bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2025–11–02
nineteen papers selected by
Mott Given
  1. Continuous Glucose Monitoring (CGM) as a Behavior Modification Tool: A Case Series on CGM-Guided Nutrition in People With Type 2 Diabetes Not Using Insulin.
  2. Implementing continuous glucose monitoring in public primary care for type 2 diabetes management: a convergent mixed-methods study of patient and provider experiences in Singapore.
  3. Effectiveness of Continuous Glucose Monitoring in a Pharmacist-Run Collaborative Drug Therapy Management Service for Underserved Individuals With Diabetes: A Quasi-Experimental Study.
  4. Duration of Continuous Glucose Monitoring and Glycemic Outcomes in Type 2 Diabetes.
  5. Expanding the Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus: Impact on Glycemic Control and Metabolic Health.
  6. Myconecrosis at the continuous glucose monitoring sensor insertion site in chronic hyperglycaemia.
  7. Continuous Glucose Monitoring Frequency and Glycemic Control in People With Type 2 Diabetes.
  8. Case Studies From India: Management of Diabetes Using Continuous Glucose Monitoring.
  9. Persistent C-peptide secretion is associated with favourable CGM metrics in adults with type 1 diabetes.
  10. The Effects of Continuous Glucose Monitoring on Patient-Reported Outcomes in Adults with Non-Insulin Dependent Type 2 Diabetes: A Randomized Controlled Trial.
  11. Continuous Glucose Monitoring in People at High Risk of Diabetes and Dysglycaemia: Transforming Early Risk Detection and Personalised Care.
  12. The impact of continuous glucose monitoring on diabetes distress among high-risk adolescents and young adults: Secondary outcomes from a pilot randomized controlled trial.
  13. Early Postoperative Hyperglycemia After Arthroplasty in Type 2 Diabetes: Insights from Continuous Glucose Monitoring and Identification of Predictive Glycemic Parameters.
  14. Harnessing dysglycaemia heterogeneity for precision type 2 diabetes prevention.
  15. Systematic intensive therapy in addition to continuous glucose monitoring in adults with type 1 diabetes: a multicentre, open-label, randomised controlled trial.
  16. Diabetes-related emotional distress, depressive symptoms, and continuous glucose monitoring outcomes.
  17. Diabetes heterogeneity beyond 3.8 years: missed risks of silent hypoglycaemia and long-term complications in the 4C study.
  18. The Impact of Insulin Pump Therapy on Glycemic Control and Acute Diabetes Complications in Type 1 Diabetes: Real-World Evidence From a Single Center.
  19. Efficacy and Safety of iLet Bionic Pancreas in Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta Analysis.
  1. Clin Diabetes. 2025 ;43(4): 610-617
    Continuous Glucose Monitoring (CGM) as a Behavior Modification Tool: A Case Series on CGM-Guided Nutrition in People With Type 2 Diabetes Not Using Insulin.
    Tara M Ettestad, Holly J Willis, Elizabeth Johnson, Courtney R Green, Richard M Bergenstal.
      
    DOI:  https://doi.org/10.2337/cd24-0106
  2. BMC Prim Care. 2025 Oct 31. 26(1): 336
    Implementing continuous glucose monitoring in public primary care for type 2 diabetes management: a convergent mixed-methods study of patient and provider experiences in Singapore.
    Shilpa Tyagi, Keith Sng, David Wei Liang Ng, Valerie Hui Ying Teo, Si Min Thio, Jeremy Cong En He, Chun Yen Beh, Ming Hann Cheah, Nooradlin Marina Binti Mohammad Junaidi See Toh, Jiawei Chen, Gerald Choon-Huat Koh.
       BACKGROUND: Type 2 diabetes (T2D) is highly prevalent in Singapore, yet glycemic control remains suboptimal in primary care. Continuous glucose monitoring (CGM) offers real-time feedback that may improve self-management, but adoption in Asian primary care settings is limited by cost and system integration challenges. This study evaluated the feasibility, acceptability, and perceived impact of CGM implementation in Singapore's public primary care clinics using a convergent mixed-methods design.
    METHODS: A CGM pilot program was conducted across five public polyclinics. We studied a purposive sample of 12 adults with T2D and 10 primary care providers. Patients used CGM sensors for two cycles over a three- to six-month period. Quantitative surveys assessed usability, satisfaction, and perceived outcomes. Semi-structured interviews with patients and providers explored user experiences and implementation barriers. Data were analysed independently and then integrated for a comprehensive assessment.
    RESULTS: Among the study participants, over 80% of patients found the CGM device easy to use, comfortable, and useful in understanding daily glucose fluctuations. Real-time feedback prompted immediate behaviour changes, 83% reported healthier diets and more frequent glucose monitoring, and 67% felt more confident managing diabetes. Providers unanimously reported that CGM improved clinical decision-making and enhanced patient engagement, enabling more timely and tailored treatment adjustments. Key barriers identified included cost (only 58% of patients were willing to pay out-of-pocket; 89% of providers cited funding concerns), added workload for data interpretation and patient education, and difficulties integrating CGM data into existing workflows. Nonetheless, 67% of patients expressed willingness to reuse CGM if affordable, and providers endorsed its clinical value.
