bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2026–09–20
nineteen papers selected by
Mott Given
  1. Recorded Webcast: Continuous Glucose Monitoring.
  2. Use of Continuous Glucose Monitoring Indicators to Guide Dose Titration of Weekly Basal Insulin Efsitora Alfa in Insulin-Naive and Basal Insulin-Experienced Adults with Type 2 Diabetes: A Retrospective Analyis.
  3. Performance of the i-SENS CareSens Air CGM System in Compliance with the European CGM (eCGM) Clinical Performance Criteria: A Pooled Analysis.
  4. Continuous glucose monitoring in older inpatients with type 2 diabetes and cognitive impairment: an open single-arm feasibility study.
  5. Characterizing Continuous Glucose Monitoring Prescription Patterns Between 2020 and 2024: A Retrospective Study at a Single Primary Care Facility in the United States.
  6. Association between worsening time in range and microvascular complications in type 1 diabetes: real-world 5-year study.
  7. Three-Year Glycemic Trajectories in Subgroups With Type 1 Diabetes at Risk for Suboptimal Glycemic Control: A Multicenter Continuous Glucose Monitoring Study.
  8. Favorable CGM metrics do not exclude SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis: an educational case report with narrative review of literature.
  9. Scheduled remote review of continuous glucose monitoring data with targeted intervention vs standard care in children with Type 1 Diabetes: A parallel-groups study.
  10. Artificial intelligence meets continuous glucose monitoring data: Genie in the bottle.
  11. Glycaemic Variability and Glucose Excursions in GCK Diabetes Compared With Type 1 Diabetes and the Healthy Population.
  12. Relationships between Continuous Glucose Monitoring-Derived Glycemic Parameters and Early Retinal Vascular Changes in Children with Type 1 Diabetes Mellitus.
  13. Early and sustained diabetes technology exposure is associated with cognitive outcomes in youth with type 1 diabetes.
  14. Sensor-Detected Hypoglycaemia Is Associated With Inflammatory Protein and Immune Cell Alterations in People With Diabetes: Findings From the Hypo-METRICS Study.
  15. Bedtime Snack Composition and Overnight Glycemic Profiles in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injections: A Randomized Crossover Study.
  16. Durable Insulin-free Remission in A-β+ Ketosis-Prone Diabetes With SGLT2 Inhibition: A Case Report With Longitudinal C-Peptide and CGM Data.
  17. Beyond the CE Mark: A Call to Action for Minimum CGM Accuracy Standards in Central and Eastern European Nations.
  18. All-in-one sensor design with overlapping sensor transition reduces automode interruptions and improves patient-reported outcomes in adolescents with type 1 diabetes: real-world evidence from simplera sync integration.
  19. Post-exercise hypoglycaemia in adults with cystic fibrosis compared to healthy control adults.
  1. J Am Coll Clin Pharm. 2026 Oct;9(10): e70284
    Recorded Webcast: Continuous Glucose Monitoring.
    Diana Isaacs, Megan Adelman.
      
    DOI:  https://doi.org/10.1002/jac5.70284
  2. Diabetes Technol Ther. 2026 Sep 17. 15209156261485755
    Use of Continuous Glucose Monitoring Indicators to Guide Dose Titration of Weekly Basal Insulin Efsitora Alfa in Insulin-Naive and Basal Insulin-Experienced Adults with Type 2 Diabetes: A Retrospective Analyis.
    Richard M Bergenstal, Michael B Davidson, David Ahn, Grazia Aleppo, Thomas W Martens, Eden M Miller, David L Duke, Michael Case, Liza L Ilag, Jennal Johnson, Eyal Dassau.
       INTRODUCTION: Basal insulin dose titration has historically relied on fasting self-monitoring blood glucose (SMBG) and hypoglycemic events. This retrospective analysis of the QWINT-2 and QWINT-3 Phase 3 trials aimed to evaluate the use of continuous glucose monitoring (CGM)-derived indicators for weekly insulin efsitora alfa (efsitora) titration in insulin-naive and basal insulin-experienced adults with type 2 diabetes (T2D) through dose-to-dose comparisons with self-monitoring fasting plasma glucose (FPG) and CGM-derived hypoglycemic events, and by assessing concordance between CGM fasting indicators and FPG independent of insulin dose adjustment.
    METHODS: CGM and self-monitoring FPG data from QWINT-2 (insulin-naive, N = 466) and QWINT-3 (basal insulin-experienced, N = 655) efsitora-treated participants were analyzed. CGM fasting indicators were compared with FPG through weekly dose-to-dose titration decisions following the SMBG-based Phase 3 trial dose titration algorithm, and by assessing concordance between CGM fasting indicator and FPG values. CGM hypoglycemia indicators were assessed weekly for agreement with CGM-derived hypoglycemic events below 70 mg/dL and 54 mg/dL following the SMBG-based Phase 3 trial hypoglycemia criteria. User burden was considered, with low burden meaning a CGM indicator was readily available in an ambulatory glucose profile (AGP) report.
    RESULTS: CGM hypoglycemia indicators demonstrated 91.5%-98.3% agreement with CGM-derived hypoglycemic events in QWINT-2 and QWINT-3. CGM fasting indicators "Lowest median of AGP," and "Typical fasting 25% from AGP" demonstrated clinical equivalency with FPG, with dose differences within 20 weekly units for 90.7%-93.4% of dose decisions for both studies.
