bims-glumda Biomed News
on CGM data in management of diabetes
Issue of 2025–11–30
seventeen papers selected by
Mott Given
  1. Patient-accessible continuous glucose monitoring for cardiometabolic risk reduction in type 2 diabetes: A meta-analysis of randomized controlled trials.
  2. Continuous Glucose Monitoring.
  3. Double-Layer Simplified Complex Interval Neural Network Stacking for Blood Glucose Prediction of Continuous Glucose Monitoring System.
  4. Does continuous glucose monitoring deliver in gestational diabetes?
  5. Continuous glucose monitoring in high-risk individuals.
  6. Expanding Primary Care Prescribing of Continuous Glucose Monitors Through an Electronic Health Record-Based Order Set.
  7. Cost-effectiveness of continuous glucose monitoring in Chinese adults with uncontrolled type 2 diabetes: A modelling study stratified by baseline HbA1c.
  8. Foreword: Patient-accessible continuous glucose monitoring for cardiometabolic risk reduction in type 2 diabetes: A meta-analysis of randomized controlled trials.
  9. Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial.
  10. Feasibility study of a combined insulin-delivery and glucose sensor system worn over 7 days in persons with type 1 diabetes.
  11. Continuous blood glucose monitoring prediction for diabetes using evolving neural network.
  12. Injury to tissue caused by device penetration of the skin triggers formation of extracellular traps.
  13. Effects of three aerobic exercise protocols on acute glucose response and continuous glucose monitoring trends in patients with type 2 diabetes mellitus and stroke: a randomized controlled trial.
  14. Cost-effectiveness of Freestyle Libre Systems for People with Type 2 Diabetes Mellitus on Basal Insulin Therapy in the Netherlands: An Economic Evaluation from a Societal Perspective Within a Publicly Funded Healthcare System.
  15. Sequential use of continuous glucose monitoring, with or without exercise trackers, significantly improves glycemic control in patients with type 2 diabetes.
  16. Triple arm, prospective, real-world study comparing the efficacy of FDC teneligliptin + dapagliflozin to FDC sitagliptin + dapagliflozin, and FDC linagliptin + empagliflozin in Indian type 2 diabetes mellitus patients using CGM device: the Amplify-TIR study.
  17. Insulin dose adjustment policy for certified diabetes care and education specialists: Safe and effective.
  1. Dis Mon. 2025 Nov 26. pii: S0011-5029(25)00197-X. [Epub ahead of print] 102043
    Patient-accessible continuous glucose monitoring for cardiometabolic risk reduction in type 2 diabetes: A meta-analysis of randomized controlled trials.
    Sneha Annie Sebastian, Inderbir Padda, Tia Bimal, Shalendra Varma, Jessicah Collins, Zahid Ahmad, Maya S Safarova.
       BACKGROUND: Continuous glucose monitoring (CGM) is extensively studied for its role in glycemic control, but evidence regarding its effects on cardiometabolic and clinical outcomes in type 2 diabetes (T2D) is limited. This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the impact of patient-accessible CGM on cardiometabolic risk factors and examine its potential for improving cardiovascular health and integration into T2D care.
    METHODS: We performed a systematic review by searching MEDLINE, Scopus, ScienceDirect, the Cochrane Library, and ClinicalTrials.gov up to April 2025. We included RCTs comparing real-time continuous glucose monitoring (rtCGM) or intermittently scanned continuous glucose monitoring (isCGM) versus self-monitoring of blood glucose (SMBG) or usual care in adults with T2D. Statistical analysis was conducted using RevMan 5.4, applying an inverse variance random effects model to compute mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes. Our study protocol is registered with PROSPERO (CRD42024578002).
