bims-glumda 2026-01-04 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2026–01–04
sixteen papers selected by
Mott Given

Performance of a New Continuous Glucose Monitoring System in German Adults Living with Diabetes.
Effects of Continuous Glucose Monitoring Discontinuation in Adults With Type 2 Diabetes Not Using Insulin.
Continuous Glucose Monitoring in the Management of Gestational Diabetes in Switzerland (DipGluMo): An Open-Label, Single-Centre, Randomized, Controlled Trial.
Comparative effectiveness of glucose monitoring methods and glycaemic control in patients with type 2 diabetes: An umbrella review.
Remote Patient Monitoring with Continuous Glucose Monitoring Improves Glycemic Outcomes in Patients with Type 2 Diabetes at a Safety-Net Hospital.
An Exploratory Analysis of Continuous Glucose Monitoring Metrics in Relation to Prediabetes in Youths with Obesity.
Performance of continuous glucose monitoring systems (CGMs) during commercial flights in T1DM: A within-subject comparative pilot study.
Continuous glucose monitoring reveals high prevalence of hyperglycaemia in patients prior to pancreatic surgery: A pilot study.
Continuous Glucose Monitors Among Adults With Type 2 Diabetes Mellitus in the Primary Care Setting: Qualitative Study Informed by Technology Acceptance Model and Health Belief Model.
Skin Autofluorescence and Perinatal Outcomes in Pregnant Women with a Positive Glucose Challenge Test: A Prospective Study with Exploratory Analyses of Oxidative Stress and CGM Metrics.
Continuous Glucose Monitor Use and Diabetes Self-Management Behaviors in Adults Managed in Specialty Clinic: Qualitative Descriptive Study.
Glycemia risk index in pediatric type 1 diabetes: A retrospective observational study of a novel metric for assessing glycemic control and variability.
Can Glucose Alarm Fatigue Threaten the Absolute Clinical Benefit of Continuous Glucose Monitoring in Optimal Glucose Management in Children and Adolescents with Type 1 Diabetes? A Narrative Review.
Effect of digital interventions on adherence to the management of type 1 diabetes mellitus patients: a systematic review.
Effects of Continuous Glucose Monitoring on Glycemic Control, Mental Health and Self-Management in Adults with Type 1 Diabetes: A Randomized Controlled Trial.
User evaluation of the Hypo-METRICS app: A tool for real-time symptom reporting of hypoglycaemia.

Diabetes Ther. 2025 Dec 29.

Performance of a New Continuous Glucose Monitoring System in German Adults Living with Diabetes.

Nina Jendrike, Manuela Link, Sükrü Öter, Jiangfeng Fei, Jiyun Zheng, Fei Gao, Ao Gao, Siting Zhu, Leon Shi, Poul Strange, Frank Flacke, Manuel Eichenlaub, Guido Freckmann.

   INTRODUCTION: The True Vie I3 continuous glucose monitoring system (i3 CGM, Sinocare Meditech Inc., also approved in Europe as GlucoMen® iCan or iCan CGM system) is a new real-time continuous glucose monitoring system (CGM) intended for the management of diabetes mellitus. This pivotal study evaluated the performance of the factory-calibrated CGM system.
METHODS: In this center-specific dataset, 35 adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) wore sensors on the abdomen and arm for 15 days. Four in-clinic visits were scheduled, during which frequent comparator sampling of venous blood was performed every 5-15 min for up to 10 h, and a glucose manipulation was performed. CGM performance compared to Yellow Springs Instrument 2300 Stat Plus Glucose and Lactate Analyzer (Yellow Springs, OH) glucose analyzer was evaluated for abdomen and arm sensors separately, regarding mean absolute relative difference (MARD) and agreement rates (AR) stratified by glucose range and rate of change (RoC). Additionally, clinical accuracy, sensor attachment rate, pain, and safety were assessed. This single-center analysis was developed with the intention to provide European-and particularly German-data. The presented site was the highest-enrolling center in the study and, as such, can be considered representative of the overall study population-an assumption that the analysis confirmed.
RESULTS: 20/20 AR and MARD were 95.5% and 9.4% for abdomen sensors, and 95.3% and 9.8% for arm sensors, respectively. Consensus error grid (CEG) analyses revealed that 100% of CGM-comparator pairs fell in zones A and B for abdomen and arm sensors. Accuracy of sensors remained stable throughout the wearing time. Adhesion rate was 100% for abdomen sensors and 97.1% for arm-worn sensors, without the use of any over-tape during the 15-day study period. Pain during insertion and removal was reported as minimal, and no unexpected safety issues were identified.
CONCLUSIONS: Data from a single study center showed that the performance of the i3 CGM is comparable to that published for other established CGM devices, and accuracy results were within limits specified for integrated continuous glucose monitoring systems (iCGM). The i3 CGM showed reliability, and its safety was validated during the 15 study days.
TRIAL REGISTRATION: The study was registered under ClinicalTrials.gov (ID: NCT05806554).

