bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2025–11–16
fifteen papers selected by
Mott Given
  1. Continuous glucose monitoring and microvascular complications in diabetes: Bridging glycemic metrics with clinical outcomes.
  2. The role of continuous glucose monitoring in improving glycemic control in adolescents with type 1 diabetes.
  3. The Impact of Interfering Substances on Continuous Glucose Monitors: Part 1: Classification of Continuous Glucose Monitoring Devices and Mechanisms of Substance Interference.
  4. Factors Associated with Blood Glucose Fluctuations in Patients with Type 2 Diabetes: A Retrospective Observational Study Using Continuous Glucose Monitoring.
  5. Exploring Relationships Between Maternal Characteristics, Continuous Glucose Monitoring Data, and Neonatal Hypoglycemia in Gestational Diabetes Pregnancies Using Probabilistic Modeling.
  6. Biweekly dosing of efsubaglutide alfa maintains glycaemic and continuous glucose monitoring control in type 2 diabetes: A randomised multicentre trial.
  7. Interference of Intravenous Acetaminophen with Continuous Glucose Monitoring System.
  8. Evaluating the Clinical Utility of the Glycemia Risk Index.
  9. Association of HbA1c and an updated glucose management indicator (uGMI) with incident diabetic retinopathy in adults with type 1 diabetes: a longitudinal study.
  10. GLM-DM: language model boosted neural networks for HbA1c trend prediction in diabetes mellitus.
  11. The impact of monetary incentives and gamification on glucose levels: real-world assessment in people with diabetes.
  12. The use of technology in diabetes in pregnancy: a position statement of expert opinion from the association of medical diabetologists (AMD), the Italian society of diabetology (SID) and the interassociative diabetes and pregnancy study group.
  13. Hypoglycaemia episodes in older diabetic adults undergoing haemodialysis.
  14. Increased HbA1c relative to actual glycemic control in patients treated with sodium-glucose cotransporter 2 inhibitors.
  15. A glucose time in range of 70% attenuates the senescence-inducing and pro-inflammatory effects of hyperglycemia.
  1. Diabetes Obes Metab. 2025 Nov 10.
    Continuous glucose monitoring and microvascular complications in diabetes: Bridging glycemic metrics with clinical outcomes.
    Lilian Anagnostopoulou, Alexandros L Liarakos, Ioannis Ntanasis-Stathopoulos, Alexandros Briasoulis, Anastasios Tentolouris.
      Continuous glucose monitoring (CGM) has emerged as a complementary and more dynamic method for evaluating glycemic control in people with diabetes. Relevant studies examining the association between CGM parameters, including time in range (TIR), glycemic variability (GV), and time in tight range (TITR), and diabetic nephropathy, retinopathy, and neuropathy, were reviewed. Evidence consistently demonstrates that lower TIR and TITR, as well as higher GV, are associated with increased risk and severity of microvascular complications in both type 1 and type 2 diabetes. Studies employing corneal confocal microscopy and sudomotor function testing further support these associations for small-fibre neuropathy. Although CGM-guided therapy improves TIR and GV, data directly linking optimisation of these metrics to reduced complication rates remain limited. Most available studies are cross-sectional or retrospective, with short CGM durations and heterogeneous methodologies. CGM-derived indices provide valuable insights into glycemic quality beyond HbA1c and may serve as complementary tools for early risk stratification and individualised management of diabetic microvascular disease. However, prospective and interventional trials are required to confirm whether improving CGM metrics can translate into clinically meaningful reductions in microvascular morbidity. Broader access to CGM and standardisation of its key metrics will be essential to fully realise its potential in modern diabetes care.
    Keywords:  continuous glucose monitoring (CGM); diabetic neuropathy; diabetic retinopathy; glycemic variability (GV); microvascular complications; time in range (TIR)
    DOI:  https://doi.org/10.1111/dom.70288
  2. Ann Pediatr Endocrinol Metab. 2025 Oct;30(5): 268-274
    The role of continuous glucose monitoring in improving glycemic control in adolescents with type 1 diabetes.
    Minkyu Seo, Kyu Hyun Park, Ji Won Park, EunJeong Kim, Do Young Shin, Eungu Kang, Hyo-Kyoung Nam, Young-Jun Rhie, Kee-Hyoung Lee.
       PURPOSE: Continuous glucose monitoring (CGM) technology offers real-time glucose feedback and has shown potential to improve glycemic control. This retrospective study evaluated the effect of CGM on glycemic outcomes in Korean children and adolescents with type 1 diabetes mellitus (T1DM) in a real-world setting.
