bims-glumda 2025-09-28 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–09–28
twenty-six papers selected by
Mott Given

The cost-effectiveness of real-time continuous glucose monitoring versus intermittently scanned continuous glucose monitoring in individuals with insulin-treated Type 2 diabetes mellitus in Canada.
Practical Use of Continuous Glucose Monitoring to Adjust Glucose-Lowering Therapy in Hemodialysis Patients: A Case Series.
Using Nutrition to Improve Time in rangE (UNITE): A Randomized Clinical Trial with Continuous Glucose Monitoring in People with Type 2 Diabetes Not Taking Insulin.
Optimizing Perioperative Glycaemic Control with Continuous Glucose Monitoring in Pregestational Diabetes: Feasibility and Comparative Analysis of Two Systems: A Pilot Study.
Glucostats: an efficient Python library for glucose time series feature extraction and visual analysis.
Usability of Continuous Glucose Monitoring for Older Adults with Type 2 Diabetes: A Systematic Review.
Continuous glucose monitoring: criteria for the diagnosis of type 2 diabetes mellitus with clinical obesity after gestational diabetes.
Association of the Glycemia Risk Index With Glycemic Metrics and Sensor Usage in a Real-World Pediatric Population With Low Hypoglycemia Rates in Saudi Arabia.
Comment on "Feasibility of continuous glucose monitoring in children with diabetic ketoacidosis".
Glycemic Levels and Insulin Use Daily and During Hospital Shifts in Hospitalized Patients With Type 2 Diabetes.
Continuous glucose monitoring evidence of celiac disease in type 1 diabetes.
GlucoNet-MM: A multimodal attention-based multi-task learning framework with decision transformer for personalised and explainable blood glucose forecasting.
Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review.
Decision Support Tool for Self-Management of Insulin Dosing in Type 1 Diabetes with Multiple Daily Injections: A Proof-of-Concept Study.
Correlation between time in range and mild cognitive impairment in older adults with type 2 diabetes mellitus.
Risk of Diabetes-Specific Eating Disorders in Children with Type 1 Diabetes Mellitus Using Continuous Subcutaneous Insulin Infusion: A CGM-Based Cross-Sectional Study.
Relationship between the triglyceride glucose index and time in range: A cross-sectional study based on patients with type 2 diabetes mellitus.
Clinical and biochemical predictors of large for gestational age during pregnancy in women with type 1 diabetes mellitus - current insight.
Impact of Simplification Strategies on Postmeal Glucose Excursions in Older Adults with Type 1 Diabetes and Hypoglycemia.
CGMacros: a pilot scientific dataset for personalized nutrition and diet monitoring.
Effect of Adherence to Oral Semaglutide on Glycemic Control in People With Type 2 Diabetes Treated With Metformin: Protocol for an Open-Label Clinical Trial.
The Glycemia Risk Index (GRI) as a Biomarker for Subclinical Endothelial Dysfunction in Type 1 Diabetes: A Cross-Sectional Study.
Flexible and Stretchable Microneedle Electrode Arrays by Soft Lithography for Continuous Monitoring of Glucose.
A Real-World Study Comparing Advanced Hybrid Closed-Loop Systems During Pregnancy in Women with Type 1 Diabetes.
Work-Related Stress and Glucose Regulation in Air Traffic Control Officers: Implications for Medical Certification.
Carbohydrate Counting/Bolus Calculator Mobile Application Improves Time in Range in Adults with Type 1 Diabetes Subjects.

J Comp Eff Res. 2025 Sep 24. e250125

The cost-effectiveness of real-time continuous glucose monitoring versus intermittently scanned continuous glucose monitoring in individuals with insulin-treated Type 2 diabetes mellitus in Canada.

Michael Willis, Andreas Nilsson, Hamza Alshannaq, Jessica Matuoka, Gregory Norman.

  Aim: Continuous glucose monitoring (CGM) supports glycemic control and reduces diabetes complications. CGM systems include intermittently scanned CGM (is-CGM) and real-time CGM (rt-CGM). While rt-CGM may provide better outcomes than is-CGM, it costs more upfront and its cost-effectiveness in Canada has not been established. We assessed the cost-effectiveness of rt-CGM versus is-CGM in people with insulin-treated Type 2 diabetes mellitus (T2DM) from a Canadian healthcare payer perspective. Materials & methods: We used the ECHO-T2DM microsimulation model to estimate incremental lifetime health outcomes and costs of rt-CGM versus is-CGM. Clinical inputs came from an indirect treatment comparison; cost and utility data were drawn from published sources. Sensitivity analyses tested robustness. Results: Rt-CGM was more effective and less costly than is-CGM, yielding 0.346 additional quality-adjusted life-years and CAD 2237 in savings over 30 years. Benefits stemmed primarily from better glycemic control and fewer complications, reductions in glycemic events, and reduced fear of hypoglycemia. Although rt-CGM incurred CAD 3867 higher acquisition costs, these were more than offset by avoided complications. Deterministic analysis showed dominance in 14 of 18 scenarios, and cost-effectiveness in the remaining four. Uncertainty analysis showed rt-CGM had an ICER below CAD 50,000 in 98% of simulations. Discussion: Rt-CGM is potentially a cost-saving alternative to is-CGM among people with insulin-treated T2DM in Canada. This finding was strengthened by rigorous sensitivity analysis. Study strengths include use of a validated microsimulation model and adoption of conservative assumptions. Limitations include absence of head-to-head trial evidence and indirect use of time in and out of range. Conclusion: Rt-CGM is a potentially cost-saving option for managing insulin-treated T2DM in Canada, with implications for clinical practice and reimbursement policy.

Keywords:  Canada; ECHO-T2DM; Type 2 diabetes; continuous glucose monitoring; cost-utility analysis; economic model; is-GCM; rt-CGM

DOI:  https://doi.org/10.57264/cer-2025-0125
Hemodial Int. 2025 Sep 21.

Practical Use of Continuous Glucose Monitoring to Adjust Glucose-Lowering Therapy in Hemodialysis Patients: A Case Series.

Christine L Meyer-Olesen, Merete B Christensen, Dea H Kofod, Mads Hornum, Kirsten Nørgaard, Tobias Bomholt.

   INTRODUCTION: Diabetes management in hemodialysis patients is complicated by limited treatment options and challenges in glycemic monitoring. Continuous glucose monitoring (CGM) provides detailed glucose profiles, enabling tailored glucose-lowering therapy.
METHODS: This case series presents three insulin-treated hemodialysis patients with type 1 or type 2 diabetes.
FINDINGS: Each case reveals significant glycemic abnormalities, including excessive hyperglycemia with nocturnal glucose drops, unrecognized hypoglycemia, and extreme glucose variability. We propose specific personalized insulin adjustments based on CGM readings to optimize treatment across these different clinical scenarios.
CONCLUSIONS: The case series highlights the potential to rethink glucose monitoring in hemodialysis patients with diabetes and underlines the need for future studies evaluating CGM use in this population.

Keywords:  CGM; diabetes; hemodialysis; insulin

DOI:  https://doi.org/10.1111/hdi.70024
Diabetes Technol Ther. 2025 Sep 23.

