128. [Epub ahead of print]
    Evaluating the role of pharmacist intervention in improving continuous glucose monitor access for patients with uncontrolled diabetes at an FQHC.
    Armin Pashaeimofrad, Christopher Schriever, Tony Rosella, Annette Carmichael.
       PURPOSE: To describe the implementation and outcomes of a pharmacist-led initiative designed to improve access to continuous glucose monitoring (CGM) technology for adults with uncontrolled type 2 diabetes at a Federally Qualified Health Center (FQHC).
    SUMMARY: Uncontrolled diabetes remains highly prevalent among underserved populations and contributes to major health disparities. CGM can enhance glycemic control and patient engagement, yet in resource-limited communities access remains a major issue. Pharmacists are positioned to address these disparities by facilitating education, device access, and insurance navigation.
    CONCLUSION: Pharmacist-led interventions at an FQHC substantially improved access to CGM devices for patients with uncontrolled diabetes. Through direct education, payor navigation, and device coordination, pharmacists mitigated common financial and logistical barriers to care. This model offers a potential scalable strategy to advance health equity in access to diabetes technology.
    Keywords:  Federally Qualified Health Centers; access to care; continuous glucose monitoring; diabetes mellitus; health disparities; pharmacist intervention
    DOI:  https://doi.org/10.1093/ajhp/zxag128
  2. Med Clin (Barc). 2026 May 27. pii: S0025-7753(26)00100-4. [Epub ahead of print]166(7): 107450
    Continuous glucose monitoring to support the diagnosis of MODY: A multicenter cross-sectional and prospective study.
    Jesus Moreno-Fernandez, Jose Ignacio Martínez Montoro, Jose Ramon Muñoz-Rodriguez, Sandra Herranz-Antolin, Amparo Marco, Pedro Pines, María Ruiz de Ancos, Javier González, Esther Maqueda, Julia Sastre, María José Picón.
       AIM: Maturity onset diabetes of the young (MODY) is often misdiagnosed as type 1 diabetes (T1D). We proposed using continuous glucose monitoring (CGM) data as an additional tool to select patients in whom the fulfillment of classical MODY criteria should be reassessed, who may then be considered for genetic testing.
    METHOD: A multicentric cross-sectional and prospective study was designed to evaluate the clinical utility of CGM in the diagnosis of MODY among adult patients initially diagnosed as T1D with active CGM data. Pre-specified CGM criteria included: glucose management indicator <7%, time in range (70-180mg/dL [3.9-10.0mmol/L]) >70% and coefficient of variation <36%. Those meeting these requirements were assessed for classical clinical criteria and subsequently genetic testing.
    RESULTS: A total of 503 subjects with T1D out of 5571 fulfilled the pre-established glycometric requirements. After reviewing their medical records, 42 of them met the classic clinical criteria for MODY and genetic testing was performed in 34 patients. Finally, we found 5 new cases of MODY (3 patients with HNF1A-MODY3, 1 patient with HNF1B-MODY5 and 1 patient with ABCC8-MODY12) and detected 3 patients with heterozygous mutations associated with the development of diabetes.
    CONCLUSION: CGM added to classic clinical criteria for MODY may constitute an effective and easily implemented approach in routine clinical practice to identify patients with MODY who have been misdiagnosed as having T1D.
    Keywords:  Continuous glucose monitoring; Diabetes tipo 1; Diagnosis; Diagnóstico; MODY; Monitorización continua de glucosa; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.medcli.2026.107450
  3. Acta Diabetol. 2026 May 28.
    Evidence-based recommendations for the use of continuous glucose monitoring in type 2 diabetes: the Italian guidelines.
    A Giaccari, G Gliozzo, G Ciccarelli, G Di Giuseppe, C Castellano, S Cum, L Delle Monache, M Gallo, M Lastretti, G Medea, M Monesi, R Napoli, B Pintaudi, E Succurro, G Turchetti.
       BACKGROUND AND AIMS: Although continuous glucose monitoring (CGM) devices are now standard of care among Type 1 diabetes patients, they are still relatively underutilized in Type 2 diabetes (T2D), particularly in those patients not treated with insulin. Widespread adoption continues to be hindered by a combination of factors. Chief among these is the scarcity of long-term, large-scale clinical trials demonstrating the benefits of the use of CGM in T2D. This meta-analysis aimed to address this gap by comparing CGM with self-blood glucose monitoring (SBMG), with primary outcomes of HbA1c and time in range (TIR) in insulin-treated and non-insulin-treated TD2 patients.