    RESULTS: Thirty RCTs (19 rtCGM, 11 isCGM) with 3133 participants (mean age 60.2 years; baseline HbA1c 8.5 %) were included. CGM use reduced HbA1c by -0.48 % (95 % CI: 0.68 to -0.29; p < 0.001), with greater reductions for rtCGM (-0.65 %) than isCGM (-0.25 %). Mean glucose decreased by -14.72 mg/dL (p < 0.001), and TIR increased by 10.76 % (p < 0.001). Subgroup analysis showed greater HbA1c reduction in non-insulin-treated individuals (-0.57 %) versus insulin-treated (-0.46 %). CGM lowered non-HDL cholesterol (-9.31 mg/dL), triglycerides (-32.17 mg/dL), systolic blood pressure (-3.47 mmHg), weight (-3.26 kg), and BMI (-0.87 kg/m²). No significant differences were found in MACE or hypoglycemia. Treatment satisfaction and physical activity were higher with CGM versus SMBG.
    CONCLUSIONS: Patient-accessible CGM significantly impacts cardiometabolic risk reduction, emphasizing the need for further RCTs with extended follow-ups focusing on these outcomes as primary endpoints. Integrating CGM into clinical practice may enhance personalized care and cardiovascular health for individuals with T2D. Layman Summary: Our study analyzed 30 randomized controlled trials involving over 3000 adults with type 2 diabetes to evaluate the effects of continuous glucose monitoring (CGM) on metabolic and cardiovascular health. Compared with traditional finger-stick glucose testing, CGM use led to significant improvements in blood glucose control, with reductions in HbA1c, average glucose levels, cholesterol, triglycerides, blood pressure, and body weight. Participants using CGM also spent more time in the target glucose range and reported higher treatment satisfaction and physical activity. Overall, CGM use was associated with improved cardiometabolic health and may contribute to better cardiovascular outcomes in type 2 diabetes beyond glycemic control alone.
    Keywords:  CGM; Cardiometabolic outcomes; Cardiovascular health; Continuous glucose monitoring; Type 2 diabetes
    DOI:  https://doi.org/10.1016/j.disamonth.2025.102043
  2. JAMA. 2025 Nov 24.
    Continuous Glucose Monitoring.
    Richard M Bergenstal, Thomas W Martens, Roy W Beck.
      
    DOI:  https://doi.org/10.1001/jama.2025.19197
  3. Biosensors (Basel). 2025 Oct 22. pii: 707. [Epub ahead of print]15(11):
    Double-Layer Simplified Complex Interval Neural Network Stacking for Blood Glucose Prediction of Continuous Glucose Monitoring System.
    Shaowei Kong, Yusheng Fu, Jingshan Duan, Jian Yan.
      Diabetes is a metabolic disorder characterized by persistent hyperglycemia, with its incidence steadily rising worldwide. Blood glucose monitoring is a core measure in diabetes management, and continuous glucose monitoring provides more comprehensive and accurate glucose data compared to traditional fingerstick testing. To collect continuous glucose data from patients, precise glucose prediction algorithms can help them better control their blood glucose fluctuations. Therefore, by addressing the issues of low prediction accuracy, complex input features, and poor generalization performance in existing glucose prediction methods, this paper proposes a glucose prediction model based on a double-layer SCINet stack using time-series analysis methods. SCINet effectively captures multi-scale dynamic features in time-series data through recursive down-sampling and convolution operations, making it suitable for glucose prediction tasks. Experimental data were sourced from real-world continuous glucose monitoring records of patients at Yixing People's Hospital. Model input features were optimized through variable selection and data preprocessing, with predictive performance validated on a test dataset. The results demonstrate that the proposed model outperforms existing time-series prediction models across varying prediction horizons and patient datasets, exhibiting high predictive accuracy and stability.
    Keywords:  SCINet; blood glucose prediction; continuous glucose monitoring; diabetes; time series analysis
    DOI:  https://doi.org/10.3390/bios15110707
  4. Lancet Diabetes Endocrinol. 2025 Nov 24. pii: S2213-8587(25)00297-9. [Epub ahead of print]
    Does continuous glucose monitoring deliver in gestational diabetes?
    Lene Ringholm.
