bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2026–10–25
twenty-one papers selected by
Mott Given
  1. Improving Continuous Glucose Monitoring Access Among Adults With Type 1 Diabetes in an Urban Safety-Net Hospital.
  2. Real-Time Continuous Glucose Monitoring Use and Kidney Function Among People With Diabetes and CKD or At-Risk for CKD.
  3. Advancing Type 2 Diabetes Care: The Role of Continuous Glucose Monitoring in Noninsulin-Treated Patients.
  4. Continuous Glucose Monitoring Is Not Ready for the Diagnosis of Prediabetes.
  5. Association of continuous glucose monitoring metrics with cardiovascular and kidney outcomes in type 2 diabetes: Data from the GRADE-CGM substudy.
  6. Practical consideration for the application of continuous glucose monitoring in older adults with insulin treated diabetes.
  7. Comparative Effectiveness of Continuous Glucose Monitoring Versus Blood Glucose Monitoring in Pregnancy With Diabetes: Systematic Review and Meta-analysis With Trial Sequential Analysis.
  8. Real-world accuracy, extended-wear performance, and user satisfaction with a novel 21-day continuous glucose monitoring system in pediatric type 1 diabetes.
  9. Acceptability of blinded continuous glucose monitoring for people with serious mental illness and type 2 diabetes: findings from an exploratory mixed-methods study.
  10. Efficacy and Feasibility of Just-in-Time Nudging in Reducing Evening Snacking Measured by Continuous Glucose Monitoring in Adults With Type 2 Diabetes: A Micro-Randomized Study.
  11. Impact of Transition to Insulin U-500 during Pregnancy on Continuous Glucose Monitoring-Derived Glycemic Metrics among Women with Type 2 Diabetes.
  12. Scalable elastic band resistance training improves glycemic control in older adults with type 2 diabetes: A CGM-based randomized crossover study.
  13. Intraoperative Continuous Glucose Monitor Sensor-Receiver Connectivity Is Maintained With Alternative Sensor Placement: A Pilot Study.
  14. Timing of Insulin Glargine Administration During Intermittent Ramadan Fasting in patients With Type1 Diabetes: A Randomized Controlled Trial (GLARIF).
  15. [Treatment of type 2 diabetes mellitus].
  16. Useful Signals, Poor Predictors: What Does CGM Add Beyond HbA1c for Predicting Severe Hypoglycemia and Diabetic Ketoacidosis in Type 1 Diabetes, and How Can Prediction Improve?
  17. Acceptability and Feasibility of a Primary Care Hypoglycemia Prevention Program: A Pilot Study.
  18. Comment on Park et al. High-Amplitude and Prolonged Glucose Excursions as a Key Determinant of Discordance Between Glucose Management Indicator and Glycated Hemoglobin in Type 1 Diabetes.
  19. A study on the dose-response relationship between glycemic variability and in-dialysis hypotension in patients with diabetes undergoing hemodialysis.
  20. Study Engagement in the ROUTE Randomized Controlled Trial: A Diabetes Educator-Led Behavioral Intervention to Promote Continuous Glucose Monitor Use Among Youth With Type 1 Diabetes.
  21. The Smart MDI System in People With Type 1 Diabetes and High HBA1C: A Randomized Controlled Trial Demonstrating That Response to Alerts Drives Outcomes.
  1. Diabetes Obes Cardiometab CARE. 2026 Mar-Apr;1(2):1(2): 184-188
    Improving Continuous Glucose Monitoring Access Among Adults With Type 1 Diabetes in an Urban Safety-Net Hospital.
    Alisha Virani, Kristi Quairoli, Francisco J Pasquel, Georgia M Davis.
       OBJECTIVE: To increase continuous glucose monitoring (CGM) access among adults with type 1 diabetes at the Grady Diabetes Center and identify barriers to technology adoption.
    RESEARCH DESIGN AND METHODS: We conducted an 11-month quality improvement initiative using sequential plan-do-study-act cycles led by a multidisciplinary team. Interventions included standardizing CGM workflows, training staff to document active device use, implementing a structured CGM education program, and using a pilot survey to facilitate discussion of CGM during clinical encounters.
    RESULTS: CGM access increased from 46% to 65% over the intervention period. While the proportion of patients achieving HbA1c <8% remained stable (22% vs. 24%), the first cohort completing CGM classes demonstrated a 10.7% mean increase in time in range without increased hypoglycemia. Notably, early survey data revealed that CGM prescriptions did not consistently translate into device initiation, underscoring persistent downstream barriers to actual use.
    CONCLUSIONS: Targeted CGM workflow redesign, combined with structured CGM education, improved CGM uptake and glycemic outcomes. Sustained improvement will depend on continued integration of CGM data into clinical workflows, streamlining prescription processes and building educational infrastructure.
    DOI:  https://doi.org/10.2337/doc25-0043
  2. Endocrinol Diabetes Metab. 2026 Nov;pii: e70344. [Epub ahead of print]9(6):
    Real-Time Continuous Glucose Monitoring Use and Kidney Function Among People With Diabetes and CKD or At-Risk for CKD.
    Katia L Hannah, Christina Chen, Jessica R Castle, Gregory J Norman, Rodolfo J Galindo.
