bims-glumda 2025-06-29 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–06–29
fifteen papers selected by
Mott Given

Association between continuous glucose monitoring derived metrics and clinical parameters in Indian people living with type 2 diabetes.
Future of diabetic foot risk: Unveiling predictive continuous glucose monitoring biomarkers.
Association between continuous glucose monitoring metrics and cardiovascular autonomic neuropathy in diabetic patients: a systematic review.
Continuous Glucose Monitoring Metrics as a Predictor of Acute Complications in Youth with Type 1 Diabetes.
CGM-Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction.
Expanding Access to Continuous Glucose Monitoring in Medicare Patients Receiving Specialty Diabetes Care: A Quality Improvement Project.
Correlation of HbA1c and Continuous Glucose Monitor Time in Range.
Glycated hemoglobin is not enough: The role of glycemia risk index for glycemic control assessment in type 1 diabetes.
Safety and efficacy of continuous glucose monitoring devices in individuals with diabetes undergoing hyperbaric oxygen therapy: a scoping review.
Moving the Goalposts: Do Adults with Type 1 Diabetes Want Time in Tight Range (TITR)?
Review on Advancement of AI in Nutrigenomics.
Moving the Goalposts: Do Adults With Type 1 Diabetes Want Time in Tight Range?
The Validation of the Parental Self-Efficacy Scale for Diabetes Management Among Parents of Children Wearing a Continuous Glucose Monitoring Sensor.
Sweat Wearable Sensor Based on Confined Pt Nanoparticles in 2D Conductive Metal-Organic Frameworks for Continuous Glucose Monitoring.
Long-term health economic evaluation of automated insulin delivery system compared with continuous subcutaneous insulin infusion pumps and CGM in a real-world setting in Finnish paediatric and adult individuals with type 1 diabetes.

Prim Care Diabetes. 2025 Jun 26. pii: S1751-9918(25)00111-1. [Epub ahead of print]

Association between continuous glucose monitoring derived metrics and clinical parameters in Indian people living with type 2 diabetes.

Purvi Chawla, Alpana Sowani, Rakesh Parikh, Amit Gupta, Jothydev Kesavadev, Rutul Gokalani, Banshi Saboo, Manoj Chawla.

   BACKGROUND: To evaluate the correlation between continuous glucose monitoring (CGM)-derived metrics such as time in range (TIR) and time below range (TBR) and clinical parameters in Indian patients with type 2 diabetes mellitus (T2DM), providing insights into the effectiveness of CGM in this population.
METHODS: This is a single-center, retrospective-observational study of T2DM patients aged 18 or older years using the Freestyle Libre/Libre Pro CGM system. Demographic and clinical data of these patients were extracted from medical records, and glycemic metrics from CGM profiles.
RESULTS: The study included 248 T2DM patients, of whom 72.98 % were male, with a mean age of 60.48 years and a mean HbA1c value of 8.319 %. Linear regression analysis revealed that TIR was significantly negatively associated with HbA1c values (coefficient=-6.746) and duration of diabetes (coefficient=-0.425). The body mass index (BMI) showed a positive association with TIR (coefficient=0.649; P = 0.032). For TBR, only HbA1c values showed a significant negative association (coefficient=-1.051; P = 0.009), whereas age, duration of diabetes, and BMI were not significant predictors.
CONCLUSION: The study highlights the significant relationships between CGM-derived metrics (TIR and TBR), and clinical parameters in Indian patients with T2DM, and their effectiveness in identifying patients at risk of inadequate glycemic control.

Keywords:  Abbott FreeStyle Libre; Continuous glucose monitoring; Standard blood glucose monitoring; Time in range; Time in target range; Type 2 diabetes mellitus

DOI:  https://doi.org/10.1016/j.pcd.2025.06.004
World J Diabetes. 2025 Jun 15. 16(6): 107006

Future of diabetic foot risk: Unveiling predictive continuous glucose monitoring biomarkers.

Haewon Byeon.