    CONCLUSION: CGM use in Singapore's public primary care was feasible and acceptable, supporting individualized diabetes care. Broader adoption will require addressing cost, IT integration, and provider support to realize CGM's full potential in routine T2D management.
    Keywords:  Continuous glucose monitoring; Diabetes; Qualitative research; Quantitative research; Telemonitoring; User-experience
    DOI:  https://doi.org/10.1186/s12875-025-03001-x
  3. Clin Diabetes. 2025 ;43(4): 554-560
    Effectiveness of Continuous Glucose Monitoring in a Pharmacist-Run Collaborative Drug Therapy Management Service for Underserved Individuals With Diabetes: A Quasi-Experimental Study.
    Jodie S Gee, Natalie Rosario, Kevin W Garey, Bernadette Asias-Dinh.
      The American Diabetes Association recommends continuous glucose monitoring (CGM) to assist people with diabetes in reaching glycemic targets. However, implementation of CGM into routine practice, especially for clinics caring for underserved populations, is not well described. This study assessed the impact of short-term CGM in combination with a pharmacist-led collaborative drug therapy management service on glycemic control in underserved people with diabetes. The pharmacist-led CGM program resulted in improved glycemic control in this population. Future studies should evaluate the scalability and sustainability of this model across diverse clinical practice settings.
    DOI:  https://doi.org/10.2337/cd25-0010
  4. JAMA Netw Open. 2025 Oct 01. 8(10): e2539286
    Duration of Continuous Glucose Monitoring and Glycemic Outcomes in Type 2 Diabetes.
    Peter Lommer Kristensen.
      
    DOI:  https://doi.org/10.1001/jamanetworkopen.2025.39286
  5. Life (Basel). 2025 Oct 01. pii: 1543. [Epub ahead of print]15(10):
    Expanding the Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus: Impact on Glycemic Control and Metabolic Health.
    Mi-Joon Lee, Bum-Jeun Seo, Jae-Hyoung Cho.
      This study aims to investigate the effects of continuous glucose monitoring (CGM) on glycemic control in patients with diabetes mellitus (DM) and to identify the sociodemographic or health behavioral factors that influence the outcomes. The data were collected from 510 diabetic patients prescribed to use CGM for 12 weeks and analyzed using SPSS 27.0. Paired samples t-tests were used to compare the glycemic control (HbA1c and fasting glucose) and metabolic health (body mass index and total cholesterol) measures of subjects before and after the CGM use, and independent t-tests were conducted to examine whether the effectiveness of CGM differs according to subjects' sociodemographic and health behavioral characteristics. As a result of this study, the use of CGM resulted in a significant reduction in HbA1c from 8.09 to 7.48 percent (p < 0.001) and in fasting glucose from 152.41 to 137.16 mg/dL (p < 0.001). In the subgroup analysis of CGM effectiveness, fasting glucose reduction was greater in females than in males and in patients with type 2 diabetes than in those with type 1 diabetes. In conclusion, it is essential to consider patient characteristics to enhance the effectiveness of CGM and to expand its use to type 2 diabetes to reduce the social burden of the disease.
    Keywords:  blood glucose; continuous glucose monitoring; diabetes mellitus; digital health; health behavior
    DOI:  https://doi.org/10.3390/life15101543
  6. BMJ Case Rep. 2025 Oct 28. pii: e267838. [Epub ahead of print]18(10):
    Myconecrosis at the continuous glucose monitoring sensor insertion site in chronic hyperglycaemia.
    Rosalyn Ly, Alexander Yao, Jessica O'Keeffe, Rahul D Barmanray.
      
    Keywords:  Diabetes; Diabetes Mellitus, Type 1; Fungal Infections
    DOI:  https://doi.org/10.1136/bcr-2025-267838
  7. JAMA Netw Open. 2025 Oct 01. 8(10): e2539278
    Continuous Glucose Monitoring Frequency and Glycemic Control in People With Type 2 Diabetes.
    Irl B Hirsch, Satish K Garg, Enrico Repetto, Janet Snell-Bergeon, Brian Ulmer, Christopher Perkins, Richard M Bergenstal.
       IMPORTANCE: The association of continuous glucose monitoring (CGM) frequency with glycemic control among people with type 2 diabetes has not been well-studied.
    OBJECTIVE: To evaluate the association of CGM frequency with glycemic status over 12 months vs no CGM use.
    DESIGN, SETTING, AND PARTICIPANTS: This retrospective, propensity score-matched, cross-sectional study used Optum deidentified Market Clarity Data (claims and electronic medical record data) obtained between January 1, 2019, and December 31, 2023, including data from 6 months prior to each participant's index date with 12 months follow-up. Participants with type 2 diabetes, aged 18 years or older, and with hemoglobin A1C (HbA1C) levels between 7.0% to 15.0% at baseline were included.
