bims-glumda 2026-09-27 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2026–09–27
fourteen papers selected by
Mott Given

From Glucose Data to Distress: Recognizing Anxiety Related to Continuous Glucose Monitoring.
Continuous Glucose Monitoring Alert Settings and Glycemic Control in People With Diabetes.
Combining Contingency Management With Continuous Glucose Monitoring to Support Type 2 Diabetes Prevention and Care.
Continuous Glucose Monitoring and Hospitalization Outcomes in Adults with Insulin-Treated Type 2 Diabetes and Complex Care Needs: A Population-Based Study.
Effects of short-bout accumulated physical activity and sedentary-break interventions on continuous glucose monitoring metrics in adults with type 2 diabetes: A systematic review and meta-analysis.
An international position statement on practical approaches for inpatient continuous glucose monitoring, insulin pumps and automated insulin delivery systems in adults.
Accelerometer-Derived Physical Activity, Sedentary Behavior, and Continuous Glucose Monitoring-Derived Glycemic Variability in Adults with Type 2 Diabetes: A Longitudinal Repeated-Measures Study.
Association Between Continuous Glucose Monitoring Utilization and Glucagon-Like Peptide-1 Receptor Agonist Discontinuation in Type 2 Diabetes: A Real-World Study.
An International Position Statement on Practical Approaches for Inpatient Continuous Glucose Monitoring, Insulin Pumps, and Automated Insulin Delivery Systems in Adults.
Letter: The Moving Target of Continuous Glucose Monitor Contact Dermatitis: Dexcom G7 Reformulation and the Argument for Device Ingredient Disclosure.
Interpretation of the ambulatory glucose profile in diabetes: practical application in community pharmacy.
Insulin Resistance Modifies the Glycemic Impact of Carbohydrate Across Distinct Meal Contexts: A Repeated-Measures Dual-CGM Study.
A Patient- and Function-Centric Model/Approach for Hypoglycemia Management in Older Adults.
Diabetes Technology in the School Setting for Preschool-Aged Children.

J Diabetes Sci Technol. 2026 Sep 25. 19322968261489628

From Glucose Data to Distress: Recognizing Anxiety Related to Continuous Glucose Monitoring.

Peihong Chen, Shan Zhang, Limei Zheng, Yinfang Tu, Haifeng Xu, Haoyong Yu.



Keywords:  anxiety; continuous glucose monitoring; diabetes distress; diabetes technology; psychological burden

DOI:  https://doi.org/10.1177/19322968261489628
JAMA Netw Open. 2026 Sep 01. 9(9): e2635687

Continuous Glucose Monitoring Alert Settings and Glycemic Control in People With Diabetes.

Yaguang Zheng, Stephen B Johnson, Eduardo Iturrate, Bei Wu, Heng Huang, William Small, Susan Zweig, Rozalina G McCoy.

DOI: https://doi.org/10.1001/jamanetworkopen.2026.35687
J Diabetes Sci Technol. 2026 Sep 25. 19322968261484170

Combining Contingency Management With Continuous Glucose Monitoring to Support Type 2 Diabetes Prevention and Care.

Jesse Dallery, Bengisu Tulu, Steven Jenkins, Rachael Fitzgerald, Arnie P Aldridge, Ian Duncan, David Kerr.

  Diabetes prevention and care require recurring self-management behaviors whose benefits are often delayed and uncertain. Digital contingency management (CM), which arranges incentives contingent on objective evidence of behavior or outcomes, offers a scalable way to strengthen these behaviors. This commentary argues that continuous glucose monitoring (CGM) can transform CM for diabetes by enabling frequent, remote reinforcement of clinically meaningful proximal targets, including sensor wear, time in range, and other glucose-derived metrics. Emerging artificial intelligence tools may further personalize treatment during risk periods and tailor reinforcement schedules. Although cost-effectiveness data in diabetes are needed, the high clinical and economic burden of diabetes provides a strong rationale for evaluating CGM-linked CM as a scalable behavioral intervention. We discuss previous CM research, implementation readiness, and future research priorities.