    METHODS: We included 66 participants divided into a CGM group (n=22) and a self-monitoring blood glucose (SMBG) group (n=44). We compared changes in hemoglobin A1c (HbA1c) of the 2 groups over 1 year and observed changes in CGM activation time, mean glucose, glucose management indicator (GMI), coefficient of variation (CV), time in range (TIR), and hypoglycemia.
    RESULTS: The CGM group had a mean age of 16.63 years and time from diagnosis to the initiation of study of 4.19 years, while those of the SMBG group were 17.85 years and 5.19 years, respectively. In the CGM group, mean HbA1c decreased from 8.68% at baseline to 7.92% at 12 months (P=0.011), whereas HbA1c increased from 8.46% to 8.93% in the SMBG group (P<0.001). The changes in HbA1c at 1 year between the CGM and SMBG groups were significantly different (-0.76%±1.39% vs. 0.47%±1.38%, P=0.001). CGM activation time decreased slightly (89.09% to 79.24%, P=0.093), and there were no significant changes in TIR, mean glucose, GMI, CV, or hypoglycemia over time.
    CONCLUSION: CGM use in Korean children and adolescents with T1DM significantly improves HbA1c levels over 12 months compared to SMBG. The implementation of CGM may provide valuable benefits in glycemic control and potentially reduce the risk of diabetes-related complications.
    Keywords:  Adolescence; Continuous glucose monitoring; Glycemic outcome; Type 1 diabetes mellitus
    DOI:  https://doi.org/10.6065/apem.2550006.003
  3. J Diabetes Sci Technol. 2025 Nov 11. 19322968251377027
    The Impact of Interfering Substances on Continuous Glucose Monitors: Part 1: Classification of Continuous Glucose Monitoring Devices and Mechanisms of Substance Interference.
    Steven John Setford.
      Presented is a series of narrative reviews that summarize published information regarding the effect or potential effect of interfering substances on the accuracy of continuous glucose monitoring (CGM) devices. While drawing together what is currently known regarding this topic, the future direction in this field and clinical implications posed by polypharmacy on CGM performance are considered. This first in a series of four review articles classifies commercially available CGMs by glucose measurement principle before reviewing what is currently known regarding substance interference mechanisms and design approaches that may serve to reduce interfering effects. Points covered include the following: minimally invasive electrochemical CGMs, which may be classified by first-, second-, or third-generational design (these models are at risk of interference from electroactive substances, or substances that can interfere with the enzymatic biorecognition process); non-invasive fluid sampling CGMs, which draw glucose across the skin barrier but are similarly reliant on the electrochemical measurement of an enzymatic reaction product; and minimally invasive implantable CGMs, which exhibit different interfering substance behaviors to other CGM classes, using a non-enzyme-based glucose-recognition agent coupled to optical detection. An understanding of substance-interfering mechanisms allows consideration of the potential impact on clinical accuracy of substances that are routinely prescribed, can be purchased over the counter, or are new to market.
    Keywords:  accuracy; clinical implications; continuous glucose monitor; interferents; mechanisms; polypharmacy
    DOI:  https://doi.org/10.1177/19322968251377027
  4. Diabetes Metab Syndr Obes. 2025 ;18 4049-4057
    Factors Associated with Blood Glucose Fluctuations in Patients with Type 2 Diabetes: A Retrospective Observational Study Using Continuous Glucose Monitoring.
    Ni Zhong, Ao Zhang, Jiashen Chen, Zihan Hu, Renshan Nie, Jinzhu Huang, Meifen Wu, Haiyan Pan.
       Objective: To investigate the factors associated with glucose fluctuations in patients with type 2 diabetes mellitus (T2DM) using continuous glucose monitoring (CGM).
    Methods: This retrospective observational study included 252 patients with T2DM who underwent CGM during hospitalization. Participants were stratified into two groups based on their coefficient of variation (CV) of glucose: the high-CV group (CV ≥ 33%, n=53) and the low-CV group (CV < 33%, n=199). Glucose fluctuation indices were calculated from CGM data. All patients underwent 3-day CGM during hospitalization. General clinical data and biochemical indicators were collected. Statistical analyses included t-tests, Mann-Whitney U-tests, logistic regression, and restricted cubic spline models.