  This study critically analyzes the findings of Geng et al, which investigated the association between continuous glucose monitoring (CGM) metrics and the risk of diabetic foot (DF) in individuals with type 2 diabetes mellitus. The study demonstrated significant associations between lower time in range, higher glycemic risk index, mean blood glucose, and time above range and an increased risk of DF. While acknowledging the study's strengths, such as its large sample size and robust statistical methods, this analysis also highlights its limitations, including its cross-sectional design and reliance on self-reported data. The findings are discussed within the framework of established theories, including the concepts of metabolic memory, the glucocentric paradigm, and the role of inflammation. This analysis emphasizes that a comprehensive approach to glucose management, extending beyond traditional glycated hemoglobin A1c measurements, is crucial for DF risk mitigation. Recognizing the impact of poor adherence and ongoing inflammation, future research should prioritize exploring causal mechanisms, the effectiveness of interventions aimed at improving CGM metrics, and the specific contributions of glucose variability to DF development. In conclusion, these findings strongly support the clinical application of diverse CGM metrics to enhance patient outcomes and effectively manage the risk of DF.

Keywords:  Continuous glucose monitoring; Diabetic foot; Glycemic risk index; Glycemic variability; Time in range

DOI:  https://doi.org/10.4239/wjd.v16.i6.107006
Rev Endocr Metab Disord. 2025 Jun 21.

Association between continuous glucose monitoring metrics and cardiovascular autonomic neuropathy in diabetic patients: a systematic review.

Yifan Jia, Dan Long, Wei Song, Qiong Wang, Qian Zhang.

  Cardiovascular autonomic neuropathy (CAN) is a serious and prevalent complication of diabetes, linked to significant morbidity and mortality. Continuous glucose monitoring systems (CGM) provide a comprehensive and continuous glucose profile, enabling precise assessment of glycemic variability, hypoglycemia, and other key glucose metrics. Despite the increasing use of CGM, the relationship between CGM-derived metrics and CAN risk has yet to be rigorously evaluated. A systematic search of PubMed, Cochrane Library, Web of Science, Medline, and Embase was conducted up to 30 September 2024. Eligible observational studies assessed the association between CGM metrics and CAN in diabetic adults, using ORs with 95% CIs. Heterogeneity was evaluated via Cochrane's Q and I2 statistics, and meta-analysis was performed when at least three studies provided comparable CGM metrics and outcomes. Sixteen studies involving 1,814 participants were included in the systematic review. Among these, four studies each for coefficients of variation (CV) and standard deviation (SD), and five studies for mean amplitude of glycemic excursions (MAGE) provided data suitable for meta-analysis. Higher CV (OR 1.08; 95% CI 1.04-1.12) and SD (OR 1.03; 95% CI 1.01-1.06) were significantly associated with increased CAN risk, whereas MAGE was not significantly associated (OR 1.01; 95% CI 0.99-1.03). Other metrics such as time in range (TIR), time above/below range (TAR/TBR), and low blood glucose index (LBGI) showed inconsistent results across studies and were synthesized narratively. Higher glycemic variability, notably CV and SD, is linked to increased CAN risk in patients with diabetes. Monitoring CGM metrics may aid early detection and management of CAN. Further high-quality longitudinal studies are warranted.

Keywords:  Cardiovascular autonomic neuropathy; Continuous glucose monitoring; Diabetes; Glycemic variability; Systematic review

DOI:  https://doi.org/10.1007/s11154-025-09981-6
Diabetes Technol Ther. 2025 Jun 23.

Continuous Glucose Monitoring Metrics as a Predictor of Acute Complications in Youth with Type 1 Diabetes.

Julie K Sklar, Lisa K Volkening, Liane J Tinsley, Lori M Laffel.

