bims-glumda 2025-06-01 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–06–01
fifteen papers selected by
Mott Given

Continuous glucose monitoring in gestational diabetes.
Developing CGMap: Characterizing Continuous Glucose Monitoring Data in Patients with Type 2 Diabetes.
Beyond the Trend Arrow: Potential Value of Artificial Intelligence-Supported Glucose Predictions for People with Type 1 Diabetes Using Continuous Glucose Monitoring Systems.
Rapid increase in continuous glucose monitoring use among adults with type 1 diabetes admitted to hospital: a Melbourne multicentre observational study.
Real-world initiation of continuous glucose monitoring (CGM) in adults with type 1 diabetes leads to increased body mass index - A brief report from IMI-SOPHIA study.
A Pilot Study Examining If the Additional Use of a Continuous Glucose Monitoring Is Helpful for Glucose Control in Older Adults.
Temporal Glycemic Patterns in Type 1 and Type 2 Diabetes: Insights From Extended Continuous Glucose Monitoring.
Initiation of Continuous Glucose Monitoring and Mortality in Type 2 Diabetes.
Overall Uptake and Racial, Ethnic, and Socioeconomic Disparities in the Use of Continuous Glucose Monitoring Devices Among Insulin-Treated Older Adults With Type 2 Diabetes.
Association between urinary albumin-to-creatinine ratio within the normal range and continuous glucose monitoring-derived metrics in children and adolescents with type 1 diabetes.
Continuous glucose monitoring in the management of gestational diabetes in Switzerland (DipGluMo): an open-label, single-centre, randomised, controlled trial.
Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring.
Understanding Device Integrations Within Diabetes Apps: Mixed Methods Analysis of App Features and User Reviews.
Promoting the signal reliability of non-invasive biosensors via a N-doped graphene quantum dot modified Prussian blue analogue protective layer for glucose monitoring.
Wearable Wireless Patch with Unidirectional Microfluidic Chamber for Enzyme-Free Glucose Monitoring in Sweat.

Lancet Diabetes Endocrinol. 2025 May 26. pii: S2213-8587(25)00093-2. [Epub ahead of print]

Continuous glucose monitoring in gestational diabetes.

David Simmons, Thora Y Chai.

DOI: https://doi.org/10.1016/S2213-8587(25)00093-2
Biomedicines. 2025 Apr 29. pii: 1080. [Epub ahead of print]13(5):

Developing CGMap: Characterizing Continuous Glucose Monitoring Data in Patients with Type 2 Diabetes.

Shuzhen Bai, Chu Lin, Xiaoling Cai, Suiyuan Hu, Jing Wu, Ling Chen, Wenjia Yang, Linong Ji.

  Objectives: This study will characterize continuous glucose monitoring (CGM) data in patients with type 2 diabetes in China, and assess the relationship between CGM-derived indicators and diabetes-related clinical parameters. Methods: The data for this study were collected from a randomized trial in China (ChiCTR2000039424) from February 2020 to July 2022 in which patients wore a CGM device for 14 days. Glycemia risk index (GRI), coefficient of variation (CV), standard deviation (SD), mean amplitude of glycemic excursions (MAGE), time in range (TIR), time above range (TAR), time below range (TBR), and estimate glycated hemoglobin (eA1c) were analyzed. Ordinary least square linear regression and the Spearman method were used to test the relationship between CGM-derived indicators and diabetes-related clinical parameters. Results: In all, 528 patients with type 2 diabetes from a randomized controlled trial were analyzed. It was shown that CV, SD, and MAGE increased with age and diabetes duration, but decreased with an increase in body mass index. Higher fasting plasma glucose, higher baseline HbA1c, and higher insulin resistance levels were associated with higher GRI, SD, MAGE, TAR, and eA1c, and they were associated with lower TIR. In addition, higher HOMA-2β was associated with higher TIR and TBR, and with lower TAR and eA1c. Hemoglobin had positive correlations to SD, TAR, and eA1c. Conclusions: It was found that glucose variability increased with age and the duration of diabetes. However, glucose variability decreased with increased BMI. Meanwhile, greater glycemic variability was associated with worse islet function, higher baseline glucose level, and higher hemoglobin.