      
    DOI:  https://doi.org/10.1016/S2213-8587(25)00297-9
  5. Clin Chim Acta. 2025 Nov 21. pii: S0009-8981(25)00612-6. [Epub ahead of print]580 120733
    Continuous glucose monitoring in high-risk individuals.
    Zhiyue Chen, Yinbei Zhang, Lin Sun, Weiying Guo.
      In recent years, continuous glucose monitoring (CGM) has become a major means of monitoring blood glucose in diabetic patients, reducing the need for frequent fingertip blood collection compared to traditional glucose monitoring. For children and pregnant patients, this can effectively improve the psychological discomfort of these two groups of high-risk patients, increasing compliance and further optimizing blood glucose. Some derived metrics, such as time in range and glycemic variability, are effective in predicting diabetic microvascular and macrovascular lesions, further contributing to optimized glycemic management. CGM effectively reduces the incidence of extreme blood glucose values by providing continuous ambulatory blood glucose data, avoiding excessive high or low blood glucose. Based on this advantage, in the elderly population, hypoglycemia can be effectively identified from other neurological disorders, which reduces the adverse consequences of hypoglycemia and helps clinicians to take better countermeasures. However, the accuracy of CGM can be affected by various factors and often requires frequent calibration. Additionally, for individuals with sensitive skin, it may cause dermatological issues. This paper systematically summarizes the glycemic characteristics of different diabetic patients with high risk factors, the advantages and limitations of applying CGM, and proposes the direction of upgrading and changing CGM devices in the future. Meanwhile, more clinical studies are needed to further clarify the criteria for glycemic control of CGM in different populations.
    Keywords:  Continuous glucose monitoring; Diabetes; High-risk individuals
    DOI:  https://doi.org/10.1016/j.cca.2025.120733
  6. J Diabetes Sci Technol. 2025 Nov 27. 19322968251387149
    Expanding Primary Care Prescribing of Continuous Glucose Monitors Through an Electronic Health Record-Based Order Set.
    Amanda Liu, Amanda Phoenix, Charnicia Huggins, Vivien Leung.
      
    Keywords:  blood glucose; continuous glucose monitor; diabetes; self-monitoring of blood glucose
    DOI:  https://doi.org/10.1177/19322968251387149
  7. Diabetes Obes Metab. 2025 Nov 27.
    Cost-effectiveness of continuous glucose monitoring in Chinese adults with uncontrolled type 2 diabetes: A modelling study stratified by baseline HbA1c.
    Guangxin Han, Xiaoning Zhang, Yubing Ye, Changsheng Wang, Li Hu, Hanbiao Wu, Zhikun Qiu, Fang Yuan, Jisheng Chen, Sha Lai.
       OBJECTIVE: To evaluate the long-term cost-effectiveness of continuous glucose monitoring (CGM) versus self-monitoring of blood glucose (SMBG) in Chinese adults with uncontrolled type 2 diabetes (T2D) to inform optimal disease management and reimbursement policies.
    METHODS: The United Kingdom Prospective Diabetes Study Outcomes Model version 2 was used to simulate 30-year cost and health outcomes for cohorts with baseline HbA1c levels of 7.70%, 8.70%, 9.70%, and 10.70%. Clinical efficacy data were derived from meta-analyses. A cost-effectiveness analysis from China's healthcare perspective referenced a $40 344 per quality-adjusted life year (QALY) willingness-to-pay (WTP) threshold, equal to three times China's per capita gross domestic product (GDP). Sensitivity and scenario analyses addressed model uncertainty and determined annual CGM cost thresholds.
    RESULTS: For baseline HbA1c levels of 7.70%-10.70%, CGM yielded incremental cost-effectiveness ratios (ICERs) of $29 428 to $38 819 per QALY gained, respectively-all below the WTP threshold. Higher baseline HbA1c was associated with greater cost-effectiveness. Sensitivity analyses showed CGM utility benefits and device costs were key drivers. All cohorts demonstrated >96% cost-effectiveness probability. Annual CGM cost thresholds for cost-effectiveness ranged from $1920 to $2316 depending on baseline HbA1c levels of 7.70%-10.70%.