       INTRODUCTION: Continuous glucose monitoring (CGM) use may benefit people with diabetes and chronic kidney disease (CKD). In this propensity-matched, retrospective analysis using Truveta-provided de-identified EMR data, changes in kidney function and glycemia were compared between cohorts starting real-time CGM (RT-CGM) use and CGM non-users (No CGM).
    METHODS: Adults with type 1 or type 2 diabetes, treated with any insulin, with estimated glomerular filtration rate (eGFR) of 15-89 mL/min/1.73 m2 were included. Changes in eGFR, albumin-to-creatinine ratio (ACR), and HbA1c between baseline and 3-year follow-up were assessed.
    RESULTS: RT-CGM initiation (N = 518 per cohort) was associated with a significantly slower decline in eGFR compared to No CGM. There was no significant difference in change in ACR between the groups (N = 138 per cohort). RT-CGM use (N = 461 per cohort) was associated with a significantly greater decrease in HbA1c compared to No CGM.
    CONCLUSIONS: These findings support RT-CGM initiation among people with diabetes and CKD or at risk for CKD.
    Keywords:  HbA1c; chronic kidney disease; continuous glucose monitoring; diabetes mellitus
    DOI:  https://doi.org/10.1002/edm2.70344
  3. Diabetes Obes Cardiometab CARE. 2026 Mar-Apr;1(2):1(2): 288-297
    Advancing Type 2 Diabetes Care: The Role of Continuous Glucose Monitoring in Noninsulin-Treated Patients.
    James R Gavin, Naunihal Virdi.
      Continuous glucose monitoring (CGM) is standard of care as part of diabetes management for people with type 1 or type 2 diabetes using insulin therapy. Recently, the American Diabetes Association recommended CGM use be considered in adults with type 2 diabetes using noninsulin medications for managing blood glucose levels. Despite this recommendation, many people using noninsulin therapies for type 2 diabetes encounter restrictions on access to CGM. We have reviewed the available studies exploring the utility of CGM in this patient population, with a focus on glycemic management and health care resource utilization. Numerous studies focusing on this patient group, including systematic reviews and meta-analyses, randomized controlled trials, other prospective studies, and retrospective analyses, have consistently found that use of CGM is associated with improvements in HbA1c and time in range. A few studies also reported that CGM use was associated with reductions in diabetes-associated health care utilization. Although the available studies have limitations, they reveal a compelling trend supporting beneficial effects of CGM in noninsulin-using people with type 2 diabetes. Payors and policymakers should consider these studies and this compelling evidence when making decisions regarding CGM access. Video 1.Video abstract4b256fe6-3f25-4d79-adeb-93b3562c7122docm250058video1.
    DOI:  https://doi.org/10.2337/doc25-0058
  4. Diabetes Technol Ther. 2026 Oct 19. 15209156261485015
    Continuous Glucose Monitoring Is Not Ready for the Diagnosis of Prediabetes.
    J Hans DeVries.
      With the growing availability of over-the-counter continuous glucose monitors, the question arises whether Continuous Glucose Monitoring (CGM) can be used to diagnose prediabetes. Traditionally, prediabetes is diagnosed using the oral Glucose Tolerance Test, a test with poor reproducibility. In a study from Singapore, there was large overlap between Ambulatory Glucose Profiles of people with prediabetes and normoglycemia. The optimal threshold of 5.64% Time above 140 mg/dL, the best discriminator, yielded 88% specificity and 48% sensitivity, indicating insufficient discriminatory value in many cases. In a study from Stanford, administration of a 75-gram oral glucose load while wearing CGM showed poor agreement with venous sampling between the category outcomes normoglycemia, prediabetes and diabetes. Future large cohort studies and AI may improve this situation. But for the moment, when a question of prediabetes arises, the most practical answer is to measure HbA1c, which allows for an elegant classification of normoglycemia, prediabetes and diabetes.
    Keywords:  CGM; OGTT; prediabetes
    DOI:  https://doi.org/10.1177/15209156261485015
  5. J Diabetes Complications. 2026 Oct 19. pii: S1056-8727(26)00184-4. [Epub ahead of print]40(12): 109439
    Association of continuous glucose monitoring metrics with cardiovascular and kidney outcomes in type 2 diabetes: Data from the GRADE-CGM substudy.
    Mengyao Tang, David M Nathan, Deborah J Wexler, Melissa S Putman, John M Higgins, Hui Zheng, Eugene P Rhee, Ian H de Boer, Sahir Kalim.
       AIMS: We compared associations of CGM-derived time in range (TIR) and glucose management indicator (GMI) vs. HbA1c with CVD and eGFR decline in type 2 diabetes.
    METHODS: We studied 1363 participants with ≥10-day blinded CGM in the GRADE-CGM Substudy. Exposures were TIR and GMI, with HbA1c as comparator. Cox models estimated hazard ratios (HR) for the composite of any CVD or all-cause death. Linear mixed-effects models estimated eGFR slope. Models were adjusted for age, sex, race/ethnicity, treatment group, diabetes duration, and baseline eGFR, then mutually adjusted each CGM metric with HbA1c.