    Results: Significant differences were observed between the two groups in terms of disease duration, BMI, triglycerides, and C-peptide levels (P<0.05). Compared to the low-CV group, patients in the high-CV group had significantly lower Time in Range (TIR) and higher Time Above Range (TAR) and Time Below Range (TBR) (all P<0.001).Multivariate Logistic regression analysis revealed that low BMI, low C-peptide, and longer disease duration may be risk factors for abnormal blood glucose fluctuations in T2DM patients (P<0.05). Linear regression revealed a significant negative correlation between C-peptide levels and CV (β = -0.02, P=0.003).A threshold effect was observed between C-peptide and the coefficient of variation(CV) of blood glucose (Cut-off=0.913 nmol/L), with CV increasing by 0.07 per 1 nmol/L decrease in C-peptide below this threshold (P=0.029).
    Conclusion: This study suggests that patients with longer disease duration, lower BMI, and poorer pancreatic function have higher odds of significant glucose fluctuations. Enhanced monitoring of glucose fluctuations and education on potential risks are recommended for these subgroups to improve self-management abilities.
    Keywords:  coefficient of variation; continuous glucose monitoring; glucose fluctuation; time in range; type 2 diabetes mellitus
    DOI:  https://doi.org/10.2147/DMSO.S542547
  5. J Diabetes Sci Technol. 2025 Nov 10. 19322968251388107
    Exploring Relationships Between Maternal Characteristics, Continuous Glucose Monitoring Data, and Neonatal Hypoglycemia in Gestational Diabetes Pregnancies Using Probabilistic Modeling.
    Giacomo Cappon, Marco Catanuso, Erica Tavazzi, Karen Elkind-Hirsch, Andrea Facchinetti.
       BACKGROUND: Gestational diabetes mellitus (GDM) is a frequent metabolic complication during pregnancy that significantly impacts both maternal and neonatal health outcomes regularly resulting in NH. Exploring the interactions between maternal characteristics, neonatal outcomes, and data collected from wearable technologies, such as continuous glucose monitoring (CGM) could potentially enable the development of predictive models and support personalized care.
    METHODS: This study employed probabilistic modeling, using Bayesian networks (BNs), to analyze data from the STEADY SUGAR clinical trial (N = 118 women with GDM) with the aim of discovering interactions between maternal characteristics, CGM-derived features calculated in the 90 days preceding delivery, and neonatal outcomes, particularly NH. The final BN returns a graph and conditional probability tables between inputs and outputs, whose statistical relevance has been quantified via odds ratios (ORs).
    RESULTS: Direct associations were identified between NH and maternal hypertension (OR: 2.13 [1.02, 4.46]), family history for diabetes (OR: 1.43 [0.57, 3.57]), and elevated maternal body mass index (BMI) (OR: 3.59 [1.42, 9.08] comparing lower vs higher BMI categories). Cesarean delivery also influenced NH risk (OR: 2.05 [0.98, 4.28]). Indirect associations involving medication regimens and delivery type were significant. Ethnic disparities emerged, notably higher hyperglycemia among Afro-American patients (OR: 2.91 [1.19, 7.11]), highlighting ethnicity-related variations in glycemic control. Notably, CGM-derived metrics were associated with multiple neonatal outcomes.
    CONCLUSIONS: Bayesian network allowed to explore the complex interactions between variables in pregnancies affected by GDM. This framework will be extended with wider data sets to provide valuable insights for clinical decision-making able to mitigate maternal and neonatal risks.
    Keywords:  Bayesian networks; continuous glucose monitoring; gestational diabetes mellitus; neonatal outcomes
    DOI:  https://doi.org/10.1177/19322968251388107
  6. Diabetes Obes Metab. 2025 Nov 10.
    Biweekly dosing of efsubaglutide alfa maintains glycaemic and continuous glucose monitoring control in type 2 diabetes: A randomised multicentre trial.
    Rui Sun, Ying Wang, Hongyan Shu, Li Li, Jianping Yao, Xiuhai Su, Bimin Shi, Chaoming Wu, Jianhua Ma, Qinghua Wang.
       AIMS: To compare the glycaemic efficacy, continuous glucose monitoring (CGM) metrics, and safety of biweekly efsubaglutide alfa 3 mg (Q2W) versus weekly 1 mg (QW) in adults with type 2 diabetes inadequately controlled with lifestyle intervention.