    CONCLUSION: In insulin-naive and basal insulin-experienced populations treated with weekly efsitora, CGM indicators of hypoglycemia and fasting glucose yielded clinically equivalent dose titration decisions as CGM-derived hypoglycemic events and self-monitoring FPG, respectively. These findings support translation of established titration practices to a CGM-based workflow in insulin-naive and basal insulin-experienced adults with T2D, consistent with recommendations for CGM use in adults with diabetes on insulin therapy.
    Keywords:  basal insulin titration; continuous glucose monitoring; insulin efsitora alfa; self-monitoring blood glucose; type 2 diabetes
    DOI:  https://doi.org/10.1177/15209156261485755
  3. Diabetes Ther. 2026 Sep 15.
    Performance of the i-SENS CareSens Air CGM System in Compliance with the European CGM (eCGM) Clinical Performance Criteria: A Pooled Analysis.
    Nina Jendrike, Kyung-Soo Kim, Seung-Hwan Lee, Won Sang Yoo, Cheol-Young Park, Sükrü Öter, Lorena Morent, Manuel Eichenlaub, Guido Freckmann.
       INTRODUCTION: The eCGM designation is a recently proposed framework for the approval of continuous glucose monitoring (CGM) systems in Europe. The aim of this analysis was to assess whether the performance of the CareSens Air CGM system (i-SENS, Inc., Republic of Korea), derived from a pooled dataset comprising three clinical investigations, complies with eCGM requirements.
    METHODS: A total of 164 participants (86% type 1 diabetes, 50% female, 66% on multiple daily injections) across the three studies contributed 17,655 data points to the data analysis. Meal and/or insulin challenges were implemented to obtain sufficient data points at comparator glucose concentrations <70 mg/dL (10.9%) and >300 mg/dL (5.7%). Measurement accuracy was assessed by applying eCGM accuracy requirements.
    RESULTS: The CareSens Air CGM system complies with eCGM accuracy requirements in this data analysis. Approximately 91.0% of the CGM readings <70 mg/dL were found within ±15 mg/dL from the paired comparator value. At eu- (70-180 mg/dL) and hyperglycemic (>180 mg/dL) CGM readings, 78.6% and 84.4% of CGM readings exhibited differences ≤ ±15%. Overall, 90.3% of CGM readings were found within ±20% of the paired comparator values across the measuring range. Accuracy remained stable throughout the sensor lifetime.
    CONCLUSIONS: The CareSens Air CGM system is suitable for nonadjunctive insulin dosing decisions and integration with automated insulin delivery systems.
    TRIAL REGISTRATION: The three studies whose data were used in this pooled analysis were registered in the Republic of Korea's Clinical Research Information Service (KCT0009215) and the German Clinical Trials Register (DRKS00028739 and DRKS00037132).
    Keywords:  Accuracy; Continuous glucose monitoring; Diabetes; Diabetes technology; Performance; eCGM
    DOI:  https://doi.org/10.1007/s13300-026-01917-w
  4. BMJ Open. 2026 Sep 11. 16(9): e118196
    Continuous glucose monitoring in older inpatients with type 2 diabetes and cognitive impairment: an open single-arm feasibility study.
    Busra Donat Ergin, Katharina Mattishent, Anne Marie Minihane, Richard Ian Gregory Holt, Helen Murphy, Ketan Dhatariya, Michael Hornberger.
       BACKGROUND: Type 2 diabetes (T2DM) and cognitive impairment are common long-term chronic conditions affecting older people in hospital. Cognitive impairment can complicate glucose monitoring and lead to diabetes-related emergencies in T2DM. Traditionally, point of care test measurements of capillary blood glucose are conducted in-hospital for T2DM while continuous glucose monitoring (CGM) is not widely used.
    AIM: To understand the feasibility, acceptability and tolerability of using CGM in older inpatients with T2DM and cognitive impairment.
    METHODS: 32 older people (mean age=78.7±6.7 years) with comorbid T2DM and cognitive impairment (Abbreviated Mini-Mental Test ≤8/10 and Mini-Addenbrooke's Cognitive Examination ≤22/30) were recruited within a tertiary care hospital in the UK. All participants were naive to CGM and were asked to wear blinded Dexcom G7 sensors for up to 10 days. Participants were asked about feasibility, acceptability and tolerability questions at the point of sensor removal.
    RESULTS: 29 participants (96%) reported no pain during CGM fitting. All participants (100%) agreed that they did not notice wearing the sensor, and it did not affect their day-to-day hospital activities. All participants (100%) found it 'very easy' or 'easy' to have the sensor fitted and wearing it for 10 days, with 27 participants (90%) finding CGM convenient. 17 participants (57%) reported favourable perceptions of the subcutaneous sensor sensation.
    CONCLUSION: CGM use in older inpatients with T2DM and cognitive impairment is highly feasible and acceptable for patients. Future studies and trials are now needed to evaluate the clinical use of CGM for glucose monitoring in hospitalised or community-dwelling older individuals with T2DM and cognitive impairment.
    Keywords:  Dementia; Diabetes Mellitus, Type 2; Hospitalization; Inpatients
    DOI:  https://doi.org/10.1136/bmjopen-2026-118196
  5. J Diabetes Res. 2026 ;2026(1): e8650831
    Characterizing Continuous Glucose Monitoring Prescription Patterns Between 2020 and 2024: A Retrospective Study at a Single Primary Care Facility in the United States.