    RESULTS: Over median 2.3 years, 74 CVD or death occurred, eGFR slope was -2.37 mL/min/1.73m2/year. GMI, HbA1c, and TIR were each significantly associated with CVD/death (adjusted HR 1.44 [1.21-1.71] per 1% GMI; 1.37 [1.16-1.61] per 1% HbA1c; 0.73 [0.61-0.87] per 20% TIR). Higher GMI and HbA1c were associated with faster eGFR decline (-0.35 [-0.63, -0.07] and - 0.38 [-0.65, -0.11] mL/min/1.73m2/year); TIR was not significantly associated with eGFR slope. After mutual adjustment, most associations of CGM metrics and HbA1c with outcomes were attenuated.
    CONCLUSIONS: In type 2 diabetes, GMI and HbA1c were comparably associated with cardiovascular and kidney outcomes, whereas TIR was associated with cardiovascular outcomes only.
    Keywords:  Cardiovascular outcomes; Continuous glucose monitoring; HbA1c; Time in range; Type 2 diabetes; eGFR
    DOI:  https://doi.org/10.1016/j.jdiacomp.2026.109439
  6. Endocr Pract. 2026 Oct 23. pii: S1530-891X(26)01293-0. [Epub ahead of print]
    Practical consideration for the application of continuous glucose monitoring in older adults with insulin treated diabetes.
    Leszek Czupryniak, Malgorzata Mysliwiec, Ryszard Gellert, Piotr Jankowski, Agnieszka Mastalerz-Migas, Krzysztof Strojek, Mieczyslaw Walczak, Tomasz Targowski.
      The increased prevalence of diabetes among older individuals presents challenges for delivery of effective care for each older person with diabetes, for their families, and for healthcare providers. Along with established risks for microvascular and macrovascular disease, diabetes in older adults is also associated with risk factors for cognitive impairment and dementia, depression and physical frailty. Many of these risk factors are linked to hypoglycaemia, which in turn can be related to polypharmacy and overprescribing in older individuals. Use of continuous glucose monitoring (CGM) technology is proven to prevent hypoglycaemia and can mitigate many averse outcomes of frailty, both in type 1 diabetes (T1D and type 2 diabetes (T2D). Similarly, use of CGM improves glucose stability, reducing risks for vascular complications of diabetes. Intrinsic capacity (IC) is a concept used in geriatric medicine to provide an objective composite of physical and mental capacities that an older individual can draw on. Reduced IC is associated with a number of CGM metrics, including time in range (TIR), time above range (TAR), rather than hypoglycaemia. Use of CGM can also facilitate telemedicine for adults with diabetes and frailty, reducing the burden of clinic attendance and increasing the frequency of healthcare contacts, further increasing the quality of care and quality of life for older individuals with diabetes. Given the significant benefits, the application of CGM alongside geriatric principles can be proposed to improve overall care and outcomes for people with diabetes.
    Keywords:  Type 1 diabetes; continuous glucose monitoring; frail; insulin pumps; older; type 2 diabetes
    DOI:  https://doi.org/10.1016/j.eprac.2026.10.010
  7. Diabetes Obes Cardiometab CARE. 2026 Sep-Oct;1(5):1(5): 963-973
    Comparative Effectiveness of Continuous Glucose Monitoring Versus Blood Glucose Monitoring in Pregnancy With Diabetes: Systematic Review and Meta-analysis With Trial Sequential Analysis.
    Raveendhara R Bannuru, Meredith Noble, Grazia Aleppo, Sarit Polsky, Katherine Fazioli, Tracy C Shields, Nuha A El Sayed.
       OBJECTIVE: The value of adding continuous glucose monitoring (CGM) to blood glucose monitoring (BGM) during pregnancy is unclear.
    PURPOSE: To clarify CGM's role in pregnancy using meta-analysis, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ratings, harmonized neonate size definitions, and trial sequential analysis (TSA).
    DATA SOURCES: We performed bibliographic database and hand searches. We selected clinically relevant randomized controlled trials (RCTs) comparing CGM and BGM in pregnancy.
    DATA EXTRACTION: Neonate size measures were primary; additional maternal, obstetric, and neonatal outcomes data were also extracted.
    DATA SYNTHESIS: Seventeen RCTs (n = 2,672 participants) met inclusion criteria. Incidence of macrosomia was reduced overall (risk ratio [RR] 0.67 [95% CI 0.48, 0.94]; strength of evidence [SOE], moderate) and for gestational diabetes mellitus (GDM) (RR 0.55 [95% CI 0.35, 0.86]; SOE, high); incidence of large for gestational age was also reduced overall (RR 0.77 [95% CI 0.61, 0.98]; SOE, very low) and for GDM (RR 0.65 [95% CI 0.45, 0.96]; SOE, very low). Incidence of small for gestational age (SGA) was elevated with CGM but not statistically significant (RR 1.37 [95% CI 0.96, 1.95]; SOE, moderate). The TSA showed no neonate size outcome met the required information size (RIS) to draw firm conclusions, and no cumulative Z curve crossed the adjusted monitoring boundary. Summary statistical significance may fluctuate with the publication of new studies.