    CONCLUSIONS: CGM represents a cost-effective intervention for Chinese adults with uncontrolled T2D, demonstrating enhanced economic value in populations with elevated baseline HbA1c levels. Implementing risk-stratified reimbursement policies coupled with price negotiations aligned with evidence-based cost thresholds ($1920-$2316 annually), may optimize healthcare resource allocation.
    Keywords:  continuous glucose monitoring; cost‐effectiveness; model analysis; self‐monitoring blood glucose; type 2 diabetes
    DOI:  https://doi.org/10.1111/dom.70333
  8. Dis Mon. 2025 Nov 23. pii: S0011-5029(25)00196-8. [Epub ahead of print] 102042
    Foreword: Patient-accessible continuous glucose monitoring for cardiometabolic risk reduction in type 2 diabetes: A meta-analysis of randomized controlled trials.
    Jerrold B Leikin.
      
    DOI:  https://doi.org/10.1016/j.disamonth.2025.102042
  9. Lancet Diabetes Endocrinol. 2025 Nov 24. pii: S2213-8587(25)00288-8. [Epub ahead of print]
    Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial.
    GRACE study collaborative group
       BACKGROUND: Data regarding the impact of real-time continuous glucose monitoring (rt-CGM) on reducing adverse pregnancy outcomes in women with gestational diabetes are contradictory. We aimed to assess differences in the proportion of large-for-gestational-age (LGA) newborns between women using rt-CGM versus self-monitoring of blood glucose (SMBG).
    METHODS: For this open-label, parallel-group, multicentre, randomised controlled trial, women aged 18-55 years with singleton pregnancy and gestational diabetes (diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria), were randomly assigned (1:1) to rt-CGM or SMBG. The first allocation was by chance; for subsequent allocations, minimisation was used to balance three prespecified factors: gestational age at study entry, previous gestational diabetes, and preconceptional BMI. SMBG participants used blinded CGM for 10 days after randomisation and at 36-38 weeks; rt-CGM participants used open rt-CGM until delivery. All were managed according to standard care protocols in four university hospitals in Austria, Germany, and Switzerland. The primary endpoint was the proportion of LGA newborns (using the Perinatal Institute's GROW customised birthweight percentiles), assessed in the intention-to-treat population. Secondary endpoints included the requirement for glucose-lowering medication, CGM metrics, and non-glycaemic maternal and neonatal outcomes. Recruitment and follow-up are complete. This study is registered with ClinicalTrials.gov (NCT03981328).
    FINDINGS: Between Aug 24, 2020, and May 30, 2024, 610 women were screened for eligibility, of whom 375 (diagnosed with gestational diabetes at a mean of 25·2 weeks [SD 2·3] of gestation), were randomly assigned to rt-CGM (n=190) or SMBG (n=185) at a mean of 28·6 weeks (SD 1·9) of gestation. 170 intervention and 175 control participants with available data were assessed for the primary endpoint. LGA neonates were born to six (4%) of 170 rt-CGM and 18 (10%) of 175 SMBG participants (OR 0·32, 95% CI 0·10-0·87, p=0·014). Small-for-gestational-age (SGA) neonates were born to 33 (19%) and 23 (13%) participants, respectively (OR 1·59, 0·86-2·99, p=0·11). Serious adverse events occurred in 23 (12%) of 190 versus 28 (15%) of 185 participants (OR 0·77, 0·42-1·40, p=0·39).
    INTERPRETATION: rt-CGM use in women with gestational diabetes reduced LGA births, without differences in serious adverse events. The higher-than-expected overall prevalence of SGA infants, possibly related to the tight glycaemic control in our cohort, requires further research.
    FUNDING: Dexcom.
    TRANSLATION: For the German translation of the abstract see Supplementary Materials section.
    DOI:  https://doi.org/10.1016/S2213-8587(25)00288-8
  10. Diabetes Obes Metab. 2025 Nov 25.
    Feasibility study of a combined insulin-delivery and glucose sensor system worn over 7 days in persons with type 1 diabetes.