Keywords:  Accuracy; Agreement rates; Diabetes; MARD; Performance evaluation; iCGM

DOI:  https://doi.org/10.1007/s13300-025-01832-6
J Diabetes Sci Technol. 2025 Dec 29. 19322968251404496

Effects of Continuous Glucose Monitoring Discontinuation in Adults With Type 2 Diabetes Not Using Insulin.

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

   INTRODUCTION: Growing research suggests continuous glucose monitoring (CGM) may help improve glycemic outcomes in noninsulin-using people with type 2 diabetes (T2D). The continuous biofeedback from CGM provides considerable opportunities to support personalized behavior changes; however, limited research exists to describe what happens to glycemia in this population when CGM is removed. The purpose of this follow-up study is to evaluate the effects of CGM discontinuation in noninsulin-using people with T2D.
METHODS: The effects of CGM discontinuation were assessed using data from the UNITE study (NCT05928572). Phase 1 of UNITE was a two-month intervention that evaluated the impact of using a nutrition-focused approach during CGM initiation on glycemic measures in people with T2D. In Phase 2, after discontinuing CGM use for four months, blinded CGM data and other measures were collected at Follow-up and compared to data from the post-intervention (Post) period.
RESULTS: The percent time in range 70 to 180 mg/dL decreased from 77% in the Phase 1 Post period to 60% during the Phase 2 Follow-up period (95% confidence interval [CI] = -22%, -12%; P < .0001). Several additional glycemic metrics also worsened significantly from Post to Follow-up (P < .05). Dietary intake and exercise at Follow-up were not statistically different from Post (P > .05), but physical activity decreased (P = .01).
CONCLUSION: In noninsulin-using people with T2D, glycemic measures improved with real-time CGM use, but these improvements deteriorated substantially and significantly when CGM use was discontinued. More research and more sensitive behavioral assessments are needed to better understand which factors and behavior changes may account for the glycemic decline.

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

DOI:  https://doi.org/10.1177/19322968251404496
Obstet Gynecol Surv. 2025 Nov 01. 80(11): 679-681

Continuous Glucose Monitoring in the Management of Gestational Diabetes in Switzerland (DipGluMo): An Open-Label, Single-Centre, Randomized, Controlled Trial.

Sofia Amylidi-Mohr, Giulia Zennaro, Sophie Schneider, Luigi Raio, Beatrice Mosimann, Daniel Surbek.

(Abstracted from Lancet Diabetes Endocrinol 2025;13:591-599) The incidence rate for gestational diabetes mellitus (GDM) is as high as 14%, making it one of the more common complications of pregnancy. Glycemic control is an important factor in the treatment of GDM and includes self-monitoring of blood glucose (SMBG).

DOI: https://doi.org/10.1097/01.ogx.0001172276.61602.22
Diabetes Obes Metab. 2025 Dec 28.

Comparative effectiveness of glucose monitoring methods and glycaemic control in patients with type 2 diabetes: An umbrella review.

Nathaniel Foo, Sri Chodapaneedi, Brayden Gibson, Harvey Jia Wei Koh, Danijela Gasevic, Peter Hamblin, Caroline Trin, Pilar Cataldo, Ella Zomer, Anthony Russell, Sophia Zoungas, Stella Talic.

  Type 2 diabetes is highly prevalent, and many adults, especially those not using insulin, struggle to reach HbA1c targets. This review aimed to evaluate the effect of self-monitoring blood glucose (SMBG) and continuous glucose monitoring (CGM) on glycaemic control in adults with type 2 diabetes. We searched MEDLINE, Cochrane Library, Embase, and Scopus from January 2014 to May 2025 for systematic reviews of randomized controlled trials enrolling adults with type 2 diabetes that evaluated SMBG or CGM versus no monitoring or SMBG, respectively. Fifteen systematic reviews comprising 81 unique studies and 23 657 participants were included. Reviews comparing SMBG with no monitoring demonstrated a modest but significant reduction in HbA1c (MD -0.23%, 95% CI -0.29 to -0.18; I2 = 21%). Reviews directly comparing CGM with SMBG showed greater HbA1c reduction with CGM (MD -0.29%, 95% CI -0.34 to -0.24; I2 = 0%). Subgroup analyses for SMBG indicated consistent benefits across follow-up duration, monitoring structure, and study quality, although heterogeneity was high in some comparisons. Subgroup analyses for CGM types found both isCGM/FGM (MD -0.27%, 95% CI -0.43 to -0.11) and rtCGM (MD -0.36%, 95% CI -0.45 to -0.27) superior to SMBG. These findings support glucose monitoring for optimizing glycaemic management and outcomes. Further investment in cost-effectiveness studies is warranted to assess broader implementation in this population.