    CONCLUSIONS: CGM benefits mothers with preexisting diabetes and GDM and their neonates for varying outcomes, including reducing large size at birth. Our TSA found that the RIS for neonate size outcomes has not been reached. Literature should be monitored particularly for RCTs reporting SGA in GDM, which the TSA shows cannot be conclusively ruled out as a risk.
    DOI:  https://doi.org/10.2337/doc26-0018
  8. BMJ Open Diabetes Res Care. 2026 Oct 21. pii: e006467. [Epub ahead of print]14(5):
    Real-world accuracy, extended-wear performance, and user satisfaction with a novel 21-day continuous glucose monitoring system in pediatric type 1 diabetes.
    Erdal Eren, Yasemin Denkboy Ongen, Burcu Eryilmaz, Zeynep Yildizer Senoglu, Zehra Kuscu.
      
    Keywords:  Biosensing Techniques; Blood Glucose; Diabetes Mellitus, Type 1; Pediatrics
    DOI:  https://doi.org/10.1136/bmjdrc-2026-006467
  9. Front Clin Diabetes Healthc. 2026 ;7 1923186
    Acceptability of blinded continuous glucose monitoring for people with serious mental illness and type 2 diabetes: findings from an exploratory mixed-methods study.
    Jennifer V E Brown, Ramzi A Ajjan, Najma Siddiqi, Peter A Coventry.
       Introduction: People with serious mental illness (SMI) experience a disproportionately high prevalence of type 2 diabetes and a reduced life expectancy of 15 to 20 years. While continuous glucose monitoring (CGM) has revolutionised diabetes self-management in the general population, its feasibility and acceptability among individuals living with co-existing SMI remain largely unexamined.
    Methods: The study was embedded within the DIAMONDS feasibility study. Community-dwelling adults with SMI and type 2 diabetes (N = 21 eligible) were invited to wear a blinded CGM sensor (FreeStyle LibrePro) for 14 days. Quantitative metrics evaluated uptake, wear duration, data completeness, and adverse events. Semi-structured qualitative interviews (n = 9) explored user experiences. The qualitative analysis used a hybrid human-AI framework approach to map findings onto the Theoretical Framework of Acceptability (TFA) and the Theoretical Domains Framework (TDF), followed by data integration using a convergence coding matrix.
    Results: Sixteen participants agreed to wear the device (76.2% uptake), achieving a mean wear duration of 11 days. Of the returned sensors with data, 92.8% captured ≥5 days of readings, and no adverse events were reported. Qualitative analysis demonstrated highly positive affective attitudes and a significantly lower perceived burden compared with traditional finger-stick testing, despite minor challenges with sensor adhesion. Cross-framework integration revealed that high acceptability was driven by the device's low-friction physical layout, positive participant beliefs about data consequences, and alignment with a proactive, research-contributing identity.
    Discussion: The use of blinded CGM is both feasible and acceptable for people living with SMI and type 2 diabetes. These findings offer a robust foundation for developing structured, low-burden, and theory-informed physical health interventions aimed at closing the mortality gap in this underserved population.
    Keywords:  acceptability; continuous glucose monitoring (CGM); feasibility; mixed-methods; serious mental illness (SMI); type 2 diabetes
    DOI:  https://doi.org/10.3389/fcdhc.2026.1923186
  10. Diabetes Obes Metab. 2026 Oct 20.
    Efficacy and Feasibility of Just-in-Time Nudging in Reducing Evening Snacking Measured by Continuous Glucose Monitoring in Adults With Type 2 Diabetes: A Micro-Randomized Study.
    Lijun Zhao, Niranjan Bidargaddi, Andrew Vakulin, Wenhao Li, Natalie Luscombe-Marsh, Fiona Benton, Robert Adams, Eva Kemps, Andrew D Vincent, Leonie K Heilbronn, Gary A Wittert.
       AIMS: This study aimed to determine whether in people with Type 2 diabetes mellitus (T2DM), a digital nudge delivered by a smartphone app soon after dinner reduces subsequent snacking events as measured by continuous glucose monitoring (CGM).
    METHODS: Participants: Adults with T2DM, managed with diet or stable oral antidiabetic medication for at least 3 months, and who habitually snacked after dinner on ≥ 3 nights/week.
    DESIGN: Pictographic nudges were co-designed with consumers. After-dinner snacking behaviours were confirmed during a 2-week Lead-In phase by CGM. Thereafter, eligible participants were micro-randomized daily (1:1, MRT phase) to either a pictographic nudge delivered-in-time (Intui Research) or no nudge for a second 2-week period. The primary outcome was the difference in incremental area under the CGM curve (net-iAUC) between nudging days and non-nudging days during the period 90-min post-dinner until 4 AM.
    RESULTS: Sixty-six participants completed the Lead-In phase and 56 completed the MRT phase with available CGM data. CGM data were collected over 911 nights during the Lead-In phase and 780 nights during the MRT phase, with a total of 410 digital nudges sent. Over the entire 2-week period there was no effect of nudging on the primary outcome (net-iAUC). However, secondary analyses showed that there was an initial nudge effect that faded over time. Similar results were observed for snacking behaviour and CGM time-in-range.
    CONCLUSION: This study provides preliminary feasibility of delivering just-in-time nudges in adults with T2DM, with no overall glycaemic benefit. Exploratory early effects warrant confirmation and investigation of strategies to sustain efficacy.