    MATERIALS AND METHODS: In this multicentre, randomised, open-label trial, 59 adults were allocated 1:1 to efsubaglutide alfa 3 mg Q2W or 1 mg QW for 12 weeks after a 1-week 1 mg run-in. The primary endpoint was change in HbA1c from baseline to week 13 (end of 12-week treatment). Secondary endpoints included fasting plasma glucose (FPG), CGM time in range (TIR, 3.9-10.0 mmol/L) and tight TIR (3.9-7.8 mmol/L), 24-h mean glucose, weight, lipids, and adverse events. Continuous outcomes were analysed using a mixed model for repeated measures (MMRM); categorical outcomes used stratified Mantel-Haenszel tests; p values/CI were descriptive.
    RESULTS: HbA1c decreased by -1.45% (SE 0.14) with Q2W and -1.53% (0.14) with QW; LS mean difference (Q2W-QW) 0.09% (95% CI -0.32, 0.50). FPG fell similarly (-2.07 vs. -2.22 mmol/L). TIR increased from 45.0% to 77.2% with Q2W and 75.1% with QW; tight TIR reached 53.8% and 48.8%, respectively. End-of-treatment 24-h mean CGM glucose was 8.12 versus 8.66 mmol/L (Q2W vs. QW). At week 13, HbA1c <7.0% was achieved by 55.2% (Q2W) and 65.5% (QW); ≤6.5% by 37.9% and 24.1%. Gastrointestinal adverse events predominated and were mostly mild to moderate; no hypoglycaemia or cardiovascular events occurred.
    CONCLUSIONS: Over 12 weeks, efsubaglutide alfa 3 mg Q2W provided glycaemic and CGM benefits comparable to 1 mg QW with favourable tolerability. These findings support the feasibility of a biweekly regimen as an alternative to weekly dosing; larger, longer-duration confirmatory trials in more diverse populations are warranted.
    Keywords:  continuous glucose monitor (CGM); diabetes; efsubaglutide alfa; glucagon‐like peptide‐1 receptor agonist; glycosylated haemoglobin (HbA1c); obesity
    DOI:  https://doi.org/10.1111/dom.70262
  7. JMA J. 2025 Oct 15. 8(4): 1463-1467
    Interference of Intravenous Acetaminophen with Continuous Glucose Monitoring System.
    Misayo Matsuyama, Satoru Meiri, Hirotake Sawada, Ryuta Masuya, Kazuhiko Nakame, Hiroshi Moritake.
      Sensor-augmented pumps (SAPs) and automated insulin delivery (AID) systems are innovative technologies for diabetes management. Accurate continuous glucose monitoring (CGM) is crucial for their safe and effective use; however, certain commonly used drugs can interfere with CGM accuracy. Although acetaminophen is known to cause falsely elevated CGM glucose values, previous CGM studies have primarily focused on its oral administration, with limited data on intravenous use. We report a case of a CGM reaction after the intravenous administration of acetaminophen in a boy with type 1 diabetes using SAP. The patient received repeated doses of intravenous acetaminophen (15 mg/kg for 15 min) for pain relief. After administration, we recorded a rapid increase in his CGM readings without a corresponding increase in blood glucose levels. The CGM glucose peaked at 29.2 ± 1.9 min (mean ± standard deviation) after administration and an estimated discrepancy of 55 to 114 mg/dL compared with capillary blood glucose measurements. Discrepancies between measured blood glucose and CGM readings were significantly greater at lower glucose levels. These falsely elevated CGM readings could potentially trigger an inappropriate autocorrection bolus in AID systems and increase the risk of hypoglycemia. Medical professionals should be fully aware of acetaminophen-induced CGM interference, particularly the potential risks in patients using AID systems.
    Keywords:  automated insulin delivery; continuous glucose monitoring; intravenous acetaminophen; sensor-augmented pump
    DOI:  https://doi.org/10.31662/jmaj.2025-0186
  8. J Diabetes Sci Technol. 2025 Oct 14. 19322968251382604
    Evaluating the Clinical Utility of the Glycemia Risk Index.
    Agatha F Scheideman, Mandy M Shao, Yijiong Yang, David C Klonoff, Jane Jeffrie Seley, Neesha Ramchandani, David T Ahn, Ralph Oiknine, Jing Wang.
       BACKGROUND: The Glycemia Risk Index (GRI) is a composite score designed to simplify continuous glucose monitoring (CGM) interpretation by quantifying risks associated with hypoglycemia, hyperglycemia, and glucose variability in a single number. Although proposed as a decision-support tool, its clinical utility has not been well studied yet.