Using Nutrition to Improve Time in rangE (UNITE): A Randomized Clinical Trial with Continuous Glucose Monitoring in People with Type 2 Diabetes Not Taking Insulin.

Holly J Willis, Sally K Gustafson, Elizabeth Johnson, Meghan M JaKa, Richard M Bergenstal.

  Introduction: Preliminary research suggests that continuous glucose monitoring (CGM) can be used to guide food and lifestyle choices. The objective of the Using Nutrition to Improve Time in rangE (UNITE) study was to compare the glycemic and dietary impact of using either a nutrition-focused approach (NFA) or a self-directed approach (SDA) during CGM initiation in people with type 2 diabetes (T2D) not on insulin. Methods: UNITE was a 60-day, two-arm, randomized clinical trial. The NFA arm was designed to help participants use CGM data to guide evidenced-based food choices to improve percent time in range with glucose 70-180 mg/dL (TIR70-180) and diet quality, whereas the SDA arm was designed to guide participants to use CGM data in any way that felt useful to them. Changes in outcomes from baseline (Base) to postintervention (Post) were estimated by arm and compared between arms using difference-in-differences; analyses were limited to those with adequate CGM data at Base and Post. Results: Adults (NFA: N = 64, SDA: N = 60) with a mean (standard deviation) age of 65.0 (10.3) years, T2D duration of 10.7 (6.5) years, and HbA1c of 7.9% (0.7) participated. There was no differential change in TIR70-180 between arms (P = 0.14), but both arms improved from Base to Post (NFA: 46%-71%, SDA: 55%-71%; within-arm differences both P < 0.001). Time with glucose >250 mg/dL decreased more from Base to Post in the NFA versus the SDA (-14% versus -6%; differential change P = 0.047). NFA participants had several minor, but significant, within-arm changes in dietary intake, and the NFA arm reported significantly more confidence using CGM data than the SDA arm (P < 0.05). Conclusion: Changes in mean TIR70-180 did not differ between the NFA and SDA arms; however, both arms experienced significant within-arm improvements, which support the use of CGM to improve glycemia in people with T2D not on insulin.

Keywords:  behavior change; continuous glucose monitoring; diet quality; lifestyle modification; nutrition; time in range; type 2 diabetes

DOI:  https://doi.org/10.1177/15209156251377799
J Clin Med. 2025 Sep 22. pii: 6670. [Epub ahead of print]14(18):

Optimizing Perioperative Glycaemic Control with Continuous Glucose Monitoring in Pregestational Diabetes: Feasibility and Comparative Analysis of Two Systems: A Pilot Study.

Joanna Kacperczyk-Bartnik, Aleksandra Urban, Paweł Bartnik, Piotr Świderczak, Aneta Malinowska-Polubiec, Aleksandra Bender, Ewa Romejko-Wolniewicz, Krzysztof Czajkowski, Jacek Sieńko.

  Background: Continuous glucose monitoring (CGM) has changed the clinical practice in diabetes management during pregnancy; however, its application during caesarean section remains understudied. This feasibility study evaluates the performance, reliability, and clinical utility of two CGM systems-FreeStyle Libre 2 and Medtronic Guardian Connect-during caesarean delivery and the early postpartum period in a patient with pregestational diabetes mellitus (PGDM). Methods: A prospective, single-patient study was conducted. A 32-year-old woman with type 1 diabetes underwent elective caesarean section at 38 weeks of gestation. Both CGM systems were applied over 18 h prior to surgery and monitored continuously through the intraoperative and five-day postpartum period. Glucose data, device performance, and usability were assessed. Results: Both CGM systems provided uninterrupted, high-quality glucose data throughout the perioperative period, including during spinal anaesthesia, surgical manipulation, and postoperative recovery. No sensor displacement nor signal loss occurred. Glycaemic readings remained within the normoglycaemic range (90-100 mg/dL) during surgery, with mild elevations observed during anaesthesia initiation. Postoperatively, both systems showed comparable glucose trends, with slightly lower readings from FreeStyle Libre 2. Conclusions: CGM is feasible and reliable during caesarean section in PGDM patients. These findings support the integration of CGM into obstetric surgical care and highlight the need for larger studies to validate clinical benefits.

Keywords:  Perioperative Glycaemic Control; caesarean section; continuous glucose monitoring; feasibility study; pregestational diabetes mellitus

DOI:  https://doi.org/10.3390/jcm14186670
BMC Bioinformatics. 2025 Sep 24. 26(1): 230

Glucostats: an efficient Python library for glucose time series feature extraction and visual analysis.

Pablo Peiro-Corbacho, Francisco J Lara-Abelenda, David Chushig-Muzo, Ana M Wägner, Conceição Granja, Cristina Soguero-Ruiz.

   BACKGROUND: The advancement of technology and continuous glucose monitoring (CGM) systems has introduced several computational and technical challenges for clinicians and researchers. The growing volume of CGM data necessitates the development of efficient computational tools capable of handling and processing this information effectively. This paper introduces GlucoStats, an open-source and multi-processing Python library designed for efficient computation and visualization of a comprehensive set of glucose metrics derived from CGM. It simplifies the traditionally time-consuming and error-prone process of manual CGM metrics calculation, making it a valuable tool for both clinical and research applications.
RESULTS: Its modular design ensures easy integration into predefined workflows, while its user-friendly interface and extensive documentation make it accessible to a broad audience, including clinicians and researchers. GlucoStats offers several key features: (i) window-based time series analysis, enabling time series division into smaller 'windows' for detailed temporal analysis, particularly beneficial for CGM data; (ii) advanced visualization tools, providing intuitive, high-quality visualizations that facilitate pattern recognition, trend analysis, and anomaly detection in CGM data; (iii) parallelization, leveraging parallel computing to efficiently handle large CGM datasets by distributing computations across multiple processors; and (iv) scikit-learn compatibility, adhering to the standardized interface of scikit-learn to allow an easy integration into machine learning pipelines for end-to-end analysis.
CONCLUSIONS: GlucoStats demonstrates high efficiency in processing large-scale medical datasets in minimal time. Its modular design enables easy customization and extension, making it adaptable to diverse research and clinical needs. By offering precise CGM data analysis and user-friendly visualization tools, it serves both technical researchers and non-technical users, such as physicians and patients, with practical and research-driven applications.

Keywords:  Continuous glucose monitoring; Feature glucose extraction; Glucose visualization; Sliding time window

DOI:  https://doi.org/10.1186/s12859-025-06250-w
Diabetes Technol Ther. 2025 Sep 23.

Usability of Continuous Glucose Monitoring for Older Adults with Type 2 Diabetes: A Systematic Review.

April Savoy, Cristina Barboi, Melissa R Thomas, Michael Weiner.