    Rahma Mkuu, Protiva Rahman, Daniela Rivero-Mendoza, William Troy Donahoo, Elizabeth Shenkman, Diandra Ojo, Marcos R Lamas.
       OBJECTIVE: Examine the factors associated with continuous glucose monitoring (CGM) device prescriptions in a primary care facility.
    MATERIALS AND METHODS: We conducted a retrospective study of 1476 patients with Type 1 and Type 2 diabetes receiving care at a single primary care facility between 2020 and 2024. We examined the associations between receiving a CGM prescription and demographic characteristics, health factors, de-identified physician information, and insurance status. We conducted univariate analysis using chi-square tests. Multivariate logistic regression models accounted for multiple factors predicting receiving a CGM prescription.
    RESULTS: The average CGM prescription rate per physician was less than 4%. Various factors were significantly associated with receiving a CGM prescription. Notably, younger patients on insulin, with Type 1 diabetes, and higher glycated hemoglobin (HbA1C) values were more likely to be prescribed a CGM device. Patients with nutritional and metabolic diseases or abnormal lab values were less likely to receive a CGM prescription.
    CONCLUSIONS: Our findings are similar to those of other CGM studies, which show that CGM prescriptions are significantly higher among patients who are younger and who have Type 1 diabetes. There is a need for future studies that aim to better understand CGM prescribing decision-making among PCPs to inform the development of targeted interventions to improve CGM prescribing rates for all eligible patients.
    DOI:  https://doi.org/10.1155/jdr/8650831
  6. J Clin Endocrinol Metab. 2026 Sep 16. pii: dgag380. [Epub ahead of print]
    Association between worsening time in range and microvascular complications in type 1 diabetes: real-world 5-year study.
    Amber Sabbe, Niels Bochanen, Annelies Van den Broucke, Katarina Mihaljčić, Axelle Bigaré, Kristof Van Dessel, Jason Bouziotis, Kristien Ledeganck, Eveline Dirinck, Nancy Bolsens, Jolien De Meulemeester, Pieter Gillard, Christophe De Block.
       CONTEXT: Beyond HbA1c, continuous glucose monitoring (CGM) is now widely used in clinical practice, providing more detailed information about glycemic control. However, its ability to predict long-term microvascular outcomes in type 1 diabetes remains unclear.
    OBJECTIVE: To evaluate the association between CGM-derived glucometrics and the 5-year incidence of microvascular complications, providing longitudinal real-world evidence in adults with type 1 diabetes.
    DESIGN: Longitudinal real-world cohort study with five-year follow-up.
    SETTING: Tertiary referral center.
    PARTICIPANTS: 246 adults with type 1 diabetes (median age 40 [28-53] years, diabetes duration 24 [13-33] years).
    INTERVENTION: No interventional treatment.
    MAIN OUTCOME MEASURE: Composite microvascular endpoint including nephropathy (persistent albuminuria ≥20 µg/min, eGFR <60 mL/min/1.73 m2, and/or RAAS inhibitor use for albuminuria), severe retinopathy (proliferative retinopathy, maculopathy, and/or blindness), and peripheral neuropathy (monofilament score <6/6 and/or abnormal nerve conduction).
    RESULTS: HbA1c decreased from 7.6% (59 mmol/mol) to 7.2% (55 mmol/mol), and time in range (TIR, 70-180 mg/dL) increased from 50 ± 14% to 61 ± 15%. All CGM-derived metrics (TIR, mean glucose, glucose management indicator) were associated with the composite endpoint. In this longitudinal real-world cohort, a ≥ 10% decrease in TIR was associated with higher complication rates (33.3%) compared with a stable TIR (7.9%) or ≥10% increase (15.0%) (p = 0.011). In multivariable analyses adjusted for age and baseline TIR, change in TIR (ΔTIR) remained independently associated with outcomes. BMI and systolic blood pressure were not significant. Models incorporating glucometrics and age showed acceptable discriminative performance (AUCs 0.757-0.787).
    CONCLUSIONS: CGM-derived glucometrics were associated with the 5-year incidence of microvascular complications in this real-world cohort, with ΔTIR potentially providing additional prognostic information beyond HbA1c. Further validation is needed before routine clinical implementation.
    Keywords:  HbA1c; continuous glucose monitoring; microvascular complications; time in range; type 1 diabetes
    DOI:  https://doi.org/10.1210/clinem/dgag380
  7. Diabetes Care. 2026 Sep 16. pii: dc261039. [Epub ahead of print]
    Three-Year Glycemic Trajectories in Subgroups With Type 1 Diabetes at Risk for Suboptimal Glycemic Control: A Multicenter Continuous Glucose Monitoring Study.
    Jee Hee Yoo, Seohyun Kim, Yeonsoo Park, Soojin Park, Choon Hee Chung, Jae Hyeon Kim, Soo Heon Kwak, Gyuri Kim.
       OBJECTIVE: To examine 3-year longitudinal trajectories of continuous glucose monitoring (CGM) metrics across subgroups at risk for suboptimal glycemic control among adults with type 1 diabetes.
    RESEARCH DESIGN AND METHODS: In this multicenter study, 1,028 individuals contributed 3,441 longitudinal CGM profiles. Participants were stratified on the basis of age, chronic kidney disease (CKD), β-cell function, BMI, and triglyceride-glucose (TyG) tertile. Linear mixed-effects models were used to estimate subgroup differences in longitudinal changes.