  Continuous glucose monitors (CGMs) offer insight into glycemic control but have not been established as predictors of acute diabetes complications. Using data from 120 youth with type 1 diabetes (ages 8-17) enrolled in a 24-month study, we investigated associations of CGM-derived metrics (time-in-range [TIR] 70-180 mg/dL, time <70, time >180, time >250, mean glucose, glucose coefficient of variation [CV]) with incidence rates of severe hypoglycemia and diabetic ketoacidosis (DKA)/severe hyperglycemia. Over 285 person-years of follow-up, there were 75 events of severe hypoglycemia and 15 events of DKA/severe hyperglycemia. TIR and CV were significantly associated with severe hypoglycemia. Those with <45% TIR had 2.09 times the rate of severe hypoglycemia than those with ≥45% TIR (P = 0.003). Those with CV ≥41% had 2.03 times the rate of severe hypoglycemia than those with CV <41% (P = 0.006). No CGM metrics were significantly associated with DKA/severe hyperglycemia. CGM data could serve as additional predictors for acute complications, particularly severe hypoglycemia.

Keywords:  continuous glucose monitoring; diabetic ketoacidosis (DKA); hyperglycemia; hypoglycemia; type 1 diabetes; youth

DOI:  https://doi.org/10.1089/dia.2025.0233
Endocr Pract. 2025 Jun 14. pii: S1530-891X(25)00918-8. [Epub ahead of print]

CGM-Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction.

Erin R Giovannetti, Rachael O Lee, Robert L Thomas, Tamar Wolinsky, Adrianne V Talbot, Rabia S Ali, Tricia Santos Cavaiola, Kristen Kulasa, Schafer C Boeder.

   OBJECTIVES: Evaluate the integration of real-time continuous glucose monitoring (rtCGM) into an insulin infusion computer calculator (IICC) to improve glycemic control, time efficiency, safety, and clinician workflow in the intensive care unit (ICU).
METHODS: A retrospective analysis was conducted on 35 critically ill adult patients requiring insulin infusion in the surgical and medical ICUs. Dexcom G7 rtCGM values were integrated into an institution-developed IICC using an ongoing validation protocol, allowing for non-adjunctive CGM use. The accuracy of rtCGM was assessed by comparing matched CGM and POC glucose values using mean absolute relative difference (MARD), Surveillance Error Grid, and Parkes Error Grid analyses. CGM time-in-range (TIR) metrics, clinician turnaround time (TAT) for glucose monitoring, and nurse satisfaction were also evaluated.
RESULTS: A total of 1,291 matched glucose pairs were analyzed. The rtCGM system demonstrated a MARD of 12.5%, with 99.6% of values falling within clinically acceptable error zones (A+B) on the Parkes Error Grid. Patients in the rtCGM-IICC protocol had mean glucose 141.9 mg/dL, with mean TIR (70-180 mg/dL) 82.8%, time above range (>180 mg/dL) 14.5%, and time below range (<70 mg/dL) 0.5%. Clinician time efficiency improved significantly, with POC testing requiring a mean TAT of nearly 5 minutes compared to 3-second CGM retrieval. All surveyed nurses (n=20) reported rtCGM increased efficiency and improved safety, and preferred rtCGM with POC over POC testing alone.
CONCLUSIONS: Integrating rtCGM with an IICC protocol in the ICU enhances glycemic control, improves workflow efficiency, and reduces clinician workload while maintaining high accuracy.

Keywords:  Clinician turnaround time (TAT); Intensive care unit (ICU); Mean absolute relative difference (MARD); Real-time continuous glucose monitoring (rtCGM); Surveillance Error Grid (SEG)

DOI:  https://doi.org/10.1016/j.eprac.2025.05.751
Endocr Pract. 2025 May 12. pii: S1530-891X(25)00105-3. [Epub ahead of print]

Expanding Access to Continuous Glucose Monitoring in Medicare Patients Receiving Specialty Diabetes Care: A Quality Improvement Project.

Kristen L Flint, Tiffany Ting, Kyianna Rivera, Prakriti Tamang, Caitlin A Colling, Josephine H Li, Melissa S Putman.