Keywords:  continuous glucose monitoring; glycaemic control; non‐insulin glucose‐lowering therapy; self‐monitoring of blood glucose; type 2 diabetes mellitus; umbrella review

DOI:  https://doi.org/10.1111/dom.70401
Endocr Pract. 2025 Dec 30. pii: S1530-891X(25)01345-X. [Epub ahead of print]

Remote Patient Monitoring with Continuous Glucose Monitoring Improves Glycemic Outcomes in Patients with Type 2 Diabetes at a Safety-Net Hospital.

Katherine Cuan, Tiffany X Lu, Travis Goettemoeller, Xianhong Xie, Sharon Rikin, Sarah W Baron, Jill P Crandall, David J Carruthers.

   OBJECTIVE: The Bronx has a high prevalence of type 2 diabetes mellitus (T2DM) but limited primary care access, delaying evaluation and treatment. Remote patient monitoring (RPM) with continuous glucose monitors (CGM) may improve outcomes in T2DM. We evaluated whether RPM with CGM improved hemoglobin A1c (HbA1c) compared to standard care at our safety-net hospital.
METHODS: This retrospective cohort study compared a pilot RPM diabetes program to a control cohort receiving standard care. RPM and control patients were ≥18 years old with T2DM and had HbA1c >8.5% (69 mmol/mol), and basal insulin and CGM prescriptions. Participants had monthly telemedicine visits with an endocrine specialist for 3-6 months. Patients unable or unwilling to use telemedicine or CGM were excluded. Primary outcome was change in HbA1c from baseline to repeat HbA1c at 2-6 months. A multivariable logistic regression model adjusted for baseline HbA1c and demographics.
RESULTS: The RPM (n=41) and control (n=766) cohorts had mean baseline HbA1c of 10.5±1.4% (91±15.6 mmol/mol) and 10.6±1.7% (92±18.8 mmol/mol), respectively. At follow up, HbA1c decreased by 3.0% (32.9 mmol/mol) in the RPM group vs. 2.1% (22.4 mmol/mol) in controls (P = 0.004). A goal HbA1c <7.5% (58 mmol/mol) was achieved in 58.5% of RPM patients vs. 36.2% of controls (OR 2.53, 95% CI 1.31 - 4.88, P<0.01). Most frequent medication adjustments occurred with insulin, GLP-1, and GLP-1/GIP.
CONCLUSION: RPM with CGM improved glycemic control in T2DM in an under-resourced setting, compared to standard care. Further research is needed to explore implementation on a larger scale.

Keywords:  Continuous Glucose Monitoring; Remote Patient Monitoring; Telemedicine; Type 2 Diabetes Mellitus

DOI:  https://doi.org/10.1016/j.eprac.2025.12.016
Diabetes Technol Ther. 2025 Dec 22.

An Exploratory Analysis of Continuous Glucose Monitoring Metrics in Relation to Prediabetes in Youths with Obesity.

Claudia Piona, Eleonora Maria Aiello, Valentina Mancioppi, Erika Caiazza, Francesca Olivieri, Stefano Passanisi, Fortunato Lombardo, Concetta Mastropasqua, Cosimo Giannini, Giuseppe Riccardi, Claudio Maffeis.