    EXPOSURE: Number of days using CGM during the 12-month postindex period (frequency 1, ≥1 to ≤90 days; frequency 2, >90 to ≤180 days; frequency 3, 180 to ≤270 days; frequency 4, >270 days; control, no CGM use).
    MAIN OUTCOMES AND MEASURES: The primary outcome was change in HbA1C relative to frequency of CGM use vs no CGM. A mixed-model analysis was used to determine HbA1C changes across groups.
    RESULTS: The analysis included 9258 patients (4207 female [45.4%]; mean [SD] age, 55.9 [10.6] years), with 4629 patients in the control group, 1081 in frequency 1, 523 in frequency 2, 540 in frequency 3, and 2485 in frequency 4. High CGM use (frequency 4) was associated with greater reductions in HbA1C at 12 months (-1.52 percentage points; 95% CI, -1.73 to -1.32 percentage points) vs no CGM use (-0.63 percentage points; 95% CI, -0.80 to -0.45 percentage points). CGM users experienced the greatest reductions at approximately 3 months (frequency 1: -0.59 percentage points; 95% CI, -0.96 to -0.21 percentage points; frequency 2: -0.57 percentage points; 95% CI, -1.10 to -0.05 percentage points; frequency 3: -0.79 percentage points; 95% CI, -1.25 to -0.34 percentage points; frequency 4: -0.91 percentage points; 95% CI, -1.12 to -0.70 percentage points) compared with control patients (-0.28 percentage points; 95% CI, -0.47 to -0.09 percentage points). No further glycemic improvement was observed in frequency 2 and frequency 3 groups after 6 months. Improvements in patients in frequency 1 and frequency 4 groups were sustained for the duration of the postindex period. The addition of a glucagon-like peptide-1 receptor agonist in the frequency 4 group was associated with an HbA1C treatment difference of -1.13 percentage points (95% CI, -1.46 to -0.80 percentage points) vs controls at approximately 12 months.
    CONCLUSIONS AND RELEVANCE: This cross-sectional study found that frequent use of CGM (>75% sensor wear) was associated with improved glycemic control compared with infrequent or no use of CGM. These findings suggest that clinicians should monitor CGM use at 6 months, identify potential therapeutic obstacles, and encourage continuous use of CGM.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2025.39278
  8. Cureus. 2025 Sep;17(9): e93177
    Case Studies From India: Management of Diabetes Using Continuous Glucose Monitoring.
    Ajay Kumar Gupta, Ajay Krishnan, Manu Kataria, Nishesh Jain.
      Continuous glucose monitoring (CGM) has significantly advanced diabetes management by enabling real-time glucose tracking. However, many patients with diabetes still fail to achieve optimal glycemic control. This case series reviews the role of CGM by analyzing case studies from various clinical departments of a quaternary care center in Northern India. We identified four cases: a 46-year-old male patient with chronic liver disease on CGM who achieved optimal glycemic control (average glucose, 105 mg/dL; estimated glycated hemoglobin (HbA1c), 5.8%) by maintaining a time in range (TIR) of 98%; a 31-year-old female patient diagnosed with gestational diabetes mellitus (GDM) who maintained excellent glycemic control (estimated HbA1c, 6%; TIR, 96%) using basal insulin, with minimal glucose variability and no significant complications; a 28-year-old female patient with diabetes in pregnancy (DIP) who achieved a 100% TIR for over 14 days, with an average glucose of 106 mg/dL and estimated HbA1c of 5.8%. The patient was on insulin Degludec (Tresiba®, Novo Nordisk A/S, Bagsværd, Denmark) and experienced two minor low-glucose events but no major complications; a 69-year-old male patient with diabetes, hypertension, and coronary artery disease who had a TIR of 56% on Tresiba® and oral medications, with an average glucose of 177 mg/dL and estimated HbA1c 7.5%, controlled glucose variability, and no hypoglycemic events. These cases highlight the effectiveness of CGM in managing diabetes across diverse clinical conditions in adults. The CGM system enables tailoring of treatment regimens to improve glycemic control and reduce the risk of hypoglycemia, all of which are essential for optimizing patient outcomes.
    Keywords:  continuous glucose monitoring; diabetes in pregnancy; diabetes management; gestational diabetes; type 2 diabetes
    DOI:  https://doi.org/10.7759/cureus.93177
  9. Diabetologia. 2025 Oct 30.
    Persistent C-peptide secretion is associated with favourable CGM metrics in adults with type 1 diabetes.
    Roland H Stimson, Anna R Dover, Catriona Clarke, Carina Conceicao, Lindsay McDonald, Lucy Miller, Helen Wise, Shareen Forbes, Rohana J Wright, Marcus J Lyall, Mark W J Strachan, Fraser W Gibb.