  This systematic review aims to examine the use and usability of continuous glucose monitoring (CGM) among older adults with type 2 diabetes mellitus. The following databases, PubMed, Embase, and CINAHL, were searched for studies published between 2019 and 2024, and results were documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Eligibility criteria included English-language studies that researched the use and usability of CGM in adults 60 years or older with a minimum wear time of 2 weeks. We extracted usability (efficiency, effectiveness, and satisfaction) outcomes. Study quality was assessed using the Critical Appraisal Skills Program Checklist. Of the 118 identified titles, 58 articles underwent a full-text review, with seven being included in the final analysis. Studies evaluated clinical management of type 2 diabetes with CGM, assessing the following differences: CGM versus usual care, CGM across device types, and CGM across care models. Clinical effectiveness, based on glycated hemoglobin and time-in-range, and satisfaction were higher across CGM types compared with usual care. Based on descriptive measures, satisfaction was higher with real-time CGM than professional-mode CGM. Efficiency findings were not reported in the included studies. There were no findings on the effectiveness, efficiency, and satisfaction of ambulatory glucose profile (AGP) metrics. Although the clinical effectiveness of CGM among adults 60 years or older was demonstrated in the reviewed studies, our usability assessment is inconclusive. There is a gap in evidence related to the essential components that comprise the context of CGM use, which prohibits a complete usability assessment. Future studies are warranted to investigate CGM usability, emphasizing AGP metrics, to inform improvements and personalization for older adults.

Keywords:  ambulatory glucose profile; clinical effectiveness; continuous glucose monitoring; diabetes; older adults; usability

DOI:  https://doi.org/10.1177/15209156251369021
Am J Obstet Gynecol. 2025 Sep 18. pii: S0002-9378(25)00694-5. [Epub ahead of print]

Continuous glucose monitoring: criteria for the diagnosis of type 2 diabetes mellitus with clinical obesity after gestational diabetes.

Cristina Gómez Fernández, Rea Mitsigiorgi, Micaela Fochini, Angel Leung, Cristina Fernández Pérez, Kypros H Nicolaides.

   OBJECTIVE: To compare Continuous Glucose Monitoring (CGM) to American Diabetes Association (ADA) criteria, in the postpartum period in women who had developed gestational diabetes (GDM) during their recent pregnancy, for diagnosis of type 2 diabetes (DMT2) complicated by clinical obesity.
STUDY DESIGN: Between September 2023-April 2025, we conducted a multiproposal cohort study at King's College Hospital, London, UK. We invited consecutive women with and without GDM at 5-months postpartum. GDM patients were also invited for a 1-year follow-up clinic. Blinded CGM (Dexcom G7; Dexcom, San Diego, CA) was performed for 10 days. The primary outcome was T2DM with clinical obesity, defined by first, the ADA criteria (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-hour OGTT of ≥200 mg/dL), and second, CGM average glucose ≥131.5 mg/dL, which is the mean + 2SD of our non-GDM group. Clinical obesity was defined by the recently published The Lancet Diabetes and Endocrinology Commission, as excess body fat directly affecting the function of organs and tissues.
RESULTS: We examined 1,118 women, including 276 (24.7%) non-GDM controls at 5- months postpartum, 539 (48.2%) post-GDM at 5-months postpartum and 303 (27.1%) post-GDM at 1-year postpartum. In the non-GDM group the mean + 2SDs average glucose was ≥131.5 mg/dL. At 5-months postpartum in the GDM group, CGM classified 8.9% (48/539) women as DMT2 with clinical obesity and the respective value by the ADA criteria was 4.3% (23/539). Women diagnosed by CGM but not the ADA criteria (n=35) had a worse cardiometabolic profile than those diagnosed by the ADA criteria alone (n=10). Out of the 35 additional cases, classified only by CGM, 26 attended to the 1-year postnatal clinic and all still had an average glucose ≥131.5 mg/dL measured by CGM and abnormal cardiometabolic profile.
CONCLUSIONS: Postpartum follow-up in women who had GDM should not only focus on dysglycemia but on their cardiometabolic profile. In this respect, CGM is superior to ADA criteria for diagnosis of DMT2 with clinical obesity.

Keywords:  Cardiometabolic profile; Clinical Obesity; Continuous glucose monitoring; Diabetes mellitus type 2; Gestational Diabetes; Postpartum

DOI:  https://doi.org/10.1016/j.ajog.2025.09.031
Cureus. 2025 Aug;17(8): e90536

Association of the Glycemia Risk Index With Glycemic Metrics and Sensor Usage in a Real-World Pediatric Population With Low Hypoglycemia Rates in Saudi Arabia.

Lamya M Alzubaidi, Faisal S El Enezi, Afaf I Alsagheir, Muna H Hassanein, Abdullah M Alsoheimi, Abdullah M Arabe, Amera S Alrshood, Abdulmohsen K Bakhsh.

   INTRODUCTION: The Glycemia Risk Index (GRI) is a recently developed composite measure designed to consolidate overall glycemic control into a single, interpretable score. The aim of this study was to investigate the associations between the GRI and glycemic metrics derived from continuous glucose monitoring (CGM), including sensor usage time, in children with diabetes using the FreeStyle Libre 2 Plus® CGM system (Abbott Diabetes Care, Witney, UK).
METHOD: De-identified CGM data from 147 pediatric patients with diabetes in Saudi Arabia, treated at two governmental hospitals between January 2023 and September 2024, were analyzed. Glycemic metrics from the ambulatory glucose profile were recorded, and the GRI and its hypoglycemia and hyperglycemia components were calculated. Correlations between the GRI, its components, and time in range with glycemic metrics were assessed using Pearson and Spearman correlation coefficients. The associations between GRI and its components and two sensor usage time groups (70%-89% versus >90%) were evaluated using the independent t-test and Mann-Whitney U test. A p-value < 0.05 was considered statistically significant.
RESULTS: There was a negative correlation between GRI and time in range (r = -0.941), level one time above range (181-250 mg/dl; r = -0.447), time below range (< 70 mg/dl; r = -0.244), level one time below range (69-54 mg/dl; r = -0.248), and hypoglycemia component (r = -0.243) (all p-values <0.05). There was a positive correlation between GRI and average blood glucose (r = 0.923), glucose management indicator (r = 0.922), time above range (>180 mg/dl; r = 0.893), level two time above range (>250 mg/dl; r = 0.944), and hyperglycemia component (r = 0.929) (all p-values <0.05). Participants with lower sensor usage (70-89%) had significantly higher GRI values (median: 96.00; IQR: 75.80-100.00) compared to those with ≥90% usage (median: 82.40; IQR: 60.40-100.00; p = 0.004). The hyperglycemia component was also significantly higher in the lower usage group (mean: 53.65 vs. 46.62, p = 0.032).
CONCLUSION: Average glucose, glucose management indicator, and time in range showed negative correlations with GRI, while extreme hyperglycemia correlated positively. These results support GRI's role in assessing hyperglycemic exposure and treatment efficacy. Unexpected negative correlations with mild hyperglycemia and mild hypoglycemia warrant further studies. GRI and its hyperglycemic component improved with increased sensor usage, suggesting better glycemic control with higher CGM adherence.

Keywords:  continuous glucose monitoring; glycemia risk index; glycemic metrics; pediatrics; sensor usage time; type 1 diabetes mellitus

DOI:  https://doi.org/10.7759/cureus.90536
Eur J Pediatr. 2025 Sep 24. 184(10): 634

Comment on "Feasibility of continuous glucose monitoring in children with diabetic ketoacidosis".

Muhammad Mustafa Khan, Abdullah Abdullah, Abdul Saboor.