    OBJECTIVE: To evaluate how Diabetes Care and Education Specialists (DCESs) and other health care professionals (HCPs) perceive the GRI and its usefulness in clinical practice, and to assess its perceived advantages, limitations, and potential for integration into the care of individuals with diabetes.
    METHODS: In this observational study, 28 DCESs and other HCPs participated in a virtual educational session about the GRI and then completed an online survey. The survey collected demographic information, preferences for using GRI versus the Ambulatory Glucose Profile (AGP) to evaluate glycemic management, and feedback on the GRI's usefulness. Open-ended qualitative responses were rated independently by investigators on a 5-point Likert scale (1-5, with 1 being least positive/most negative and 5 being most positive/least negative) and analyzed thematically.
    RESULTS: Most participants preferred using the GRI alongside the AGP rather than either tool alone. When tracking individual progress over time, 50% preferred using both tools, while 39% preferred the GRI alone, and 11% preferred the AGP alone. The majority (75%) were willing to integrate the GRI into their clinical workflows. Participants rated the GRI highly for its advantages (4.57 ± 0.84) and usefulness for primary care practitioners (4.5 ± 0.96) and diabetes specialists (4.18 ± 1.28), while concerns about disadvantages were moderate (3.04 ± 1.20). Participants discussed in free-text four themes, including how GRI (1) simplifies data, (2) helps clinical decision support, (3) promotes better understanding of CGM data, and (4) needs wider dissemination.
    CONCLUSIONS: The GRI is perceived as a valuable complement to traditional CGM reports, particularly in facilitating quick clinical assessments and furthering diabetes care and education. While enthusiasm for broader integration is high, barriers such as lack of standardization, limited guideline adoption, and HCP training must be addressed to support its clinical uptake. Future work should assess the GRI's impact on clinical outcomes and explore implementation strategies.
    Keywords:  ambulatory glucose profile; continuous glucose monitoring; education; glycemia risk index; survey
    DOI:  https://doi.org/10.1177/19322968251382604
  9. Diabetologia. 2025 Nov 11.
    Association of HbA1c and an updated glucose management indicator (uGMI) with incident diabetic retinopathy in adults with type 1 diabetes: a longitudinal study.
    Viral N Shah, Yongjin Xu, Yaghoub Dabiri, Hemanth P Mohanadas, Alan Cheng, Timothy C Dunn.
       AIMS/HYPOTHESIS: This study aimed to compare the predictive performance of HbA1c and a continuous glucose monitoring (CGM)-based updated glucose management indicator (uGMI) in assessing incident diabetic retinopathy risk.
    METHODS: We used the data from a previously published longitudinal case-control study that collected CGM data for up to 7 years prior to diagnosis of incident diabetic retinopathy or no retinopathy (control participants) among adults with type 1 diabetes. Mutual information scores (MIS), receiver operating characteristics (ROC) curves and machine learning models were used to assess the associations of diabetic retinopathy with HbA1c, uGMI and CGM-derived metrics.
    RESULTS: The uGMI demonstrated a stronger association with incident diabetic retinopathy (MIS 0.148) compared with HbA1c (MIS 0.078). ROC analysis showed that uGMI had a modestly higher AUC (AUC 0.733) than HbA1c (AUC 0.704). Decision tree models incorporating both HbA1c and uGMI did not improve clinically significant diabetic retinopathy risk prediction. Machine learning models confirmed the better predictive value of uGMI, especially for HbA1c values between 54 mmol/mol (7.1% NGSP) and 58 mmol/mol (7.5% NGSP), where diabetic retinopathy risk escalated significantly.
    CONCLUSIONS/INTERPRETATION: The uGMI is a slightly stronger predictor of diabetic retinopathy risk compared with HbA1c. HbA1c and uGMI do not appear to be complementary for diabetic retinopathy risk prediction.
    Keywords:  CGM; Diabetic retinopathy; HbA1c ; Type 1 diabetes; Updated GMI
    DOI:  https://doi.org/10.1007/s00125-025-06599-w
  10. Future Sci OA. 2025 Dec;11(1): 2567166
    GLM-DM: language model boosted neural networks for HbA1c trend prediction in diabetes mellitus.
    Yikun Ban, Xinrui He, Patricia M Verona, Curtiss B Cook, Jingrui He.
       AIM: Predict Hemoglobin A1c (HbA1c) trends, a key metric in diabetes mellitus (DM) management, using readily available patient variables and language models (LMs).