    TRIAL REGISTRATION: ACTRN12622000531718.
    Keywords:  Type 2 diabetes; continuous glucose monitoring; dietary behaviour; evening snacking; glucose; mHealth; nudging
    DOI:  https://doi.org/10.1111/dom.71439
  11. Am J Perinatol. 2026 Oct 21.
    Impact of Transition to Insulin U-500 during Pregnancy on Continuous Glucose Monitoring-Derived Glycemic Metrics among Women with Type 2 Diabetes.
    Elizabeth O Buschur, Alexandra Scheiber, Jiqiang Wu, Annabeth Brewton, Steven G Gabbe, Shaylyn Vickers, Mark B Landon, Courtney Lynch, William A Grobman, Christine P Field, Kartik K Venkatesh.
       Objective: Insulin U-500 is a highly concentrated regular insulin that is five times stronger than standard U-100 and is used to treat severe insulin resistance. Glycemic data from continuous glucose monitoring (CGM) in relation to initiation of U-500 insulin in pregnancy with type 2 diabetes are limited. We examined CGM-derived glycemic measures before and after insulin U-500 transition during pregnancy among women with type 2 diabetes.
    Study Design: We conducted a case-crossover study evaluating glycemic measures before and after transition to insulin U-500 during pregnancy among women with type 2 diabetes. The case period was from prenatal care to insulin U-500 transition, and the control period was after insulin U-500 transition to delivery. Outcomes included CGM metrics (time in range [TIR; 65-140 mg/dL], time above range [TAR], and time below range), mean glucose and standard deviation, estimated A1c per glucose management indicator, coefficient of variation, and number of hypoglycemic episodes and were compared pre versus post insulin U-500 transition. Adjusted linear mixed models were used.
    Results: Among 21 women with type 2 diabetes, the median gestational age at prenatal care initiation was 11.1 weeks, at insulin U-500 transition was 25.4 weeks, and at delivery was 37.1 weeks. The insulin U-500 dose at initiation was 300 units/day and at delivery was 422.5 units/day. The TIR was higher, and TAR and mean glucose were lower post versus pre insulin U-500 transition (p < 0.05).
    Conclusion: In this cohort of pregnant women with type 2 diabetes, transition to insulin U-500 was associated with a modest improvement in some CGM-derived glycemic measures.
    Key Points: · Transition to insulin U-500 was associated with a modest improvement in CGM-derived glycemic measures.. · CGM data using U-500 insulin in pregnancy with type 2 diabetes are limited.. · This is the largest contemporary pregnancy cohort who transitioned to insulin U-500 using CGM..
    DOI:  https://doi.org/10.1055/a-2979-5956
  12. J Sci Med Sport. 2026 Oct 15. pii: S1440-2440(26)00611-0. [Epub ahead of print]
    Scalable elastic band resistance training improves glycemic control in older adults with type 2 diabetes: A CGM-based randomized crossover study.
    Bin Gai, Wenpeng Chen, Liling Qiu.
       OBJECTIVES: To compare the acute and 24-hour glycemic effects of scalable aerobic, elastic-band resistance, and combined training in older adults with type 2 diabetes mellitus using Continuous Glucose Monitoring.
    DESIGN: Randomized crossover trial.
    METHODS: Thirty older adults with type 2 diabetes mellitus were enrolled, and 23 completed all three exercise sessions and were included in the per-protocol analysis. Interstitial glucose was monitored over 14 days. The non-exercise control condition was the average of four pre-training days. Bonferroni correction was applied to mean glucose, Time in Range, and Glycemic Risk Index. Other Continuous Glucose Monitoring metrics were exploratory. Exploratory Generalized Estimating Equation models compared each condition with control, adjusting for age, sex, body mass index, and HbA1c.
    RESULTS: In exploratory analysis, only combined training was associated with lower 24-hour mean glucose versus control (β = -0.513, p = 0.0019, Bonferroni-corrected p = 0.017). No other principal-outcome comparison remained significant after correction. Aerobic training produced the steepest acute glucose decline (-0.0256 mmol/L/min). In secondary pairwise comparisons, combined training had higher Time in Range than aerobic training, while resistance training had lower Glycemic Risk Index than aerobic training after Bonferroni correction. Combined training produced the latest glucose nadir (185 min).
    CONCLUSIONS: In exploratory analysis, only combined training significantly reduced 24-hour mean glucose relative to control. Time in Range and Glycemic Risk Index differed by modality in secondary comparisons. Elastic-band resistance training may be a practical, low-cost strategy warranting further study.
    Keywords:  Aerobic exercise; Combined training; Continuous glucose monitoring; Elastic band training; Time in Range; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.1016/j.jsams.2026.10.009
  13. Diabetes Obes Metab. 2026 Oct 19.
    Intraoperative Continuous Glucose Monitor Sensor-Receiver Connectivity Is Maintained With Alternative Sensor Placement: A Pilot Study.
    Reece Stutzman, Lauren S Pineda, Edgardo E Reynoso, Peichung Chou, Ryan E Lauer, Richard L Applegate, Melissa D McCabe.