  Introduction: Youth obesity is a strong risk factor for prediabetes (PD) and type 2 diabetes. Current criteria for the diagnosis of PD/diabetes, including fasting glucose, 2-h blood glucose after oral glucose tolerance test (OGTT), and HbA1c, have some acknowledged limitations in youth. Continuous glucose monitoring (CGM) offers the opportunity to record daily glucose profiles in a free-living conditions. This study aims to explore how the CGM metrics are related to PD in youths with obesity. Method: Youths with obesity (BMI-for-age > 2SD, age 10-18 years) wore a Freestyle Libre 2 CGM sensor for 2 weeks. Several CGM metrics were measured, including time in tight ranges (TITR) 70-140 and 70-120 mg/dL. All subjects underwent OGTT, and normal glucose tolerance (NGT) and prediabetes (PD) were defined by American Diabetes Association criteria. A nonparametric Wilcoxon rank-sum test was used to compare NGT and PD youths, and logistic regression analysis was performed to investigate the ability of CGM metrics to predict PD. Results: Overall, 84 youths (age 12.6 ± 1.9 years, 42.4% female, BMI 32.8 ± 6.6 kg/m2, HbA1c5.4 ± 0.2%, CGM use >80%) were recruited. HbA1c, blood glucose measured at baseline, 30, 90, and 120 min, and the area under the curve of glucose after glucose load were significantly higher (P value <0.05) in PD than in NGT youths. TITR 70-140 mg/dL and TITR 70-120 mg/dL were significantly (P < 0.05) lower in PD than in NGT youths. No other CGM metrics differed between the two groups. Both TITR 70-140 and 70-120 mg/dL significantly predict PD (P = 0.02), independent of age and sex, though with modest discriminative ability. Conclusions: This exploratory study showed that TITR measured in free-living may aid the identification of PD in youths with obesity, although the discriminative ability of CGM metrics was limited. Future works will focus on the analysis of the concordance of plasma glucose and CGM during OGTT, as well as their predictive performance.

Keywords:  children and adolescents; continuous glucose monitoring; obesity; prediabetes; time in tight range

DOI:  https://doi.org/10.1177/15209156251407959
Diabetes Obes Metab. 2026 Jan 02.

Performance of continuous glucose monitoring systems (CGMs) during commercial flights in T1DM: A within-subject comparative pilot study.

EASA Diabetes Consortium

   AIMS: Continuous glucose monitoring (CGM) systems are increasingly used, but their accuracy under flight-conditions remains insufficiently studied. We assessed sensor accuracy of four CGMs during in-flight (mid-haul) and ground conditions.
MATERIALS AND METHODS: Participants (n = 20) wore four sensors (Abbott Libre 3, Dexcom G7, Medtronic Simplera, and Sinocare iCan i3) in parallel, inserted 1 day prior to experiment. Capillary reference measurements were performed every 30 min. Accuracy evaluation included: proportion of CGM values within 10% of comparator glucose levels >100 mg/dL or within 10 mg/days of comparator levels ≤100 mg/dL (%10/10), along with %20/20 agreement rates, mean absolute relative difference (MARD), Consensus error grid.
RESULTS: Twenty participants with type 1 diabetes (age: 37.9 ± 12.8 years, HbA1c: 52.3 ± 4.9 mmol/mol, diabetes duration 19.25 ± 10.6 years) were included in the analysis. Data from 297 sensors with 3473 matched pairs (G7/Libre3/Simplera/i3) were analysed. The overall MARDs were: 9.5% ± 3.3% (G7), 9.6% ± 3.8% (Libre3), 19.9% ± 6.2% (Simplera) and 15.7% ± 6.6% (i3). Overall %20/20 and %10/10 agreement rates were 90.6%/70.2% (G7), 90.8%/66.8% (Libre3), 63.6%/37.8% (Simplera) and 72.5%/42.2% (i3) respectively. The proportion of values in Zones A and B of the Consensus error grid was 98.9% (G7), 99.0% (Libre 3), 94.5% (Simplera) and 97.5% (i3). Prandial state and flight phase had limited influence on the relative performance ranking of the devices.
CONCLUSIONS: G7 and Libre3 showed consistently higher accuracy and clinical reliability across various phases of flight and ground conditions. Simplera and i3 exhibited greater variability in accuracy. These findings suggest that while modern CGMs could support diabetes management in aviation, individual system performance may differ under specific operational conditions.

Keywords:  CGM; aviation; diabetes; insulin; pilots; technology

DOI:  https://doi.org/10.1111/dom.70418
J Clin Transl Endocrinol. 2026 Feb;43 100426

Continuous glucose monitoring reveals high prevalence of hyperglycaemia in patients prior to pancreatic surgery: A pilot study.

Heleen Driessens, Josephine A C Woldring, Maarten W Nijkamp, Peter R van Dijk, Joost M Klaase.