    Hannah Cunningham, John Apostolopoulos, Jennifer Ngan, Hanna Jones, Katharine Barnard-Kelly, Katrin Brown, Ralph Dutt-Ballerstadt, Steve Flint, Yee Wen Kong, Emma Netzer, Varuni Obeyesekere, Solomon Reid, Huan-Ping Wu, Thomas Seidl, David O'Neal.
       AIMS: We aimed to evaluate sensor accuracy and insulin delivery integrity of a novel device combining continuous glucose monitoring (CGM) with an insulin delivering cannula (CGM-IS) (Pacific Diabetes Technologies, Portland, Oregon, USA) during 7-day wear, in adults with type 1 diabetes (T1D).
    MATERIALS AND METHODS: This single centre, single arm, non-randomised study involves 40 T1D adults who were using insulin pumps and CGM for 7 days, with three meal test days and four free living days. The main endpoints were sensor accuracy according to mean average relative difference (MARD) and infusion set function reflected by time in range (TIR), mean sensor glucose and total daily dose (TDD) of insulin.
    RESULTS: Sensor MARD was 16.4%, 14.8% and 17.7% on Days 1, 4 and 7, respectively. 60.0% of readings met the 15/15 criterion for blood glucose (BG) readings <70.2 mg/dL. Insulin delivery integrity was maintained to Day 3. At Days 5-6 TDD increased by 7.3 units/day (16%), mean BG increased by 16.2 mg/dL (10.2%), and TIR fell by -7.8% (11.2%). 92.1% of devices lasted >4 days. Mean wear time was 6.3 ± 1.4 days. The device was well tolerated.
    CONCLUSION: This human feasibility study supports the potential of CGM-IS use for up to 7 days with a mean survival of over 6 days. However, our data indicate that the durability of insulin delivery and sensor refinement are required prior to commercialisation.
    Keywords:  continuous glucose monitoring; continuous glucose monitor‐insulin set; extended‐wear infusion set; feasibility study; insulin cannula
    DOI:  https://doi.org/10.1111/dom.70331
  11. Sci Rep. 2025 Nov 25.
    Continuous blood glucose monitoring prediction for diabetes using evolving neural network.
    Neil Vaughan.
      This research presents a new evolving neural network approach to forecast blood glucose for people with diabetes. The accuracy of forecasting using the proposed evolving neural network is demonstrated to outperform a conventional back propagation neural network. People with diabetes need to control their blood sugar levels. High blood sugar over long term leads to many other health complications. To avoid high blood sugar, it is important for people to be able to predict what will happen to blood sugar so that they can do something to prevent hypo or hyper glycaemia. However, many external uncontrollable factors can make blood glucose difficult to predict, such as meals which increase carbs and glucose goes up. Exercise also affects blood glucose, but exercise can be aerobic or anaerobic and these affect blood glucose in opposite ways. There has been research aiming to predict blood glucose by analysing previous recorded data from continuous glucose monitoring devices. This research applies a new approach with evolutionary computation to evolve a neural network, using neuro evolution, and the optimised neural network is then applied to predict and forecast blood glucose changes. In the comparison of accuracy, the results show that evolved neural network outperformed a back-propagation neural network in this task on forecasting CGM data. This can help people with diabetes to have a better idea about how their blood glucose is going to change before it occurs, so that hypo and hyper can be avoided. This can reduce diabetes complications and costs for the health service.
    Keywords:  Blood glucose; CGM; Diabetes; Forecast
    DOI:  https://doi.org/10.1038/s41598-025-29169-x
  12. Commun Biol. 2025 Nov 25. 8(1): 1669
    Injury to tissue caused by device penetration of the skin triggers formation of extracellular traps.
    Kenneth A Wood, Priscila S Cunegundes, Jean G de Souza, Joseph Cavataio, Tejas Kakunje, Don L Kreutzer, Ulrike Klueh.
