bims-glumda 2025-10-12 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–10–12
ten papers selected by
Mott Given

Impact of diabetes-specific nutrition formulas on time in range in overweight or obese Colombian patients with diabetes: A case series study.
Effect of an Intensive, Integrated Telehealth Intervention on Glycemic Control in Children and Adolescents With Type 1 Diabetes Using Continuous Glucose Monitoring: A Randomized, Crossover Trial.
Time in Range and Incident Diabetic Retinopathy: Clinical and Economic Evidence from Real-World Type 1 Diabetes Care.
Redefining inpatient diabetes care: A policy-driven approach to safe and effective technology use.
Managing Exercise-Related Glycemic Events in Type 1 Diabetes: Development and Validation of Predictive Models for a Practical Decision Support Tool.
Response to "Feasibility of continuous glucose monitoring in children with diabetic ketoacidosis: an exploratory observational study" by Izquierdo et al.
Serum value of fasting C-peptide (FC-P), fasting insulin (FIns), and glycated hemoglobin (HbA1c) after dynamic blood glucose monitoring-guided personalised nutrition and insulin pump therapy for type II diabetes mellitus.
Mobile application-based lifestyle intervention for improving glycemic control and body composition in manufacturing company employees in South Korea.
Italian guidelines for the treatment of type 1 diabetes.
Preliminary real-world observational data on A8 TouchCare use in adults with type 1 diabetes.

J Int Med Res. 2025 Oct;53(10): 3000605251382375

Impact of diabetes-specific nutrition formulas on time in range in overweight or obese Colombian patients with diabetes: A case series study.

Ana-M Gomez, Maria-P Chicue, Diana-C Henao, Oscar-M Muñoz-Velandia.

  The use of diabetes-specific nutrition formulas reduces postprandial glucose and insulin levels and promotes satiety, thereby improving glycemic control and contributing to weight loss. The effect of diabetes-specific nutrition formulas on the percentage of time in range (70-180 mg/dL) has not yet been investigated. This longitudinal pilot study was based on a case series of overweight or obese patients diagnosed with diabetes using continuous glucose monitoring and managed at the Hospital Universitario San Ignacio in Bogotá (Colombia). We compared continuous glucose monitoring data and anthropometric variables before and after 4 weeks of using a diabetes-specific nutrition formula as replacement for breakfast and afternoon snack. Eleven patients were included in this study; of these, 63.7% were men. The mean patient age was 55 ± 14.5 years, and 81.1% had type 2 diabetes. The mean percentage of time in range increased from 64% ± 24% to 75% ± 16% (mean difference: 10.63; 95% confidence interval: 2.13, 19.14; p = 0.01). The mean percentage of time above range (>180 mg/dL) decreased from 34% ± 25% to 23% ±14% (mean difference: -11.27; 95% confidence interval: -2.48, -20.05; p = 0.02), with no difference in hypoglycemia incidence or anthropometric variables. Our study suggests that the use of a diabetes-specific nutrition formula as replacement for breakfast and afternoon snack improves glycemic control, as measured via continuous glucose monitoring, in overweight or obese patients with type 2 diabetes. This adds to the emerging evidence on the effect of this intervention on continuous glucose monitoring metrics. Further evidence is needed from larger clinical trials to support the inclusion of this intervention in routine clinical practice.

Keywords:  Colombia; Diabetes-specific nutrition formula; continuous glucose monitoring; diabetes; time in range

DOI:  https://doi.org/10.1177/03000605251382375
Pediatr Diabetes. 2025 ;2025 7261998

Effect of an Intensive, Integrated Telehealth Intervention on Glycemic Control in Children and Adolescents With Type 1 Diabetes Using Continuous Glucose Monitoring: A Randomized, Crossover Trial.

Asma Deeb, Lubna Eldeeb, Shaker Suliman, Deepti Chaturvedi, Mary Tomy, Ghada Alkahlout, Reem Hassan Beck, Nabras Al Qahtani.