    METHODS: We propose GLM (Language Model Boosted Neural Network) -DM, which leverages data augmentation and language model-driven feature encoding to predict HbA1c trends using easily accessible patient-level variables. Our model captures complex relationships among patient characteristics and enhances predictive performance through Generative Adversarial Networks (GANs) for synthetic data augmentation and LMs for feature embedding. By transforming patient profiles into rich latent representations, our approach enables a more comprehensive analysis of how patient-level variables correlate with HbA1c trends over time.
    RESULTS: Using clinical data from 257 DM patients, GLM-DM achieves 70.2% accuracy of HbA1c trend prediction, outperforming classic classifiers and transformer-based models. Ablation studies confirm the effectiveness of GAN-based augmentation and LM-driven embedding. Our model achieves 68.2% prediction accuracy for Type 1 DM and 72.7% for Type 2 DM.
    CONCLUSION: Proposed approach learns the underlying complex function of HbA1c using clinical variables easily available at the patient visit and leveraging the power of LMs to accurately predict the trend of HbA1c in a period. The model can enhance patient advisories for daily diabetes management without the need for continuous glucose monitoring.
    Keywords:  blood glucose; deep learning; diabetes mellitus; generative adversarial network; hemoglobin A1c; language models
    DOI:  https://doi.org/10.1080/20565623.2025.2567166
  11. Sci Rep. 2025 Nov 13. 15(1): 39891
    The impact of monetary incentives and gamification on glucose levels: real-world assessment in people with diabetes.
    Mohammed E Al-Sofiani, Sahar K Alharthi, Saud M Albalawi, Erfan M Allababidi, Olayan Alharbi, Amir Raouf, Suliman Alblowi.
      Karaz is a mobile health solution designed to leverage real-time monitoring, monetary incentives, and gamification to improve health outcomes in people with diabetes (PWD). Data generated by wearables are all displayed on a unified interface for users and healthcare professionals. Karaz app rewards users for engaging in health-promoting behaviors by offering points redeemable for monetary value. To evaluate the changes in continuous glucose monitoring (CGM) metrics, level of physical activity, and sleep duration over three months among PWD who used Karaz app for ≥ 3 months. Data from 384 Karaz app users who had diabetes, were wearing CGM, and used Karaz app for ≥ 3 months were retrospectively analyzed. Logistic regression analysis was performed to identify potential predictors of improvement in time in range (TIR) after using Karaz app. The average age of the study participants was 24 years, 57% women, and 78% had type 2 diabetes. In PWD who had baseline TIR ≤ 60%, CGM metrics improved from baseline to month 3: TIR (43.1 to 45.89%, p < 0.01), time above range (TAR) > 250 mg/dL (24.66 to 22.5%, p < 0.01), TAR > 180 mg/dL (51.83 to 48.79%, p < 0.01), glycemia risk index (GRI) (87 to 84%, p < 0.01), and time in tight range (TITR) 70-140 mg/dL (25.54 to 27.84%, p < 0.01). Whereas, in PWD with baseline TIR > 60%, glucose levels changed from baseline to month 3 as follows: TIR (74.88 to 73.53%, p < 0.01), TAR > 250 (4.03 to 4.81%, p = 0.03), TAR > 180 (20.19 to 21.24%, p = 0.07), TITR (52.63 to 52.04%, p = 0.29). Compared to PWD with baseline TIR > 70%, those with baseline TIR 40-70% and TIR < 40% were 10 and 8 times, respectively, as likely to experience a significant improvement in TIR, by > 5%, after adjusting for age, gender, baseline TBR, and daily steps. Use of Karaz app, with monetary incentives and gamification, was associated with significant improvements in CGM metrics in PWD who had suboptimal glucose control at baseline. This highlights the promising role of innovative digital solutions and management approaches in improving health outcomes in PWD.
    DOI:  https://doi.org/10.1038/s41598-025-23762-w
  12. Acta Diabetol. 2025 Nov 10.
    The use of technology in diabetes in pregnancy: a position statement of expert opinion from the association of medical diabetologists (AMD), the Italian society of diabetology (SID) and the interassociative diabetes and pregnancy study group.
    Veronica Resi, Cristina Bianchi, Silvia Burlina, Valeria Grancini, Elisa Manicardi, Maria Masulli, Antonietta Maria Scarpitta, Gian Pio Sorice, Raffaella Fresa.