   Aims: Patients with pancreatic tumours are at increased risk of diabetes mellitus (DM) and hyperglycaemia and a subsequent higher risk of developing postoperative complications. Continuous glucose monitoring (CGM) can be used to assess the prevalence of hyperglycaemia in pancreatic surgery patients.
Methods: This single-centre observational pilot study (2023-2025) included 15 patients with DM type 2 or new onset DM (HbA1c ≥ 48 mmol/mol (6.5 %)) undergoing pancreatic surgery. Blinded CGM was performed for 2 weeks preoperatively and 2 weeks perioperatively. Primary outcome was time above range (TAR)(glucose > 10.0 mmol/l (180.2 mg/dl)) as a percentage of total CGM wear time. Secondary outcomes were time below and in range, glucose metrics, difference in preoperative HbA1c and patient satisfaction regarding CGM wear.
Results: In total, 5 patients had new-onset DM, 6 suboptimal controlled DM (HbA1c ≥ 53 mmol/mol (7.0 %)) and 4 optimal controlled DM (HbA1c < 53 mmol/mol (7.0 %)) at baseline. Median preoperative TAR (>10.0 mmol/L (180.2 mg/dl)) was highest in the suboptimal controlled DM group (59.7 % [35.1-68.6]), compared to 7.9 % [0.9-19.4] in the optimal controlled and 16.7 % [7.7-23.7] in the new-onset DM group. Perioperatively, the optimal controlled DM group had the highest TAR (26.7 % [11.3-49.0]) while the new-onset and suboptimal controlled DM group had TARs of 4.6 % [1.2-9.6] and 16.3 % [11.5-23.4], respectively.
Conclusions: Blinded CGM revealed frequent pre- and perioperative hyperglycaemia and high inter-individual variability in TAR among patients with (new-onset) DM undergoing pancreatic surgery. These findings support the need for stricter and more individualized glucose monitoring. This could optimize preoperative glucose management and thereby possibly reduce postoperative complications.

Keywords:  Diabetes mellitus; Pancreatic cancer; Postoperative complications; Prehabilitation

DOI:  https://doi.org/10.1016/j.jcte.2025.100426
JMIR Diabetes. 2025 Dec 30. 10 e73446

Continuous Glucose Monitors Among Adults With Type 2 Diabetes Mellitus in the Primary Care Setting: Qualitative Study Informed by Technology Acceptance Model and Health Belief Model.

Michelle I Knopp, Ann Marie Castleman, Anna Schwarz, Jamarin Belger-Wallace, Mercedes Falciglia, Aleona Zuzek, Eneida Mendonca.

   Background: Continuous glucose monitors (CGM) reduce the burden of glycemic monitoring and improve glycemic control, quality of life, and decreased health care use. Despite expanded insurance coverage and adoption, barriers remain, especially in primary care. Existing research largely evaluates specific populations or interventions, leaving limited insight into the broader primary care experience.
Objective: This study aims to examine the experiences of adults with type 2 diabetes mellitus (T2DM) using CGM in primary care, guided by the Health Belief Model and Technology Acceptance Model.
Methods: This qualitative study included in-person semistructured sessions (interviews or a focus group), surveys, and electronic health record data. Participants were recruited from 3 urban primary care (internal medicine and internal medicine-pediatrics) clinics affiliated with a large academic health system in Southwest Ohio, United States, with high rates of public insurance (Medicare or Medicaid). Eligible participants were adults (≥18 y) with T2DM and a CGM prescription. Data were analyzed using theme generation guided by directed content analysis in MAXQDA (VERBI Software GmbH) with codes derived from Health Belief Model and Technology Acceptance Model constructs. Survey data were used to triangulate to enhance validity.
Results: Overall, 16 participants (interviews: n=12; 1 focus group: n=4) were recruited for the study with a mean age of 56.9 (SD 10.5) years. In total, 69% (11/16) identified as Black, 100% (16/16) as Non-Hispanic, and 69% (11/16) as female, and 94% (15/16) used public insurance. Six themes emerged: disease susceptibility, disease severity, influential drivers, perceived ease of use, perceived usefulness, and attitude toward using CGM. All participants found CGM helpful and would recommend it to others. While affirming numerous barriers well-described in other populations, this study uniquely describes the burden of comorbidities, the trust in CGM data compared to glucometer-based monitoring, and the reliance on receivers to use CGM technology in this patient population.
Conclusions: CGM is valued by adults with T2DM in primary care, yet barriers remain. Tailored support for initiation, troubleshooting, and education (especially alarm management and data interpretation) is needed. These insights can inform scalable strategies to enhance CGM use and experience in primary care.

Keywords:  CGM; Technology Acceptance Model; continuous glucose monitors; primary care; qualitative research; type 2 diabetes mellitus

DOI:  https://doi.org/10.2196/73446
J Clin Med. 2025 Dec 12. pii: 8796. [Epub ahead of print]14(24):

Skin Autofluorescence and Perinatal Outcomes in Pregnant Women with a Positive Glucose Challenge Test: A Prospective Study with Exploratory Analyses of Oxidative Stress and CGM Metrics.