   OBJECTIVE: Despite recent revisions of Medicare coverage guidelines for continuous glucose monitoring (CGM) in 2023, the policy change has been slow to disseminate to providers and patients. This quality improvement project aimed to increase CGM prescriptions and utilization amongst qualifying Medicare patients with diabetes on insulin.
METHODS: An interprofessional study team used process mapping to define the baseline state of CGM ordering and opportunities for improvement at a single diabetes specialty clinic. Several interventions were trialed through Plan-Do-Study-Act (PDSA) cycles, including general and targeted provider education, provider-facing technology support documents, a formulary guide, and patient-facing education about the new coverage requirements. The primary outcome was percentage of eligible patients using CGM. Process measures included the number of CGM orders started monthly. Demographic and socioeconomic factors in patients using and not using CGM were measured to assess for differences in prescribing practices.
RESULTS: Over 8 months of intervention, the percentage of eligible Medicare patients using CGM increased from 49.6% to 62.6%. The median number of CGM orders started monthly increased from 34 to 60. Both pre- and postintervention, compared to patients not using CGM, patients using CGM were younger, had lower A1c, and were more often enrolled in the electronic health record patient portal. There were no differences in other demographic factors between the groups.
CONCLUSION: Quality improvement interventions targeting providers and patients can help translate policy changes into clinical practice. Creating interventions with all patients in mind can prevent new differences in care as innovations are adopted.

Keywords:  access; continuous glucose monitoring; quality improvement

DOI:  https://doi.org/10.1016/j.eprac.2025.04.001
J Pharm Technol. 2025 Jun 24. 87551225251348832

Correlation of HbA1c and Continuous Glucose Monitor Time in Range.

Hannah DePasquale, Alexander DeLucenay, Nabila Ahmed-Sarwar.

  Background: Current literature is limited to describing the correlation of continuous glucose monitor (CGM) use and improved HbA1cs in patients with type 2 diabetes. There is a lack of literature correlating HbA1c and time in range (TIR). In addition, data such as time spent with low or very low blood glucose levels are not assessed in existing literature. Objective: To assess the correlation between reduction of HbA1c and increase in TIR for patients using CGMs meeting with an interdisciplinary team. Methods: This retrospective chart review includes adult patients seen in an interdisciplinary internal medicine clinic consisting of a pharmacist and nurse practitioner. Data collection included patients with diabetes using CGMs for at least 3 months, who had a visit with the team in the last 12 months. Information collected included demographics, insurance, comorbidities, diabetes medications, HbA1c and CGM data at baseline and 3-month visit, and number of pharmacist medication interventions. Fisher's exact, chi-square, and Mann-Whitney U tests were used where appropriate. Results: HbA1c decreased from 8.6% to 7.5% 3 months later (P = 0.002). The average increase in TIR was 55.5% to 65.1% (P = 0.007). The overall decrease in HbA1c and increase in TIR had a high inverse correlation at baseline and 3 months (r = -0.7 and r = -0.7, P < 0.001). Conclusion: There is a strong inverse relationship between HbA1c and TIR, reduction in glucose variability with a slightly higher incidence time in low/very low following intervention. The type and frequency of pharmacist-initiated interventions support the clinical decision-making potential for pharmacotherapy adjustments.

Keywords:  A1c value(s); continuous glucose monitor; type 2 diabetes

DOI:  https://doi.org/10.1177/87551225251348832
World J Diabetes. 2025 Jun 15. 16(6): 104024

Glycated hemoglobin is not enough: The role of glycemia risk index for glycemic control assessment in type 1 diabetes.

Bin-Bin He, Zi-Zhu Liu, Ruo-Yao Xu, Li Fan, Rui Guo, Chao Deng, Yu-Ting Xie, Zhi-Guang Zhou, Xia Li.