    METHODS AND RESULTS: Following the stringent rules mandated by our National Health Service (which requires a panel composed of all stakeholders involved in diabetes treatment, and includes PICO, GRADE, AGREE, and meta-analyses), we performed a systematic review of RCTs that enrolled two groups of individuals with T2D, those treated with insulin (including basal and basal-bolus regimens), and those receiving treatments other than insulin. All included trials compared CGM with structured blood glucose monitoring (SBGM) with glycated hemoglobin (HbA1c) as the main endpoint. Based on the strength and consistency of the evidence, the panel issued a strong recommendation in favor of CGM for individuals with T2D treated with insulin (including those on basal insulin alone) and for individuals with T2D not treated with insulin, particularly for those with glycated hemoglobin levels ≥ 7%. From a pharmacoeconomic perspective, outcomes were positive in both patient groups.
    CONCLUSION: CGM represents a clinically effective and cost-efficient approach to optimizing glycemic control in T2D, becoming mandatory among individuals on insulin therapy. Our findings support a shift in clinical practice toward the more widespread use of CGM in T2D, with regulatory frameworks and reimbursement policies needing to adapt accordingly.
    Keywords:  CGM; GRADE; Guidelines; Metanalysis; PICO; Type 2 Diabetes
    DOI:  https://doi.org/10.1007/s00592-026-02693-6
  4. J Diabetes Sci Technol. 2026 May 23. 19322968261442573
    Accuracy of a Continuous Glucose Monitoring System Under Hyperglycemic Challenge in Chinese Hospitalized Patients With Diabetes.
    Xingmei Liu, Dongmei Zheng, Yachao Yang, XiujuanZhang Md, ChunxiaoYu PhD, Xiaolong Jin, Zhenhua Tian, Anqi Dai, Chao Xu, Feng Xu, Qingbo Guan.
       BACKGROUND: To assess the accuracy of a continuous glucose monitoring (CGM) system under hyperglycemic conditions, we conducted a steamed bread meal tolerance test (SBMTT) in hospitalized patients aged 18 years or older with type 1and 2 diabetes mellitus.
    METHODS: Hospitalized adults with diabetes wore a Sibionics CGM (GS1) sensor, which was placed at least 48 hours prior to the test. Participants subsequently underwent an SBMTT containing 75 g of carbohydrates. Plasma glucose (PG) was measured at 0, 30, 60, 120, and 180 minutes. Accuracy was evaluated by calculating the mean absolute relative difference (MARD), %15/15, %20/20, %30/30, and %40/40 agreement rates. Clinical accuracy was assessed using the Diabetes Technology Society (DTS) error grid analysis. The time lag between CGM and PG was calculated.
    RESULTS: A total of 580 matched CGM-PG pairs from 116 participants were analyzed. The overall MARD was 11.83%, with agreement rates of 69.5% (%15/15), 86.2% (%20/20), 98.3% (%30/30), and 99.7% (%40/40). Diabetes Technology Society error grid analysis showed 100% of the CGM points falling into zones A and B, with 86% in zone A and 14% in zone B. After minimizing MARD, the overall CGM lag time was 5 minutes, but it increased during rapid glucose rise (0-60 minutes), reaching 10 minutes at 30 minutes and 20 minutes at 60 minutes.
    CONCLUSIONS: Continuous glucose monitoring maintained good accuracy during hyperglycemic challenges in hospitalized patients with diabetes. The time lag was influenced by the rate of glucose change, showing prolongation during the rapid glucose rise phase (0-60 minutes).
    Keywords:  accuracy; continuous glucose monitoring; inpatient diabetes; mean absolute relative difference; plasma glucose; steamed bread meal tolerance test
    DOI:  https://doi.org/10.1177/19322968261442573
  5. Patient Educ Couns. 2026 May 26. pii: S0738-3991(26)00241-7. [Epub ahead of print]150 109708
    Adopters and discontinuers: Mapping the diabetes device adoption journeys of adults with type 1 diabetes after continuous glucose monitoring uptake.
    Mabelle B Pasmooij, Dessi P Zaharieva, Ny'Nika McFadden, Shelagh Mulvaney, Molly L Tanenbaum.
       OBJECTIVES: Automated insulin delivery (AID) is standard of care for type 1 diabetes (T1D) management and requires using an insulin pump and continuous glucose monitor (CGM). While AID uptake is increasing, barriers remain to adopting and maintaining device use. Little is known about barriers and facilitators of optimal AID adoption and use.
    METHODS: We conducted follow-up interviews with adults with T1D who had participated in a CGM uptake study and either a) adopted AID within the first year of CGM uptake or b) discontinued CGM use within the first year of CGM adoption. Semi-structured interviews elicited barriers and facilitators experienced at each phase of the device adoption journey. Interviews were audio-recorded, transcribed, and analyzed using content analysis, and used to map device adoption journeys.