       AIMS/HYPOTHESIS: Residual endogenous insulin secretion, reflected by measurable C-peptide, has been linked to improved glycaemic management in type 1 diabetes. We aimed to assess the relationship between random plasma C-peptide levels and continuous glucose monitoring (CGM) metrics in a large, real-world cohort of adults with type 1 diabetes.
    METHODS: We conducted a cross-sectional analysis of adults with type 1 diabetes attending a single UK centre. Inclusion criteria were diabetes duration >1 year, random plasma glucose >4 mmol/l at C-peptide sampling and ≥70% data completeness on the Freestyle Libre 2 CGM device within the corresponding month. Associations between C-peptide categories (<50 pmol/l to >400 pmol/l) and CGM/HbA1c outcomes were assessed using non-parametric tests and multivariable logistic regression.
    RESULTS: In total, 945 adults with type 1 diabetes were included with a median age of 45 years (33-57) and median diabetes duration of 18 years (7-29). Of these, 54% were male and median HbA1c was 63 mmol/mol (54-73) (7.9% [7.1-8.8]). Higher C-peptide levels were associated with shorter diabetes duration (OR 0.87 per year, p<0.001), older age at diagnosis (OR 1.04 per year, p<0.001) and male sex (OR 1.44, p=0.042). Higher C-peptide was significantly associated with favourable CGM metrics, including lower time below range (2% [1-5] in those with C-peptide <50 pmol/l vs 1% [0-3] in those with C-peptide 101-200 pmol/l), lower glucose variability (glucose CV 37.5% [34.2-42.0] in those with C-peptide <50 pmol/l vs 32.5% [29.0-36.6] in those with C-peptide 101-200 pmol/l), higher time in range (45.0% [32.0-61.0] in those with C-peptide <50 pmol/l vs 55.0% [37.0-66.5] in those with C-peptide 50-100 pmol/l) and favourable hyperglycaemia measures (time above 13.9 mmol/l 20.0% [9.0-36.0] in those with C-peptide <50 pmol/l vs 10.0% [5.5-31.5] in those with C-peptide 50-100 pmol/l) (p<0.05 for all pairwise comparisons). C-peptide ≥100 pmol/l was independently associated with meeting time below range <4% (OR 5.4, p<0.001), and C-peptide ≥100 pmol/l was also associated with achieving HbA1c <53 mmol/mol (7%) (OR 1.8, p=0.043. No significant glycaemic differences were seen between individuals with C-peptide <10 pmol/l and 10-49 pmol/l.
    CONCLUSIONS/INTERPRETATION: Random C-peptide measurement in routine care identifies adults with type 1 diabetes who are more likely to achieve CGM and HbA1c targets. Differences in glycaemic metrics are clinically meaningful at thresholds ≥100 pmol/l. These findings support efforts to preserve residual beta cell function and highlight the potential value of C-peptide in individualising therapy.
    Keywords:  Clinical diabetes; Clinical science; Devices; Human; Hypoglycaemia
    DOI:  https://doi.org/10.1007/s00125-025-06578-1
  10. Can J Diabetes. 2025 Oct 27. pii: S1499-2671(25)00354-5. [Epub ahead of print]
    The Effects of Continuous Glucose Monitoring on Patient-Reported Outcomes in Adults with Non-Insulin Dependent Type 2 Diabetes: A Randomized Controlled Trial.
    Inga Olu-Jordan, Pratima Singh, Jiawei Ryan Zheng, Roseanne O Yeung, Donna P Manca, Tawnya Perry, Gulelala Rahim, Evan Hagen, Darren Lau.
       AIM: Assess the effect of a 6-week continuous glucose monitor (CGM) intervention with telemonitoring-enabled virtual diabetes educator visits on patient-reported outcomes (PROs) in adults with type 2 diabetes (T2D) not using insulin.
    METHODS: Individuals with HbA1c > 7.0% (n=105) were computer-randomized in an open-label parallel-group design (clinicaltrials.gov NCT05319496) to receive 6 weeks of upfront CGM (weeks 0-6) (n = 45) or to enhanced usual care (n = 41), both with virtual diabetes educator visits. The following outcomes were measured at baseline (week 0), 6 weeks, and 12 weeks: Problem Areas in Diabetes (PAID), Diabetes Empowerment Scale-Short Form, EuroQol-5D visual analogue scale, International Physical Activity Questionnaire, and the UK Diabetes and Diet Questionnaire. Between-group differences in change scores for each outcome at 6 and 12 weeks were assessed using T-tests.
    RESULTS: Of 105 participants (mean age 57 years, 51% male, HbA1c 8.1%), 86 completed the trial. CGM participants exhibited a greater reduction in total PAID scores at 12 weeks vs. baseline, in comparison to those not using CGM (p = 0.03), with similar between-group differences observed for PAID sub-scales of emotional distress (p = 0.02) and food-related problems (p = 0.004). CGM participants also had larger improvements in diabetes empowerment at 6 weeks (p = 0.009). We did not detect any differences in the number of anti-hyperglycemic medication classes, physical activity, and diet.