Yuri Kakuto, Makoto Ohara, Keiko Koide, Anna Osamura, Rei Matsuura, Sho-Ichi Yamagishi, Akihiko Sekizawa.

  Background/Objectives: Skin autofluorescence (SAF), a marker of advanced glycation end products (AGEs), reflects cumulative hyperglycemia and may predict vascular complications in diabetes. Continuous glucose monitoring (CGM) also provides detailed glycemic profiles, but their prognostic values in gestational diabetes mellitus (GDM) are unclear. The primary aim was to evaluate whether SAF predicts adverse maternal or neonatal outcomes, whereas secondary exploratory analyses assessed oxidative stress markers and CGM-derived metrics. Methods: We prospectively enrolled 115 Japanese pregnant women with plasma glucose ≥ 140 mg/dL at 60 min after 50-g GCT. At around 29 weeks' gestation, SAF and diacron-reactive oxygen metabolites (d-ROMs) were measured, and a subset underwent 14-day CGM. Maternal and neonatal outcomes were obtained from medical records. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: In the primary analysis of the overall cohort, SAF did not predict adverse outcomes. In the CGM subgroup, mean glucose level (MGL) was significantly higher in women with maternal complications. Multivariate analysis identified MGL as the only independent predictor of maternal adverse events (adjusted OR 10.45 per 10 mg/dL, 95% CI 1.93-56.5; AUC 0.818; cutoff 86.8 mg/dL). No marker predicted neonatal outcomes. Conclusions: The pre-specified primary endpoint was negative (SAF was not predictive), and oxidative stress markers were also not predictive, whereas CGM-derived MGL independently predicted maternal adverse outcomes, underscoring the utility of CGM for risk stratification in pregnant women with abnormal GCT results.

Keywords:  continuous glucose monitoring; gestational diabetes mellitus; glucose variability; oxidative stress; skin autofluorescence

DOI:  https://doi.org/10.3390/jcm14248796
Sci Diabetes Self Manag Care. 2026 Jan 02. 26350106251405751

Continuous Glucose Monitor Use and Diabetes Self-Management Behaviors in Adults Managed in Specialty Clinic: Qualitative Descriptive Study.

Patricia C Underwood, Viktoriya Babicheva, Jordan Keels, Caitlin Flewelling, Victor Petreca, Cherlie Magny-Normilus, Jagriti Upadhay.

PURPOSE: The purpose of the study was to explore perceptions of using continuous glucose monitor (CGM) use and how it affects diabetes self-management behaviors in adult patients with diabetes.
METHODS: Individual qualitative interviews following a structured script were conducted with 10 adult patients (mean age 31.2, ±14.5 SD) with type 1 or type 2 diabetes seen in an endocrine specialty clinic in the United States.
RESULTS: Multiple themes related to diabetes self-management were reported, including nutrition choices, exercise engagement, medication management, endocrine provider communication, and managing hypoglycemia. Furthermore, themes of diabetes distress, including financial concerns over health insurance coverage of CGM supplies and provider communication over supply refills, emerged.
CONCLUSION: Study interviews highlight several areas of focus that may help providers incorporate CGM use into diabetes self-management education and management plans. To validate these findings, future quantitative research is needed to better understand how to incorporate CGM use into diabetes self-management education interventions to support healthy behavior change in adults with diabetes.

DOI: https://doi.org/10.1177/26350106251405751
Endocrine. 2025 Dec 29. 91(1): 4

Glycemia risk index in pediatric type 1 diabetes: A retrospective observational study of a novel metric for assessing glycemic control and variability.

Mohammad Hosny Awad, Reham Ghanim, Motaz Azzam, Allaa Backour, Nandu Thalange.



Keywords:  Continuous glucose monitoring; Glycemia risk index; Glycemic variability; Pediatrics; Type 1 diabetes

DOI:  https://doi.org/10.1007/s12020-025-04534-y
Children (Basel). 2025 Dec 08. pii: 1668. [Epub ahead of print]12(12):

Can Glucose Alarm Fatigue Threaten the Absolute Clinical Benefit of Continuous Glucose Monitoring in Optimal Glucose Management in Children and Adolescents with Type 1 Diabetes? A Narrative Review.

Styliani Giza, Eleni P Kotanidou, Vasiliki Rengina Tsinopoulou, Thekla Poukoulidou, Stergianna Ntouma, Assimina Galli-Tsinopoulou.