Keywords:  contingency management; continuous glucose monitoring; diabetes; digital health; financial incentives; self-management

DOI:  https://doi.org/10.1177/19322968261484170
Diabetes Technol Ther. 2026 Sep 24. 15209156261492377

Continuous Glucose Monitoring and Hospitalization Outcomes in Adults with Insulin-Treated Type 2 Diabetes and Complex Care Needs: A Population-Based Study.

Pablo Rodríguez de Vera Gómez, Ángel Manuel Mesa Díaz, Eduardo Mayoral Sánchez, Fernando Gómez-Peralta, Guillermo E Umpierrez, María Asunción Martínez Brocca.

   AIM: Continuous glucose monitoring (CGM) improves glycemic outcomes in insulin-treated type 2 diabetes (T2D), but evidence in individuals with complex care needs (CCN) is limited. We evaluated the association between CGM initiation and hospitalization outcomes in a population-based cohort of adults with insulin-treated T2D and CCN.
METHODS: We conducted a population-based quasi-experimental study including all eligible adults with insulin-treated T2D and CCN who initiated CGM through the Andalusian Public Health System. Rates of acute diabetes-related complications and cardiovascular admissions were compared before and after CGM initiation using Poisson regression models adjusted for person-time. Interrupted time-series analyses, length of stay (LOS), and hospitalization costs were also evaluated.
RESULTS: Of 17,561 adults initiating CGM, 5281 met criteria for CCN and were included (mean age 79 years; 55.1% aged ≥ 80 years). Acute diabetes-related hospitalization rates decreased from 144.27 to 41.04 per 10,000 person-years (rate ratio [RR] 0.28, 95% CI 0.19-0.42), and cardiovascular admission rates decreased from 387.25 to 251.96 per 10,000 person-years (RR 0.65, 95% CI 0.54-0.78). Interrupted time-series analyses showed post-intervention hospitalization rates consistently below counterfactual estimates. Mean LOS decreased by 3.68 days (95% CI -5.26 to -2.10; P < 0.001), and hospitalization costs decreased by USD657.39 per patient-year.
CONCLUSION: In this population-based cohort of adults with insulin-treated T2D and CCN, CGM initiation was associated with fewer hospitalizations, shorter hospital stays, and lower hospitalization costs, supporting the integration of diabetes technology into chronic care strategies for highly vulnerable populations.

Keywords:  acute diabetes complications; cardiovascular complications; complex care needs; continuous glucose monitoring; hospitalization; multimorbidity; type 2 diabetes

DOI:  https://doi.org/10.1177/15209156261492377
Front Endocrinol (Lausanne). 2026 ;17 1901259

Effects of short-bout accumulated physical activity and sedentary-break interventions on continuous glucose monitoring metrics in adults with type 2 diabetes: A systematic review and meta-analysis.

Sicheng Cao, Haozhe Wang, Yongliang Zhu, Changkun Shan, Wenjia Chen.

   Objective: Glycated hemoglobin does not fully capture postprandial hyperglycemia or intraday glycemic fluctuation, whereas continuous glucose monitoring (CGM) characterizes mean glucose, hyperglycemic exposure, and glycemic variability. Short-bout accumulated physical activity and sedentary-break interventions are low-burden strategies that can be integrated into daily routines, but their overall effects on CGM-derived outcomes in adults with type 2 diabetes remain uncertain. We systematically reviewed and quantitatively synthesized these effects.
Methods: We searched 11 bibliographic and registry sources from inception to 29 July 2026, after an initial eight-database search through 4 June 2026. Randomized and controlled crossover trials were eligible. We retained the original broad eligibility criteria and examined a narrower post-hoc intervention definition in sensitivity analysis. Paired mean differences and standard errors were extracted or reconstructed. Random-effects meta-analysis used restricted maximum likelihood with Hartung-Knapp-Sidik-Jonkman inference. When paired covariance was unavailable, r = 0.50 was used, with r = 0.25 and r = 0.75 sensitivity analyses. Risk of bias was assessed for specific results with crossover RoB 2 and certainty was assessed with GRADE.
Results: Thirteen studies were included; 10 studies (175 participants) contributed to the overall mean-glucose synthesis. Short-bout activity reduced mean glucose (MD = -0.71 mmol/L, 95% CI -1.28 to -0.13; p = 0.021), with considerable heterogeneity (I² = 91%; tau² = 0.55) and a prediction interval that included the null value (no effect) (-2.48 to 1.06). Intervention category did not explain heterogeneity (p = 0.628). All leave-one-out estimates remained significant; omitting Dempsey (2017) reduced I² to 5.8% and yielded MD = -0.33 mmol/L (95% CI -0.50 to -0.16). Mean amplitude of glycemic excursions (MAGE) favored activity, whereas glucose standard deviation (SD), coefficient of variation (CV), and time in range (TIR) were inconclusive. Hyperglycemia time was pooled only for compatible thresholds and windows. Certainty ranged from moderate to very low and was low for mean glucose.
Conclusion: Short-bout accumulated physical activity may reduce CGM-derived mean glucose in adults with type 2 diabetes. Although effects remained favorable across correlation, model, arm-selection, and leave-one-out analyses, considerable heterogeneity and a prediction interval that included the null value (no effect) limit confidence in the effect expected in a new setting. Evidence for other glycemic outcomes and safety remains uncertain.
Systematic Review Registration: www.crd.york.ac.uk/prospero, identifier CRD420261415265.