DOI: https://doi.org/10.1007/s00431-025-06507-9
J Endocr Soc. 2025 Oct;9(10): bvaf137

Glycemic Levels and Insulin Use Daily and During Hospital Shifts in Hospitalized Patients With Type 2 Diabetes.

Mikkel Thor Olsen, Signe Hjejle Jensen, Louise Mathorne Rasmussen, Carina Kirstine Klarskov, Birgitte Lindegaard, Jonas Askø Andersen, Hans Gottlieb, Suzanne Lunding, Kirsten Nørgaard, Ulrik Pedersen-Bjergaard, Katrine Bagge Hansen, Peter Lommer Kristensen.

   Objective: To characterize glucose levels and insulin use daily and during hospital shifts throughout hospitalization, which might inform treatment planning and improve outcomes.
Methods: This is a post hoc analysis from a 2-center randomized trial with 166 nonintensive care unit hospitalized patients with type 2 diabetes. Diabetes management was performed by regular staff, guided by diabetes teams using insulin titration algorithms based on either point-of-care glucose testing (POC arm) or continuous glucose monitoring (CGM arm). POC-arm participants wore blinded continuous glucose monitors. The primary outcome was the development in time in range (TIR) (3.9-10.0 mmol/L) between arms during hospitalization.
Results: TIR improved progressively to nearly 90% in the CGM arm by discharge, compared to 60% in the POC arm, which plateaued after day 5 (P < .001). Both arms showed the lowest TIR and highest insulin use during the day shift (07:00-15:00 hours). Correctional insulin doses were lower in the CGM arm compared to the POC arm across all shifts: 0.7 IU (±0.3) lower during day shifts (07:00-15:00 hours, P = .016), 1.2 IU (±0.4) lower during evening shifts (15:01-23:00 hours, P = .005), and 0.3 IU (±0.1) lower during night shifts (23:01-06:59 hours, P = .038). Prandial insulin doses were 1.1 IU (±0.5) lower during evening shifts in the CGM arm (P = .021).
Conclusion: TIR improved continuously to nearly 90% in the CGM arm by discharge, compared to 60% in the POC arm, which plateaued after day 5, despite lower daily insulin doses in the CGM arm. These findings underscore the sustained effectiveness of CGM in enhancing glycemic levels throughout the entire duration of hospitalization.

Keywords:  continuous glucose monitoring; diabetes; glucose; hospital; inpatient; insulin

DOI:  https://doi.org/10.1210/jendso/bvaf137
J Pediatr Endocrinol Metab. 2025 Sep 25.

Continuous glucose monitoring evidence of celiac disease in type 1 diabetes.

Jessica L Ruiz, Lisa A Asaro, Allison S Bernique, Elizabeth Healey, Jocelyn A Silvester, David Wypij, Michael S D Agus, Christina M Astley.

   OBJECTIVES: Quantitative glycemic metrics are needed to identify undiagnosed celiac disease in type 1 diabetes and reduce delays in celiac diagnosis. Celiac enteropathy drives malabsorption that increases the risk of prandial insulin-glucose mismatch and hypoglycemia. We assessed if children with type 1 diabetes and celiac disease have lower post-prandial glucose levels preceding celiac diagnosis vs. those without celiac disease, leveraging continuous glucose monitoring (CGM) data and a computational meal annotation algorithm.
METHODS: In this retrospective cohort study, children with type 1 diabetes <12 months duration using CGM, positive celiac serologies and biopsy confirmed celiac disease (n=16) were matched 1-to-4 to those with negative celiac serologies (n=60). Meals were computationally annotated in the 30-day window before serologies. Differences in post-prandial trough glucose and other prandial glycemic outcomes were assessed via mixed models.
RESULTS: Undiagnosed celiac disease was associated with a lower glucose rise from meal start to peak vs. no celiac disease (-8.9 %, 95 % CI, -14.9--2.5 %, p=0.009) and, during the first meal of the day, a lower fall from peak to trough (-9.3 %, 95 % CI, -16.5 %--1.5 %, p=0.02). There was no significant association between celiac disease and trough glucose, meal hypoglycemia or time hypoglycemic.
CONCLUSIONS: Computational analysis revealed that blunted prandial glycemic trajectories, not hypoglycemia, are associated with undiagnosed celiac disease in children with type 1 diabetes using CGM. These findings challenge current guidelines, and future studies should validate and integrate these glycemic biomarkers into a CGM-based model for real-time prediction of celiac disease in type 1 diabetes.

Keywords:  celiac disease; continuous glucose monitoring; pediatric diabetes; postprandial; type 1 diabetes

DOI:  https://doi.org/10.1515/jpem-2025-0302
Diabetes Obes Metab. 2025 Sep 22.

GlucoNet-MM: A multimodal attention-based multi-task learning framework with decision transformer for personalised and explainable blood glucose forecasting.

Sarmad Maqsood, Muhammad Abdullah Sarwar, Egle Belousovienė, Rytis Maskeliūnas.

   AIMS: Accurate and personalized blood glucose prediction is critical for proactive diabetes management. Conventional machine learning (ML) models often struggle to generalize across patients due to individual variability, nonlinear glycemic dynamics, and sparse multimodal input data. This study aims to develop an advanced, interpretable deep learning (DL) framework for patient-specific, policy-aware blood glucose forecasting.
MATERIALS AND METHODS: We propose GlucoNet-MM, a novel multimodal DL framework that combines attention-based multi-task learning (MTL) with a Decision Transformer (DT), a reinforcement learning paradigm that frames policy learning as sequence modeling. The model integrates heterogeneous physiological and behavioral data, continuous glucose monitoring (CGM), insulin dosage, carbohydrate intake, and physical activity, to capture complex temporal dependencies. The MTL backbone learns shared representations across multiple prediction horizons, while the DT module conditions future glucose predictions on desired glycemic outcomes. Temporal attention visualizations and integrated gradient-based attribution methods are used to provide interpretability, and Monte Carlo dropout is employed for uncertainty quantification.
RESULTS: GlucoNet-MM was evaluated on two publicly available datasets, BrisT1D and OhioT1DM. The model achieved R2 scores of 0.94 and 0.96 and mean absolute error (MAE) values of 0.031 and 0.027, respectively. These results outperform single-modality and conventional non-adaptive baseline models, demonstrating superior predictive accuracy and generalizability.
CONCLUSION: GlucoNet-MM represents a promising step toward intelligent, personalized clinical decision support for diabetes care. Its multimodal design, policy-aware forecasting, and interpretability features enhance both prediction accuracy and clinical trust, enabling proactive glycemic management tailored to individual patient needs.

Keywords:  blood glucose forecasting; decision transformer; explainable artificial intelligence; multimodal deep learning; multi‐task learning

DOI:  https://doi.org/10.1111/dom.70147
Life (Basel). 2025 Aug 28. pii: 1369. [Epub ahead of print]15(9):

Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review.

Bianca-Margareta Salmen, Delia Reurean-Pintilei, Teodor Salmen, Roxana-Elena Bohîlțea.