    RESULTS: Thirty-four participants attended interviews (n = 15 AID users: M age 32.9 ± 6 years, T1D duration 20.5 ± 12 years, 80% female; 67% Non-Hispanic White; and n = 19 CGM discontinuers: M age 34.7 ± 8 years, T1D duration 19.4 ± 10 years, 84% female, 74% Non-Hispanic White). Of CGM discontinuers, 14 had returned to CGM use and 5 were on AID by the time of participation in the follow-up interview. CGM discontinuers' reported barriers included insurance/cost, wearability, and data burden. AID adoption barriers were limited education and counseling for system decision-making and initial adjustment to AID. Participants with access to this support described positive onboarding experiences. AID users reported benefits of AID systems, hurdles encountered during ongoing use, and suggestions for improving onboarding.
    CONCLUSIONS: Support for CGM and AID adoption and ongoing use is not standardized or consistently delivered; participants described heterogeneous pathways to device adoption and levels of support, highlighting opportunities to enhance education, counseling, and ongoing support for AID use along the full adoption journey.
    PRACTICE IMPLICATIONS: Availability of as-needed, ongoing support for AID decision-making, adoption, and use particularly during the initial months will improve and sustain device uptake.
    Keywords:  Automated insulin delivery; Continuous glucose monitoring; Device uptake; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.pec.2026.109708
  6. Contemp Clin Trials. 2026 May 25. pii: S1551-7144(26)00143-6. [Epub ahead of print]166 108357
    The glucose monitoring comparison in primary care study (GluCoCare): Study design, methods, recruitment success, and baseline characteristics of study participants.
    Thomas W Martens, Stephen E Asche, Meghan M JaKa, Mary L Johnson, Sean Dunnigan, Alyse L Haven, Colette Morris, David Barnaby, Michael V Maciosek, Jennifer M Dinh, Samantha J Kaiser, Nicole K Trower, Sally K Gustafson, Kathryn Leet, Shannon K Krizka, Stephanie H Zimmerman, Veronika G Castellanos, Kelsea R Forrester, Richard M Bergenstal.
       BACKGROUND: While both fingerstick blood glucose monitoring (BGM) and continuous glucose monitoring (CGM) are currently available for people managing type 2 diabetes (T2D) with insulin, it is not currently known which is more effective in optimizing glycemia and decreasing disease burden in this population in real-world settings.
    OBJECTIVES: This two-arm cluster-randomized trial will compare use of BGM versus CGM in individuals with T2D using insulin not meeting A1C goals. We will compare change in hemoglobin A1c (A1C) (primary outcome measure) and Diabetes Distress Scale score (DDS) (secondary outcome measure) in individuals attending primary care clinics randomized to either BGM or CGM monitoring over 12 months.
    MATERIALS AND METHODS: Fifty clinics in a large healthcare system in Minnesota and Wisconsin were randomized to enroll individuals to monitor with BGM (25 clinics) or CGM (25 clinics). Adults aged 18-75 with T2D using insulin, A1C 7.5-12%, were recruited from these clinics to be managed by their primary care clinician in a fundamentally pragmatic intervention over 12 months. A1C, DDS, and blinded CGM along with patient reported outcome (PRO) measures will be compared between 0 and 12 months.
    RESULTS: GluCoCare met its enrollment goals, enrolling 360 individuals from 42 primary care clinics between September 2022 and June 2024, age (mean ± SD) 60.5 ± 10.3 years, diabetes duration 14.3 ± 8.2 years, A1C 8.8% ± 1.1%, and DDS 2.2 ± 0.9.
    CONCLUSIONS: We have successfully enrolled participants with T2D using insulin, to test in a real-world primary care setting, whether BGM versus CGM improves A1c or decreases Diabetes Distress Scale score more.
    Keywords:  Blood glucose monitor; Continuous glucose monitor; Primary care; Type 2 diabetes
    DOI:  https://doi.org/10.1016/j.cct.2026.108357
  7. Diabetes Technol Obes Med. 2025 Jan-Dec;1(1):1(1):
    A Machine Learning Framework to Quantify Postprandial Glucose Responses in Gestational Diabetes.
    Souptik Barua, Tenzin Sangmo, Dhairya Upadhyay, Esra Mucahit, Vanessa Martinez, Lauren Berube, Christina Penfield, Hye Heo, Ling-Jun Li, Shauna Williams, Todd Rosen, Shristi Rawal.