    RESULTS: At baseline, there was more time spent with glucose above target range, >180 mg/dL, for the subgroups of older age, CKD, severe β-cell failure, higher BMI, and highest TyG tertile (all P < 0.05), while severe β-cell failure was additionally associated with more time spent with glucose below target range (TBR), <70 mg/dL, along with greater glycemic variability (all P < 0.001). In relation to younger individuals, for older adults improvement in time spent with glucose in target range (TIR), 70-180 mg/dL, was comparable (β = 0.110; P = 0.102) and lower TBR was maintained (3.5% vs. 1.7%, respectively; P < 0.001). Among the CKD group significant improvement in TIR was seen (β = 0.228; P = 0.002) without exacerbation of hypoglycemia. Severe β-cell failure attenuated TIR improvement (β = -0.119; P = 0.025) and TBR reduction (β = 0.046; P < 0.001). Lower absolute TIR was seen for those with higher BMI and those in the highest TyG tertile. Greater TIR improvement was observed for those in the highest TyG tertile (β = 0.083; P = 0.001). CGM metrics varied widely within these subgroups.
    CONCLUSIONS: Older age and CKD were associated with longitudinal glycemic improvement without worsening of hypoglycemia, whereas severe β-cell failure limited glycemic gains; substantial within-group heterogeneity supports individualized glycemic targets informed by CGM trajectories in type 1 diabetes.
    DOI:  https://doi.org/10.2337/dc26-1039
  8. Endocr J. 2026 Sep 16.
    Favorable CGM metrics do not exclude SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis: an educational case report with narrative review of literature.
    Miyuki Iwamoto, Shuji Hidaka, Takamasa Iwamoto, Hirotaka Shibata.
      Sodium-glucose cotransporter 2 inhibitors (SGLT2i) carry a risk of euglycemic diabetic ketoacidosis (euDKA) during acute illness. We report an educational case of a 45-year-old man with type 1 diabetes (T1D) receiving ipragliflozin who developed severe euDKA precipitated by COVID-19. During this sick-day period, he independently discontinued basal insulin-partly because his continuous glucose monitoring (CGM) readings remained within the target range-while continuing ipragliflozin. He presented to the emergency department with worsening gastrointestinal symptoms. On arrival, although blood glucose was 246 mg/dL, venous blood gas revealed severe metabolic acidosis (pH 7.040, HCO3- 9.6 mmol/L) and 3+ urinary ketones. Remarkably, CGM data for the 48 hours prior to ambulance arrival showed a time in range of 71%, indicating clinically acceptable glycemic control. Quantitative analysis confirmed minimal glycemic variability (coefficient of variation 15.8%; mean amplitude of glycemic excursions 77 mg/dL). To our knowledge, this is one of the first reports to quantitatively characterize CGM data, demonstrating that favorable CGM metrics do not preclude a metabolic crisis. Although reimbursement for self-monitoring of blood ketones (SMBK) for patients with T1D receiving SGLT2i has been introduced in Japan, National Database reports reveal limited utilization and structural barriers, such as restrictions on test strip supplies. While promoting SMBK is important, the concept of euDKA remains difficult for patients to grasp. Therefore, clinicians must prioritize symptom-based sick-day rules over "normal" glucose numbers to prevent false reassurance from clinically acceptable CGM metrics. This case underscores the inherent limitations of glucose-centric monitoring and the necessity of multifaceted patient education.
    Keywords:  Continuous glucose monitoring (CGM); Euglycemic diabetic ketoacidosis (euDKA); Glycemic variability (GV); Sodium-glucose cotransporter 2 inhibitors (SGLT2i); Type 1 diabetes (T1D)
    DOI:  https://doi.org/10.1507/endocrj.EJ26-0282
  9. Horm Res Paediatr. 2026 Sep 12. 1
    Scheduled remote review of continuous glucose monitoring data with targeted intervention vs standard care in children with Type 1 Diabetes: A parallel-groups study.
    Frances Ellen Gehrmann, Lauren Haddow, Peter William James Delaney, Grant James Smith, Craig E Taplin, Timothy W Jones, Elizabeth A Davis.
       AIM: This study evaluated the impact of scheduled review of continuous glucose monitoring (CGM) data with targeted remote intervention on glycaemic and person-reported outcomes in children with type 1 diabetes (T1D).
    METHODS: Children aged 5-14 years with T1D using CGM were recruited from two metropolitan clinics at Perth Children's Hospital in Western Australia; one clinic group was assigned to intervention and the other to control. The intervention group underwent CGM review by a diabetes educator every 14-days. Participants with >10% decrease in time in range (TIR: 3.9-10.0 mmol/L) from the previous review period, or who were not meeting consensus CGM targets, were prioritised and offered personalised remote advice via phone or email; the number receiving contact was constrained based on allocated educator time in each 14-day period. Those improving or meeting targets received positive feedback by SMS. Change in TIR from baseline to 6 months was compared between groups using difference-in-difference analysis. Person-reported outcomes were assessed using Type 1 Diabetes and Life (T1DAL) and Diabetes Treatment Satisfaction (DTSQ) questionnaires.