  (1) Background: Gestational diabetes mellitus (GDM) is a glucose metabolism disorder that typically develops in the second half of pregnancy, transforming a normal pregnancy into a high-risk condition, with both short- and long-term complications for the mother and the fetus. Achieving optimal glycaemic control during pregnancy is essential for preventing these outcomes and could be realized using continuous glucose monitoring systems (CGMSs). This systematic review aims to evaluate the role of the CGMS as a potential diagnostic aid and predictor of maternal and fetal outcomes in GDM. (2) Methods: Following the PRISMA guidelines (protocol ID: CRD42024559169), we performed a literature search using the terms "(continuous glucose monitoring system OR CGMS) AND (gestational diabetes mellitus OR GDM)" in the PubMed, Web of Science, and Scopus databases. (3) Results: Twelve studies were included, all reporting data on CGMS use in pregnancies complicated by GDM. The data included in our analysis are heterogeneous, the results suggesting that the CGMS may offer several advantages such as improved glycaemic control (by avoiding hyper- and hypoglycaemia), better gestational weight management, timely initiation of pharmacologic treatment, lower rates of preeclampsia, and improved neonatal outcomes. (4) Conclusions: the CGMS offers a more detailed assessment of both maternal and fetal exposure to high glucose levels, which could lead to earlier detection of those at risk for GDM complications and better guide treatment regimens, especially timely pharmacological intervention. While the current data are heterogeneous, reporting both limited or no benefits and superior benefits compared to the classic monitoring, larger longitudinal studies are mandatory to validate these findings and to better refine the role of CGMS in the monitoring and management of GDM.

Keywords:  CGMS; GDM; continuous glucose monitoring system; gestational diabetes mellitus; pregnancy outcome

DOI:  https://doi.org/10.3390/life15091369
Diabetes Technol Ther. 2025 Sep 23.

Decision Support Tool for Self-Management of Insulin Dosing in Type 1 Diabetes with Multiple Daily Injections: A Proof-of-Concept Study.

Revital Nimri, Sarit Weizman Demri, Naama Fisch-Shvalb, Ido Muller, Anat Raz, Eran Atlas, Moshe Phillip.

  Objective: To assess feasibility and safety of a decision support system (AI-DSS) that provides algorithm-generated insulin dosing recommendations directly to individuals with type 1 diabetes (T1D) managed with multiple daily injections (MDI). Methods: This single-arm, prospective proof-of-concept study included individuals with T1D managed with MDI and continuous glucose monitoring (CGM). Participants underwent a 4-week run-in period followed by a 12-week intervention phase, during which every two weeks algorithm-generated insulin titration recommendations were provided via a mobile application. CGM metrics were compared between the last 2 weeks of the run-in (baseline) and the last 2 weeks of the intervention periods. Primary safety outcomes included percent time <54 mg/dL and >250 mg/dL. Secondary outcomes included changes in HbA1c and time in range (TIR, 70-180 mg/dL). Results: The study cohort included 16 young adults (mean age 25.1 ± 4.1 years; 56% female, mean HbA1c 7.6% ± 0.8%) who completed the study. Median HbA1c significantly decreased from 7.5% (IQR: 7.1, 8) to 7.1% (IQR: 6.5, 7.3), from start to end of study (P = 0.013). TIR significantly improved by 3.5% ± 7.3% (P = 0.039). Time <54 mg/dL remained unchanged (0.9% ± 0.86% vs. 1.12% ± 1.11%; P = 0.191), with a trend toward reduced time >250 mg/dL (14.3% ± 10.71% vs. 12.32% ± 10.91%; P = 0.055). No severe adverse events were reported. Conclusion: Decision support tool for self-managed insulin dosing in individuals with T1D using MDI was feasible, safe, and improved glycemic control, supporting further evaluation in large-scale randomized trials.

Keywords:  decision support system; insulin titration; multiple daily injections; type 1 diabetes

DOI:  https://doi.org/10.1177/15209156251380860
J Diabetes Investig. 2025 Sep 27.

Correlation between time in range and mild cognitive impairment in older adults with type 2 diabetes mellitus.

Jiajun Bao, Tianhong Xu, Ting Gu, Yi Sun, Yilan Jiang, Jing Xiao, Yunjuan Gu.

   AIMS: To investigate the association between time in range (TIR) and mild cognitive impairment (MCI) in older adult patients with type 2 diabetes mellitus (T2DM) and the contributions of various indicators to MCI.
MATERIALS AND METHODS: Two hundred and three participants received continuous glucose monitoring and cognitive assessments. Relative weight analysis assessed TIR and other factors' contributions to MCI. Binary logistic analysis explored TIR-MCI associations across the sample and by age and sex.
RESULTS: TIR showed a stronger association with MCI than diabetes duration, education, systolic blood pressure (SBP), urinary albumin-creatinine ratio (UACR), and C-peptide (25.59% relative weight). Multivariable-adjusted odds ratios (ORs) for MCI declined with increasing TIR quartile (Q) (Q1 [reference group], ≤40%; Q2, 40.3-51.1%, OR 0.402, 95% confidence interval [CI] 0.094-1.717; Q3, 51.2-61.2%, OR 0.113, 95% CI 0.023-0.565; Q4, ≥61.3%, OR 0.050, 95% CI 0.007-0.343). This protective association remained when TIR was treated as a continuous variable and adjusted for covariates (OR 0.917, 95% CI 0.867-0.969, P = 0.002). Women with TIR ≥61.3% had lower MCI risk. Men with TIR 51.2-61.2% had lower MCI risk.
CONCLUSIONS: Besides hemoglobin A1c, clinicians should consider low TIR as a risk factor for MCI in older T2DM patients. Women potentially require a higher TIR target to prevent MCI.

Keywords:  Cognitive dysfunction; Continuous glucose monitoring; Diabetes mellitus

DOI:  https://doi.org/10.1111/jdi.70161
Medicina (Kaunas). 2025 Sep 02. pii: 1585. [Epub ahead of print]61(9):

Risk of Diabetes-Specific Eating Disorders in Children with Type 1 Diabetes Mellitus Using Continuous Subcutaneous Insulin Infusion: A CGM-Based Cross-Sectional Study.

Özge Köprülü, Hülya Tan, İbrahim Mert Erbaş, Fatma Yavuzyılmaz Şimşek, Nilüfer Uyar, Murat Çağlar Karataş, Özlem Nalbantoğlu, Hüseyin Anıl Korkmaz, Behzat Özkan.

  Background and Objectives: Eating disorders are one of the most widespread health concerns, mainly among adolescents. Children and adolescents with type 1 diabetes mellitus (T1DM) have been reported to have a high prevalence of eating disorders. The aim of our study is to evaluate the risk of diabetes-specific eating disorders in children with T1DM using continuous subcutaneous insulin infusion (CSII), with real-time glycemic data from continuous glucose monitoring (CGM). Materials and Methods: Sixty-four patients (aged 7-18 years) completed the Diabetes Eating Problem Survey-Revised (DEPS-R). The DEPS-R is a diabetes-specific self-report questionnaire to assess diabetes-specific compensatory behaviors. Auxological findings, sex, age, age at diagnosis, hemoglobin A1c (HbA1c) levels, and all CGM data were obtained from their medical records. Results: Although the median DEPS-R score was higher in children and adolescents using CSII compared to those using multiple daily injections (MDIs) (14 vs. 11), the difference was not statistically significant (p = 0.302). The risk of diabetes-specific eating disorders was identified in six patients (30%) using CSII and in nine patients (20.4%) using multiple daily injections (p = 0.403). Interestingly, in the subgroup with poor glycemic control (HbA1c > 9%), DEPS-R scores were significantly lower among those using CSII compared to the MDI group. Pearson correlation analysis demonstrated positive associations between DEPS-R scores and diabetes duration, weight SDS, body mass index (BMI), BMI SDS, HbA1c, mean glucose, Glucose Management Indicator (GMI), time above range (TAR) (very high), and coefficient of variation (CV), while a moderate negative correlation was observed with time in range (TIR). Conclusions: This study showed that the treatment of CSII had a beneficial effect on the risk of eating disorders in patients with poor glycemic control. As well, from this perspective, CSII maintains its status as a potentially beneficial therapeutic approach in diabetes management.