       Objective: To develop a machine learning (ML) framework to identify postprandial glucose responses (PPGR) automatically from continuous glucose monitoring (CGM) data in pregnant adults with gestational diabetes mellitus (GDM).
    Methods: Pregnant adults diagnosed with GDM or impaired glucose tolerance (IGT) wore blinded CGMs and logged mealtimes for up to three 14-day time periods after enrollment. A random forest ML algorithm was applied to identify morning PPGRs from daily CGM profiles, and its performance compared against PPGRs derived using self-reported mealtimes.
    Results: 21 participants provided analyzable data. Relative to self-reported mealtime, the ML algorithm's predicted mealtimes had an absolute error of a median 30 [IQR: 20,45] minutes. Comparing 1-hour and 2-hour PPGR values from the CGM using self-reported and ML-predicted mealtimes showed a median difference of 8.7 [IQR: 0,22.7] mg/dL and 3.3 [IQR: 0,13.2] mg/dL respectively for the two timepoints.
    Conclusion: A random forest ML algorithm accurately identified PPGRs from CGM data in persons with GDM, enabling an automated and convenient approach to monitoring postprandial dysglycemia in this population.
    Keywords:  Gestational diabetes mellitus; continuous glucose monitoring; machine learning; postprandial glucose response
    DOI:  https://doi.org/10.1089/dtom.2024.0003
  8. Diabet Epidemiol Manag. 2026 ;pii: 100305. [Epub ahead of print]21
    Association Between Therapeutic Inertia and Future Hypoglycemia Among Patients with Type 2 Diabetes.
    Helen Chen, Lap Pui Chung, Yutong Chen, Titus Schleyer, Kai DeMeritt, Ethan A Halm, Lisa S Chow, Lan Luo, Julian Wolfson.
       Introduction: Therapeutic inertia (TI), the failure to adjust therapy when HbA1c remains above- target, is a barrier to optimal glycemic control in type 2 diabetes (T2D). This study examined the association between TI and subsequent-year hypoglycemia visit, and whether continuous glucose monitoring (CGM) modifies this relationship.
    Methods: We analyzed electronic health records (2017-2023) from two Midwest US healthcare systems, including adults with T2D, at least one above-target HbA1c (>7% for ages 18-64; >8% for ages ≥65), and glucose-lowering prescriptions. TI was calculated annually as the percentage of above-target HbA1c results without prescription changes within 30 days. We fitted logistic regression models to examine whether high TI (>50%) was associated with subsequent-year hypoglycemia visits. An interaction term tested whether this association differed between those who used vs. did not use CGM.
    Results: Among 65,983 participants (mean age 56, 51% male, 75% White), mean HbA1c at last follow-up was 8.1% (ages 18-64) and 8.0% (ages ≥ 65). High TI was associated with 31% increased odds of hypoglycemia visit (OR=1.74; 95% CI: 1.61-1.88; p<0.001). Insulin users had threefold higher odds (OR=2.95; p<0.001). Medicare beneficiaries had 31% higher odds than Medicaid beneficiaries. Adults aged 18-44 years had more hypoglycemia visits compared to other age groups. Low CGM use (7%) limited the interpretation of interaction effects (95% CI: 0.47-1.1, p=0.12).
    Conclusions: In this cohort, high TI predicted hypoglycemia-visit. Further research is needed to understand TI drivers and how to balance improving glycemic control without increasing the risk of hypoglycemia.
    Keywords:  HbA1c; Type 2 diabetes; continuous glucose monitoring; prescriptions; therapeutic inertia
    DOI:  https://doi.org/10.1016/j.deman.2026.100305
  9. Int Urol Nephrol. 2026 May 28.
    Association between time in range and incident early diabetic kidney disease in patients with type 2 diabetes: a retrospective cohort study.
    Ling Chen, Lingyan Zhang, Niuniu Zhou.
       BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease in type 2 diabetes mellitus (T2DM). Time in range (TIR), a continuous glucose monitoring-derived metric, has emerged as an important glycemic control indicator, but evidence linking TIR to incident early DKD in T2DM remains limited.
    METHODS: This retrospective cohort study included 498 Chinese T2DM patients with preserved kidney function at baseline who underwent continuous glucose monitoring between January 2020 and December 2022, with follow-up until December 2024. TIR and other glycemic metrics were assessed at baseline. The primary outcome was incident early DKD. Cox proportional hazards models evaluated associations between TIR and early DKD risk, with comprehensive adjustment for demographics, clinical characteristics, and medications. Subgroup and sensitivity analyses were performed.