    RESULTS: A total of 113 children were recruited, 60 in the intervention (53% male, age 10. 2(2.7) years, baseline TIR 66.9% (13.4), HbA1c 7.2% (1.3)) and 53 in the control (51% male, age 9.6 (2.6) years, baseline TIR 69.4% (13.4), HbA1c 6.9% (0.8)). Most participants used automated insulin delivery systems; 64% in the control and 72% in the intervention. Across 14-day periods, mean (95% CI) 71% (67, 75) of participants in the intervention group were identified for targeted support; 39% (30, 49) received remote advice. Positive feedback was sent to 38% (32, 43) in each 14-day period. Compared with the control group, the intervention group showed a non-significant 3.1 percentage point increase in time in range (β = 3.1, p = 0.11). Over six-months, mean TIR decreased in the control group (69.4% to 66.6%) and was unchanged in the intervention group (66.9% to 67.0%). No significant between-group differences were observed in T1DAL or DTSQ scores, limited by low end-of-intervention questionnaire response rates.
    CONCLUSIONS: Regular CGM review identified many participants not meeting CGM targets, and over half received targeted intervention. However, the intervention did not significantly improve TIR or person‑reported outcomes. While it did not bring participants into target range in this well‑controlled cohort, the model may have greater effect in children with lower baseline TIR. Future trials should evaluate its impact in higher‑risk youth.
    DOI:  https://doi.org/10.1159/hrp/adaag028
  10. Chin Med J (Engl). 2026 Sep 14.
    Artificial intelligence meets continuous glucose monitoring data: Genie in the bottle.
    Jingyi Lu, Ziyi Zhang, Yaxin Wang, Jinghao Cai, Xia Yu, Geng Zong, Jian Zhou.
      
    DOI:  https://doi.org/10.1097/CM9.0000000000004229
  11. J Paediatr Child Health. 2026 Sep 15.
    Glycaemic Variability and Glucose Excursions in GCK Diabetes Compared With Type 1 Diabetes and the Healthy Population.
    Ann R Nillsen, Jack Ho, Jessica Lai, Sue Mei Lau, Ailsa Marshall, Sarah McMahon, Kim Ramjan, Vallimayil Velayutham, Amy Wanaguru, Yoon Hi Cho, Tony Huynh, Charles F Verge, Shihab Hameed.
       AIM: Monogenic diabetes due to abnormalities in the GCK gene causes lifelong hyperglycaemia without microvascular complications. We aimed to compare dysglycaemia in GCK diabetes to Type 1 diabetes.
    METHODS: We performed blinded Continuous Glucose Monitoring (CGM) in GCK diabetes (n = 13, 6 male, median age 20 years, range 7-48 years). We assessed diabetes complications including retinal photography and first-morning urine albumin: creatinine. We compared CGM results from GCK diabetes to 13 youth with Type 1 diabetes (median 16.8 years, range 11-18 years, case-matched for sex, height, weight) and to published CGM results from healthy individuals.
    RESULTS: Participants with GCK diabetes had no detectable diabetes complications, despite higher percentage time > 10 mmol/L (median 5%, IQR 3%-11%, range 0%-50%) than healthy individuals (0%, IQR 0%-0.2%). Glycaemic variability (GV) by coefficient of variation in GCK diabetes was similar to healthy individuals, 17% ± 3% for both. Youth with Type 1 diabetes had higher GV (37% ± 5%, p < 0.001) and percentage CGM time 10-13.9 mmol/L (36%, IQR 26%-47%, p < 0.001) than those with GCK diabetes.
    CONCLUSIONS: After life-long diabetes duration of up to 48 years, GCK diabetes had no associated diabetes complications, despite individuals spending up to 50% time with elevated glucose 10-13.9 mmol/L. GCK diabetes had low GV, comparable to results from healthy individuals, but significantly lower than found in Type 1 diabetes. GCK diabetes may represent a model of dysglycaemia which can be tolerated over a lifetime without microvascular complications. Efforts to reduce GV may be of particular importance in minimising microvascular complications in Type 1 diabetes.
    Keywords:  CGM; GCK diabetes; Type 1 diabetes; glycaemic variability
    DOI:  https://doi.org/10.1111/jpc.70581
  12. J Clin Res Pediatr Endocrinol. 2026 Sep 16.
    Relationships between Continuous Glucose Monitoring-Derived Glycemic Parameters and Early Retinal Vascular Changes in Children with Type 1 Diabetes Mellitus.
    Bediz Özen, Hakan Öztürk, Emrullah Arslan, Müge Nasırlı, Eren Er, Bumin Nuri Dündar.
       Objective: This study investigated relationships between continuous glucose monitoring (CGM)-derived metrics and early retinal vascular changes in children having type-1 diabetes mellitus (T1DM) with no clinically-visible diabetic retinopathy (T1DM-noR).
    Methods: Forty-two T1DM-noR patients and 45 healthy children were enrolled. Optical coherence tomography angiography (OCTA) parameters of superficial and deep capillary plexuses (SCP/DCP) were compared between groups. In T1DM-noR group, correlations of OCTA parameters with HbA1c, diabetes duration, time-in-range (TIR), time-in-tight-range (TITR), time-above-range (TAR), glucose-management-indicator (GMI) and coefficient of variation (CV) were examined, followed by adjusted multivariable regressions.