      Over the last 10 years, the number of women with diabetes during pregnancy has increased steadily. Maternal glycaemic control is the most important factor influencing maternal and neonatal outcomes, and technological advances have become integral to the evolution of diabetes care during pregnancy. However, rapid technological development must be accompanied by the equally rapid dissemination of information. In particular, knowledge of the availability of automated insulin delivery (AID) systems for managing type 1 diabetes in pregnancy, and of glucose continuous monitoring (CGM) systems for gestational and type 2 diabetes, needs to be increased. The AMD-SID Italian Diabetes and Pregnancy Study Group, supported by the Technology and Diabetes Study Group, has produced this position paper of expert opinion to review the main international guidelines and current evidence on new technologies for the management of pregnancy in women with GDM, type 1 and type 2 diabetes, and to provide detailed suggestions for the use of commercially available systems in clinical practice.
    Keywords:  Automated insulin delivery; Continuous glucose monitoring; Delivery; Do it yourself artificial pancreas systems; Gestational diabetes; Insulin pump; Pregnancy; Type 1 diabetes; Type 2 diabetes
    DOI:  https://doi.org/10.1007/s00592-025-02592-2
  13. Clin Kidney J. 2025 Nov;18(11): sfaf183
    Hypoglycaemia episodes in older diabetic adults undergoing haemodialysis.
    Jinzhu Li, Qiangguo Ao, Ruiqin Zhang, Xiaoling Cheng, Xiaomin Meng, Xian Zhang, Mingxu Li, Jun Zhao, Fengkun Chen, Shanshan Yan, Rong Fang, Qingli Cheng, Yanlan Ma, Guang Yang.
       Background: Diabetes significantly contributes to chronic kidney disease and end-stage kidney disease. With advancing haemodialysis (HD) technology and an ageing HD population, glycaemic control has become increasingly complex. Herein, we aimed to analyse the blood glucose fluctuations and hypoglycaemia risk factors in older adults with diabetes undergoing HD.
    Methods: This study included older adults with diabetes undergoing HD (April-July 2024). Continuous glucose monitoring assessed glycaemic profiles, comparing HD and non-HD days. Subgroup analyses examined all-day, dialysis-related, post-dialysis, and nocturnal hypoglycaemia.
    Results: Among 104 participants, 57 (54.8%) experienced hypoglycaemia on HD days versus 25 (24.0%) on non-HD days (P < .001). Two hours post-HD, 29 participants (27.88%) had hypoglycaemia compared with three (2.88%) (P < .001) on non-HD days. Mean blood glucose (MBG) was higher on HD days (7.59 vs. 7.45 mmol/l), with greater variability (coefficients of variation: 29.0% vs. 20.2%; standard deviation: 1.78 vs. 1.47 mmol/l; P < .001). Older age, morning dialysis, and lower MBG and BG at HD initiation increased hypoglycaemia risk during HD and within 2 h post-HD (all P < .05). Elevated MBG {odds ratio (OR) [95% confidence interval (CI)]: 0.20 (0.07, 0.58), P = .003} and BG ≥ 8.0 mmol/l at HD initiation (OR (95% CI): 0.04 (0.00, 0.34), P = .003) reduced hypoglycaemia risk during HD.
    Conclusion: Older adults with diabetes undergoing HD exhibited significant glycaemic fluctuations and hypoglycaemia prevalence on HD days, particularly during or post-dialysis. Maintaining higher MBG and pre-HD BG may reduce hypoglycaemia. These findings underscore the need for tailored glycaemic management.
    Keywords:  continuous glucose monitoring; diabetes; haemodialysis; hypoglycaemia; older adults
    DOI:  https://doi.org/10.1093/ckj/sfaf183
  14. J Diabetes Investig. 2025 Nov 14.
    Increased HbA1c relative to actual glycemic control in patients treated with sodium-glucose cotransporter 2 inhibitors.
    Keigo Mizutani, Eita Uenishi, Takeshi Onoue, Ryutaro Maeda, Koji Suzuki, Tomoko Handa, Tomoko Kobayashi, Shintaro Iwama, Takashi Miyata, Mariko Sugiyama, Daisuke Hagiwara, Hidetaka Suga, Masaki Okazaki, Atsushi Hashizume, Hiroshi Arima.
       AIMS/INTRODUCTION: Among patients with diabetes receiving sodium-glucose cotransporter 2 (SGLT2) inhibitors, HbA1c levels are higher than glycated albumin levels. This study therefore aimed to evaluate the discrepancy between HbA1c and glucose management indicator (GMI), an index of glucose management derived from continuous glucose monitoring, in this population.