    RESULTS: During a median 24-month follow-up, 62 (12.4%) patients developed early DKD. After full adjustment, TIR ≥ 70% was associated with lower early DKD risk versus TIR < 70% (HR = 0.54, 95%CI 0.30-0.96, p = 0.048). A significant dose-response relationship was observed across TIR quartiles (P for trend = 0.008), with each 10% TIR increase associated with a 16% risk reduction (HR = 0.84, 95%CI 0.73-0.98, p = 0.022). The protective association was more pronounced in patients not using sodium-glucose cotransporter 2 inhibitors (P for interaction = 0.036). Results remained consistent across sensitivity analyses.
    CONCLUSIONS: Higher TIR is significantly associated with reduced risk of incident early DKD in T2DM patients with preserved kidney function, exhibiting a clear dose-response pattern. TIR may serve as a valuable complementary metric for assessing renal complication risk.
    Keywords:  Cohort study; Continuous glucose monitoring; Diabetic kidney disease; Time in range; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.1007/s11255-026-05210-4
  10. Sci Diabetes Self Manag Care. 2026 May 28. 26350106261451194
    Does Continuous Glucose Monitoring Improve Glycemic Control and Quality of Life Among Adults With Type 2 Diabetes in Primary Care Settings? A Systematic Review and Meta-Analysis.
    Helen Park-Chong, Michelle Benrimon, Arlene Smaldone.
       PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the impact of continuous glucose monitoring (CGM) on glycemic control and quality of life (QoL) among adults with type 2 diabetes (T2DM) managed within primary care settings.
    METHODS: Following PRISMA 2020 guidelines, 4 databases were comprehensively searched for randomized controlled trials (RCTs) published through July 9, 2025. Eligible trials reported on A1C, QoL, diabetes distress, and device satisfaction. Shorter term (6-8 months) and longer term (12-14 months) A1C outcomes were synthesized using random effects meta-analysis models.
    RESULTS: Of 739 records, 4 multisite RCTs (6 reports) met inclusion criteria and represent data from 566 adults with T2DM in primary care settings. Two trials utilized real time CGM, while others employed retrospective or intermittently scanned CGM. Participants attended primary care visits during the trial, receiving diabetes management and medication changes as required. The CGM intervention significantly improved glycemic control with pooled A1C reduction of -0.46% at 6 to 8 months and -0.33% at 12 to 14 months and device satisfaction with no differences in QoL.
    CONCLUSION: These results demonstrate that CGM significantly improves glycemic control with no change in QoL among adults with T2DM in primary care and suggest that CGM utilization within this setting offers distinct advantages in patient engagement and diabetes management, particularly when integrated through a multidisciplinary team approach. Future research should prioritize populations currently ineligible for CGM coverage, such as non-insulin-using patients and underserved groups, while also investigating the impact of updated sensors' accuracy on clinical outcomes.
    DOI:  https://doi.org/10.1177/26350106261451194
  11. Medicina (Kaunas). 2026 May 11. pii: 938. [Epub ahead of print]62(5):
    Association of Continuous Glucose Monitoring with Glycaemic, Distress, and Quality of Life Outcomes in Insulin-Treated Type 2 Diabetes: A 12-Month Prospective Study.
    Klara Dzojic, Ema Schönberger, Matea Petrinović, Daria Sladić Rimac, Ema Erzic, Maja Cigrovski Berkovic, Miro Bakula, Ines Bilić-Ćurčić, Silvija Canecki-Varžić.
      Background and Objectives: Continuous glucose monitoring (CGM) improves glycemic control in type 2 diabetes (T2DM), but its effects on diabetes-related distress and quality of life (QoL), particularly in patients on intensive insulin therapy, are less well studied. Aim: We aim to assess the impact of CGM on glycemic control, diabetes distress, and QoL in adults with T2DM on intensified insulin therapy. Materials and Methods: This prospective observational study included 226 adults with T2DM using multiple daily insulin injections or basal-bolus therapy. CGM was initiated at baseline. HbA1c, fasting glucose, and lipid profile were measured at baseline, 3, 6, 9, and 12 months. Diabetes-related distress (DDS-17) and quality of life (MDQoL-17) were assessed at the same time points. Longitudinal changes were analyzed using linear mixed-effects models. Results: Mean age was 66 ± 9.1 years; 55% were male. HbA1c decreased from 8.56 ± 1.87% to 7.20 ± 0.90% at 3 months (p < 0.001) and remained improved at 12 months (7.21 ± 1.04%). Diabetes distress declined significantly over time (β = -0.025/month; p = 0.001). Older age and lower income were associated with higher distress. Quality of life improved significantly during follow-up; higher income predicted better QoL, while greater distress predicted poorer QoL. HbA1c did not independently influence QoL. CGM metrics (GMI, mean glucose, TIR, glycemic variability) remained stable after initial improvement. Conclusions: In 226 insulin-treated T2DM patients, implementation of CGM as part of a structured insulin intensification strategy was associated with sustained improvements in glycaemic control, reduced diabetes-related distress, and enhanced quality of life over 12 months. These findings support routine CGM use and highlight the importance of addressing psychosocial outcomes in diabetes care.