    Results: Compared to controls, T1DM-noR group showed significantly reduced SCP and DCP vessel densities in whole retina (p=0.038; p=0.017), fovea (p=0.046; p=0.041), parafovea (p=0.025; p=0.012) and perifovea (p=0.032; p=0.021). In T1DM-noR cases, whole retina, fovea, parafovea and perifovea measurements of SCP and DCP were significantly negatively correlated with HbA1c, diabetes duration, TAR, GMI and CV, but positively correlated with TIR and TITR (p<0.05). In multivariable regression, all significant associations in DCP and almost all in SCP remained independent after adjusting for age and diabetes duration (p<0.05).
    Conclusion: We found that T1DM children had reduced SCP and DCP vessel densities before development of clinically-visible retinopathy. In our study, as TIR and TITR decreased and HbA1c, diabetes duration, TAR, GMI and CV increased, SCP and DCP vessel densities decreased. Our study suggested that reduced densities, independently associated with CGM metrics (especially in DCP), might serve as early indicator of retinal changes in T1DM-noR children, and in such patients, more effective glycemic control should be considered.
    DOI:  https://doi.org/10.4274/jcrpe.galenos.2026.2026-7-21
  13. Diabetes Res Clin Pract. 2026 Sep 17. pii: S0168-8227(26)00468-7. [Epub ahead of print] 113548
    Early and sustained diabetes technology exposure is associated with cognitive outcomes in youth with type 1 diabetes.
    Marta Bassi, Pasquale Capuozzo, Marta Scalas, Noemi Zampatti, Andreina Conte, Giordano Spacco, Andrea Pintabona, Alice Parodi, Maria Grazia Calevo, Benedetta Salvadori, Carola Di Meo, Nicola Minuto, Mohamad Maghnie, Cristina Venturino.
       AIMS: To evaluate neurocognitive and behavioral outcomes in youth with pediatric-onset type 1 diabetes (T1D), focusing on the associations between continuous glucose monitoring (CGM) and automated insulin delivery (AID), and WISC-IV scores. The role of disease duration, age and mode at onset, glycemic control, socioeconomic status, and diabetes-related complications and comorbidities was also explored.
    METHODS: In this prospective observational cohort study, 153 children and adolescents (6-17 years) with T1D underwent standardized assessments of intelligence, executive function and behavior (WISC-IV, BRIEF-2, and CBCL). Clinical and socioeconomic data were collected. Associations between glycemic control, technology adoption, comorbidities, acute complications, and neurocognitive outcomes were analyzed.
    RESULTS: Participants showed high-average full-scale IQ with relative working-memory weakness. Sustained CGM use (≥90 % of disease duration) and higher AID use (≥50 %) were associated with higher Verbal Comprehension (p = 0.005 and p = 0.025) and General Ability Index (p = 0.015 and p = 0.043). HbA1c ≤ 7 % [53 mmol/mol] during the first 2-5 years after diagnosis was associated with better verbal reasoning, executive-function, and behavioral profiles. Lower socioeconomic status was associated with higher internalizing symptoms.
    CONCLUSIONS: Early and sustained CGM/AID were associated with more favorable verbal cognitive and general ability outcomes in youth with T1D, supporting a potential neuroprotective role of advanced diabetes technologies.
    Keywords:  Automated insulin delivery (AID); Cognitive function; Cognitive outcomes; Continuous glucose monitoring (CGM); Type 1 diabetes (T1D)
    DOI:  https://doi.org/10.1016/j.diabres.2026.113548
  14. Diabetes Obes Metab. 2026 Sep 17.
    Sensor-Detected Hypoglycaemia Is Associated With Inflammatory Protein and Immune Cell Alterations in People With Diabetes: Findings From the Hypo-METRICS Study.
    Hypo‐RESOLVE Consortium
       AIMS: Experimental hypoglycaemia induces a persistent inflammatory response. We investigated whether real-life sensor-detected hypoglycaemia (SDH) is associated with immune parameters in people with Type 1 and Type 2 diabetes and explored potential differences between the groups.
    MATERIALS AND METHODS: In a multi-center observational study, 177 people with Type 1 diabetes and 185 with insulin-treated Type 2 diabetes were recruited to wear blinded glucose sensors for 10 weeks. SDH metrics derived from these sensors included SDH frequency, SDH duration, and time below range (TBR). At the end of the observation period, fasting blood was drawn to measure levels of circulating inflammatory proteins (Type 1 n = 177, Type 2 n = 185), ex vivo monocyte function (Type 1 n = 59; Type 2 n = 90), and circulating immune cell counts (Type 1 n = 29; Type 2 n = 87).
    RESULTS: Four circulating inflammatory proteins (CCL28, CX3CL1, IL-17A, IL-17C) were positively associated with SDH frequency, SDH duration and TBR in both groups (all p < 0.05). In Type 1 diabetes, pro-inflammatory responses of monocytes to pathogenic stimuli were inversely associated with SDH frequency, SDH duration and TBR, particularly Pam3Cys-induced IL-6 production (all p < 0.05); similar but less pronounced associations were observed in Type 2 diabetes. SDH frequency and TBR were inversely associated with total circulating immune cell, neutrophil and monocyte counts in Type 1 diabetes (all p < 0.05).
    CONCLUSIONS: Exposure to real-life hypoglycaemia is associated with immune alterations in people with Type 1 and Type 2 diabetes, including increased levels of circulating inflammatory proteins in both diabetes types and reduced monocyte function and immune cell counts, particularly in Type 1 diabetes.