Keywords:  continuous glucose monitoring; diabetes management; type 2 diabetes

DOI:  https://doi.org/10.3390/biomedicines13051080
Diabetes Technol Ther. 2025 May 29.

Beyond the Trend Arrow: Potential Value of Artificial Intelligence-Supported Glucose Predictions for People with Type 1 Diabetes Using Continuous Glucose Monitoring Systems.

Sufyan Hussain, William Polonsky, Renza Scibilia, Timor Glatzer.

  Advances in diabetes technologies such as continuous glucose monitoring (CGM) have provided significant opportunities to improve glycemic and quality-of-life outcomes for people with type 1 diabetes (T1D). The ambulatory glucose profile and the introduction of glucose thresholds helped a lot to identify patterns, which was the first step toward improving hyper-and hypoglycemia management. Despite these innovations, the relentless burden of day-to-day T1D management continues to be a challenge for individuals and their families. In particular, hypoglycemia remains a significant cause of morbidity and mortality, as well as a barrier to achieving optimal glycemia, contributing to anxiety, fear, worry, and distress. Algorithm developments have led to CGM device-based thresholds and predictive alarms to warn individuals of impending hypoglycemia. More recent developments with artificial intelligence technology now allow for forecasting glucose trends and values over longer time frames, thereby aiding therapy decision-making. In this article, we focus on hypoglycemia and summarize recent developments in glucose prediction from CGM devices. While not intended to be a comprehensive review, we provide an update, highlight anticipated developments, and speculate on potential pitfalls and the potential value from medical, psychosocial, and lived experience perspective.

Keywords:  artificial intelligence; continuous glucose monitoring; diabetes; digital health; glucose prediction; predictive analytics

DOI:  https://doi.org/10.1089/dia.2025.0293
Intern Med J. 2025 May 29.

Rapid increase in continuous glucose monitoring use among adults with type 1 diabetes admitted to hospital: a Melbourne multicentre observational study.

Ray Wang, Brintha Krishnamoorthi, Ailie Connell, Cherie Chiang, Debra Renouf, Rahul Barmanray, Mervyn Kyi, Spiros Fourlanos.

  Continuous glucose monitoring (CGM) technology is transforming community diabetes management. Interest in the utility of CGM during hospitalisation is increasing. This multicentre retrospective observational study found that, among adult inpatients with type 1 diabetes, the proportion with inpatient CGM glucose data in hospital-linked CGM software accounts increased from 3.2% in 2021 to 20.5% in 2023. This study highlights the need for hospital-based clinicians to familiarise themselves with CGM technology.

Keywords:  continuous glucose monitor; diabetes; inpatient; type 1 diabetes

DOI:  https://doi.org/10.1111/imj.70095
J Diabetes Complications. 2025 May 24. pii: S1056-8727(25)00142-4. [Epub ahead of print]39(8): 109089

Real-world initiation of continuous glucose monitoring (CGM) in adults with type 1 diabetes leads to increased body mass index - A brief report from IMI-SOPHIA study.

Jimena Soto-Hernaez, Rory J McCrimmon, Ewan R Pearson, Enrique Soto-Pedre.

  Continuous glucose monitoring (CGM) has beneficial effects on glycaemic control in adults with type 1 diabetes (T1D), but the potential effects on body mass index (BMI) remain unclear. This study underscores a trend of increasing BMI within two years after CGM initiation.

Keywords:  Body Mass Index; Cohort studies; Continuous glucose monitoring; Obesity; Overweight; Type 1 diabetes mellitus

DOI:  https://doi.org/10.1016/j.jdiacomp.2025.109089
Yonsei Med J. 2025 Jun;66(6): 346-353

A Pilot Study Examining If the Additional Use of a Continuous Glucose Monitoring Is Helpful for Glucose Control in Older Adults.

Kwang Joon Kim, Yang Sun Park, Eunseo Sun, Euna Jo, Jiwon Shinn, Hyeon Woo Yim, Chang Oh Kim, Hun-Sung Kim.