Keywords:  DEPS-R; continuous glucose monitoring; continuous subcutaneous insulin infusion; diabetes-specific eating disorders; time in normoglycemia

DOI:  https://doi.org/10.3390/medicina61091585
J Int Med Res. 2025 Sep;53(9): 3000605251381190

Relationship between the triglyceride glucose index and time in range: A cross-sectional study based on patients with type 2 diabetes mellitus.

Hongbo Shang, Xiaoli Qin, Wenxian Li, Yanrong Xu, Weixuan Wang.

  ObjectiveThe objective of this study was to investigate the relationship between the triglyceride glucose index and time in range in patients with type 2 diabetes mellitus.MethodsThis is a cross-sectional study based on patients with type 2 diabetes mellitus. The time in range was measured in all patients using continuous glucose monitoring. Differential analyses were performed to compare the differences in clinical information between groups. Linear regression and logistic regression techniques were employed to construct a novel predictive model that encompassed the triglyceride glucose index, with the aim of assessing time in range attainment. The predictive value of the new model was then assessed using receiver operator characteristic curves.ResultsLinear and logistic regression analyses showed a significant negative correlation between the triglyceride glucose index and time in range, identifying the triglyceride glucose index as an independent risk factor for time in range attainment. Furthermore, restricted cubic spline plots indicated a nonlinear correlation between the triglyceride glucose index and time in range. The area under the curve of the novel prediction model constructed on the basis of the triglyceride glucose index for predicting time in range attainment was 0.81, thus demonstrating efficacious clinical application.ConclusionsThe study revealed a nonlinear relationship between the triglyceride glucose index and time in range, highlighting the triglyceride glucose index as a crucial indicator of time in range attainment.

Keywords:  Triglyceride glucose index; area under the curve; continuous glucose monitoring; time in range; type 2 diabetes mellitus

DOI:  https://doi.org/10.1177/03000605251381190
Ginekol Pol. 2025 Sep 26.

Clinical and biochemical predictors of large for gestational age during pregnancy in women with type 1 diabetes mellitus - current insight.

Milena Skibinska, Katarzyna Cypryk.

   OBJECTIVES: Large for gestational age (LGA) is defined as a birth weight equal to or higher than the 90th centile for a certain gestational age. Despite the efforts to optimize therapeutic goals to stabilize diabetes, there is still a high rate of LGA in type 1 diabetes mellitus (T1DM) mothers. The aim of this paper is a literature review of the data on predictors of LGA incidence in pregnancies complicated by type 1 diabetes mellitus.
RESULTS: Potential LGA predictors in pregestational diabetes include glucose concentration during pregnancy, maternal age, diabetes duration, increased body weight both at the beginning of gestation and at the time of delivery, as well as the weight gain in pregnancy. LGA risk is also associated with the use of an insulin pump (CSII), especially without the support of a continuous glucose monitoring system (CGMS). Significant glycaemic control parameters among others include average fasting glycaemia in the 3rd trimester, HbA1c in the 1st and 3rd trimesters, and among CGMS parameters - shorter TIR (time in range), shorter TBR (time below range) in the 2nd and 3rd trimesters, longer TAR (time above range) > 140 and average glycaemia in each trimester of gestation.
CONCLUSIONS: There is still a need for identification of new predictors and theraputic goals in pregnancy in T1DM women to reduce the prevalence of LGA newborns.

Keywords:  glycaemic control; large for gestational age; pregestational type1 diabetes mellitus

DOI:  https://doi.org/10.5603/gpl.105127
Diabetes Technol Ther. 2025 Sep 25.

Impact of Simplification Strategies on Postmeal Glucose Excursions in Older Adults with Type 1 Diabetes and Hypoglycemia.

Elena Toschi, Molly Savory, Colin Conery, Noa Krakoff, Atif Adam, Christine Slyne, Medha Munshi.

  Continuous glucose monitoring with simplification strategies reduces hypoglycemia in older adults with type 1 diabetes (T1D), however the impact on postmeal glycemia is not known. A post-hoc analysis of older adults with T1D randomized to intervention with mealtime simplification strategies, or control, assessed weekly postmeal hypoglycemia and hyperglycemia. At baseline, 88 older adults with T1D (71 ± 5 years) in intervention (n = 47) and control (n = 41) had similar number of episodes of postmeal hypo- and hyperglycemia. The mean decrease from baseline to 6 months in episodes of postmeal hypoglycemia was: after breakfast (-0.77 vs. -0.32; P = 0.02), lunch (-0.80 vs. -0.32; P = 0.05), and dinner (-0.73 vs. -0.22; P = 0.04); and the mean change in episodes of postmeal hyperglycemia was: after breakfast (-2.05 vs. -1; P = 0.04), lunch (-1.23 vs. -0.87; P = 0.09), and dinner (-1.45 vs. -1.66; P = 0.33), respectively in intervention and control. Simplification strategies in older adults with T1D resulted in fewer episodes of postmeal hypoglycemia without worsening episodes of postmeal hyperglycemia.

Keywords:  continuous glucose monitoring; glucose excursions; hypoglycemia; older adults; simplification; type 1 diabetes

DOI:  https://doi.org/10.1177/15209156251370985
Sci Data. 2025 Sep 25. 12(1): 1557

CGMacros: a pilot scientific dataset for personalized nutrition and diet monitoring.

Anurag Das, David Kerr, Namino Glantz, Wendy Bevier, Rony Santiago, Ricardo Gutierrez-Osuna, Bobak J Mortazavi.

Tracking food intake is key to using nutrition to prevent or manage common diseases including type 2 diabetes (T2D) and obesity. Several datasets are publicly available to promote research in diet monitoring, but generally contain data from a limited set of sensors (e.g., accelerometry, food images), which limits their application to specific use cases such as activity recognition or image recognition. Also lacking are publicly available datasets with food macronutrients and their associated continuous glucose measurements; datasets containing such rich information are proprietary. To address this gap, we present CGMacros, a dataset containing multimodal information from an activity tracker, two continuous glucose monitors (CGM), food macronutrients, and food photographs, as well as anonymized participant demographics, anthropometric measurements and health parameters from blood analyses and gut microbiome profiles. CGMacros contains data for 45 participants (15 healthy, 16 pre-diabetes, 14 T2D) who consumed meals with varying and known macronutrient compositions in a free-living setting for ten consecutive days. To our knowledge, this is the first database of its kind to be made publicly available. CGMacros, and larger publicly available datasets that we hope may follow, are essential to democratize academic research in personalized nutrition and algorithmic approaches to automated diet monitoring.