  Aim: To examine the impact of adding an intensive, integrated telehealth intervention on glycemic control in children and adolescents with type 1 diabetes using continuous glucose monitoring (CGM) and multiple daily injections (MDIs) of insulin. Materials and Methods: In this randomized, two-period crossover trial conducted between May 2023 and June 2024, 105 children and adolescents with type 1 diabetes using FreeStyle Libre 2 CGM were randomized to receive intensive telehealth weekly over 12 weeks first followed by routine care (n = 50) or routine care over 12 weeks first followed by intensive telehealth weekly (n = 55), with a 2-week washout. Intensive telehealth was intensified follow-up with weekly teleconsultation (20 min, by telephone) and digital support from a trained diabetes educator delivering structured support, including review of the latest ambulatory glucose profile. The primary outcome measures were HbA1c and GCM metrics. Results: The average (SD) age of the study cohort (n = 105) was 11.8 (4.2) years, 48.6% were female, with an average diabetes duration of 3.5 (3.0) years and suboptimally controlled diabetes in terms of HbA1c levels (9.4 (1.6) %, target < 6.5%), and other 14-day CGM metrics. Compared with routine care, intensified follow-up with weekly intensive telehealth was associated with a decrease in HbA1c (-0.29 (0.60) %, 95%CIs -0.41 to -0.17, p < 0.001), significantly increased time in range (TIR), and decreased time above range (TAR), average glucose level, glucose variability, glucose management indicator (GMI), and frequency of low glucose events. Teleconsultation did not affect time below range (TBR), which was already within target. Conclusion: This randomized, controlled, and crossover study shows that intensified follow-up with a weekly telehealth intervention results in small but significant improvements in glycemic control metrics in children and adolescents. The clinical impact of these changes requires prospective study.

Keywords:  adolescents; continuous glucose monitoring; intervention; randomized crossover trial; teleconsultation

DOI:  https://doi.org/10.1155/pedi/7261998
J Clin Endocrinol Metab. 2025 Oct 04. pii: dgaf544. [Epub ahead of print]

Time in Range and Incident Diabetic Retinopathy: Clinical and Economic Evidence from Real-World Type 1 Diabetes Care.

Nai-Chia Chen, Viral N Shah, Robert Brett McQueen.

   BACKGROUND: Continuous glucose monitoring (CGM) metrics are increasingly used to study the relationship between glycemic control and diabetic complications; however, the correlated glucose measurements and unequal follow-up times in real-world CGM data necessitate more advanced analytical approaches to yield unbiased estimates. This retrospective case-cohort study aimed to estimate longitudinal changes in time in range (TIR) on progression to diabetic retinopathy among patients with type 1 diabetes (T1D).
METHODS: This was a retrospective case-cohort study among patients with T1D, using CGM devices. We analyzed linked CGM and electronic health record data from 161 patients with T1D, with long-term follow-up for incident diabetic retinopathy diagnoses. TIR was defined as time spent in sensor glucose between 70-180 mg/dL. Multilevel mixed-effects parametric survival models and Markov models were constructed to obtain effects of TIR (e.g., hazard ratios) and lifetime trajectories of developing retinopathy and blindness, respectively.
RESULTS: A retrospective case-cohort of 161 patients with T1D (mean duration 13.7 years) included 71 cases (baseline HbA1c 8.2%) and 90 controls (baseline HbA1c 7.3%). A 10% increase in TIR was associated with a modestly lower risk of retinopathy progression (HR 0.88; 95% CI, 0.78-0.98) and an estimated prevention of 39 cases of blindness per 1,000 individuals over time (TIR 70% vs. 40%). Economic simulation modeling suggested $2,581 lower costs per person and a gain of 0.13 quality-adjusted life years (QALYs).
CONCLUSIONS: These findings can guide real-world CGM studies and support diabetes simulation models to predict future treatment outcomes from CGM metrics.

Keywords:  CGM metrics; Diabetic retinopathy; Long-term outcomes; Real-world evidence; Time in range; Type 1 diabetes

DOI:  https://doi.org/10.1210/clinem/dgaf544
J Am Assoc Nurse Pract. 2025 Oct 09.

Redefining inpatient diabetes care: A policy-driven approach to safe and effective technology use.

Mary E Holliday, Laura Herbert, Jan Kubas.

   BACKGROUND: Patients with diabetes are using advanced diabetes self-management technology, such as integrated insulin pumps with continuous glucose monitors (CGM) during hospitalization. Concerns surround their use in the inpatient setting ranging from safety risks to provider and nursing comfort in overseeing these devices.
LOCAL PROBLEM: At a 332-bed hospital in the Southeastern United States, the inpatient insulin pump policy did not support current evidence-based clinical recommendations.
METHODS: An updated policy was designed, allowing patients to continue using automated insulin pumps during hospitalization. Pre- and postpolicy nursing knowledge surveys, patient glucose metrics (including mean Glucose and Time in Range of 70-180 mg/dl), and patient narratives were evaluated to determine if the inpatient policy maintained optimal glucose control, improved patient satisfaction, and increased nursing comfort levels.
INTERVENTIONS: The updated policy was applied to all patients admitted using automated insulin pumps over 19 weeks. Nursing education was provided on the new policy release.
RESULTS: Mean glucose was 153.6 mg/dl for time segments on automated insulin pump, versus 201.4 mg/dl for stand-alone insulin pump without CGM and 262.3 mg/dl with subcutaneous insulin injections. Time in range was achieved at 72.1% (goal >70%) for time segment patients continued automated insulin pump, versus 44.3% insulin pump without CGM and 31.7% on subcutaneous insulin injections. Five of nine realms on the postnursing survey showed significant improvement (p < .05).
CONCLUSIONS: Applying an evidence-based policy that allows patients to remain on their automated insulin pump during hospitalization maintains glycemic control and patient satisfaction, as well as improves nursing comfort levels.