    Keywords:  CGM; HbA1c; distress; insulin therapy; quality of life; type 2 diabetes
    DOI:  https://doi.org/10.3390/medicina62050938
  12. Sci Rep. 2026 May 25.
    Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study.
    Joanna Ostrowska, Ewa Kobos, Mariola Pietrzak, Agata Szymczak, Katarzyna Wiktorzak, Marta M Pisano-González.
      Type 2 diabetes remains a major public health challenge, requiring lifelong management. Structured lifestyle-based interventions are increasingly recognised for their role in supporting self-management. The CARE4DIABETES (C4D) programme, part of a Joint Action funded by the EU4Health initiative, aims to implement and evaluate a behavioural lifestyle model (Reverse Diabetes2 Now) across 12 European countries. C4D is a 12-month, quasi-experimental, structured, digitally supported lifestyle programme comprising multiple group-based educational sessions delivered by a multidisciplinary team (MDT) and addressing nutrition, physical activity, sleep, and stress management. This interim analysis includes the Polish cohort (n = 38; type 2 diabetes duration ≤ 10 years), presented overall and stratified by continuous glucose monitoring (CGM) users (n = 21) versus self-monitoring of blood glucose (SMBG, n = 17). At 6 months, participants showed significant improvements. Mean HbA1c decreased by 0.78% points (-10.9%; p < 0.001) to 6.35%. Body weight decreased by 6.04 kg (-6.5%; p < 0.001), waist circumference by 6.77 cm (-6.4%; p < 0.001), fat mass by 2.47 kg (-7.2%; p < 0.001), and triglycerides by 20.3% (p = 0.023), while total cholesterol, LDL-C, and HDL-C did not change significantly. Improvements were numerically larger in the CGM group. Between-group comparisons of change scores showed greater reductions in body weight and BMI in the CGM group compared with the SMBG group (p < 0.05; Cohen's d ≈ 0.9-1.0). The 6-month intensive phase of this structured, group-based lifestyle education programme was associated with clinically meaningful improvements in glycaemic control and anthropometric outcomes. Improvements were greater among CGM users than in the SMBG group, suggesting that integrating CGM into structured education may further enhance programme outcomes.
    Keywords:  Continuous glucose monitoring (CGM); HbA1c; Lifestyle; Self-monitoring of blood glucose (SMBG); Type 2 diabetes; Weight loss
    DOI:  https://doi.org/10.1038/s41598-026-55083-x
  13. Diabetes Res Clin Pract. 2026 May 24. pii: S0168-8227(26)00257-3. [Epub ahead of print]237 113337
    Insulin-to-carbohydrate ratio intensification during Ramadan in young people using advanced hybrid closed-loop therapy: A prospective quasi-experimental pilot study.
    Asma Deeb, Nadha Yaqoob, Reem Hassan Beck, Shaker Suliman.
       AIMS: This study evaluated whether intensifying the insulin-to-carbohydrate ratio (ICR) during the non-fasting period is associated with improved glycemic control without increasing hypoglycemia in young people with type 1 diabetes (T1D) using advanced hybrid closed-loop (AHCL) therapy during Ramadan.
    METHODS: In this prospective quasi-experimental pilot study, MiniMed 780G AHCL users fasting during Ramadan 2025 were allocated to standard care or 20% ICR intensification from Iftar to Suhoor (18:00-06:00). Continuous glucose monitoring (CGM) metrics were analyzed over Ramadan for the full 24-hour and non-fasting periods. The primary efficacy outcome was non-fasting time in range (TIR; 70-180 mg/dL); the primary safety outcome was non-fasting time below range (TBR; <70 mg/dL).
    RESULTS: Of 61 enrolled participants, 47 (29 control, 18 intervention; median age 14.9 years) were included in the analysis following post-Ramadan attrition. In an adjusted analysis (pre-specified linear regression including age and baseline HbA1c), ICR intensification was associated with a 10.4% higher non-fasting TIR (95%CI 5.2-15.5; p = 0.0002). Non-fasting TBR remained low and similar between groups, with no evidence of increased hypoglycemia.