       INTRODUCTION: Perioperative glycaemic control is associated with reduced postoperative complications. However, regulatory restrictions on point-of-care device operation and operative positioning constraints, reducing accessibility for dermal puncture, may hinder intraoperative monitoring. Although continuous glucose monitors (CGM) support real-time glucose monitoring, intraoperative patient positioning may increase compression low susceptibility, and electrosurgery interference may affect sensor-receiver connectivity. Alternative CGM sensor placement may improve intraoperative sensor-receiver connectivity.
    METHODS: In this prospective pilot study of adult surgical patients, CGM sensors were inserted in the lateral upper arm (deltoid) or lateral thigh (thigh) to limit patient position-related sensor pressure. The primary endpoint evaluated proportional duration of CGM sensor-receiver connectivity during surgery. Comparison of sensor-receiver connectivity by placement site, relation to electrosurgery and the number of alerts from the CGM receiver were also reported.
    RESULTS: Forty-five subjects were randomized: 22 deltoid and 23 thigh CGM placement. Four subjects were excluded; 20 deltoid and 21 thigh CGM sensor placements were analysed. Sensor-receiver connectivity was maintained during the surgical procedure in 40 (97.6%) irrespective of electrosurgery (21 thigh, 19 deltoid; difference 0, 95% CI: 0-0; p = 0.329). Of 26 receiver alerts, 11 occurred during electrosurgery; 15 were unrelated to electrosurgery. There was no difference in receiver alerts between deltoid and thigh placement (chi square p = 0.17; difference 0.18; 95% CI: -0.07 to 0.42).
    CONCLUSION: Finding consistent sensor-receiver connectivity using alternative CGM sensor placement sites supports intraoperative CGM feasibility. If future studies demonstrate alternative CGM sensor placement sites retain accuracy, then broader intraoperative CGM application may be reasonable.
    TRIAL REGISTRATION: NCT06614127 | https://clinicaltrials.gov/study/NCT06614127.
    Keywords:  barriers; continuous glucose monitoring; diabetes complications; glycaemic control; observational study
    DOI:  https://doi.org/10.1111/dom.71442
  14. J Diabetes Sci Technol. 2026 Oct 17. 19322968261493574
    Timing of Insulin Glargine Administration During Intermittent Ramadan Fasting in patients With Type1 Diabetes: A Randomized Controlled Trial (GLARIF).
    Reem Alamoudi, Ali Alqarni, Maram Alsubaiee, Ghofran Khogeer, Yousef Saleh, Abdulrhman Aljawharji, Hawazen Zarif, Salwa Alaidarous, Seham Khashwayn, Mohamed Hassanein.
       OBJECTIVE: The effect of basal insulin timing on hypoglycemia during Ramadan fasting remains uncertain despite recommendations to administer basal insulin earlier in the evening. We evaluated whether early evening compared with bedtime administration of insulin glargine reduces hypoglycemia and improves glycemic outcomes in individuals with type1 diabetes (T1D) fasting during Ramadan.
    METHODS: This multicenter open-label randomized controlled trial was conducted across 4 centers in Saudi Arabia. Participants with T1D intending to fast Ramadan were randomized to early evening or bedtime glargine administration. Glucose data were collected using self-monitoring of blood glucose (SMBG), intermittently scanned continuous glucose monitoring (FreeStyle Libre), and blinded continuous glucose monitoring (CGM; Medtronic iPro2).
    RESULTS: A total of 185 participants were analyzed (91 early evening, 94 bedtime). Baseline characteristics were similar between groups. Fasting interruption occurred in 75.9% versus 76.3% of participants (P = .94), with hypoglycemia accounting for >90% of interruptions in both groups. Hypoglycemia occurred predominantly during the morning period regardless of basal insulin timing. Severe hypoglycemia was reported in 2 versus 5 participants, and 1 diabetic ketoacidosis admission occurred in each group. Continuous glucose monitoring-derived glycemic metrics were similar between groups. Time in range (70-180 mg/dL) was 44.6% versus 46.1% (P = .70), time below range (<70 mg/dL) was 7.9% versus 6.4% (P = .35), and time above range (>180 mg/dL) was 47.5% in both groups (P = .99). Self-monitoring of blood glucose-detected hypoglycemic episodes and CGM-detected low glucose excursions were also comparable. Area under the curve below range was higher in the early evening group (P = .04).
    CONCLUSION: Changing insulin glargine administration from bedtime to earlier evening hours during Ramadan fasting did not significantly reduce hypoglycemia or improve overall glucose profiles in individuals with T1D. These findings suggest that routine universal shifting of basal insulin timing during Ramadan may not be necessary and support an individualized approach based on patient preference and glucose patterns.
    CLINICALTRIALS: gov identifier: NCT04383990.
    Keywords:  CGM; Ramadan fasting; basal insulin; hypoglycemia; insulin glargine; type1 diabetes
    DOI:  https://doi.org/10.1177/19322968261493574
  15. Inn Med (Heidelb). 2026 Oct 19.
    [Treatment of type 2 diabetes mellitus].
    Reiner Jumpertz von Schwartzenberg, Julia Király.