   BACKGROUND: Glycated hemoglobin (HbA1c), the gold standard for assessing glycemic control, has limited ability to reflect the risks of hypoglycemia and glycemic variability, raising great concerns, especially in patients with type 1 diabetes (T1D). The glycemia risk index (GRI), a composite metric derived from continuous glucose monitoring (CGM), has emerged as a potential solution by systematically integrating both hypoglycemia and hyperglycemia risks into a single interpretable score.
AIM: To evaluate whether the GRI addresses HbA1c limitations.
METHODS: We analyzed 328 patients with T1D using 681 CGM and clinical data points. Linear mixed-effects models were used to address the relationship between the GRI and HbA1c within repeated-measures data. Correlation and cluster analyses were used to assess the comprehensive GRI reflection of seven key ambulatory glucose profile parameters.
RESULTS: The GRI exhibited linear correlations with HbA1c (r = 0.53), time in range (r = -0.90), time above range (r = 0.63), time below range (TBR) (r = 0.37), and coefficient of variation (CV) (r = 0.71). It correlated strongly with TBR and CV than HbA1c. The association between HbA1c levels and GRI was influenced by TBR and CV. At a given HbA1c, each 1% increase in TBR or CV raised GRI by 1.87 [95% confidence interval (CI): 1.72-2.01] and 1.94 (95%CI: 1.80-2.10), respectively (P < 0.001). Clustering of the CGM data identified four subgroups: Moderate-risk glycemic fluctuations, high-risk hypoglycemia, optimal glycemic control, and high-risk hyperglycemia. The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.
CONCLUSION: The GRI offers a comprehensive view of glycemic control in T1D. Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.

Keywords:  Continuous glucose monitoring; Glycated hemoglobin; Glycemia risk index; Glycemic control assessment; Type 1 diabetes

DOI:  https://doi.org/10.4239/wjd.v16.i6.104024
Diving Hyperb Med. 2025 Jun 30. 55(2): 164-172

Safety and efficacy of continuous glucose monitoring devices in individuals with diabetes undergoing hyperbaric oxygen therapy: a scoping review.

Glen Katsnelson, Marcus Salvatori, George Djaiani, Elise Greer, Jordan Tarshis, Rita Katznelson.

   Introduction: Continuous glucose monitoring devices (CGMs) have emerged as an effective approach to optimise glycaemic control for individuals living with diabetes mellitus. Despite CGMs offering improved patient satisfaction and quality of life, they have been primarily validated for outpatient and home use. This has posed a challenge for patients and providers who wish to incorporate CGMs into clinical settings such as hyperbaric oxygen therapy (HBOT). Those with advanced diabetes mellitus who have diabetic foot ulcers that are refractory to treatment are among the most prevalent users of HBOT. However, those who prefer to use their CGM during HBOT face uncertainty regarding the accuracy and safety of their device under hyperbaric conditions.
Methods: The product specifications of commonly used CGMs were collated. In addition, a scoping review of the literature was conducted where Medline, Embase, and Scopus were searched for reports that assess the accuracy or safety of CGMs in hyperbaric conditions.
Results: The product specifications of commonly used CGMs by Dexcom, Abbott, Medtronic, and Senseonics demonstrate a maximum validated pressure of approximately 106 kPa (1.06 atmospheres absolute). Our literature search identified five reports, of which four focused on accuracy and one focused on safety of CGMs in hyperbaric conditions. Treatments were conducted in multiplace chambers and cumulatively described 39 participants, of whom 12 have diabetes. Although heterogeneous in nature, the reports generally supported the safety and accuracy of CGMs in hyperbaric conditions.
Conclusions: The safety and accuracy of using CGMs during HBOT warrants further investigation. CGMs have not been validated for repeated exposure to hyperbaric conditions and should not be used in oxygen pressurised monoplace chambers until further safety data is available. We provide practical recommendations for use of CGMs in multiplace chambers.

Keywords:  Hyperbaric medicine; Hyperbaric research; Implantable devices

DOI:  https://doi.org/10.28920/dhm55.2.164-172
Endocr Pract. 2025 Mar 19. pii: S1530-891X(25)00074-6. [Epub ahead of print]

Moving the Goalposts: Do Adults with Type 1 Diabetes Want Time in Tight Range (TITR)?

Molly L Tanenbaum, Mabelle B Pasmooij, Rachel Tam, Marina Basina, Michael S Hughes, Franziska K Bishop, David M Maahs.