    CONCLUSIONS: Prandial insulin intensification may be a safe strategy worthy of further investigation of its potential to improve glycemic control during Ramadan in young people using ACHL therapy.
    Keywords:  Advanced hybrid closed-loop; Continuous glucose monitoring; Insulin-to-carbohydrate ratio; Ramadan fasting; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.diabres.2026.113337
  14. Diabetol Metab Syndr. 2026 May 29.
    Associations between body composition and glycemic control: an exploratory analysis of bioelectrical impedance parameters in adolescents with type 1 diabetes.
    Arianna Torre, Bruno Bombaci, Mattia Papa, Sara Aramnejad, Mariarosaria La Rocca, Alessandra Di Pisa, Angela Alibrandi, Fortunato Lombardo, Giuseppina Salzano, Stefano Passanisi.
       BACKGROUND: The relationship between body composition and glycemic control in adolescents with type 1 diabetes (T1D) remains insufficiently explored. Clarifying the role of specific body compartments may provide insights into metabolic risk and inform personalized management strategies in this population. Our study aimed to describe body composition in adolescents with T1D and to evaluate the associations between anthropometric and bioelectrical impedance analysis (BIA) derived parameters and markers of glycemic control.
    METHODS: In this exploratory cross-sectional study, 133 adolescents regularly followed at our Pediatric Diabetes Center between May and December 2024 were consecutively recruited. Inclusion criteria comprised a confirmed diagnosis of T1D, complete pubertal development, and continuous glucose monitoring (CGM) use. Anthropometric measurements and body composition parameters were obtained using BIA. Glycemic control was evaluated through HbA1c, mean 12-month HbA1c, and CGM-derived metrics, including time in range (TIR), time in tight range (TITR).
    RESULTS: Visceral fat was positively correlated with both point-in-time HbA1c (r = 0.210, p = 0.016) and mean 12-month HbA1c (r = 0.216, p = 0.013), while no associations were observed with other BIA-derived parameters. TITR was independently associated with male sex (β = 0.244; p = 0.049), regular physical activity (β = 0.195; p = 0.041), use of automated insulin delivery systems (β = 0.405; p < 0.001), and BMI z-score (β = - 0.310, p = 0.016). TIR was inversely associated with basal metabolic rate (β = - 0.262, p = 0.012).
    CONCLUSIONS: In adolescents with T1D, visceral adiposity showed weak but significant associations with both point-in-time and 12-month HbA1c levels. These findings are hypothesis-generating and should be interpreted cautiously given the modest effect sizes and study design. Further longitudinal studies using imaging-based methods are needed to clarify the clinical relevance of these associations.
    Keywords:  CGM metrics; Fat mass; Glycated hemoglobin; Time in range; Visceral adiposity
    DOI:  https://doi.org/10.1186/s13098-026-02197-x
  15. Diabetol Metab Syndr. 2026 May 25.
    Continuous glucose monitoring metrics based clustering in people living with type 1 diabetes identifies phenotypes associated with higher inflammation, metabolic dysfunction-associated steatotic liver disease risk, and lower insulin sensitivity.
    Aleksejs Fedulovs, Natalia Paramonova, Leonora Pahirko, Una Riekstina, Kaspars Jekabsons, Jelizaveta Sokolovska.
       AIMS: Continuous glucose monitoring (CGM) enables scalable digital phenotyping by capturing detailed daily glucose profiles and has been shown to improve glycaemic control in individuals with type 1 diabetes (T1D). We hypothesized that clustering CGM-derived metrics could identify distinct glycemic phenotypes associated with increased insulin resistance, systemic inflammation, and risk of metabolic derangements, with potential implications for optimization of clinical care.
    MATERIALS AND METHODS: This cross-sectional study applied a hierarchical clustering approach to stratify 75 individuals with T1D based on CGM metrics obtained over 14 days (Libre ProIQ). Clustering was performed using Ward's minimum variance linkage and Euclidean distance on six CGM metrics (average glucose, coefficient of variance, time above range, time below range, time in range, and frequency of low glucose events). The resulting groups, poorly controlled diabetes (PCD) and moderately controlled diabetes (MCD), were compared for insulin resistance markers (estimated glucose disposal rate, eGDR), metabolic dysfunction-associated steatotic liver disease (MASLD) risk markers (fatty liver index, FLI; hepatic steatosis index, HSI), and inflammation and endotoxaemia markers.