Keywords:  continuous glucose monitoring; exercise snacks; glycemic variability; meta-analysis; sedentary breaks; short-bout accumulated physical activity; systematic review; type 2 diabetes

DOI:  https://doi.org/10.3389/fendo.2026.1901259
Diabetologia. 2026 Sep 22.

An international position statement on practical approaches for inpatient continuous glucose monitoring, insulin pumps and automated insulin delivery systems in adults.

Mikkel T Olsen, Elias K Spanakis, Hood Thabit, Ketan Dhatariya, Omar G Mustafa, Parizad Avari, Alistair N Lumb, Katheleen Dungan, Athena Philis-Tsimikas, Kristen Kulasa, David N O'Neal, Shashank R Joshi, Alexandros L Liarakos, Emma G Wilmot, Julie L V Shaw, Roman Vangoitsenhoven, Chantal Mathieu, Irl B Hirsch, Priyathama Vellanki, Francisco J Pasquel, Guillermo Umpierrez, Rodolfo J Galindo, Ulrik Pedersen-Bjergaard, Peter L Kristensen, Julia K Mader, Kirsten Nørgaard.

  There is an urgent and unmet need for a practical clinical guideline addressing the use of continuous glucose monitoring (CGM), insulin pumps and automated insulin delivery (AID) systems in hospital settings. The goal with this position statement is to facilitate effective and safe use of these devices to improve glycaemic management, enhance outcomes and contribute to standardisation efforts in initiating or continuing the use of these devices in hospitals for non-critically ill hospitalised adults. The topics covered include selection criteria for management with diabetes technologies, CGM-derived glycaemic metrics and goals for adults with diabetes, insulin titration and administration guidelines, perioperative care, CGM alarm settings for hypoglycaemia and hyperglycaemia, clinical staff training and workflows, integration of device data with the electronic health record, imaging tests considerations and discharge planning.

Keywords:  Automated insulin delivery; Continuous glucose monitoring; Diabetes; Diabetes technology; Hospital; In-hospital; Inpatient; Insulin pump; Position statement

DOI:  https://doi.org/10.1007/s00125-026-06838-8
J Funct Morphol Kinesiol. 2026 Aug 28. pii: 338. [Epub ahead of print]11(3):

Accelerometer-Derived Physical Activity, Sedentary Behavior, and Continuous Glucose Monitoring-Derived Glycemic Variability in Adults with Type 2 Diabetes: A Longitudinal Repeated-Measures Study.

Paul César Velásquez Porras, Alicia Olinda Neyra Aranda, Dimna Zoila Alfaro Quezada, Digmer Pablo Riquez Livia, Henri Emmanuel Lopez Gomez, Roberto Carlos Dávila-Morán.