    DISCUSSION: In adults with T2D not on insulin, CGM with virtual educator visits produced improvements in emotional and food-related distress, and diabetes-related empowerment at 12 weeks.
    Keywords:  Continuous Glucose Monitoring (CGM); Patient-Reported Outcomes (PROs); Type 2 diabetes (T2D); diabetes education; physical activity; randomized clinical trial
    DOI:  https://doi.org/10.1016/j.jcjd.2025.10.174
  11. Life (Basel). 2025 Oct 10. pii: 1579. [Epub ahead of print]15(10):
    Continuous Glucose Monitoring in People at High Risk of Diabetes and Dysglycaemia: Transforming Early Risk Detection and Personalised Care.
    Alexandros L Liarakos, Grigorios Panagiotou, Maria Chondronikola, Emma G Wilmot.
      Continuous glucose monitoring (CGM)-based interventions have been predominantly conducted in people with established diabetes. Recently, there has been an increasing interest in using CGM for clinical and research purposes in people without diabetes. In this review, we describe the current evidence regarding the use of CGM in people at high risk of diabetes. To date, there is no strong evidence to support the global implementation of CGM in individuals who are at risk of developing diabetes. However, there are promising results highlighting the benefits of CGM in specific populations such as people living with obesity, prediabetes, gestational diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, other endocrinopathies, and genetic syndromes. Also, CGM has shown promising potential in people with positive islet autoantibodies and pre-symptomatic type 1 diabetes, those treated with medications that induce hyperglycaemia or diabetes, and individuals receiving solid organ transplantation who are at risk of post-transplant diabetes mellitus. However, larger studies are needed to confirm these preliminary results. CGM-derived data are not currently validated for the diagnosis of diabetes. There is no CGM-derived definition of normoglycaemia in people without diabetes. Looking to the future, CGM metrics, in tandem with physical activity, dietary intake, and clinical parameters, and eventually bioinformatics, may inform personalised risk scores for precision prevention of individuals at risk. We conclude that further research is needed to clarify the indications, drawbacks, and feasibility of CGM use in people at high risk of diabetes to identify those groups who could benefit most from this technology.
    Keywords:  cardiovascular risk; continuous glucose monitoring; diabetes; precision medicine; prevention
    DOI:  https://doi.org/10.3390/life15101579
  12. Psychol Health Med. 2025 Oct 29. 1-18
    The impact of continuous glucose monitoring on diabetes distress among high-risk adolescents and young adults: Secondary outcomes from a pilot randomized controlled trial.
    Kathryn Jeter, Rachel Fisher, Katherine Traino, Taylor Dattilo, Rebecca Allen, Michael Anderson, James Cutler, David Sparling, Joni Beck.
      Adolescents and young adults (AYA) with Type 1 diabetes (T1D) are at an increased risk for health difficulties and diabetes distress. Continuous glucose monitoring (CGM) may decrease management burden and diabetes distress. The present study is a secondary analysis from a pilot randomized controlled trial that aims to evaluate the impact of CGM use with and without an added educational intervention on diabetes distress among a high-risk cohort of AYA with T1D. Of the 33 participants (Mage = 17.7; range 15-25 years) included in this secondary analysis, 19 were randomized to unblinded CGM with a pattern management intervention (CGM-PM) and 13 to CGM with treatment as usual (CGM-TAU), including 14 adults (≥18 years) and 19 parent/teen dyads. Adolescent participants and parents of adolescents completed the Problem Areas In Diabetes measure at baseline, 12, and 24 weeks. Multilevel modeling analyses were used to examine group differences in diabetes distress over time. At baseline, groups were similar in terms of demographics (e.g. race, age), hemoglobin A1c, and diabetes distress. In the unconditional models, diabetes distress decreased from baseline to 24 weeks for teenagers (b = -6.28, SE = 2.44, p = 0.013) and parents (b = -9.62, SE = 3.02, p = 0.004). However, diabetes distress did not significantly decrease at 12 weeks or 24 weeks for young adults (p = .050-.079). Three linear mixed models revealed no significant Time × Intervention effects for teenager, parent, or adult distress at 12 or 24 weeks. Results suggest that among a high-risk cohort, CGM technology supports reductions in diabetes distress for parents and teenagers, but not young adults. Future research should examine individual and systemic barriers that impede improvements in distress in young adults.
    Keywords:  Type 1 diabetes; adolescent; continuous glucose monitoring; diabetes distress; young adult
    DOI:  https://doi.org/10.1080/13548506.2025.2575402
  13. Life (Basel). 2025 Oct 13. pii: 1594. [Epub ahead of print]15(10):
    Early Postoperative Hyperglycemia After Arthroplasty in Type 2 Diabetes: Insights from Continuous Glucose Monitoring and Identification of Predictive Glycemic Parameters.