      Modern diabetology is undergoing a paradigm shift from glucose-centric management toward risk-adapted precision medicine. Differentiated phenotyping into clusters allows for the early identification of organ-specific risks. Pharmacotherapy now prioritizes cardiorenal protection using sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide‑1 (GLP-1) receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs; finerenone), which reduce vascular events beyond glycated hemoglobin (HbA1c) reduction alone. Technological innovations, such as continuous glucose monitoring (CGM), complement traditional markers with dynamic metrics such as time in range. A new, realistic therapeutic goal is metabolic remission, facilitated by potent incretin mimetics and early intervention during the prediabetes stage. The ultimate objective is the sustainable restoration of normoglycemia and the prevention of end-organ damage through a multifactorial, individualized approach.
    Keywords:  Cardiorenal protection; Continuous glucose monitoring; Diabetes mellitus/metabolic remission; Diabetes subtypes; Metabolic dysfunction-associated steatotic liver disease
    DOI:  https://doi.org/10.1007/s00108-026-02171-9
  16. Diabetes Care. 2026 Nov 01. 49(11): 1944-1946
    Useful Signals, Poor Predictors: What Does CGM Add Beyond HbA1c for Predicting Severe Hypoglycemia and Diabetic Ketoacidosis in Type 1 Diabetes, and How Can Prediction Improve?
    Simon A Berry, Simon Heller, Ahmed Iqbal.
      
    DOI:  https://doi.org/10.2337/dci26-0117
  17. Diabetes Obes Cardiometab CARE. 2026 Sep-Oct;1(5):1(5): 794-804
    Acceptability and Feasibility of a Primary Care Hypoglycemia Prevention Program: A Pilot Study.
    Scott J Pilla, Marielle T Bugayong, Jose Amezcua Moreno, Mohammed S Abusamaan, Somnath Saha, Claire Snyder, Rozalina G McCoy, Alexandria Ratzki-Leewing, Anna R Kahkoska, Susan H Schrock, Nestoras N Mathioudakis, Nisa M Maruthur.
       OBJECTIVE: Hypoglycemia, a major cause of morbidity for people with diabetes, is underrecognized in primary care, leading to underuse of risk mitigation strategies. This study reports the development and acceptability/feasibility testing of the Hypoglycemia Prevention Program (HPP), an electronic health record-integrated toolkit for primary care.
    RESEARCH DESIGN AND METHODS: The HPP was developed through stakeholder engagement and included a pre-visit hypoglycemia history survey, primary care provider (PCP) hypoglycemia toolkit, and patient self-management handout. The HPP pilot study was a pre-post clinical trial at one primary care practice. Participants were adults with diabetes treated with insulin or sulfonylureas, their PCPs, and clinic staff. The primary outcome was acceptability; exploratory outcomes included pre- to postintervention change in PCP hypoglycemia prevention actions, self-reported hypoglycemia, and optional blinded 10-day continuous glucose monitoring (CGM).
    RESULTS: The intervention was completed by 31 of 35 enrolled patients with diabetes (89%) for whom it triggered frequent hypoglycemia alerts. The intervention was rated acceptable or completely acceptable by 87% of patients and 100% of participating PCPs (n = 12) and clinic staff (n = 5). PCPs increased indicated glucagon prescribing from pre- to postintervention (0% preintervention to 32% postintervention, P = 0.003); there were small increases in CGM initiation and deintensification of hypoglycemia-causing medications. Self-reported and CGM-detected hypoglycemia decreased from pre- to postintervention, although with incomplete ascertainment and low CGM participation (n = 11).
    CONCLUSIONS: A hypoglycemia prevention program designed for primary care is feasible to implement and acceptable to clinical and patient stakeholders, with evidence of improved hypoglycemia prevention efforts. Further efficacy evaluation is needed.
    DOI:  https://doi.org/10.2337/doc26-0047
  18. Diabetes Care. 2026 Nov 01. 49(11): e201-e202
    Comment on Park et al. High-Amplitude and Prolonged Glucose Excursions as a Key Determinant of Discordance Between Glucose Management Indicator and Glycated Hemoglobin in Type 1 Diabetes.
    Weili Wang, Jiapeng Leng.
      
    DOI:  https://doi.org/10.2337/dc26-1795
  19. Int Urol Nephrol. 2026 Oct 19.
    A study on the dose-response relationship between glycemic variability and in-dialysis hypotension in patients with diabetes undergoing hemodialysis.
    Wei Shi.
       OBJECTIVE: To investigate the dose-response relationship between Glycemic variability (GV) and Intradialytic hypotension (IDH) in diabetic hemodialysis (MHD) patients, identify the critical Coefficient of variation (CV) threshold, and inform precision glucose management.
    METHODS: This prospective cohort enrolled 240 diabetic MHD patients (2023-2024). Continuous glucose monitoring provided GV parameters (CV, MAGE, SD). Patients were divided into IDH (n = 98) and non-IDH (n = 142) groups. Restricted cubic spline (RCS) analyzed dose-response; multivariate logistic regression assessed independent effects, with Subgroup analysis and interaction tests.