   PURPOSE: To investigate whether using a continuous glucose monitoring (CGM) for the second time (2nd_CGM) would be effective after using it for the first time (1st_CGM), depending on age.
MATERIALS AND METHODS: This study included patients aged ≥40 years who were diagnosed with type 2 diabetes and had used a CGM at least twice between 2017 and 2021. Participants were divided into two groups based on their age: those aged <60 years and those aged ≥60 years. We assessed the glycemic control status of the 1st_CGM and 2nd_CGM, along with the glycemic variability.
RESULTS: Overall, 15 patients were included in the study. The mean glucose level in users aged <60 years significantly decreased (p<0.001) owing to the CGM use, while it did not increase in those aged ≥60 years. In users aged ≥60 years, the 1st_CGM group showed a significant decrease in blood glucose levels over time (p<0.05), whereas the 2nd_CGM group only showed a non-significant decreasing trend. The time in range tended to increase in those aged <60 years but decreased in those aged ≥60 years. In those aged <60 years, the mean amplitude of glycemic excursions (p<0.001), standard deviation (p<0.05), and coefficient of variation (p<0.001) significantly decreased. In those aged ≥60 years, these parameters exhibited a non-significant decreasing trend.
CONCLUSION: Glycemic effect and variability improved as expected with 1st_CGM use. However, 2nd_CGM did not significantly improve glycemic effect or variability in users aged ≥60 years, contrary to expectations. To address this issue, further investigation is needed to understand why, compared to 1st_CGM, 2nd_CGM fails to achieve better glycemic control in individuals aged ≥60 years.

Keywords:  Aged; diabetes mellitus; glycemic control

DOI:  https://doi.org/10.3349/ymj.2024.0261
J Diabetes Sci Technol. 2025 May 24. 19322968251341264

Temporal Glycemic Patterns in Type 1 and Type 2 Diabetes: Insights From Extended Continuous Glucose Monitoring.

Tomoki Okuno, Lucas Sort, Bowen Zhang, Kerry Zhou, Matthew Kitchen, Victor Li, Donald R Miller, Gregory J Norman, Peter Reaven, Jin J Zhou.

   BACKGROUND: Achieving optimal glycemic control for persons with diabetes remains difficult. Real-world continuous glucose monitoring (CGM) data can illuminate previously underrecognized glycemic fluctuations. We aimed to characterize glucose trajectories in individuals with Type 1 and Type 2 diabetes, and to examine how baseline glycemic control, CGM usage frequency, and regional differences shape these patterns.
METHODS: We linked Dexcom CGM data (2015-2020) with Veterans Health Administration electronic health records, identifying 892 Type 1 and 1716 Type 2 diabetes patients. Analyses focused on the first three years of CGM use, encompassing over 2.1 million glucose readings. We explored temporal trends in average daily glucose and time-in-range values.
RESULTS: Both Type 1 and Type 2 cohorts exhibited a gradual rise in mean daily glucose over time, although higher CGM usage frequency was associated with lower overall glucose or attenuated increases. Notable weekly patterns emerged: Sundays consistently showed the highest glucose values, whereas Wednesdays tended to have the lowest. Seasonally, glycemic control deteriorated from October to February and rebounded from April to August, with more pronounced fluctuations in the Northeast compared to the Southwest U.S.
CONCLUSIONS: Our findings underscore the importance of recognizing day-of-week and seasonal glycemic variations in diabetes management. Tailoring interventions to account for these real-world fluctuations may enhance patient engagement, optimize glycemic control, and ultimately improve health outcomes.

Keywords:  continuous glucose monitoring; glycemic control; glycemic pattern; time in range; type 1 diabetes; type 2 diabetes

DOI:  https://doi.org/10.1177/19322968251341264
Diabetes Technol Ther. 2025 May 28.

Initiation of Continuous Glucose Monitoring and Mortality in Type 2 Diabetes.

Peter D Reaven, Sharon Macwan, Michelle Newell, Gayatri Arani, Gregory J Norman, Donald R Miller, Jin J Zhou.