  Background: Day-to-day movement behavior may influence short-term glycemic variability in adults with type 2 diabetes, but free-living evidence integrating accelerometry with continuous glucose monitoring (CGM) remains limited. Objectives: This study examined whether daily moderate-to-vigorous physical activity (MVPA) and accelerometer-defined sedentary time were associated with 24-h within-day glycemic variability. Methods: In this longitudinal repeated-measures study, 140 adults with type 2 diabetes underwent 14 days of concurrent hip-worn ActiGraph GT3X+ accelerometry and FreeStyle Libre 2 CGM under free-living conditions in Lima, Peru. The primary outcome was a daily CGM-derived coefficient of variation (CV). Linear mixed-effects models separated within-person and between-person components, with Holm adjustment for the two primary within-person associations. Results: The fully adjusted primary analysis included 132 participants and 1728 participant-days. Higher within-person MVPA was associated with a lower daily CV (β = -0.27 percentage points per 10 min/day, 95% CI -0.45 to -0.09; Holm-adjusted p = 0.006), whereas greater accelerometer-defined sedentary time was associated with a higher CV (β = 0.05, 95% CI 0.01 to 0.09; Holm-adjusted p = 0.014). Secondary concurrent analyses showed favorable MVPA and opposite sedentary time associations for time in range, time above range, mean glucose, and glucose standard deviation (all false discovery rate q ≤ 0.018), with no statistically detectable association with time below range. Lagged associations were directionally consistent, but none remained statistically significant after multiplicity correction. Conclusions: Daily MVPA and accelerometer-defined sedentary times were associated with modest differences in within-day glycemic variability and concurrent CGM profiles. These observational findings do not establish causality or a specific exercise dose.

Keywords:  free-living monitoring; isotemporal substitution; time in range; wearable sensors; within-person variation

DOI:  https://doi.org/10.3390/jfmk11030338
Diabetes Technol Ther. 2026 Sep 19. 15209156261489904

Association Between Continuous Glucose Monitoring Utilization and Glucagon-Like Peptide-1 Receptor Agonist Discontinuation in Type 2 Diabetes: A Real-World Study.

Eugene E Wright, Eileen Huang, Anila Bindal.

   INTRODUCTION: Continuous glucose monitoring (CGM) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) when used jointly are associated with significant improvement in glycemic outcomes. However, it is unknown if using CGM enhances GLP-1 RA continuation. This study assesses the relationship between adherent CGM utilization and GLP-1 RA adherence among people living with type 2 diabetes (T2D) on nonintensive therapy.
METHODS: This retrospective matched-cohort study analyzed data from Inovalon® Insights administrative claims from March 1, 2017, to April 30, 2024, for adults aged ≥18 years diagnosed with T2D, treated with basal insulin or noninsulin therapy, and CGM-naïve before starting GLP-1 RA. Adherent CGM utilization was defined as having a proportion of days covered (PDC) ≥0.8 within 1-year post GLP-1 RA initiation. CGM users were matched with non-CGM users based on age, sex, race/ethnicity, basal insulin/noninsulin therapy, GLP-1 RA type, comorbidities, insurance type, and one fill/multiple refills of GLP-1 RA. The primary outcome was GLP-1 RA discontinuation over the 12-month observation period, which was defined as the first gap of ≥90 days without GLP-1 RA supply post-index. Kaplan-Meier model was used to estimate the time to discontinuation, and hazard ratios (HRs) were calculated using a multivariable Cox proportional hazards regression model.
RESULTS: The study included 934 adherent CGM users matched with 3747 non-CGM users. One year post GLP-1 RA initiation, 68.4% (95% confidence interval [CI]: 65.5%-71.5%) of adherent CGM users remained on GLP-1 RA compared with 51.9% (95% CI: 50.3%-53.5%) of non-CGM users (P < 0.001). After adjusting for covariates, adherent CGM users were significantly less likely to discontinue GLP-1 RA compared to non-CGM users (HR: 0.56 [95% CI: 0.49-0.63], P < 0.001).
CONCLUSIONS: This study suggests that adherent CGM utilization is associated with a significantly lower risk of GLP-1 RA discontinuation and may potentially enhance adherence to GLP-1 RA medication in people living with T2D on nonintensive therapy.