    RESULTS: CV was significantly higher in the IDH group (42.3% vs. 26.5%, P<0.001). RCS revealed a nonlinear positive correlation (P<0.001). When CV>36%, IDH risk increased sharply (threshold effect). Each 10% CV rise increased IDH risk by 98.4% (OR 1.984). Compared to Q1, Q3 (OR 3.512) and Q4 (OR 8.637) showed significantly higher risk. Associations were stronger in patients aged ≥60 years, dialysis duration ≥36 months, or with cardiovascular disease (interaction P<0.05). CV predicted IDH with AUC=0.856; optimal cutoff 36.5% (sensitivity 78.6%, specificity 82.4%).
    CONCLUSION: A significant dose-response relationship exists between GV and IDH. CV>36% is an independent risk factor. Maintaining CV below 36% may reduce IDH risk and improve outcomes.
    Keywords:  Continuous glucose monitoring; Diabetes; Dose–response relationship; Glycemic variability; Hemodialysis; Hypotension during hemodialysis
    DOI:  https://doi.org/10.1007/s11255-026-05388-7
  20. Diabetes Obes Cardiometab CARE. 2026 Sep-Oct;1(5):1(5): 866-873
    Study Engagement in the ROUTE Randomized Controlled Trial: A Diabetes Educator-Led Behavioral Intervention to Promote Continuous Glucose Monitor Use Among Youth With Type 1 Diabetes.
    Amanda Perkins, Emma Straton, Shideh Majidi, John Barber, Giselle Maya, Sydney White, Maria Naveed, Randi Streisand.
       OBJECTIVE: The purpose of this study was to examine participant engagement in a behavioral intervention designed to optimize the use of continuous glucose monitoring among historically minoritized youth with type 1 diabetes.
    RESEARCH DESIGN AND METHODS: We conducted a secondary mixed-methods analysis of quantitative and qualitative data from 60 youth-caregiver dyads who participated in the Research on Optimizing the Use of Technology with Education (ROUTE-T1D) randomized controlled trial. Engagement was measured by intervention session attendance, parent coach engagement, and qualitative interviews with participants.
    RESULTS: A diverse population of youth was recruited. Session attendance was high, at 75%. Only greater caregiver education was significantly associated with greater session attendance. There was no correlation between demographic and medical factors and contact with parent coaches. Qualitative results suggest participants felt ease of engagement with the intervention.
    CONCLUSIONS: High engagement suggests the intervention was accessible to the diverse study population and demonstrates the feasibility of including diverse populations in diabetes technology research, thereby improving translation to clinical care.
    DOI:  https://doi.org/10.2337/doc26-0055
  21. Diabetes Obes Metab. 2026 Oct 19.
    The Smart MDI System in People With Type 1 Diabetes and High HBA1C: A Randomized Controlled Trial Demonstrating That Response to Alerts Drives Outcomes.
    Laurent Crenier, Martin Haluzik, Marcus Lind, Pieter Gillard, Regis P Radermecker, Angela Girelli, Jens Kroeger, Valeria Cosma, Francesco Giorgino, Charles Thivolet, Peter Adolfsson, Tobias Wiesner, Emmanuel Sonnet, Christophe de Block, Torben Biester, Helene Hanaire, Fabio di Piazza, Fabiona Hoevelaken, Renee Tillie, Tim van den Heuvel, Shannon Edd, Ohad Cohen.
       AIMS: The aim was to assess the efficacy and safety of the smart multiple daily injections (MDI) system versus MDI plus continuous glucose monitor (CGM) in people with Type 1 diabetes and HbA1c ≥ 8%.
    MATERIAL AND METHODS: After a 3-week run-in, 143 participants were randomized to Smart MDI or MDI + CGM. The primary endpoint was between-group difference (Δ) in time-in-range (TIR) at 6 months, adjusted for baseline glycaemia and assessed for non-inferiority (margin 7.5%). Secondary endpoints included HbA1c (non-inferiority margin 0.4%) and superiority analyses for TIR and HbA1c. Smart MDI alerts prompt insulin bolus actions (in contrast to traditional CGM alerts), and post hoc analyses were performed to evaluate 'alert-responsiveness' on glycaemia. Alert-responsiveness findings were validated in a real-world cohort of 5507 users. Safety endpoints were assessed.
    RESULTS: At 6 months, Δ TIR between groups was 0.19 percentage points (95% confidence interval: -4.9 to 5.3), thus meeting non-inferiority; HbA1c also met non-inferiority (Δ: -0.13 percentage points, -0.46 to 0.19) but neither showed superiority. Post hoc analyses showed higher responders to alerts (those responding more than the median response rate of 28.3%, n = 31) had greater TIR gains than lower responders (n = 28) (+8.12 percentage points; p = 0.04) and HbA1c reduction (-0.6 percentage points; p = 0.02). TIR benefits in higher responders were confirmed in the real-world cohort. One episode of diabetic ketoacidosis occurred (run-in) and one severe hypoglycaemic event occurred (control arm).
    CONCLUSIONS: Smart MDI is safe and non-inferior, achieving non-inferiority to MDI + CGM regarding TIR and HbA1c. Responding to as few as 28% of alerts resulted in glycaemic improvements.
    Keywords:  Type 1 diabetes; clinical trial; insulin
    DOI:  https://doi.org/10.1111/dom.71431
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