  Background: Although use of continuous glucose monitoring (CGM) has been linked with improved glucose control, including reductions in hemoglobin A1c and episodes of hypoglycemia, there has been little investigation of its possible role in reducing other serious clinical events. Objective: To estimate the effect of starting CGM in patients with type 2 diabetes (T2D) on mortality. Research Design: A cohort study comparing mortality between propensity score-matched CGM users and non-CGM users over 18 months. Setting: Veterans Affairs Health Care System. Participants: Adult patients with T2D receiving insulin who were identified as CGM users or non-CGM users between January 1, 2015, and December 31, 2020. Measurements: Primary outcome of all-cause mortality; secondary outcomes of serious all-cause hospitalization, cardiovascular events, and admissions related to hyperglycemia and hypoglycemia. Results: A total of 12,729 patients with T2D (94% male with mean age 66) who were new CGM users were 1:1 matched with non-CGM users. Total follow-up time was 17,676 and 17,034 person-years for CGM and non-CGM users. Risk for mortality was lower in CGM users (hazard ratio or HR 0.79: 95% confidence interval or CI 0.73-0.86), as were risks for all-cause hospitalization (0.91: 0.86, 0.96), cardiovascular events (0.84: 0.73, 0.96), and admissions for hyperglycemia (0.88: 0.81, 0.95). Lower risk for mortality persisted after accounting for early deaths, COVID-19, recent onset of diabetes, subsequent use of insulin pumps or newer diabetes medications, or when stratifying by frequency of CGM use, frailty index or mortality risk (all HRs: 0.83 or less, range of CI: 0.60-0.94). No differences between CGM and non-CGM users were seen with negative control outcomes. Limitations: Unmeasured health factors, behaviors, or other confounders may exist. Conclusion: In a large national cohort, initiation of CGM was associated with lower mortality in T2D patients using insulin and indicates use of CGM may have benefits that extend beyond glucose lowering.

Keywords:  Veterans Health Administration; continuous glucose monitoring; electronic health records; glycemic control; hemoglobin A1c; hospitalization; hyperglycemia; hypoglycemia; real-world evidence; type 2 diabetes

DOI:  https://doi.org/10.1089/dia.2025.0227
Diabetes Care. 2025 May 30. pii: dca250006. [Epub ahead of print]

Overall Uptake and Racial, Ethnic, and Socioeconomic Disparities in the Use of Continuous Glucose Monitoring Devices Among Insulin-Treated Older Adults With Type 2 Diabetes.

Wajd Alkabbani, Sara J Cromer, Dae Hyun Kim, Julie M Paik, Katsiaryna Bykov, Medha Munshi, Deborah J Wexler, Elisabetta Patorno.

OBJECTIVE: To assess time trends of and examine which sociodemographic and clinical characteristics are associated with continuous glucose monitoring (CGM) initiation in insulin-treated older adults with type 2 diabetes (T2D).
RESEARCH DESIGN AND METHODS: Using data from Medicare Fee-for-Service (2013-2020) and Optum's deidentified Clinformatics Data Mart Database (Clinformatics) (2013-2022), we identified patients aged ≥65 years with T2D receiving insulin therapy who initiated CGM annually. Initiation of a CGM device was defined based on Current Procedural Terminology codes and National Drug Codes. Then, we 1:4 matched new users of CGM to patients unexposed to CGM, using risk set sampling. Index date was the date of CGM initiation or, for control participants, the closest physician visit within ±7 days. We used logistic regression to assess demographic and clinical characteristics associated with CGM initiation.
RESULTS: The annual CGM initiation rate rose from 107 to 5,249/100,000 in Medicare (2013-2020) and from 796 to 9,195/100,000 in Clinformatics (2013-2022). Compared with White patients, Hispanic (odds ratio, 96% CI: 0.44, 0.42-0.48 in Medicare and 0.81, 0.78-0.85 in Clinformatics) and Black (0.71, 0.69-0.73 in Medicare and 0.89, 0.85-0.92 in Clinformatics) individuals were less likely to receive CGM. Older age and residing in low socioeconomic status areas were associated with lower CGM uptake, while history of hypoglycemia and lower frailty scores increased CGM initiation likelihood.
CONCLUSIONS: CGM initiation has increased over time but remains <10% among insulin-treated older adults with T2D. Substantial racial, ethnic, and socioeconomic disparities were observed.

DOI: https://doi.org/10.2337/dca25-0006
Diabetol Metab Syndr. 2025 May 26. 17(1): 173

Association between urinary albumin-to-creatinine ratio within the normal range and continuous glucose monitoring-derived metrics in children and adolescents with type 1 diabetes.