      Continuous glucose monitoring (CGM) systems are vital for diabetes management, but sensor performance is often compromised by host immune responses following insertion. This study investigates early tissue and immune reactions, focusing on neutrophil extracellular trap (NET) formation, or NETosis. In porcine models, insertion trauma rapidly induced NETosis, preceding vascular regression and fibrotic encapsulation-processes that may hinder glucose diffusion and impair sensor accuracy. In a murine air pouch model, sensor implantation elevated inflammatory cytokines (IL-6, KC/GRO) and neutrophil infiltration within 24 hours. Scanning electron microscopy revealed NETs exclusively in traumatized tissue. Notably, neutrophils from type 2 diabetes patients failed to undergo NETosis on polyurethane surfaces in vitro, suggesting impaired immune responses due to metabolic dysfunction. These findings identify NETosis as a key driver of early sensor-tissue interactions. Strategies to reduce insertion trauma and modulate NET formation may enhance CGM reliability and longevity, informing future improvements in sensor design and deployment.
    DOI:  https://doi.org/10.1038/s42003-025-09062-z
  13. BMC Sports Sci Med Rehabil. 2025 Nov 28. 17(1): 359
    Effects of three aerobic exercise protocols on acute glucose response and continuous glucose monitoring trends in patients with type 2 diabetes mellitus and stroke: a randomized controlled trial.
    Kangcheng Chen, Haifeng Ma, Yulong Wang, Dongxia Li, Jun Li, Yong Huang, Meiling Huang.
       OBJECTIVE: This study aims to assess the acute and chronic effects of three aerobic exercise protocols, namely, Moderate-Intensity Interval Training (MIIT), Low-to-Moderate Intensity Continuous Training (LMICT), and Reduced-Exertion High-Intensity Training (REHIT), on glycemic control in patients with Type 2 Diabetes Mellitus (T2DM) and stroke.
    METHODS: Forty-nine patients diagnosed with both T2DM and stroke were randomly assigned to LMICT, MIIT, REHIT, or the control group. The intervention comprised two phases: from day 3 to day 14 and from day 15 to day 28, with days 1 and 2 designated as a baseline control period. Throughout the intervention, blood glucose levels were continuously monitored and recorded using a Continuous Glucose Monitoring (CGM) system.
    RESULTS: All exercise intervention groups exhibited significant immediate reductions in blood glucose levels following exercise (t = 30.68, p < 0.001). Repeated measures analysis of variance (ANOVA) demonstrated significant main effects of group and time, as well as a significant interaction, on mean glucose (MG) and time above range (TAR) (p < 0.05). CGM indicated progressive improvements in MG, time in range (TIR), TAR, peak blood glucose, glucose standard deviation (SD-glucose), and mean amplitude of glycemic excursion (MAGE) in the MIIT group. The REHIT group exhibited significant improvements in peak blood glucose, TIR, TAR, MAGE, SD-glucose, and coefficient of variation (CV) (all p < 0.01). These trends were not evident in the LMICT group. Notably, the MIIT and REHIT groups exhibited early, significant improvements in MG, peak blood glucose, TIR, and TAR, which preceded subsequent changes in SD-glucose and MAGE relative to controls.
    CONCLUSIONS: While all exercise regimens resulted in acute reductions in blood glucose, sustained improvements in overall glycemic control and variability were observed exclusively following the four-week MIIT and REHIT interventions. Specifically, REHIT significantly reduced glucose variability, as reflected by decreases in the CV, whereas MIIT was more effective in lowering MG levels. Conversely, the lower-intensity LMICT regimen (51.23% ± 6.94% heart rate reserve) exerted minimal long-term effects. These findings underscore the potential of moderate- to high-intensity intermittent aerobic training in managing glycemic fluctuations in individuals with T2DM and stroke, thereby emphasizing their clinical relevance.
    TRIAL REGISTRATION: The study was registered with the Chinese Clinical Trial Registry (ChiCTR2200065677, http://www.chictr.org.cn/ ) on 11/11/2022.