    TRIAL REGISTRATION: NCT04304963.
    Keywords:  Type 1 diabetes; Type 2 diabetes; continuous glucose monitoring; hypoglycaemia; inflammation
    DOI:  https://doi.org/10.1111/dom.71321
  15. Nutrients. 2026 Sep 07. pii: 2924. [Epub ahead of print]18(17):
    Bedtime Snack Composition and Overnight Glycemic Profiles in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injections: A Randomized Crossover Study.
    Didem Güneş Kaya, Elvan Bayramoğlu, Hande Turan, Olcay Evliyaoğlu, Murat Bas.
      Background/Objectives: Bedtime snacks are frequently used in youth with type 1 diabetes (T1D) to reduce nocturnal hypoglycemia risk; however, the optimal macronutrient composition remains uncertain, particularly in those treated with multiple daily injections (MDI). This randomized crossover study evaluated whether standardized whole-food bedtime snacks with different macronutrient profiles yield distinct overnight continuous glucose monitoring (CGM) patterns. Methods: Twelve children and adolescents with T1D using glargine/lispro-based MDI completed four bedtime snack protocols: carbohydrate-only (CHO), carbohydrate-plus-protein (CHO + PRO), carbohydrate-plus-fat (CHO + FAT), and carbohydrate-plus-fiber (CHO + FIB). Each snack was consumed for three consecutive nights at 21:00 without additional bolus insulin. Blinded CGM data were analyzed for 21:00-09:00 and for predefined postprandial intervals. Because no a priori sample size calculation was performed, the study was conducted as an exploratory pilot trial. Nights per snack were averaged before within-subject comparisons. Results: Overnight time in range (TIR; 70-180 mg/dL) varied across protocols (p = 0.014), with the highest TIR following CHO + PRO (85.8% ± 12.1%) and the lowest following CHO + FAT (70.9% ± 19.1%); however, adjusted whole-night pairwise comparisons were not statistically significant. Differences were more pronounced during the first 6 h following snack consumption, when CHO + PRO was associated with higher TIR than CHO + FAT (91.2% ± 7.6% vs. 71.4% ± 20.8%; adjusted p = 0.011). Moreover, CHO + PRO was associated with lower peak-to-nadir glucose amplitude than CHO + FAT (88.1 ± 24.9 vs. 123.9 ± 36.5 mg/dL; adjusted p = 0.041). Hypoglycemic and hyperglycemic event rates did not significantly differ across protocols. Conclusions: In children and adolescents with T1D using MDI, bedtime snack composition was associated with differences in early nocturnal glycemic stability. CHO + PRO demonstrated higher early night TIR and lower glucose amplitude than CHO + FAT; however, event-based safety outcomes did not significantly differ. Because only two pairwise comparisons remained significant after correction for multiple testing and the four snacks were not matched for energy content, these findings should be regarded as preliminary and hypothesis-generating; in particular, they do not demonstrate that any snack composition protects against nocturnal hypoglycemia. Confirmation is required in larger, adequately powered studies that include energy-matched snacks and a no-snack control condition.
    Keywords:  adolescents; bedtime snack; children; continuous glucose monitoring; glycemic variability; macronutrient composition; multiple daily injections; nocturnal glycemia; time in range; type 1 diabetes
    DOI:  https://doi.org/10.3390/nu18172924
  16. Clin Med Insights Endocrinol Diabetes. 2026 ;19 11795514261490259
    Durable Insulin-free Remission in A-β+ Ketosis-Prone Diabetes With SGLT2 Inhibition: A Case Report With Longitudinal C-Peptide and CGM Data.
    Ahmadjon Ahmadjonov, Durr-E-Shahwar Malik, Otabek Kuziev, Shakhnoza Toshova, Aseel Smerat, Mohammad Adi, Ahmed Ashraf.
      Ketosis-prone diabetes (KPD) is a heterogeneous diabetes phenotype in which some patients with preserved β-cell function can achieve insulin independence after diabetic ketoacidosis (DKA). The role of sodium-glucose cotransporter 2 (SGLT2) inhibitors in maintaining remission in A-β+ KPD remains uncertain because of concerns regarding ketoacidosis risk. We report the case of a 45-year-old man who presented with severe DKA and was classified as A-β+ KPD based on negative islet autoantibodies and preserved C-peptide secretion. Following acute management, structured insulin withdrawal was performed, and dapagliflozin was initiated at week 4 with intensive metabolic monitoring. Over 12 months, the patient achieved sustained insulin-free remission, with significant improvements in HbA1c (12.1% to 6.4%), robust recovery of stimulated C-peptide (peak 4.8 ng/mL), and a continuous glucose monitoring (CGM) time-in-range of 82%, without recurrence of ketosis. This case suggests that in carefully selected A-β+ KPD patients with preserved β-cell reserve, SGLT2 inhibition may be safely integrated into the remission phase under close surveillance. However, these findings are hypothesis-generating, and the contribution of dapagliflozin to remission cannot be determined from a single uncontrolled observation. Prospective studies are required before this strategy can be recommended for routine use.
    Keywords:  A−β+ KPD; SGLT2 inhibitors; continuous glucose monitoring; ketosis-prone diabetes; β-cell recovery
    DOI:  https://doi.org/10.1177/11795514261490259
  17. Diabetes Obes Metab. 2026 Sep 14.
    Beyond the CE Mark: A Call to Action for Minimum CGM Accuracy Standards in Central and Eastern European Nations.