    RESULTS: Compared to MCD, subjects in the PCD group had significantly higher insulin resistance (eGDR: 4.4 vs. 7.3 mg/kg/min, p = 0.001), elevated liver enzymes (ALT: 26 vs. 20 U/L, p = 0.005; AST: 28 vs. 23 U/L, p = 0.049), increased MASLD risk markers (HSI: 37 vs. 35, p = 0.033; FLI: 29 vs. 17, p = 0.034), and higher systemic inflammation (CRP: 1.82 vs. 0.81 mg/L, p = 0.020; lipopolysaccharide-binding protein (LBP): 11.7 vs. 8.4 EU/mL, p = 0.024). Time above range correlated positively with liver and inflammatory markers, while time in range correlated negatively. Mediation analysis suggested that FLI partially mediated the effect of poor glycemic control on inflammation.
    CONCLUSIONS: In this cross-sectional cohort of adults with T1D, poorer CGM-derived glycaemic control was associated with higher systemic inflammation and higher surrogate-marker-defined MASLD risk.
    Keywords:  Continuous glucose monitoring; Insulin resistance; Intestinal permeability; Low-grade inflammation; Metabolic dysfunction-associated steatotic liver disease; Type 1 diabetes
    DOI:  https://doi.org/10.1186/s13098-026-02191-3
  16. Diabetes Technol Ther. 2026 May 28. 15209156261451052
    Increased Glycation Ratio and Risk of Complications in Latent Autoimmune Diabetes in Adults Compared With Type 1 Diabetes Onset before 30 Years: A Cohort Study.
    Sandra Herranz-Antolín, Fernando Gómez-Peralta, Xu Yongjin, María Asunción Martínez-Brocca, Gloria Cánovas-Molina, Aurora Aragón-Alonso, Miguel Brito-Sanfiel, Jose Ignacio Martínez-Montoro, Virginia Bellido, Sharona Azriel, María Del Carmen López-García, Cristina Tejera, Amparo Bartual, Verónica Perea, Pedro José Pines, Antonio J Amor, Óscar Moreno-Pérez, Rebeca Reyes-García, Gema López-Gallardo, María Durán-Martínez, Cristina Serrano, Rosa Márquez-Pardo, Noemí González-Pérez de Villar, Manuel Gargallo, Estefanía Santos, Pedro Pujante, Jessica Ares, Diego Bellido, Ignacio Conget, Yaghoub Dabiri, Timothy C Dunn.
       OBJECTIVE: To clarify the distinctions between Latent Autoimmune Diabetes in Adults (LADA) and Type 1 diabetes (T1D) diagnosed < 30 years using continuous glucose monitoring (CGM) metrics, glycation rate, and risk of complications.
    DESIGN AND METHODS: Multicenter, cross-sectional, observational study including subjects with T1D onset < 30 years (T1D cohort) and those classified as LADA diagnosed ≥ 30 years (LADA cohort) with ≥ 80% CGM coverage 56 days prior to glycated hemoglobin (HbA1c). Logistic regression was used to model the risk of complications.
    RESULTS: T1D (n = 555) and LADA (n = 890) showed different ages (43 vs. 58 years; P < 0.001), age at diagnosis (16 vs. 43 years; P < 0.001), diabetes duration (26.8 vs. 15.1 years; P < 0.001), HbA1c (7.2 vs. 7.3%; P = 0.017), microvascular complications (35 vs. 23%; P < 0.001), and daily total and basal insulin [0.63 vs. 0.59 U/(kg·d); P = 0.006 and 0.35 vs. 0.32 U/(kg·d); P = 0.002]. After adjusting for diabetes duration, T1D exhibited higher time below range (TBR70: 3.9 vs. 3.0%; P < 0.001; TBR54: 0.5 vs. 0.3%; P < 0.001) and variability [coefficient of variation (CV): 35.6 vs. 34.2%; P < 0.001; within-day CV: 31.4 vs. 30.3%; P < 0.001]. Personal glycation ratio was higher in LADA after adjusting for diabetes duration and body mass index (66.5 vs. 64.9%; P < 0.001). Estimated risks of macrovascular and microvascular complications were higher in LADA than in T1D [12.6% (95% CI 9.7-15) vs. 3.8% (95% CI 2.1-5.6) and 46.1% (95% CI 40.4-52.0) vs. 29.1% (95% CI 25.1-33.5)] after adjusted for diabetes duration.
    CONCLUSIONS: LADA cohort showed a higher glycation rate and lower time in hypoglycemia and variability. Microvascular complications were more common in T1D, but after adjusting for diabetes duration, macrovascular and microvascular risks were greater in LADA.
    Keywords:  Continuous glucose monitoring; Diabetes complications; Glycemic variability; Latent Autoimmune Diabetes in Adults; Personal glycation ratio
    DOI:  https://doi.org/10.1177/15209156261451052
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