    Keywords:  Aerobic exercise training; Continuous glucose monitoring; Glycemic variability; Stroke; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.1186/s13102-025-01402-0
  14. Diabetes Ther. 2025 Nov 28.
    Cost-effectiveness of Freestyle Libre Systems for People with Type 2 Diabetes Mellitus on Basal Insulin Therapy in the Netherlands: An Economic Evaluation from a Societal Perspective Within a Publicly Funded Healthcare System.
    Peter van Dijk, Chris Chesters, Jack Timmons, Kirk Szafranski, Julia Bakker, Fleur Levrat-Guillen.
       INTRODUCTION: Healthcare expenditure for the treatment of type 2 diabetes mellitus (T2DM) in the Netherlands is high, mainly due to the cost of treating diabetes-related complications. Guidelines recommend sensor-based glucose monitoring systems for people living with T2DM and using insulin, but these are not reimbursed in the Netherlands for those using basal insulin only. The objective of this study was to assess the cost-effectiveness of glucose monitoring with FreeStyle Libre systems (FSL), compared with capillary-based self-monitoring of blood glucose (SMBG), for people living with T2DM on basal insulin, from the perspective of the Dutch publicly funded healthcare system.
    METHODS: The patient-level microsimulation model DEDUCE (DEtermination of Diabetes Utilities, Costs, and Effects) was used to estimate the incidence of complications and acute diabetes events (ADEs; hypoglycemia and diabetic ketoacidosis). The effect of FSL was modeled as a 0.5% reduction in glycated hemoglobin level, which DEDUCE translates to a lower rate of complications, and as reductions in ADEs and absenteeism. Costs (in 2024 euros) and utilities were discounted at 3% and 1.5%, respectively. Outcomes were assessed as quality-adjusted life years (QALYs).
    RESULTS: FSL was associated with 0.53 more QALYs than SMBG (12.77 vs. 12.24), at an additional cost of €8021. The resulting incremental cost-effectiveness ratio (ICER) for FSL versus SMBG was €15,181/QALY. The increased acquisition cost of FSL (€19,738) was partially offset by reductions in costs associated with complications, ADEs, and absenteeism. Probabilistic sensitivity analysis showed that FSL was 52% likely to be cost-effective at a willingness-to-pay threshold of €20,000/QALY, and > 99% likely at thresholds ≥ €40,000/QALY. FSL had an ICER of below €50,000/QALY in all scenarios investigated.
    CONCLUSION: From a Dutch publicly funded healthcare system perspective, FSL can be considered to be cost-effective compared with SMBG for people living with T2DM on basal insulin therapy.
    Keywords:  Basal insulin; Continuous glucose monitoring; Cost-effectiveness analysis; FreeStyle libre system; Netherlands; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.1007/s13300-025-01821-9
  15. Diabetol Metab Syndr. 2025 Nov 22.
    Sequential use of continuous glucose monitoring, with or without exercise trackers, significantly improves glycemic control in patients with type 2 diabetes.
    Anushka Lahiri, Suan Tee Lim, Htike Kyu, Yock Young Dan, Chin Meng Khoo.
       AIMS: Continuous glucose monitoring systems (CGM) and exercise trackers offer real-time feedback on the effects of lifestyle intervention on blood glucose. This randomized controlled trial aimed to examine whether an additional exercise tracker (Fitbit) would improve glycemic control, in combination with sequential CGM (FreeStyle Libre), in middle-aged patients with Type 2 Diabetes.
    METHODS: This 6-month prospective study included 158 patients, of whom 138 participants completed the protocol, with a median age of 58 (54, 62) years and HbA1c of 9.7% (8.8, 10.4). There were 69.6% participants on insulin therapy. Participants were randomly assigned to one of two groups: a group wearing a CGM alone (CGM, n = 73) or a group wearing both a CGM and a Fitbit INSPIRE HR (CGM-Fit, n = 65). All participants wore three sequential CGM (2 weekly for 6 weeks), coupled with diabetes education and diet counselling.