    Tomasz Klupa, Silvija Canecki-Varžić, Adriana Ilavská, Andrej Janez, Sanja Klobučar, Mladen Krnić, Tatjana Milenkovic, Peter Novodvorský, Martin Prázný, Marko Simunovic, Jan Šoupal, Anca Pantea Stoian, Agnieszka Szadkowska, Tsvetelina Tankova, Tadej Battelino.
      
    Keywords:  continuous glucose monitoring (CGM); effectiveness; health economics; type 1 diabetes
    DOI:  https://doi.org/10.1111/dom.71344
  18. Diabetes Res Clin Pract. 2026 Sep 17. pii: S0168-8227(26)00490-0. [Epub ahead of print] 113570
    All-in-one sensor design with overlapping sensor transition reduces automode interruptions and improves patient-reported outcomes in adolescents with type 1 diabetes: real-world evidence from simplera sync integration.
    Marco Marigliano, Andrea Scaramuzza, Riccardo Bonfanti, Valentino Cherubini, Fortunato Lombardo, Chiara Mameli, Nicola Minuto, Enza Mozzillo, Barbara Piccini, Elvira Piccinno, Ivana Rabbone, Carlo Ripoli, Riccardo Schiaffini, Davide Tinti, Claudio Maffeis.
       AIMS: To assess the real-world impact of transitioning from Guardian 4 to Simplera Sync sensor on automated insulin delivery and patient-reported outcomes in adolescents using the Minimed 780G system.
    METHODS: Multicentre retrospective observational study of 42 adolescents with type 1 diabetes (median age 12.0 years) established on SmartGuard ≥ 6 months. Fourteen centres each enrolled three consecutive eligible patients. Both observation windows fell within the school term, with no pump settings changed. Continuous glucose monitoring metrics and Diabetes Intrusiveness, Difficulty and Self-care Scale scores were compared between the final two weeks of Guardian 4 use and the final two weeks after transitioning to Simplera Sync.
    RESULTS: Time in automated mode increased from 95.3% to 97.1% (+1.8 percentage points, approximately 23 min/day; p < 0.02). Time in range (70-180 mg/dL) increased from 76.7% to 79.3% (p < 0.05), mean glucose fell from 146.0 to 141.3 mg/dL (p < 0.05), and time above 250 mg/dL decreased from 3.0% to 2.0% (p < 0.01), with no worsening of hypoglycaemia. Treatment satisfaction increased and perceived burden decreased (both p < 0.01).
    CONCLUSIONS: Overlapping sensor transition was associated with increased automated delivery, modest glycaemic improvement and reduced device burden. The fully disposable design may eliminate transmitter-recharging interruptions; prospective validation is required.
    Keywords:  Adolescents; Automode continuity; Closed-loop systems; Continuous glucose monitoring; Patient-reported outcomes; Seamless transition; Sensor design; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.diabres.2026.113570
  19. J Clin Transl Endocrinol. 2026 Nov;46 100456
    Post-exercise hypoglycaemia in adults with cystic fibrosis compared to healthy control adults.
    Tiffany J Dwyer, Yuankai Gu, Ruth Dentice, Molly Cocks, Alana Hayes, Helen Jo, Jessica Marouvo, Samantha Nolan, Nicole Taylor, Simone Visser, Veronica Yozghatlian, Katrin Kosbab-Jackson, Sheila Sivam.
       Background: People with cystic fibrosis-related diabetes (CFRD) are at risk of hypoglycaemia related to insulin therapy; and hypoglycaemia is also prevalent in those without CFRD. Although people with other forms of diabetes mellitus are at risk of hypoglycaemia within 48 h after exercise, this has not been objectively measured in people with CF. This study investigated the prevalence of post-exercise hypoglycaemia in adults with CF (pre- and post-commencement of elexacaftor/tezacaftor/ivacaftor (ETI)), compared to healthy controls.
    Methods: Participants completed a 20-min supervised, moderate-intensity cycling session and wore a continuous flash glucose sensor. The prevalence of hypoglycaemia was defined as the number of participants and percentage of time glucose levels were < 3.9 mmol/L and < 3.0 mmol/L within the 48 h after exercise.
    Results: 15 adults with CF pre-ETI (abnormal glucose tolerance (impaired glucose tolerance, n = 2, or CFRD, n = 5)), 32 adults with CF post-ETI (21 abnormal glucose tolerance (impaired glucose tolerance, n = 10, or CFRD, n = 11)) and 15 healthy controls completed the study. There were no significant differences in the prevalence or duration of hypoglycaemia post-exercise between the CF and control groups; and no change after commencing ETI. There was also no significant increase in the prevalence or duration of hypoglycaemia for people with CF with abnormal glucose tolerance when comparing the 48 h post-exercise period to the 48 h period with the least exercise.
    Conclusions: The absence of any increase in significant hypoglycaemia in the post-exercise period should be reassuring for people with CF who have abnormal glucose tolerance, whether prescribed ETI or not, and their clinicians.
    Keywords:  CGM; Continuous glucose monitor; Diabetes; Elexacaftor/tezacaftor/ivacaftor; Glycaemic control
    DOI:  https://doi.org/10.1016/j.jcte.2026.100456
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