bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2025–08–24
six papers selected by
Mott Given
  1. Persistent Performance Improvement Using Team Resources and Continuous Glucose Monitoring in Patients With Poorly Controlled Type 2 Diabetes.
  2. Impact of Continuous Glucose Monitoring on Glycemic Control in Type 2 Patients with Diabetic Foot Ulcers: A Pilot Study.
  3. Limitations of Continuous Glucose Monitoring in the Pediatric Total Pancreatectomy With Islet Autotransplantation Population: Comparing Patient Experiences of the Dexcom and FreeStyle Libre Systems.
  4. Accuracy of Dexcom G6 Pro and G7 Continuous Glucose Monitors in Patients Treated with Maintenance Dialysis.
  5. Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial.
  6. Pregestational Diabetes Intervention Pilot Study With Diabetes Self-Management Education and Support and Cellular-Enabled Glucose Meter.
  1. Diabetes Spectr. 2025 ;38(3): 353-358
    Persistent Performance Improvement Using Team Resources and Continuous Glucose Monitoring in Patients With Poorly Controlled Type 2 Diabetes.
    Andrew Behnke, Kara S Lucas, Christopher G Parkin, Varsha Reddy, Michele Orlowski, Ailene Edwards.
       OBJECTIVE: The purpose of this study was to assess the impact of an interdisciplinary diabetes care team approach using continuous glucose monitoring (CGM) on glycemic outcomes in a population of adults with type 2 diabetes with suboptimal glycemic control.
    RESEARCH DESIGN AND METHODS: This 6-month, longitudinal observational study was conducted at the outpatient endocrinology clinic of Carilion Clinic in Roanoke, VA. The intervention included use of CGM and weekly interactions either virtually or by telephone by one of the team members. The primary outcomes were changes in A1C, average glucose, and glycemic time in range (TIR; 70-180 mg/dL) over the 6-month observation period. Changes in diabetes medications were also assessed.
    RESULTS: Twenty-one adults with type 2 diabetes and a baseline A1C >9% were included in the analysis. At 6 months, A1C levels decreased from 11.3 to 7.6%, average glucose decreased from 212.8 to 159.5 mg/dL, and TIR increased from 44.5 to 67.7%.
    CONCLUSION: These results suggest that an interdisciplinary team approach in combination with CGM and frequent interaction is effective in improving glycemic outcomes in a high-risk population. Studies of longer duration are needed to further elucidate the efficacy of this intervention.
    DOI:  https://doi.org/10.2337/ds24-0085
  2. Int J Low Extrem Wounds. 2025 Aug 20. 15347346251369622
    Impact of Continuous Glucose Monitoring on Glycemic Control in Type 2 Patients with Diabetic Foot Ulcers: A Pilot Study.
    Radhakrishnan Srinivasan, Aakansha Sinha, Nikolaos Tentolouris, Edward B Jude.
      AimTo determine whether the use of continuous glucose monitoring (CGM) aids in improving glycaemic control in Type 2 diabetes patients (T2DM) with foot ulcers and improve wound healing.MethodsRetrospective study on patients attending the high-risk diabetes foot clinic for the management of complex diabetic foot ulcers were provided with Continuous Glucose Monitoring (CGM) devices (Freestyle Libre 2). Patients were reviewed in the foot clinic on a weekly to bi-weekly basis, depending on the severity of their foot ulcers and glycaemic control, which was reviewed at each visit. HbA1c was measured not more than 90 days prior to starting CGM and three months after the start of CGM. Wound size was measured at start and after 3 months of CGM use. Data of the eligible patients was reviewed from the medical records.Results22 patients with T2DM with active diabetic foot ulcers were included in this study. Mean age was 65.43 years (range 39-87). Mean HbA1c prior to providing CGM was 84.10 Mmol/mol (range 54-132). The mean HbA1c after three months of CGM use was 65.05 Mmol/mol (range 32-94). Mean reduction in HbA1c was 19.05 ± 22.07 mmol/mol (p = 0.0011) and the greatest improvements were noted in those who had higher HbA1c levels at baseline. Wound size at baseline was 1.53 (0.75-7.62) cm2 and after 3 months it was 0.42 (0.0-1.16) cm2 (p < 0.001); complete wound healing achieved in 3 patients.ConclusionThis study showed a significant improvement in glycaemic control with the use of CGM and had a positive influence on wound healing. The utility of CGM in improving glycaemic control is well established and is currently widely used in type 1 diabetes mellitus and pregnancy but not directly recommended for patients with foot ulcers according to NICE guidelines. Further follow-up and larger-scale studies are needed to validate these findings and to observe the impact on wound healing.
    Keywords:  continuous glucose monitors; diabetic foot ulcer; freestyle libre; type 1 diabetes; type 2 diabetes
    DOI:  https://doi.org/10.1177/15347346251369622
  3. Diabetes Spectr. 2025 ;38(3): 300-306
    Limitations of Continuous Glucose Monitoring in the Pediatric Total Pancreatectomy With Islet Autotransplantation Population: Comparing Patient Experiences of the Dexcom and FreeStyle Libre Systems.