Keywords:  CGM; GLP-1 RA; adherence; continuous glucose monitoring; discontinuation; glucagon-like peptide-1 receptor agonists

DOI:  https://doi.org/10.1177/15209156261489904
Diabetes Care. 2026 Sep 22. pii: dci260091. [Epub ahead of print]

An International Position Statement on Practical Approaches for Inpatient Continuous Glucose Monitoring, Insulin Pumps, and Automated Insulin Delivery Systems in Adults.

Mikkel T Olsen, Elias K Spanakis, Hood Thabit, Ketan Dhatariya, Omar G Mustafa, Parizad Avari, Alistair N Lumb, Katheleen Dungan, Athena Philis-Tsimikas, Kristen Kulasa, David N O'Neal, Shashank R Joshi, Alexandros L Liarakos, Emma G Wilmot, Julie L V Shaw, Roman Vangoitsenhoven, Chantal Mathieu, Irl B Hirsch, Priyathama Vellanki, Francisco J Pasquel, Guillermo Umpierrez, Rodolfo J Galindo, Ulrik Pedersen-Bjergaard, Peter L Kristensen, Julia K Mader, Kirsten Nørgaard.

There is an urgent and unmet need for a practical clinical guideline addressing the use of continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID) systems in hospital settings. The goal with this position statement is to facilitate effective and safe use of these devices to improve glycemic management, enhance outcomes, and contribute to standardization efforts in initiating or continuing the use of these devices in hospitals for non-critically ill hospitalized adults. The topics covered include selection criteria for management with diabetes technologies, CGM-derived glycemic metrics and goals for adults with diabetes, insulin titration and administration guidelines, perioperative care, CGM alarm settings for hypoglycemia and hyperglycemia, clinical staff training and workflows, integration of device data with the electronic health record, imaging tests considerations, and discharge planning.

DOI: https://doi.org/10.2337/dci26-0091
Dermatitis. 2026 Sep 25. 17103568261492621

Letter: The Moving Target of Continuous Glucose Monitor Contact Dermatitis: Dexcom G7 Reformulation and the Argument for Device Ingredient Disclosure.

Sarah Kamsiah Zemlok, Leon Zheng, Kayla Tran, Adam Griechen, Jon Kibbe, JiaDe Yu.

DOI: https://doi.org/10.1177/17103568261492621
Farm Comunitarios. 2026 Oct 15. 18(4): e269

Interpretation of the ambulatory glucose profile in diabetes: practical application in community pharmacy.

J R García Soláns.

   Introduction: The ambulatory glucose profile summarizes continuous glucose monitoring data and complements glycated hemoglobin by providing metrics of exposure, variability, and time spent in different glucose ranges.
Objective: To review the key elements of the ambulatory glucose profile and propose a practical interpretation sequence applicable to community pharmacy.
Material and methods: A targeted narrative review of PubMed/MEDLINE-indexed literature and scientific society recommendations was performed and complemented with official Spanish guidance, with the search updated through August 2026. Priority was given to consensus statements, clinical guidelines, validation studies of glucose metrics, and literature on pharmacist-led continuous glucose monitoring services.
Results: Interpretation should begin by assessing data sufficiency, then prioritize time below range, evaluate time in range and time above range, review the glucose management indicator and coefficient of variation, and identify reproducible time-of-day patterns. Four anonymized real-world clinical profiles are presented for educational purposes together with a proposed community-pharmacy workflow.
Conclusions: A structured review of the ambulatory glucose profile may support patient education, detection of glycemic-control problems, and interprofessional coordination without replacing clinical assessment or medication changes by the appropriate prescriber.

Keywords:  Blood Glucose; Community Pharmacy Services; Continuous Glucose Monitoring; Diabetes Mellitus; Hypoglycemia; Patient Education as Topic

DOI:  https://doi.org/10.33620/FC.2173-9218.2026.30
Metabolites. 2026 Sep 11. pii: 671. [Epub ahead of print]16(9):

Insulin Resistance Modifies the Glycemic Impact of Carbohydrate Across Distinct Meal Contexts: A Repeated-Measures Dual-CGM Study.

Buket Yilmaz Bulbul, Burak Andac, Mehmet Celik.