Keywords:  automated insulin pump; continuous glucose monitoring; hybrid closed-loop pump; inpatient diabetes technology

DOI:  https://doi.org/10.1097/JXX.0000000000001209
JMIR Diabetes. 2025 Oct 10. 10 e68948

Managing Exercise-Related Glycemic Events in Type 1 Diabetes: Development and Validation of Predictive Models for a Practical Decision Support Tool.

Sisi Ma, Ryan Coopergard, Mark Clements, Lisa Chow.

   Background: Exercise is an important aspect of diabetes self-management. Patients with type 1 diabetes frequently struggle with exercise-induced hyperglycemia and hypoglycemia, decreasing their willingness to exercise.
Objective: We aim to build accurate and easy-to-deploy models to forecast exercise-induced glycemic events in real-world settings.
Methods: We analyzed free-living data from the Type 1 Diabetes Exercise Initiative study, where adults with type 1 diabetes wore a continuous glucose monitor (CGM) while performing video-guided exercises (30-minute exercises at least 6 times over 4 weeks), along with concurrent detailed phenotyping of their insulin program and diet. We built models to predict glycemic events (blood glucose ≤54 mg/dL, ≤70 mg/dL, ≥200 mg/dL, and ≥250 mg/dL) during and 1 hour post exercise with variables from 4 data modalities, such as demographic and clinical (eg, glycated hemoglobin; CGM (blood glucose value and their summary statistics); carbohydrate intake and insulin administration; and exercise type, duration, and intensity. We used repeated stratified nested cross-validation for model selection and performance estimation. We evaluated the relative contribution of the 4 input data modalities for predicting glycemic events, which informs the cost and benefit for including them in the decision support tool for risk prediction. We also evaluated other important aspects related to model translation into decision support tools, including model calibration and sensitivity to noisy inputs.
Results: Our models were built based on 1901 exercise episodes for 329 participants. The median age for the participants was 34 (IQR 26-48) years. Of the participants, 74.8% (246/329) are female and 94.5% (311/329) are White. A total of 182/329 (55.3%) participants used a closed-loop insulin delivery system, while the rest used a pump without a closed-loop system. Models incorporating information from all 4 data modalities showed excellent predictive performance with cross-validated area under the receiver operating curves (AUROCs) ranging from mean 0.880 (SD 0.057) to mean 0.992 (SD 0.001) for different glycemic events. Models built with CGM data alone have statistically indistinguishable performance compared to models using all data modalities, indicating the other 3 data modalities do not add additional information with respect to predicting exercise-related glycemic events. The models based solely on CGM data also showed outstanding calibration (Brier score ≤0.08) and resilience to noisy input.
Conclusions: We successfully constructed models to forecast exercise-induced glycemic events using only CGM data as input with excellent predictive performance, calibration, and robustness. In addition, these models are based on automatically captured CGM data, thus easy to deploy and maintain and incurring minimal user burden, enabling model translation into a decision support tool.

Keywords:  continuous glucose monitoring; decision support tool; exercise-induced glycemic events; hyperglycemia; hypoglycemia; predictive modeling; type 1 diabetes

DOI:  https://doi.org/10.2196/68948
Eur J Pediatr. 2025 Oct 07. 184(11): 663

Response to "Feasibility of continuous glucose monitoring in children with diabetic ketoacidosis: an exploratory observational study" by Izquierdo et al.

Dario Iafusco, Alessandro Pennarella, Federica Casamassima, Alessia Massa, Gulsum Ozen, Giorgia Ippolito, Emanuele Miraglia Del Giudice, Angela Zanfardino.

DOI: https://doi.org/10.1007/s00431-025-06496-9
J Med Biochem. 2025 Sep 05. 44(6): 1288-1296

Serum value of fasting C-peptide (FC-P), fasting insulin (FIns), and glycated hemoglobin (HbA1c) after dynamic blood glucose monitoring-guided personalised nutrition and insulin pump therapy for type II diabetes mellitus.

Qing Zhou, Li Zou, Yan Gao, Hua Ma, Yaping Guo, Guohong Zhu.

   Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterised by impaired glucose metabolism, which necessitates comprehensive management of blood glucose (BG), blood pressure, and lipid profiles. This study aimed to evaluate the clinical effects of individualised nutrition and insulin pump therapy, guided by continuous glucose monitoring (CGM) and the Quality Circle Control (QCC) nursing model, on various biomarkers in T2DM patients, including fasting C-peptide (FC-P), fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), fasting insulin (FIns), and glycated haemoglobin (HbA1c).
Methods: Eighty T2DM patients treated at our hospital were enrolled in the study between January 2023 and January 2024. Patients were assigned to either the experimental group (EG), which received individualised nutrition and insulin pump therapy supported by CGM and the QCC nursing model, or the regular group (RG), which received standard care. Differences in BG control, insulin usage, CGM system performance (including downtime and anomaly rates), and patient satisfaction were compared between the two groups.
Results: The EG demonstrated significant improvements in FC-P, FPG, 2hPG, FIns, and HbA1c levels compared to the RG (P<0.05). Specifically, the EG showed more rapid achievement of BG targets, reduced glucose variability, lower insulin usage, and decreased CGM system anomalies.
Conclusions: The QCC nursing model, when integrated with individualised nutrition and insulin pump therapy guided by CGM, significantly enhances blood glucose control, optimises insulin therapy, and improves patient outcomes, including dietary habits, quality of life, and reduction in hypoglycemic events. This model shows promise as an effective strategy for managing T2DM and warrants further adoption in clinical practice.

Keywords:  T2DM; continuous glucose monitoring; fasting insulin (FIns); glycated haemoglobin (HbA1c); individualised nutrition; insulin pump therapy; quality circle control nursing model; serum value of fasting C-peptide (FC-P)

DOI:  https://doi.org/10.5937/jomb0-55738
Diabetol Metab Syndr. 2025 Oct 10. 17(1): 389

Mobile application-based lifestyle intervention for improving glycemic control and body composition in manufacturing company employees in South Korea.

Dahyeon Koo, Yujin Bang, Dohoung Kim, Irang Im, Pumsoo Kim, Dougho Park.

   BACKGROUND: Workplace environments play a significant role in the development of chronic metabolic disorders. In this study, we evaluated the effectiveness of a mobile application-assisted lifestyle intervention integrated with continuous glucose monitoring (CGM) in improving glycemic control and body composition among employees of manufacturing companies and explored key predictors of intervention responsiveness.
METHODS: A prospective cohort study was conducted involving 344 employees from two manufacturing companies in South Korea. Participants underwent a 12-week intervention that included individualized coaching through a mobile application and structured behavioral support, with the first 2 weeks involving real-time glucose monitoring. The primary outcomes included changes in glycated hemoglobin (HbA1c) and body mass index (BMI). Secondary outcomes were body composition parameters and CGM-derived glycemic variability indices, including spike count, average real variability (ARV), and frequency strength variability (FSV). Logistic regression analysis was conducted to identify key predictors of intervention effectiveness.
RESULTS: After 12 weeks, HbA1c, BMI, body weight, and body fat mass significantly reduced. In addition, the muscle-to-fat ratio significantly increased. Participants with baseline HbA1c ≥ 6.5% showed greater improvements in HbA1c (7.2→6.8%, p < 0.001) than those with HbA1c < 6.5%. Similarly, the high BMI subgroup (≥ 25 kg/m2) exhibited significant improvements in BMI (27.6 to 27.0 kg/m2, p < 0.001). Early CGM data indicated significant reductions in spike count (p = 0.046), ARV (p = 0.001), and FSV (p = 0.031). Lower baseline FSV indicated greater HbA1c improvement (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.90, p = 0.008).
CONCLUSION: This study demonstrated that a 12-week mobile application-based lifestyle intervention is associated with improved glycemic control and body composition, particularly among manufacturing company employees with elevated baseline HbA1c and BMI. Early reductions in glycemic variability indicated the intervention's potential for rapid and sustained metabolic benefits.

Keywords:  Continuous glucose monitoring; Diabetes mellitus; Digital health; Employees; Healthy lifestyle

DOI:  https://doi.org/10.1186/s13098-025-01948-6
Acta Diabetol. 2025 Oct 06.

Italian guidelines for the treatment of type 1 diabetes.

for Associazione Medici Diabetologi (AMD), Società Italiana di Diabetologia (SID), Italian Society for Pediatric Endocrinology, Diabetology (SIEDP)



Keywords:  Clinical guidelines; Continuous glucose monitoring; Cost-effectiveness; Insulin pump; Insulin treatment; Type 1 diabetes

DOI:  https://doi.org/10.1007/s00592-025-02569-1
Acta Diabetol. 2025 Oct 06.

Preliminary real-world observational data on A8 TouchCare use in adults with type 1 diabetes.

Nicolò Diego Borella, Anna Corsi, Cristiana Scaranna, Roberto Trevisan, Giuseppe Lepore.



Keywords:  AID; CGM metrics; Medtrum; Touchcare A8; Type 1 diabetes

DOI:  https://doi.org/10.1007/s00592-025-02589-x