   OBJECTIVES: Our objective was to understand attitudes toward time in tight range (TITR: 70-140 mg/dL) among adults with type 1 diabetes. The perspectives of people with type 1 diabetes on TITR can inform educational approaches to introducing potential new continuous glucose monitoring (CGM) metrics in a way that optimizes glycemic and quality of life outcomes for people with type 1 diabetes.
METHODS: Focus groups with adult CGM users with type 1 diabetes elicited feedback on a potential shift to TITR. Groups were audio-recorded, transcribed, and analyzed using content analysis.
RESULTS: Participants were 33 adults (age 42.7±16.7 years, 55% female, 91% non-Hispanic White, 23±16 years living with diabetes, HbA1c 6.5±0.6% (48±6 mmol/mol)). Most (88%) used automated insulin delivery (AID). Some approved of TITR for the potential to improve their long-term health. Concerns about TITR included increased management burden; risk of anxiety, hypoglycemia, disordered eating; and feelings of failure. Participants advocated for flexible, personalized clinical targets and better technologies, insulins, and access, to make TITR achievable for more people with type 1 diabetes.
CONCLUSIONS: Results indicate that TITR may be a welcome shift for some who are already using the tighter metric but may add risks and psychosocial and self-management burden even in a group of adults predominantly using AID and achieving current HbA1c goals. Including the perspectives of people with type 1 diabetes in decision-making around CGM metrics will be important for the implementation of new clinical targets to improve patient care.

Keywords:  automated insulin delivery; clinical guidelines; continuous glucose monitoring; glycemic target; psychosocial aspects; type 1 diabetes

DOI:  https://doi.org/10.1016/j.eprac.2025.03.006
Methods Mol Biol. 2025 ;2952 429-444

Review on Advancement of AI in Nutrigenomics.

Shivani Phugat, Prabudh Goel.

  Nutrigenomics, the study of how dietary components influence gene expression and how genetic variations affect individual responses to nutrition, has emerged as a cornerstone of personalized medicine. The integration of artificial intelligence (AI) with nutrigenomic research marks a significant advancement in our ability to understand and apply personalized nutrition principles. This chapter explores the transformative role of artificial intelligence in advancing nutrigenomic research and its practical applications in personalized nutrition. The convergence of AI with nutrigenomics has revolutionized our understanding of gene-diet interactions, enabling more sophisticated analysis of individual nutritional responses based on genetic profiles. Through advanced machine learning algorithms and deep learning approaches, researchers can now process vast amounts of genetic and dietary data to generate personalized nutritional recommendations with unprecedented precision. The emergence of smart wearable and mobile applications has further enhanced real-time nutrigenomic monitoring, particularly in areas such as continuous glucose monitoring (CGM) and metabolic profiling. While the field shows promising developments, especially in managing conditions like type 2 diabetes through precision nutrition, it faces several challenges including data privacy concerns and algorithmic biases. Despite these limitations, the integration of AI with nutrigenomic principles points toward a future where personalized nutrition becomes increasingly accessible and effective, though careful validation and implementation strategies remain crucial for its success.

Keywords:  Artificial intelligence; Federated learning; Nutrigenetics; Nutrigenomics; Type 2 diabetes

DOI:  https://doi.org/10.1007/978-1-0716-4690-8_23
Endocr Pract. 2025 Apr 18. pii: S1530-891X(25)00074-6. [Epub ahead of print]

Moving the Goalposts: Do Adults With Type 1 Diabetes Want Time in Tight Range?

Molly L Tanenbaum, Mabelle B Pasmooij, Rachel Tam, Marina Basina, Michael S Hughes, Franziska K Bishop, David M Maahs.