    Bhavapriya Mani, Lindsey Hornung, Chelsie Fellman, Maisam Abu El-Haija, Siobhan Tellez, Deborah Elder.
       OBJECTIVE: Continuous glucose monitoring (CGM) systems reduce self-monitoring burden compared with glucose meter use but have limitations when used after total pancreatectomy with islet autotransplantation (TPIAT). An example is false elevation of sensor readings after hydroxyurea (HU) administration, a medication often used after TPIAT. This study compared user experiences of CGM not affected by HU with CGM affected by HU in pediatric patients post-TPIAT.
    RESEARCH DESIGN AND METHODS: This was a retrospective study of 20 TPIAT patients. Caregivers were informed of known limitations and chose the CGM system for postoperative use. Ten chose a Dexcom, and 10 chose a FreeStyle Libre CGM system. Demographic data and caregiver-reported CGM concerns were collected up to 16 weeks after discharge.
    RESULTS: Half of Dexcom users reported false hypoglycemia alerts that resolved with repositioning, recalibration, or sensor change. False hyperglycemia was an anticipated outcome and therefore not reported as concerning. Eight FreeStyle Libre users reported false hypoglycemia and frequent alarms that persisted despite sensor changes, which limited device supply. These concerns could not be independently resolved, contributed to caregiver distress, and interrupted sleep. More FreeStyle Libre patients switched to Dexcom than Dexcom patients who switched to a FreeStyle Libre system (70 vs. 10%, P = 0.02) by a median of 2.9 weeks after discharge.
    CONCLUSION: Caregivers reported frequent false alarms on both systems. The frequency of false hypoglycemia with FreeStyle Libre was an unexpected limitation with an unclear cause. The inability to calibrate the FreeStyle Libre likely contributed to frequent sensor changes and supply depletion. The ability to recalibrate the Dexcom system may provide an advantage, but not for people taking HU. Knowledge of CGM limitations post-TPIAT can help individuals make informed decisions.
    DOI:  https://doi.org/10.2337/ds24-0073
  4. Diabetes Technol Ther. 2025 Aug 18.
    Accuracy of Dexcom G6 Pro and G7 Continuous Glucose Monitors in Patients Treated with Maintenance Dialysis.
    Leila R Zelnick, Subbulaxmi Trikudanathan, Yoshio N Hall, Ernest Ayers, Lisa Anderson, Nathaniel Ashford, Evelin Jones, Andrew N Hoofnagle, Ian H de Boer, Irl B Hirsch.
      Background and Aims: Continuous glucose monitors (CGMs) can comprehensively assess glycemic patterns in patients treated with dialysis, in whom conventional biomarkers such as glycated hemoglobin are inaccurate. Nonetheless, adoption of recent versions of CGMs in this population has been complicated by concerns about interstitial volume expansion, interfering substances, and effects of dialysis treatment. This study aimed to examine the accuracy of the G6 Pro and G7 CGM systems (Dexcom, Inc.) compared with self-monitored blood glucose (SMBG) in a dialysis population. Methods: Twelve participants treated with maintenance dialysis (11 hemodialysis, 1 peritoneal dialysis [PD]) with diabetes wore concurrent G6 Pro and G7 CGMs for a period of 10 days, during which they measured SMBG using a Contour Next glucometer. We summarized CGM-glucometer Pearson correlations, calculated the mean absolute relative difference (MARD) of G6 Pro/G7 and SMBG, created Diabetes Technology Society (DTS) error grids, and investigated the CGM lag time that most closely corresponded with SMBG. Results: Mean (standard deviation [SD]) age of participants was 50 (12) years, 50% were female, mean (SD) diabetes duration was 24 (9) years, and 92% used insulin. Participants collected 245 SMBG measurements over a total of 178 days of CGM. The Pearson correlations of G6 Pro and SMBG, G7 and SMBG, and G6 Pro and G7 were 0.87, 0.88, and 0.95, respectively. The MARDs of G6 Pro versus SMBG and G7 versus SMBG were 21.2% and 16.7%, respectively; excluding one PD participant with highly variable glucose, MARDs were 18.3% and 13.5%. The DTS error grids showed that 96.7% of G6 Pro and 98.0% of G7 measurements were clinically acceptable (Zones A/B) when compared with SMBG. We observed evidence of greater lag times than previously seen in nondialysis populations and substantial between- and within-person variability in CGM performance. Conclusions: Among patients with diabetes treated with maintenance dialysis, CGM measurements of glucose had high correlation with SMBG, with better performance of the G7 compared with G6 Pro. MARD was higher than previously reported in nondialysis populations, but most values fell within clinically acceptable ranges. While issues around lag time, sensor placement, and interfering substances that may impact CGM performance warrant further investigation, our study findings support the use of CGM to evaluate glycemia in the dialysis population.
    Keywords:  accuracy; continuous glucose monitoring; diabetes mellitus; dialysis; end-stage kidney disease
    DOI:  https://doi.org/10.1177/15209156251368934
  5. Diabetes Care. 2025 Aug 19. pii: dc250452. [Epub ahead of print]
    Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial.