    Toshiyuki Tateiwa, Jumpei Shikuma, Yasuhito Takahashi, Itaru Nakamura, Hajime Matsumura, Ryo Suzuki, Kengo Yamamoto.
       BACKGROUND: Diabetes mellitus is a well-established risk factor for surgical site infections (SSIs), particularly periprosthetic joint infections (PJIs) following joint arthroplasty. Although strict glycemic control in the early postoperative period is critical, few studies have evaluated glycemic dynamics using continuous glucose monitoring (CGM) in this setting. This study aimed to characterize early postoperative glycemic patterns using CGM in patients with type 2 diabetes mellitus undergoing lower extremity arthroplasty and to identify factors associated with postoperative hyperglycemia.
    METHODS: We retrospectively analyzed 41 patients with type 2 diabetes who underwent total hip or knee arthroplasty. CGM was used to monitor glucose levels continuously for 48 h after surgery. All patients received standard glycemic management based on a sliding-scale insulin protocol. Patients were classified into two groups: normoglycemia (glucose consistently < 200 mg/dL) and hyperglycemia (glucose ≥ 200 mg/dL at least once within 48 h). Univariable and multivariable logistic regression analyses were conducted to identify predictors of postoperative hyperglycemia.
    RESULTS: Hyperglycemia occurred in 65.9% of all patients. Univariable analysis identified fasting plasma glucose (FPG), mean postoperative glucose, number of antidiabetic medications, and glucose variability as significant predictors (p < 0.05). In multivariable analysis adjusted for HbA1c, glycoalbumin, and glucose variability, FPG [odds ratio (OR): 1.07; 95% confidence interval (CI): 1.01-1.14; p = 0.024], mean glucose (OR: 1.12; 95% CI: 1.02-1.23; p = 0.017), and glucose variability (OR: 1.19; 95% CI: 1.05-1.35; p = 0.008) remained independently associated with hyperglycemia.
    CONCLUSIONS: CGM revealed a high incidence of early postoperative hyperglycemia despite conventional sliding-scale insulin therapy. These findings highlight the limitations of current glycemic protocols and underscore the potential of CGM as a diagnostic tool to guide individualized glucose management. Future studies should evaluate whether CGM-guided interventions can improve surgical outcomes, particularly in reducing SSI risk among high-risk diabetic patients.
    Keywords:  continuous glucose monitoring; glycemic variability; lower extremity arthroplasty; postoperative glycemic control; type 2 diabetes mellitus
    DOI:  https://doi.org/10.3390/life15101594
  14. Curr Opin Lipidol. 2025 Oct 30.
    Harnessing dysglycaemia heterogeneity for precision type 2 diabetes prevention.
    Suyi Xie, Jordi Merino.
       PURPOSE OF REVIEW: Type 2 diabetes (T2D) is a heterogeneous, progressive metabolic disease and a major contributor to cardiovascular disease worldwide. Current prevention strategies, centred on population-level lifestyle recommendations, have had limited success, highlighting the need for more comprehensive approaches that account for interindividual variation in intervention response.
    RECENT FINDINGS: Although discrete T2D subtypes using genomics or clinical variables have been proposed for targeted diabetes prevention and care strategies, emerging evidence supports a more dynamic view of heterogeneity as a continuous spectrum of metabolic dysfunction. Continuous glucose monitoring and multiomics profiling have shown promises in detecting early metabolic dysfunction in individuals with normal glycemia.
    SUMMARY: In this review, we synthesize advances in modelling T2D phenotypic continuum and highlight how emerging technologies, including continuous glucose monitoring and multiomics profiling, can detect early metabolic dysregulation. We also discuss methodological challenges, such as the need for standardized deep phenotyping, robust analytic frameworks, and inclusion of diverse populations to ensure equity in translation. Finally, we outline future directions for translating these insights into scalable, mechanism-informed interventions that address glycaemic progression from subclinical changes to more advanced forms of the disease.
    Keywords:  continuous glucose monitoring; genomics; multiomics; precision prevention; type 2 diabetes continuum
    DOI:  https://doi.org/10.1097/MOL.0000000000001018
  15. Lancet Reg Health Eur. 2025 Dec;59 101485
    Systematic intensive therapy in addition to continuous glucose monitoring in adults with type 1 diabetes: a multicentre, open-label, randomised controlled trial.
    Arndís F Ólafsdóttir, Kari-Anne Sveen, Magnus Wijkman, Sara Hallström, Per-Henrik Nilsson, Sofia Sterner Isaksson, Helene Holmer, Marie Ekström, Henrik Imberg, Marcus Lind.
       Background: Although continuous glucose monitor/intermittent scanning continuous glucose monitor (CGM/isCGM) is widely used for glucose monitoring, many adults with type 1 diabetes (T1D) still fail to achieve recommended glycaemic targets. We aimed to evaluate whether digital distance counselling based on CGM data could improve glycaemic control in adults with T1D and suboptimal control.