DOI: https://doi.org/10.1038/s41597-025-05851-7
JMIR Res Protoc. 2025 Sep 23. 14 e64899

Effect of Adherence to Oral Semaglutide on Glycemic Control in People With Type 2 Diabetes Treated With Metformin: Protocol for an Open-Label Clinical Trial.

Nynne Sophie Holdt-Caspersen, Claus Dethlefsen, Ole Hejlesen, Erik Christiansen, Stine Hangaard, Peter Vestergaard, Morten Hasselstrøm Jensen.

   BACKGROUND: Treatment adherence by people with type 2 diabetes (T2D) is overall suboptimal, which can hinder glycemic control. Multiple adherence barriers have been identified, such as the dislike and fear of injections. Several of the recommended antidiabetic drugs are available in oral formulations, which may be a good alternative to injection therapy when possible. However, strict dosing instruction could pose adherence barriers; for example, oral semaglutide requires predose and postdose fasting and restricted water intake at dosing time. Currently, oral semaglutide is the only oral glucagon-like peptide-1 receptor agonist and has only been available for a few years; therefore, limited knowledge exists on adherence to it.
OBJECTIVE: The aim of this study is to investigate the effect of adherence to oral semaglutide dosing instructions on glycemic control in people with T2D who are dysregulated on metformin and optionally a sodium-glucose cotransporter-2 inhibitor and naïve to oral semaglutide.
METHODS: This prospective, noninterventional, open-label, clinical trial with a duration of 12 weeks will be conducted in Denmark. Eligible participants are adults (aged ≥18 years) with dysregulated T2D (hemoglobin A1c of 53-75 mmol/mol) currently treated with metformin and optionally a sodium-glucose cotransporter-2 inhibitor for whom the next natural step in the treatment is to add an antidiabetic drug to the treatment regimen. Potential participants are recruited through announcements on social media and digital mail sent to their official digital mailbox (e-boks). During the trial, 20 participants will be initiated on oral semaglutide and escalated in dosage in accordance with the label. Information on the participants' behavior related to the dosing instructions will be collected using the following devices: a smartwatch to track activity and sleep time, a smart pill bottle to track dosing time, a smart bottle to track time and volume of water intake at dosing time, and a smartphone to take a photo of their breakfast to log time of breakfast. Glycemic control will be assessed using an unblinded continuous glucose monitoring sensor that the participants will wear. Participants are asked to report any cases of nausea or vomiting in terms of time of occurrence, duration, and severity. The primary endpoint is change from baseline to end-of-study time-in-range derived from continuous glucose monitoring data.
RESULTS: The first participant visit was in April 2024. Three months of high frequency temporal data on adherence behavior will be collected, despite the relatively few expected participants included.
CONCLUSIONS: Participants may change their behavior due to awareness of being observed. Regardless, the knowledge gained from this trial might be integrated into a decision support system, providing people with diabetes with guidance on how to increase adherence and potentially improving glycemic control.
TRIAL REGISTRATION: ClinicalTrials.gov NCT06333080.; https://clinicaltrials.gov/study/NCT06333080.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64899.

Keywords:  continuous glucose monitoring; dosing instructions; medication adherence; observational study; oral antidiabetic drug; oral semaglutide

DOI:  https://doi.org/10.2196/64899
Int J Mol Sci. 2025 Sep 20. pii: 9196. [Epub ahead of print]26(18):

The Glycemia Risk Index (GRI) as a Biomarker for Subclinical Endothelial Dysfunction in Type 1 Diabetes: A Cross-Sectional Study.

Nicole Di Martino, Silvia Angelino, Antonietta Maio, Paolo Cirillo, Alessandro Pontillo, Mariangela Caputo, Lorenzo Scappaticcio, Paola Caruso, Miriam Longo, Giuseppe Bellastella, Maria Ida Maiorino, Katherine Esposito.

  Circulating levels of endothelial progenitor cells (EPCs) involved in endothelial homeostasis are often reduced in people with type 1 diabetes (T1D). The Glycemia Risk Index (GRI) quantifies the quality of glucose control by assessing both hypo- and hyperglycemia risk. We aim to investigate the association between the GRI and circulating EPC levels in people with T1D. This cross-sectional study included 132 adults with T1D, on intensive insulin therapy. We calculated GRI from 14 days continuous glucose monitoring-derived metrics and quantified EPCs count by flow cytometry, stratifying results by GRI zones, ranging from A (lowest risk) to E (highest risk). Higher GRI scores were significantly associated with poorer metabolic parameters. Circulating levels of CD34+, CD133+, KDR+, and CD34+KDR+ cells were lower in participants with a worse GRI compared to adults with a better GRI. Linear regression analyses showed a negative association between GRI and CD34+ (β = -1.079, p = 0.006), CD34+CD133+ (β = -0.581, p = 0.008), and CD34+KDR+ (β = -0.147, p = 0.010). No significant association was found between HbA1c and any EPC phenotype. Adults with T1D and a high GRI level had a lower EPCs count. GRI was significantly associated with certain EPC phenotypes, suggesting its potential role as a biomarker for cardiovascular risk assessment.

Keywords:  GRI; cardiovascular risk; endothelial dysfunction; endothelial progenitor cells; glucose control; glucose variability; type 1 diabetes

DOI:  https://doi.org/10.3390/ijms26189196
Biosensors (Basel). 2025 Sep 02. pii: 576. [Epub ahead of print]15(9):

Flexible and Stretchable Microneedle Electrode Arrays by Soft Lithography for Continuous Monitoring of Glucose.

Yong-Ho Choi, Honglin Piao, Jia Lee, Jaehyun Kim, Heon-Jin Choi, Dahl-Young Khang.

  Continuous monitoring of glucose (CGM) level is of utmost importance to diabetic patients, especially with no or minimal pain. Microneedle arrays with desired electrode patterns have been fabricated by soft lithographic molding, and the patterned electrodes were formed via shadow evaporation through a shadow mask that was made from a modified molding technique. With immobilization of glucose oxidase (GOx), the microneedle electrode arrays (MEAs) have been successfully employed for the in vitro CGM using impedance spectroscopy. The fabricated MEAs could monitor the varying glucose level continuously for up to ~10 days. Similar processes have been applied for the fabrication of stretchable MEAs, which can conform to complex curvilinear surfaces. The simple and low-cost fabrication of MEAs, either in flexible or stretchable forms, may find various applications in wearable health monitoring techniques.

Keywords:  continuous glucose monitoring; impedance spectroscopy; microneedle electrode arrays; soft lithography

DOI:  https://doi.org/10.3390/bios15090576
Diabetes Technol Ther. 2025 Sep 26.

A Real-World Study Comparing Advanced Hybrid Closed-Loop Systems During Pregnancy in Women with Type 1 Diabetes.