  Background/Objectives: Postprandial glycemic responses vary markedly among individuals, but it remains unclear whether the glycemic effect of incremental carbohydrate exposure is systematically modified by insulin resistance. We examined whether insulin resistance alters the carbohydrate-postprandial glucose dose-response across distinct meal contexts. Methods: We performed a secondary repeated-measures analysis of the publicly available CGMacros cohort. Forty-five adults spanning normoglycemia, prediabetes, and type 2 diabetes wore blinded FreeStyle Libre Pro and Dexcom G6 Pro continuous glucose monitors while recording meals for approximately 10 days. The primary outcome was 2-h incremental area under the glucose curve (iAUC). Mixed-effects models tested carbohydrate × HOMA-IR interactions, adjusted for protein, fat, fiber, premeal glucose, age, sex, and BMI. Breakfast was the primary structured context, lunch provided within-cohort contextual confirmation, dinner was a free-living contrast, and Dexcom analyses assessed cross-device robustness. Results: The primary Libre analysis included 423 breakfasts and 414 lunches from 44 participants. Higher HOMA-IR significantly amplified the iAUC associated with each 10-g increment in carbohydrate during breakfast (interaction β = 178.5 mg·min/dL per 1-SD higher HOMA-IR; 95% CI 79.5-277.5; p < 0.001) and lunch (β = 109.8; 95% CI 34.2-185.3; p = 0.004). The direction was supported with Dexcom during breakfast (β = 165.3; 95% CI 45.0-285.6; p = 0.007) and lunch (β = 87.9; 95% CI 2.6-173.1; p = 0.043) and remained robust in GEE, participant fixed-effects, random-slope, activity-adjusted, and other sensitivity analyses. No positive interaction was observed during dinner. Conclusions: In this observational secondary analysis, insulin resistance modified the glycemic impact of carbohydrate across two structured meal contexts, with supportive cross-device evidence. These findings are hypothesis-generating and do not establish HOMA-IR-based dietary prescriptions; prospective external validation is required.

Keywords:  CGMacros; HOMA-IR; carbohydrate; continuous glucose monitoring; insulin resistance; personalized nutrition; postprandial glycemia; precision nutrition

DOI:  https://doi.org/10.3390/metabo16090671
Geriatrics (Basel). 2026 Sep 03. pii: 118. [Epub ahead of print]11(5):

A Patient- and Function-Centric Model/Approach for Hypoglycemia Management in Older Adults.

Kannayiram Alagiakrishnan, Laurie Mereu, Gulelala Rahim, Mahua Ghosh, Albert Vu.

  Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients' health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being.

Keywords:  continuous glucose monitoring; diabetes; fear of hypoglycemia; function-centric approach; hypoglycemia distress; hypoglycemia unawareness; intranasal glucagon

DOI:  https://doi.org/10.3390/geriatrics11050118
J Diabetes Sci Technol. 2026 Sep 25. 19322968261486007

Diabetes Technology in the School Setting for Preschool-Aged Children.

Raquel M Gupta, Daniel J DeSalvo, Kelly Hicks, Sarah R Kelly, Serife Uysal-Demiroz, Crystal Woodward, Sarah K Lyons.

  Diabetes technology has transformed the management of type 1 diabetes (T1D) and improved glycemic outcomes, yet preschool-aged children with T1D remain a uniquely vulnerable population. Complete dependence on caregivers and practical considerations such as limited body surface area and skin sensitivity create distinct barriers to effective technology use. These challenges are often compounded by the transition to daycare or school setting, where disruption in diabetes care coordination between home and classroom can compromise glycemic outcomes. This review synthesizes the evidence for diabetes technology use, summarizes the current guidelines, provides practical considerations, and reviews guidance for training protocols and competency requirements in the educational setting. School-based legal protections are discussed, including Section 504 plans and Individualized Education Programs, which should outline the diabetes-related accommodations required in the school setting in alignment with the Diabetes Medical Management Plan. Targeted interventions to improve training of school/daycare staff, facilitate communication across home and school settings, and address disparities in technology access are essential to optimize care and improve long-term health outcomes.

Keywords:  continuous glucose monitors; insulin infusion systems; preschool children; type 1 diabetes

DOI:  https://doi.org/10.1177/19322968261486007