    Methods: In this multicentre, open-label, randomised controlled trial, adults with T1D and HbA1c ≥58 mmol/mol, already using CGM/isCGM with insulin therapy (multiple daily injections or pump), were enrolled across eight sites in Sweden and Norway. Participants were allocated (1:1) via a minimisation algorithm to receive either systematic intensive therapy (SIT) or conventional therapy (CT). The SIT group received weekly distance counselling, including CGM interpretation, if mean glucose was ≥8·4 mmol/L, during an 18-week intervention period. The control group attended two clinical visits during this period. The primary outcome was change in HbA1c from baseline to 18 weeks. Adverse events of special interest (AESI; severe hypoglycaemia or diabetic ketoacidosis) were assessed in the safety population. This trial is registered at clinicaltrials.gov number NCT03474393.
    Findings: 117 participants were enrolled and randomised (59 SIT, 58 control). At 18 weeks, mean (SD) HbA1c decreased by -10·7 (9·4) mmol/mol (-0·98% [0·86]) in the SIT group compared with -2·4 (8·4) mmol/mol (-0·22% [0·77]) in CT, resulting in an adjusted mean difference of -8·3 mmol/mol (95% CI -11·2 to -5·5), equivalent to -0·76% (95% CI -1·02 to -0·50%; P < 0·0001). No AESI were observed in the SIT group, compared with one event in the control group (1·7%), giving a risk difference of -1·7% (95% CI -5·1 to 1·6%).
    Interpretation: SIT improves glycaemic control in adults with T1D using CGM/isCGM who are not achieving recommended glycaemic targets, without evidence of safety concerns. These findings highlight the critical role of structured, individualised interventions in addressing persistent glycaemic management deficits and advancing clinical outcomes in this population.
    Funding: The study was supported by the Swedish state, Region Västra Götaland, and the Swedish Diabetes Foundation.
    Keywords:  Digital health; Glycaemic control; HbA1c; Telemedicine; Time in range; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.lanepe.2025.101485
  16. Health Psychol. 2025 Oct 27.
    Diabetes-related emotional distress, depressive symptoms, and continuous glucose monitoring outcomes.
    Michael Morreale, Emily C Soriano, Alyssa L Fenech, Hannah A Brownlee, Scott D Siegel, Jean-Philippe Laurenceau.
       OBJECTIVE: The objective of this study was to examine how diabetes-related emotional distress and depressive symptoms are uniquely related to objective measures of glycemic outcomes in people with Type 2 diabetes mellitus (T2DM). Existing research demonstrates that diabetes distress is better able to account for glycemic outcomes when compared to depressive symptoms. However, few studies have focused on this comparison when assessing glycemic outcomes using continuous glucose monitoring (CGM) indices specifically in T2DM populations.
    METHOD: Sixty-three adults diagnosed with T2DM were recruited from an outpatient endocrinology clinic. Diabetes-related emotional distress and depressive symptoms were assessed via self-report measures. Glycemic outcomes were measured using the gold standard hemoglobin A1c and 7 days of CGM data (measuring both glucose concentration levels and variation). The relationship between diabetes-related emotional distress (operationalized as a latent factor), depressive symptomatology, and glycemic outcome metrics (i.e., hemoglobin A1c and CGM-based) was evaluated using structural equation modeling.
    RESULTS: Moderate-sized associations were observed between diabetes-related emotional distress and a majority of the glycemic outcome metrics when controlling for depressive symptoms. No associations were observed between depressive symptoms and glycemic outcome metrics when controlling for diabetes-related emotional distress.
    CONCLUSIONS: The findings suggest that following a T2DM diagnosis, diabetes-related emotional distress is better able to account for variance in glycemic outcomes when compared to depressive symptoms. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
    DOI:  https://doi.org/10.1037/hea0001550
  17. Diabetologia. 2025 Oct 30.
    Diabetes heterogeneity beyond 3.8 years: missed risks of silent hypoglycaemia and long-term complications in the 4C study.
    Wenhua Liu, Bin Deng.
      
    Keywords:  China Cardiometabolic Disease and Cancer Cohort; Continuous glucose monitoring; Diabetes heterogeneity; Hypoglycaemia; Long-term follow-up
    DOI:  https://doi.org/10.1007/s00125-025-06588-z
  18. Cureus. 2025 Sep;17(9): e93242
    The Impact of Insulin Pump Therapy on Glycemic Control and Acute Diabetes Complications in Type 1 Diabetes: Real-World Evidence From a Single Center.
    Osama Saad BinDajam, Samia Abdallah Bokhari, Muneera Abd Ulmalik Alshareef, Turki Abdul Aziz Al-Harthi, Shadia Talat Howladar, Nouf Abdulkarim Alshehri, Shahad Jamil Ashgar, Razan Z Alnugali, Fahad Saud Albogami, Haidar Mohammed Haidar Alshamrani.