Carmen Quirós, Ana M Wägner, Sharona Azriel, Berta Soldevila, Pilar I Beato-Vibora, Mayte Herrera Arranz, Lía Nattero, María José Picón-César, Elisenda Climent, Judit Amigó, Natalia Colomo, María Durán-Martínez, Macarena Alpañes Buesa, Ana Megía, Irene Vinagre, Begoña Vega Guedes, Gonzalo Díaz-Soto, Orosia Bandrés, Beatriz Barquiel, Cristina López Tinocco, Rosa Márquez-Pardo, Maria A Martínez-Brocca, Rosa Corcoy, Mercè Codina, María Piedra, Ángel Rebollo Román, Martín Cuesta, Gema López-Gallardo, Maria M Goya Canino, Fernando Bugatto, Lilian C Mendoza, María Del Pilar Olvera Márquez, Verónica Perea.

  Objective: To compare maternal glucose metrics and pregnancy outcomes of three advanced hybrid closed-loop (aHCL) systems (MiniMed 780G®, CamAPS® FX, and Tandem Control-IQ) in a real-world, multicenter cohort of pregnant women with type 1 diabetes. Research Design and Methods: Cohort study including 137 pregnant women with type 1 diabetes using aHCL from 27 hospitals in Spain. Participants were grouped according to the aHCL system used: 85 MiniMed 780G (62%), 38 CamAPS FX (27.7%), and 14 Control-IQ (10.2%). Maternal glucose metrics (HbA1c and time spent within [TIRp], below [TBRp], and above [TARp] the pregnancy-specific glucose range 3.5-7.8 mmol/L), as well as pregnancy outcomes, were analyzed. Adjusted models were applied to account for potential confounding factors. Results: No between-group differences in HbA1c levels were observed at baseline. By the third trimester, CamAPS FX and Control-IQ users had significantly lower HbA1c levels compared with the MiniMed 780G group (βadjusted -4.77 mmol/mol, 95% confidence interval [CI] -7.40 to -2.13; and βadjusted -4.79, 95% CI -8.53 to -1.06; respectively). In the second trimester, CamAPS FX was associated with a higher percentage of time in range (βadjusted +5.88%, 95% CI 1.09 to 10.67) and a lower percentage of time above range (βadjusted -6.36%, 95% CI -11.46 to -1.26) compared with MiniMed 780G, with no other significant differences observed in other trimesters. Both CamAPS FX and Control-IQ were associated with lower odds of large-for-gestational-age (LGA) infants (CamAPS FX: ORadjusted 0.25, 95% CI 0.08 to 0.77; Control-IQ: ORadjusted 0.10, 95% CI 0.01 to 0.99) compared with MiniMed 780G. Conclusions: In this multicenter observational study, CamAPS FX and Control-IQ users achieved better glycemic metrics and lower odds of delivering LGA infants compared with those using MiniMed 780G. These findings warrant investigation to confirm associations and inform individualized clinical decision-making in pregnant women with type 1 diabetes.

Keywords:  HbA1c; advanced hybrid closed-loop; continuous glucose monitoring; maternal–fetal outcomes; pregnancy; type 1 diabetes

DOI:  https://doi.org/10.1177/15209156251379488
Biomedicines. 2025 Aug 30. pii: 2125. [Epub ahead of print]13(9):

Work-Related Stress and Glucose Regulation in Air Traffic Control Officers: Implications for Medical Certification.

Paola Verde, Laura Piccardi, Sandro Gentile, Graham A Roberts, Andrea Mambro, Sofia Pepe, Felice Strollo.

  Background/Objectives: Following the recent publication of reassuring outcomes from the ARA MED 330 protocol regarding long-term insulin use in pilots, combined with continuous advancements in diabetes technology, European aeromedical examiners are increasingly optimistic about establishing more flexible medical requirements for insulin-treated aviation professionals. These professionals have historically been considered unfit for duty due to hypoglycemic risks. According to current research, hypoglycemia, the primary incapacitation risk for flight crew, is considered virtually non-existent among air traffic controllers (ATCOs). Additionally, stress-induced hyperglycemia also represents a low-frequency risk in these professionals, who are experienced in managing highly stressful operational environments. This study presents a narrative review examining stress and its metabolic effects in healthy individuals, ATCOs, and people with diabetes (PwD). Methods: This narrative review was conducted based on a comprehensive PubMed search performed by two independent reviewers (GAR and AM) spanning January 2023 to January 2025. The search strategy focused on English-language, peer-reviewed studies involving human participants and addressed stress, glucose regulation, and occupational factors in ATCOs and people with diabetes. Additional relevant articles were identified through reference screening. A total of 33 studies met the inclusion criteria. Studies focusing solely on oxidative or molecular mechanisms were excluded from the analysis. Results: Stressful events consistently triggered the expected hyperglycemic reaction in both healthy individuals and PwD. However, the literature indicates ATCOs demonstrate remarkable stress resilience and adaptation to the demanding conditions of their work environment, suggesting a unique occupational profile regarding metabolic stress responses. Conclusions: These findings contribute valuable insights to ongoing discussions regarding aeromedical fitness standards. The evidence suggests that ATCOs may not face the same metabolic risks as flight crews, indicating that current medical certification processes for insulin-treated aviation professionals warrant reconsideration in light of this emerging evidence. This research supports the potential for more individualized, occupation-specific aeromedical standards that better reflect the actual risk profiles of different aviation roles.

Keywords:  air traffic control operator; continuous glucose monitoring; diabetes mellitus; insulin; stress

DOI:  https://doi.org/10.3390/biomedicines13092125
Diabetes Technol Ther. 2025 Sep 25.

Carbohydrate Counting/Bolus Calculator Mobile Application Improves Time in Range in Adults with Type 1 Diabetes Subjects.

Sara A AlBabtain, Nora O AlAfif, Mohammed S Almehthel, Anwar A Jammah, Tariq A Wani, Tarfa A Aldahham, Ramzi A Ajjan, Saad H AlZahrani.

  Objective: To evaluate the effectiveness and safety of a mobile application for carbohydrate counting and bolus calculation (CHOC-BC) in adults with type 1 diabetes mellitus (T1DM). Research Design and Methods: A 12-week randomized controlled trial was conducted at King Fahad Medical City, Riyadh, Saudi Arabia. Adults with T1DM on multiple daily insulin injections and using Libre 2 glucose monitors were randomized to either CHOC-BC or conventional treatment. The primary endpoint was time in range (TIR; 70-180 mg/dL). Results: A total of 127 participants (70 females) were included: 64 in the intervention group and 63 in the control group with a mean age of 26.56 ± 4.8 and 26.74 ± 6.52 years, respectively. After 3 months, the intervention group achieved better TIR than the control group (51.20% ± 11.61% vs. 46.17% ± 13.02%; mean difference [MD], 5.03; 95% confidence interval [CI], 0.70-9.36; P = 0.023). Application users showed a significant reduction in level 2 time above range (17.25% ± 11.61% vs. 24.10% ± 15.74%; MD, -6.85; 95% CI, -11.70 to -1.99; P = 0.006). No significant differences were observed in body weight or time below range. Conclusions: The CHOC-BC mobile application empowered users to achieve better glycemic control while maintaining a safe profile that avoids hypoglycemia and weight gain.

Keywords:  carbohydrate counting; carbohydrate mobile application; glucose monitoring; hemoglobin A1c; type 1 diabetes mellitus

DOI:  https://doi.org/10.1177/15209156251376012