    MATERIALS AND METHODS: This multicenter retrospective cohort study included patients with diabetes in whom HbA1c and GMI were simultaneously measured at two Japanese institutions. Data were collected when HbA1c levels had stabilized for at least 6 months after the administration of an oral hypoglycemic agent. The primary outcome was the discrepancy between HbA1c and GMI among patients receiving SGLT2 inhibitors and those receiving other oral hypoglycemic agents. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding factors.
    RESULTS: In total, 136 patients were included; of these, 109 and 27 were included in the SGLT2 inhibitor group and control group, respectively. After IPTW adjustment, the discrepancy between HbA1c and GMI (HbA1c-GMI) was significantly higher in the SGLT2 inhibitor group than in the control group (β = 0.42; 95% confidence interval 0.14-0.70; P = 0.003).
    CONCLUSIONS: Patients receiving SGLT2 inhibitors may have increased HbA1c relative to their actual glycemic control.
    Keywords:  Continuous glucose monitoring; Glycated hemoglobin; Sodium–glucose transporter 2 inhibitor
    DOI:  https://doi.org/10.1111/jdi.70191
  15. Cardiovasc Diabetol. 2025 Nov 14. 24(1): 432
    A glucose time in range of 70% attenuates the senescence-inducing and pro-inflammatory effects of hyperglycemia.
    Rosalba La Grotta, Valeria Pellegrini, Francesca Carreras, Cesare Celeste Berra, Karolina Mužina, Barbara Jenko Bizjan, Klemen Dovc, Francesco Prattichizzo, Tadej Battelino, Antonio Ceriello.
       BACKGROUND: The Time In Range (TIR) represents the amount of time spent by a given individual in the range close to normoglycemia, i.e. 70-180 mg/dl. On the basis of studies demonstrating an association of TIR with the incidence of diabetes complications, guidelines recommend a target of at least 70% of TIR for most people with diabetes. However, no study has explored the effect of variable degrees of TIR on molecular mechanisms relevant for the development of diabetes complications.
    METHODS: We exposed endothelial cells and monocytes to increasing percentages of TIR, i.e. 50%, 70%, 85% by changing cell media twice a day as appropriate, as well as to constant normoglycemia (i.e. fixed 100 mg/dl of glucose for endothelial cells) and hyperglycemia (i.e. 500 mg/dl glucose), evaluating the development of senescence, of the associated pro-inflammatory response, and monocytes adhesion to endothelial cells as a functional assay. We then assessed the expression of a plethora of markers of senescence and inflammation at the mRNA level in peripheral blood mononuclear cells (PBMC)s derived from individuals with early (i.e. 1-year post-diagnosis) type 1 diabetes (T1D, n = 37), categorized according to the TIR (< or > 70%) observed in the previous 14 days, comparing the two groups through ANCOVA adjusted for HbA1c. As a confirmatory analysis, we also compared the expression of the same markers in people with Time Above Range (TAR), considered as the whole time above 180 mg/dl, ≥ vs < 30%. Correlations between TIR values and the expression of the same markers were tested through linear regression.
    RESULTS: Constant hyperglycemia promoted the development of senescence in endothelial cells and induced inflammatory responses in both endothelial cells and monocytes, promoting also monocytes adhesion to endothelial cells. A TIR of 70%, but not of 50%, suppressed these effects while a TIR of 85% did not provide additional benefit. Data from people with T1D mirrored such results, as demonstrated by the higher expression of p16, a marker of senescence, and of IL-6, MCP-1, and CXCL1, three inflammatory mediators, in PBMCs from individuals with TIR < 70% and compared with those with TIR > 70%, independently of HbA1c. Similar results were obtained when comparing people with TAR ≥ vs < 30%. When considered as a continuous variable, TIR values were correlated with p16, IL-6, and CXCL1.
    CONCLUSIONS: A TIR above 70% is associated with attenuated pro-senescence and pro-inflammatory effects of hyperglycemia. These molecular results support the TIR target currently recommended by guidelines, especially for people with T1D.
    Keywords:  Continuous glucose monitoring; Endothelial cells; Hyperglycemia; Inflammation; Monocytes; PBMC; Senescence; TAR; TIR; Type 1 diabetes
    DOI:  https://doi.org/10.1186/s12933-025-02983-3
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