   OBJECTIVES: Our objective was to understand attitudes toward time in tight range (TITR: 70-140 mg/dL) among adults with type 1 diabetes. The perspectives of people with type 1 diabetes on TITR can inform educational approaches to introducing potential new continuous glucose monitoring (CGM) metrics in a way that optimizes glycemic and quality of life outcomes for people with type 1 diabetes.
METHODS: Focus groups with adult CGM users with type 1 diabetes elicited feedback on a potential shift to TITR. Groups were audio-recorded, transcribed, and analyzed using content analysis.
RESULTS: Participants were 33 adults (age 42.7 ± 16.7 years, 55% female, 91% non-Hispanic White, 23 ± 16 years living with diabetes, HbA1c 6.5 ± 0.6% (48 ± 6 mmol/mol)). Most (88%) used automated insulin delivery. Some approved of TITR for the potential to improve their long-term health. Concerns about TITR included increased management burden; risk of anxiety, hypoglycemia, disordered eating; and feelings of failure. Participants advocated for flexible, personalized clinical targets and better technologies, insulins, and access, to make TITR achievable for more people with type 1 diabetes.
CONCLUSIONS: Results indicate that TITR may be a welcome shift for some who are already using the tighter metric but may add risks and psychosocial and self-management burden even in a group of adults predominantly using automated insulin delivery and achieving current HbA1c goals. Including the perspectives of people with type 1 diabetes in decision-making around CGM metrics will be important for the implementation of new clinical targets to improve patient care.

Keywords:  automated insulin delivery; clinical guidelines; continuous glucose monitoring; glycemic target; psychosocial aspects; type 1 diabetes

DOI:  https://doi.org/10.1016/j.eprac.2025.03.006
Biomedicines. 2025 May 27. pii: 1309. [Epub ahead of print]13(6):

The Validation of the Parental Self-Efficacy Scale for Diabetes Management Among Parents of Children Wearing a Continuous Glucose Monitoring Sensor.

Áron Hölgyesi, Andrea Luczay, Péter Tóth-Heyn, Eszter Muzslay, Eszter Világos, Attila J Szabó, Petra Baji, Levente Kovács, László Gulácsi, Zsombor Zrubka, Márta Péntek.

  Background/Objectives: Parental involvement is essential in managing type 1 diabetes mellitus (T1DM) in children, particularly with the growing use of continuous glucose monitoring (CGM). Validated tools assessing parental self-efficacy in this context remain limited. This study aimed to validate the Parental Self-Efficacy Scale for Diabetes Management (PSESDM) among parents of children using a CGM sensor and to examine its associations with diabetes outcomes and parental characteristics. Methods: A cross-sectional study was conducted involving 106 parent-child dyads at a university pediatric diabetes center. Parents completed the Hungarian PSESDM. Data regarding children's HbA1c level were recorded, along with standard measures of their general and diabetes-specific quality of life (EQ-5D-Y-3L, PedsQL Diab); data regarding parents' health literacy (Chew), fear of hypoglycemia (HFS), health-related quality of life (EQ-5D-5L), and capability well-being (ICECAP-A) were also collected. The PSESDM's reliability, internal consistency, and discriminant and criterion validity were assessed using standard statistical methods. Results: The PSESDM demonstrated good internal consistency (Cronbach's α = 0.857) and strong item-total correlations (range: 0.678-0.791). Higher parental self-efficacy was significantly associated with better glucose control (lower HbA1c, rs = -0.50) and weakly correlated with the child's diabetes-specific quality of life (rs = 0.20). Among parental characteristics, self-efficacy correlated strongly with capability well-being (rs = 0.52), moderately with health literacy (rs = -0.30), and showed no difference between socio-demographic subgroups, except for the subgroup related to income. Conclusions: The PSESDM is a valid and reliable tool for measuring self-efficacy in parents of children with T1DM using CGM sensors. Its associations with children's HbA1c levels, diabetes-specific quality of life, and parental characteristics support its clinical relevance and potential use in identifying families at risk for poorer diabetes outcomes.

Keywords:  capability well-being; glucose control; health-related quality of life; parental self-efficacy; patient-reported outcome measures; pediatric diabetes

DOI:  https://doi.org/10.3390/biomedicines13061309
Adv Sci (Weinh). 2025 Jun 23. e07212

Sweat Wearable Sensor Based on Confined Pt Nanoparticles in 2D Conductive Metal-Organic Frameworks for Continuous Glucose Monitoring.