László Barkai, Olivér Rácz, György Eigner, Levente Kovács.

   AIMS: Albuminuria within the normal range may predict an increased risk of subsequent nephropathy in type 1 diabetes (T1D). The role of sustained hyperglycaemia in the development of nephropathy is well-known. The relationship between albuminuria within the normal range and parameters of continuous glucose monitoring (CGM) in childhood has not yet been investigated. The aim of the present study was to analyze this relationship in young T1D patients.
METHODS: A total of 54 normoalbuminuric, normotensive, real time CGM user pubertal children and adolescents with T1D were recruited for this study. Patients with medium to high normal (1.0-2.9 mg/mmol; n = 18) and those with low normal (< 1.0 mg/mmol; n = 36) urinary albumin-to-creatinin ratio (UACR) were compared regarding CGM metrics data. Relationships of UACR with clinical variables and CGM-derived metrics were analysed by multiple logistic regression.
RESULTS: Time in range (TIR) was lower in medium to high normal UACR patients than in low normal UACR patients (mean ± SD: 58.2 ± 8.4% vs. 64.5 ± 10.1%, p = 0.0199). Patients with medium to high normal UACR had a higher coefficient of variation for mean glucose (CV) than those with low normal UACR (42.4 ± 6.0% vs. 38.0 ± 6.1%, p = 0.0163). UACR was related to TIR (r=-0.55, p = 0.02), to CV (r=-0.51, p = 0.04) and to mean glucose (MG) (r=-0.48, p = 0.05). TIR, CV and puberty proved to be independently predictive for medium to high normal UACR [adjusted RR (95% CI): 0.70 (0.58-0.92), p = 0.0231; 1.28 (1.02-1.67), p = 0.0222; 1.19 (1.10-1.36), p = 0.0321, respectively].
CONCLUSION: The duration of the blood glucose level within the target range and the extent of its fluctuation may contribute to the early increase in albumin excretion within the normal range, which may play a role in the development of later complications of childhood T1D.

Keywords:  Adolescents; Albumin-to-creatinin ratio; Children; Continuous glucose monitoring; Type 1 diabetes

DOI:  https://doi.org/10.1186/s13098-025-01749-x
Lancet Diabetes Endocrinol. 2025 May 26. pii: S2213-8587(25)00063-4. [Epub ahead of print]

Continuous glucose monitoring in the management of gestational diabetes in Switzerland (DipGluMo): an open-label, single-centre, randomised, controlled trial.

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

BACKGROUND: In gestational diabetes, one of the key factors affecting perinatal outcomes is glycaemic control. We aimed to investigate the effect of real-time continuous glucose monitoring (rtCGM) on perinatal outcomes versus self-monitoring of blood glucose (SMBG).
METHODS: In this open-label, randomised, controlled trial, we recruited pregnant individuals aged 18-45 years with gestational diabetes, according to the International Association of Diabetes and Pregnancy Study Groups criteria, from a university hospital in Bern, Switzerland. Participants were randomly assigned (1:1) to the rtCGM intervention group or the SMBG control group. Randomisation was done centrally on the basis of pre-pregnancy BMI, previous gestational diabetes, family history of type 2 diabetes, and ethnicity. The primary endpoint was a composite of perinatal outcomes: large for gestational age, macrosomia, polyhydramnios, neonatal hypoglycaemia, and stillbirth. Key secondary outcomes were patient preference and maternal glycaemic control. Analyses were conducted on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT05037526.
FINDINGS: Between Sept 29, 2021, and June 11, 2024, 302 pregnant women with gestational diabetes were included in the study and randomly assigned to one of the groups. 156 participants were assigned to the rtCGM intervention group and 143 were assigned to the SMBG control group completed the study. Primary outcome data were available for 297 (99%) of 299 participants. The composite outcome did not differ significantly between the two groups (odds ratio 1·02 [95% CI 0·63-1·66]). The only adverse events were skin changes, occurring in six (4%) participants in the rtCGM intervention group and in one (<1%) participant in the SMBG control group (blinded device).
INTERPRETATION: Our results show that the outcome in individuals with gestational diabetes is not improved by the use of rtCGM. However, individuals expressed a higher preference for the rtCGM device. This finding suggests that rtCGM could be offered to simplify the management of gestational diabetes. A cost-effectiveness study could address what method requires fewer resources. To our knowledge, this is the first randomised trial powered to evaluate the efficacy of rtCGM regarding pregnancy outcomes.
FUNDING: The University of Bern and the Swiss Diabetes Foundation.
TRANSLATION: For the German translation of the abstract see Supplementary Materials section.