    Laura C Kusinski, Nooria Atta, Danielle L Jones, Suzanne Smith, Louise Cooper, Linda M Oude Griep, Kirsten L Rennie, Emanuella de Lucia Rolfe, Helen R Murphy, Eleanor M Scott, Stephen J Sharp, Roy Taylor, Claire L Meek.
       OBJECTIVE: Continuous glucose monitoring (CGM) is increasingly used in gestational diabetes mellitus (GDM), but optimal metrics, ranges, and targets in this population are undefined. We assessed associations between CGM metrics and pregnancy outcomes in GDM.
    RESEARCH DESIGN AND METHODS: During the DiGest study, 425 women with GDM (diagnosed at median [IQR] 25.1 [18.3-27.7] weeks) and BMI ≥25 kg/m2 received a dietary intervention, with masked Dexcom G6 CGM at 29 (n = 361), 32 (n = 215), and 36 (n = 227) weeks' gestation. For this secondary analysis, we used logistic regression, receiver operating characteristic curves, and the Youden index to assess associations and predictive ability of CGM metrics, including pregnancy-specific time in range (TIRp) (63-140 mg/dL [3.5-7.8 mmol/L]) and pregnancy outcomes.
    RESULTS: CGM metrics at 29 weeks were significantly associated with large for gestational age (LGA) and small for gestational age (SGA). Participants achieving mean glucose <110 mg/dL (6.1 mmol/L), TIRp ≥90%, or pregnancy-specific time above range (TARp) <10% at 29 weeks had a significantly lower risk of LGA (odds ratio [OR] 0.41 [95% CI 0.22, 0.77], 0.38 [0.20, 0.70], and 0.39 [0.20, 0.73], respectively) and SGA (0.26 [0.08, 0.79], 0.30 [0.10, 0.91], and 0.19 [0.06, 0.62], respectively). TARp <10% and mean nocturnal glucose <110 mg/dL (6.1 mmol/L) were associated with a reduced odds of preterm birth (OR 0.40 [0.17, 0.94] and 0.42 [0.19, 0.97], respectively). A stricter range (63-120 mg/dL [3.5-6.7 mmol/L]) had similar performance overall, but had no single statistically robust TIR/TAR target across all outcomes.
    CONCLUSIONS: In women with GDM, CGM mean glucose <110 mg/dL (6.1 mmol/L), ≥90% TIRp, or <10% TARp using a range of 63-140 mg/dL (3.5-7.8 mmol/L) at 29 weeks' gestation was associated with a low risk of suboptimal offspring outcomes.
    DOI:  https://doi.org/10.2337/dc25-0452
  6. Diabetes Spectr. 2025 ;38(3): 285-293
    Pregestational Diabetes Intervention Pilot Study With Diabetes Self-Management Education and Support and Cellular-Enabled Glucose Meter.
    Kathy Fincher, Casey Fiocchi, Jessica Odom, Michelle Stancil, Hannah White, Megan Schellinger.
       OBJECTIVE: Uncontrolled diabetes in pregnancy is associated with maternal and fetal complications. Individuals with pregestational diabetes require frequent glucose monitoring and insulin adjustments to meet glycemic targets. The purpose of the study was to provide improved management of diabetes during pregnancy and up to 6 weeks postpartum, improve patient understanding of diabetes and diabetes self-management, and develop a multidisciplinary obstetrics workflow model for women with diabetes that is both replicable and self-sustaining.
    RESEARCH DESIGN AND METHODS: Fifty participants who were pregnant, diagnosed with type 1 or type 2 diabetes, and ≥18 years of age comprised two groups: a historical group who received traditional diabetes education and an intervention group who received traditional diabetes education enhanced with a cellular-enabled glucose meter, both alongside their prenatal medical appointments. In the intervention group, glucose levels were monitored daily via a cloud-based portal in addition to traditional weekly review, and outreach was initiated when glucose levels met thresholds. Diabetes medications were adjusted as needed in both groups. Practice, clinical, and glycemic data were extracted from the electronic medical record and cloud portal.
    RESULTS: Neonatal hypoglycemia was reduced (P = 0.047) and more participants used continuous glucose monitoring (P = 0.01) in the intervention group. Communication by text and telephone occurred more frequently in the intervention group (P = 0.007 and P = 0.011, respectively). The intervention group also received more diabetes education (4.44 vs. 2.89 hours, P = 0.030). Differences in other clinical, practice, or glycemic outcomes did not differ significantly.
    CONCLUSION: Enhanced care with a cellular-enabled glucose meter facilitated remote patient monitoring with accurate glucose data. The intervention group received more hours of diabetes education and more text and telephone contact. Review of glucose data via the cloud-based portal increased the identification of hypoglycemic and hyperglycemic events, informing delivery decisions. Delivery was earlier for the intervention group, yet rates of neonatal hypoglycemia were reduced.
    DOI:  https://doi.org/10.2337/ds24-0052
This page is being maintained by Thomas Krichel. It was last updated on 2025‒08‒24 at 0:09.