  Technology has brought about a revolution in the management of type 1 diabetes (T1D). The adoption of continuous glucose monitoring (CGM) and insulin pump therapy in the everyday life of children and adolescents with T1D is a real innovation and the most promising choice for optimizing glycemic control in this population. The incorporation of an alarm system, including notifications, alerts and alarms and warning patients and their parents about glucose levels and upcoming events interfering with safety, is an invaluable additional tool for better targeting euglycemia. However, in parallel with the clinical benefits of alarm systems in ameliorating metabolic control parameters, alarm fatigue was recorded as a phenomenon, negatively affecting the everyday lives of patients and their caregivers, and as a cause for rejecting or abandoning CGM or pump therapy treatment. There are a few data concerning the frequency, consequences and methods of eliminating alarm fatigue among children. As a result, we have conducted a narrative review to briefly present the basic philosophy of the existing CGM alarm systems and their positive effect on glycemic management, and focus on alarm fatigue; definition, frequency, effect on quality of life and sleep, not only of T1D pediatric patients but also of their families, and methods of elimination. Efforts to achieve a more reliable and accurate alarm system and educate on adapting personalized limits and positively interpreting them may protect the T1D pediatric population from alarm fatigue and prevent rejection or incomplete use of CGM and insulin pump as the therapeutic choice, ensuring the best glycemic control.

Keywords:  adolescents; alarm fatigue; children; continuous glucose monitoring; insulin pump; type 1 diabetes

DOI:  https://doi.org/10.3390/children12121668
BMC Endocr Disord. 2025 Dec 30. 25(1): 293

Effect of digital interventions on adherence to the management of type 1 diabetes mellitus patients: a systematic review.

Mohammad Jawad, Saima Afaq, Sana Hussain, Syeda Fatima Jamal, Zia Ul Haq, Arshad Hussain, Asif Rehman, Samrina Khan, Moath Ahmed Abdullah Almuradi.

   INTRODUCTION: Digital health interventions have gained prominence in the management of chronic diseases like Type 1 Diabetes Mellitus (T1DM), helping patients adhere to their treatment plans. However, the effectiveness of these interventions in improving adherence to T1DM management varies globally.
OBJECTIVES: To systematically review existing digital interventions designed to improve adherence to T1DM management. To identify key features of digital tools that enhance adherence and glycaemic control in T1DM patients.
MAIN OUTCOME MEASURES: Primary outcomes were improvements in patient adherence, measured by frequency of insulin administration, self-monitoring of blood glucose, and HbA1c levels. Secondary outcomes included patient satisfaction and engagement with digital interventions.
METHODS: A systematic review of randomized controlled trials (RCTs) was conducted using the PICO framework. The review encompassed studies from various global regions. Studies included T1DM patients across different age groups. Databases such as PubMed, Cochrane, and Ovid were searched for relevant studies.
RESULTS: A total of 12 randomized controlled trials (RCTs) were included in this review, focusing on improving adherence in T1DM patients. The digital interventions evaluated included mobile health applications, continuous glucose monitoring, telemedicine platforms, and educational video games. Most studies demonstrated significant improvements in patient adherence behaviours, such as insulin administration and self-monitoring of blood glucose, reductions in HbA1c levels were also noted.
DISCUSSION: The improvements in HbA1c as seen in this review for individuals with T1DM are in line with findings from prior studies. The evidence showed that digital health technologies could enhance glycaemic control. These findings are in line with other studies where real-time data monitoring equipment of the emergent CGM systems and mobile apps facilitated accurate and timely modification of diabetes self-management. The reviewed studies also highlighted the effectiveness of digital technology-targeted interventions in enhancing the aspect of self-management and health behaviour among T1DM patients. These results are also aligned with the behavioural change theories which highlight the significance of education, perceived self-ability and continuous feedback in adopting good health behaviour.
CONCLUSIONS: Digital interventions have a positive impact on adherence to T1DM management and glycaemic control. Their application, particularly in low-resource settings, holds great potential for improving health outcomes.
CLINICAL TRIAL NUMBER: Not applicable. The aim of this review was to look at how mobile applications among other digital tools can assist people living with Type 1 Diabetes (T1DM) through continuous glucose monitoring to manage their health condition in a better way. For this purpose, we reviewed 12 different studies and found that interventions delivered through digital tools enhanced patients' adherence to their treatment by helping them lower the blood sugar levels as measured by HbA1c levels. Main findings reflected how digital tools improved health behaviours and self-management of T1DM. This was facilitated by real-time data monitoring and feedback for the diabetes care. In conclusion, Digital health interventions have the potential to positively impact the T1DM treatment leading to improved health outcomes especially in low resource settings.