    RESULTS: Both groups demonstrated sufficient CGM data capture at each two weeks (89.8%, 90.8%, 92%), with an average wear time of 14 days and 6-7 scans per day. Overall, time-in-range increased (61%, 67%, 71%; p < 0.01) and time-above-range decreased (35%, 27%, 25%; p < 0.01). HbA1c reduced significantly (p < 0.0001) between baseline and 3 months by 1.5% in both groups, independent of weight changes. However, between 3 and 6 months, the CGM group experienced a rise in HbA1c of 0.7% (p < 0.0001) compared (p < 0.05) to the 0.4% rise (p < 0.0001) in the CGM-fit group. The CGM-Fit group maintained their physical activity levels, whereas the CGM group experienced a significant reduction (p < 0.01) in physical activity.
    CONCLUSIONS: The use of sequential CGM, guided by Diabetes counselling and dietary advice, significantly improved HbA1c. Using an exercise tracker may help sustain physical activity and glycemic control.
    Keywords:  CGM; Exercise tracker; Sequential; Type 2 diabetes
    DOI:  https://doi.org/10.1186/s13098-025-02035-6
  16. Cardiovasc Diabetol Endocrinol Rep. 2025 Nov 26. 11(1): 32
    Triple arm, prospective, real-world study comparing the efficacy of FDC teneligliptin + dapagliflozin to FDC sitagliptin + dapagliflozin, and FDC linagliptin + empagliflozin in Indian type 2 diabetes mellitus patients using CGM device: the Amplify-TIR study.
    Suhas Erande, Mayur Agrawal, Sanjeev Gulati, Namdev Jagtap, N S Praveen Kumar, Vinod Kumar Kapoor, Sumit Bhushan, Rujuta Gadkari, Mayur Jadhav, Sanjay Choudhari, Saiprasad Patil, Hanmant Barkate.
      
    Keywords:  Continuous glucose monitoring; Dapagliflozin; Empagliflozin; Glycemic variability; HbA1c; Renal function; Sitagliptin; Teneligliptin; Time in range; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.1186/s40842-025-00244-6
  17. J Clin Transl Endocrinol. 2025 Dec;42 100423
    Insulin dose adjustment policy for certified diabetes care and education specialists: Safe and effective.
    Jeannine C Leverenz, Lauren Horton, Barry Conrad, Shannon Lin, Annette Chmielewski, Franziska K Bishop, Melissa Quaid, Priya Prahalad, David M Maahs.
      In 4T Study 1, youth with new-onset type 1 diabetes started a continuous glucose monitor (CGM) soon after diagnosis and received remote CGM data review and dose changes by a Certified Diabetes Care and Education Specialist (CDCES) via secure portal messaging. We describe the CDCES policy to make incremental dose adjustments and report its safety and effectiveness, which facilitated patients' reaching and maintaining targets. We aim to publish this data-supported CDCES protocol to facilitate use at other diabetes centers who may restrict CDCES from adjusting insulin doses. The CDCESs and Pediatric Endocrinologists agreed on criteria for making dose changes. CDCESs made insulin dose adjustments and consulted with Pediatric Endocrinologists per protocol and as needed. CDCES sent messages with suggested dose adjustments and behavior changes via secure portal messaging. In the first year, a total of 1564 remote patient monitoring messages were sent to 133 participants. Most messages were triggered by low time-in-range (TIR, 70-180 mg/dl [63 %]), hypoglycemia (39 %), decline in TIR (13 %), or insufficient CGM wear time (7 %). There were 3 episodes of severe hypoglycemia, none adjudicated related to the CDCES dosing protocol. At one year, the mean time <70 mg/dl was <2 %, and the A1C target of <7 % was met by 64 %. We created a policy for CDCESs to adjust insulin doses and increase patient interaction between visits. The results demonstrate that CDCES can work at the top of their certification to adjust insulin doses to achieve target goals without decreasing safety.
    Keywords:  Continuous glucose monitoring; Diabetes technology; Glycemic maintenance; Insulin dosing; Remote patient monitoring; Time in range; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.jcte.2025.100423
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