Wei Huang, Yong Yang, Yun Xu, Fei Xiao, Lin Wang.

  The noninvasive glucose sensors with comprehensive functional capabilities can enable wearable glucose monitoring in sweat with high sensitivity and minimal risk. However, the limited stability of natural enzymes, along with interference from electro-oxidizable species, continues to pose significant challenges for their long-term application. Herein, an integrated wearable system is presented for nonenzymatic glucose monitoring in sweat at the point of care. This system integrates a flexible microfluidic glucose sensor patch for sweat sampling and measurement, using Pt nanoparticles (Pt-NPs) confined within phthalocyanine-based conductive metal-organic frameworks (Pc-MOFs) as electrode materials, and a flexible printed circuit board for signal/analysis and wireless communication. The microfluidic sensor patch based on Pc-MOFs confined Pt-NPs exhibits significantly improved nonenzymatic glucose sensing performances. This is attributed to the ultrasmall size of Pt-NPs and the confinement effect within the Pc-MOF channels, which regulates the glucose adsorption intensity and increases the electrocatalytic activity to glucose oxidation. During the continuous monitoring process, the glucose concentration is calibrated in sweat by accounting for fluctuations in pH and temperature, and evaluated the performance of the wearable device in monitoring sweat glucose levels in human subjects over a 12-h period, achieving data as accurate as that obtained using high-performance liquid chromatography.

Keywords:  confined metal nanoparticles; integrated wearable devices; microfluidic electrochemical biosensor; nonenzymatic glucose detection; phthalocyanine‐based metal‐organic framework

DOI:  https://doi.org/10.1002/advs.202507212
Diabetes Obes Metab. 2025 Jun 27.

Long-term health economic evaluation of automated insulin delivery system compared with continuous subcutaneous insulin infusion pumps and CGM in a real-world setting in Finnish paediatric and adult individuals with type 1 diabetes.

Heta-Leena Vallivaara, Hanna A Leppänen, Jyrki Mustonen, Antti Saari, Janne Martikainen, Reeta M Rintamäki.

   AIMS: The use of automated insulin delivery (AID) systems is associated with improved glycaemic control in individuals with type 1 diabetes (T1DM). However, AID systems are more expensive than other treatment modalities for T1DM. The aim of this study was to evaluate the long-term cost-effectiveness of AID compared to continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) in individuals with T1DM at Kuopio University Hospital, Finland.
MATERIALS AND METHODS: The study included 336 individuals (mean age: 26.7 years, SD: 15.9 years), with a mean duration of diabetes of 16.6 years. Outcomes were projected in the base case of 50 years using the IQVIA CORE Diabetes Model (v10.0). Clinical data were sourced from electronic health records (EHRs), including changes in glycated haemoglobin (HbA1c) and events of hypoglycaemia and ketoacidosis. Costs were expressed in 2023 Euros (EUR).
RESULTS: The AID system was associated with an improvement in quality-adjusted life expectancy of 2.3 quality-adjusted life-years (QALYs) compared to CSII plus CGM. These benefits came from the delayed and reduced incidence of diabetes-related complications. The mean HbA1c improvement was 12.1 ± 11.7 mmol/mol (3.3% ± 3.2%) in the AID group. Direct costs were estimated to be 26 076 EUR higher for AID than for CSII plus CGM, and AID was associated with an incremental cost-effectiveness ratio (ICER) of 11 184 EUR per QALY gained.
CONCLUSIONS: Based on the results of this first cost-effectiveness study conducted in Finland, a willingness-to-pay (WTP) threshold of 50 000 EUR per QALY gained suggests that AID is more cost-effective than CSII plus CGM for the treatment of T1DM in a real-world setting.

Keywords:  automated insulin delivery; cost‐effectiveness; type 1 diabetes

DOI:  https://doi.org/10.1111/dom.16520