Keywords:  Adherence; Continuous glucose monitoring; Digital health interventions; Glycaemic control; Low-resource settings; Mobile applications; Systematic review; Telemedicine; Type 1 diabetes mellitus

DOI:  https://doi.org/10.1186/s12902-025-02100-1
Healthcare (Basel). 2025 Dec 05. pii: 3197. [Epub ahead of print]13(24):

Effects of Continuous Glucose Monitoring on Glycemic Control, Mental Health and Self-Management in Adults with Type 1 Diabetes: A Randomized Controlled Trial.

Rocío Romero-Castillo, Manuel Pabón-Carrasco, Shakira Kaknani-Uttumchandani, José Antonio Ponce-Blandón.

  Background/Objectives: Adults with type 1 diabetes (T1D) often experience psychological distress that interferes with their ability to maintain optimal self-care. The purpose of this study was to evaluate the effectiveness of the Diabself-care, a nurse-led structured diabetes self-management education (DSME) intervention designed to improve glycemic control, self-care practices and mental health among adults with T1D. Methods: A total of 224 adults with type 1 diabetes were randomized and final analyses included 110 participants in the intervention group and 106 in the control group. The intervention group received the Diabself-care program, consisting of five daily 90 min sessions integrating education, skill training, self-management and coping strategies in addition to usual care. The control group received standard diabetes care. Outcomes were assessed at baseline, 1 month and 3 months. The primary measure was glycemic control and secondary outcomes including self-management, anxiety and depressive symptoms. Results: The intervention group achieved a significant increase in time in range at both 1 and 3 months. Self-management adherence improved significantly in the intervention group (p < 0.001). Anxiety and depression scores decreased significantly in the intervention group at 1 and 3 months, while they remained unchanged in controls. Regression analyses identified depressive symptoms as the strongest predictor of anxiety (OR = 4.34, 95% CI = 2.99-6.28, p < 0.001), while female sex, older age, and low self-management were predictors of depression. Belonging to the intervention group was strongly protective against depression (OR = 0.11, 95% CI = 0.05-0.24, p < 0.001). Conclusions: The Diabself-care program significantly improved glycemic control, self-management, and psychological outcomes in adults with T1D. These findings highlight the dual clinical and mental health benefits of structured nurse-led DSME, supporting its integration into routine diabetes care. The trial is registered at ClinicalTrials.gov, ID: NCT05159843.

Keywords:  anxiety; continuous glucose monitoring; depression; self-management; type 1 diabetes mellitus

DOI:  https://doi.org/10.3390/healthcare13243197
Diabet Med. 2025 Dec 30. e70185

User evaluation of the Hypo-METRICS app: A tool for real-time symptom reporting of hypoglycaemia.

Hypo‐RESOLVE consortium

   AIMS: Hypoglycaemia remains a barrier to optimal diabetes management, with few tools for capturing real-time person-reported hypoglycaemia (PRH). This study evaluated the Hypo-METRICS app, originally developed for a multinational 10-week prospective study of hypoglycaemia. It enables real-time reporting of hypoglycaemic episodes and their impact on daily functioning using Ecological Momentary Assessment (EMA), thereby overcoming limitations of retrospective self reports.
METHODS: After completing the Hypo-METRICS study, 120 participants with type 1 diabetes mellitus (T1D) or type 2 diabetes mellitus (T2D) from Austria, Denmark, the Netherlands, and the United Kingdom were invited to complete a web-based questionnaire assessing app content, functionality, intervention effects, user engagement and the influence of the Covid-19 pandemic.
RESULTS: Ninety-six participants (80%; 29 T1D, 67 T2D) completed the questionnaire (40% women; mean age 57.2 ± 16.1 years; 26% impaired hypoglycaemia awareness; HbA1c 60 ± 13 mmol/mol (7.6 ± 1.1%); diabetes duration 20.4 ± 11.3 years). App content and functionality were rated highly (>8/10 and >7/10, respectively). Some reported declining engagement, likely due to study length. COVID-19 had a minimal impact on app use.
CONCLUSIONS: The Hypo-METRICS app was well accepted, with strong ratings for usability and functionality. Given its unique strengths, the app has the potential to become an essential instrument for researchers aiming to capture the real-world burden and impact of hypoglycaemia.

Keywords:  CGM; Hypo‐METRICS; app; continuous glucose monitoring; diabetes; diabetes management; hypoglycaemia

DOI:  https://doi.org/10.1111/dme.70185