      Background and objectives The adoption of insulin pumps in diabetes management has seen a significant rise globally, offering promising advancements in glycemic control. Despite this progress, notable disparities remain in the utilization of this technology across different populations. We hypothesized that insulin pump therapy improves glycemic control and reduces acute complications compared to multiple daily injection (MDI) therapy. This study aimed to assess the impact of insulin pump therapy on glycemic control and acute diabetes complications among patients with type 1 diabetes mellitus at King Fahad Armed Forces Hospital (KFAFH), Jeddah. We sought to compare patient outcomes before initiating insulin pump therapy (while on MDI insulin therapy), using Abbott FreeStyle Libre 2 continuous glucose monitoring (CGM), to their results after transitioning to insulin pump therapy for six months. The findings will contribute to understanding the effectiveness of this technology in a clinical setting and addressing gaps in its adoption. Methods A cross-sectional study was conducted among patients with type 1 diabetes mellitus aged seven years and older who attended the Diabetes and Endocrine Department at KFAFH, Jeddah. Data were collected using a structured survey. Results The study included 24 patients with type 1 diabetes mellitus, with a mean age of 22.79 ± 8.86 years and a mean BMI of 24.35 ± 4.96. The mean age at diagnosis was 12.25 ± 5.29 years. Most patients (n = 22, 91.7%) used the MiniMed™️ 780G system, which employs an advanced hybrid closed-loop (AHCL) algorithm. All participants underwent carbohydrate-counting sessions prior to the initiation of insulin pump therapy. After six months of insulin pump therapy, significant improvements (p<0.05) were observed in hemoglobin A1C (HbA1c) or glucose management indicator (GMI) levels, Percentage of time spent in target blood glucose range (TIR) per day, Percentage of time below target glucose range (TBR) per day, percentage of time very low below target glucose range per day, Frequency of hypoglycemia per week, diabetic ketoacidosis (DKA) admissions, and meal time flexibility. The findings will contribute to understanding the effectiveness of this technology in a clinical setting and addressing gaps in its adoption Conclusions Insulin pump therapy is associated with improved and sustained glycemic control in patients with type 1 diabetes mellitus. Achieving optimal blood glucose levels is critical for reducing the risk of diabetes-related complications and lowering mortality rates. These improvements significantly enhance the quality of life and reduce the economic burden associated with diabetes management.
    Keywords:  abbott freestyle libre 2 continuous glucose monitoring; advanced hybrid closed-loop (ahcl) algorithm; diabetes complications; glycemic control; impact; insulin pump therapy; minimed™ 780g system; type 1 diabetes
    DOI:  https://doi.org/10.7759/cureus.93242
  19. Endocrinol Diabetes Metab. 2025 Nov;8(6): e70127
    Efficacy and Safety of iLet Bionic Pancreas in Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta Analysis.
    Sunny Kumar, F N U Aakash, Nisha Kumari, Chandar Kanta Lohana, Alina Abbas, F N U Gyaneshwari, Raveena Kumari, F N U Eman, Reena Bai, Saifullah Syed, Mahveer Maheshwari, Rahul Rai, Faiqa Iqbal, Mohammad Jawwad, Hira Riaz.
       BACKGROUND: This systematic review and meta-analysis evaluated the efficacy and safety of the iLet bionic pancreas (iLet BP), a novel automated insulin delivery (AID) system, in managing type 1 diabetes. Unlike conventional AID systems, which require user input for insulin dosing, the iLet BP autonomously determines insulin delivery based solely on body weight. The study synthesized data from five randomized controlled trials (RCTs), comprising a total of 1130 patients, comparing iLet BP with standard care (SC).
    OUTCOMES ASSESSED: Primary outcomes included changes in HbA1c, mean glucose levels, and time in target glucose range (70-180 mg/dL), measured via continuous glucose monitoring (CGM). Secondary outcomes assessed adverse events and hypoglycaemia.
    KEY FINDINGS: Results demonstrated that the iLet BP significantly improved glycaemic control. The pooled analysis showed a standardised mean difference (SMD) in HbA1c of -0.50 [-0.63, -0.38] and in mean glucose levels of -0.36 [-0.50, -0.21] favouring iLet BP. Time in target glucose range was significantly higher with iLet BP (SMD: 0.58 [0.43, 0.73]). However, the odds of adverse events were notably higher in the iLet BP group (OR: 15.48 [8.07, 29.70]), while the risk of hypoglycaemia (OR: 2.22 [0.83, 5.94]) was not statistically significant.
    CONCLUSION: In conclusion, the iLet BP shows strong potential in improving glycaemic outcomes in patients with type 1 diabetes. However, concerns remain regarding its safety profile, particularly related to adverse events. Further large-scale, high-quality studies are needed to confirm its effectiveness and ensure broader clinical applicability.
    Keywords:  continuous glucose monitoring; endocrine disorder; iLet bionic pancreas; insulin; type 1 diabetes
    DOI:  https://doi.org/10.1002/edm2.70127
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