DOI: https://doi.org/10.1016/S2213-8587(25)00063-4
Life (Basel). 2025 May 17. pii: 798. [Epub ahead of print]15(5):

Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring.

Aleksandra Kezić, Selena Gajić, Ana Račić Ostojić, Ivana Bekić, Ana Bontić, Jelena Pavlović, Marko Baralić, Ljiljana Popović.

  Optimized glycemic management is crucial for controlling atherosclerosis and consequent cardiovascular morbidity in patients with diabetes. Due to the continuous glucose burden from glucose-containing peritoneal dialysis (PD) solutions, PD patients with diabetes experience difficulties in glucose level regulation with glucose hypervariability and worsening dyslipidemia. Even in non-diabetic PD patients, glucose-containing PD solutions aggravate insulin resistance and cause overweight. Additionally, glucose degradation products (GDP) from glucose-based PD solutions provoke oxidative stress and complex inflammatory processes, leading to chronic deleterious and fibrotic peritoneal membrane changes. In this narrative review, we searched the literature using PubMed, MEDLINE, and Google Scholar over the last three decades to summarize the most important facts relevant to the presented issues, aiming to inform both endocrinologists and nephrologists in providing the best currently available care for people with diabetes on PD. We not only focus on adequate tailoring of insulin therapy adapted at the time of PD exchange with hypertonic glucose solution., but also emphasize the use of continuous glucose monitoring (CGM) that allows assessment of mean glucose values and time spent in normal, hypo, and hyperglycemia. However, the routine use of CGM in PD patients is limited due to high cost, and hemoglobin A1c (HbA1c) analysis is still recommended as a basic clinical tool for the assessment of glycemic control. Possible choices of antidiabetic drugs were considered given the narrowed choice due to contraindications for metformin and sulfonylurea. The other important therapeutic approach in PD patients with diabetes is using glucose-sparing PD regimens based on icodextrin and amino acid PD solutions with the addition of just one or two bags of low glucose concentration PD solution daily. This glucose-sparing approach not only reduces the glucose load and improves glycoregulation with correction of the lipid profile but also maintains the viability of the peritoneal membrane by reducing the harmful effects of GDPs.

Keywords:  continuous glucose monitoring; diabetes mellitus; icodextrin; peritoneal dialysis

DOI:  https://doi.org/10.3390/life15050798
JMIR Diabetes. 2025 May 27. 10 e62926

Understanding Device Integrations Within Diabetes Apps: Mixed Methods Analysis of App Features and User Reviews.

Jessica Turner, Katarzyna Stawarz.

   Background: Diabetes management involves a large degree of data collection and self-care in order to accurately administer insulin. Several mobile apps are available that allow people to track and record various factors that influence their blood sugar levels. Existing diabetes apps offer features that enable integrations with various devices that streamline diabetes management, such as continuous glucose monitors, insulin pumps, or regular activity trackers. While this reduces the tracking burden on the users, the research highlighted several issues with diabetes apps, including issues with reliability and trustworthiness. As pumps and continuous glucose monitors are safety-critical systems-where issues can result in serious harm or fatalities-it is important to understand what issues and vulnerabilities could be introduced by relying on popular diabetes apps as an interface for interacting with such devices.
Objective: As there is a lack of research examining in detail the integrations and potential suitability of apps as part of a wider self-management ecosystem, our goal was 2-fold. First, we aimed to understand the current landscape of device integrations within diabetes apps and how well they meet users' needs. Second, we identified the key issues users of the most popular apps face currently and what features are the source of these issues.
Methods: Through searches in Android and iPhone app stores, we systematically identified 21 diabetes apps that offer integrations. We conducted a detailed analysis of 602 user reviews. For each review, we recorded its sentiment, features and issues, and additional contextual information provided by the review writers. We used descriptive statistics to analyze the features and issues. We also analyzed the reviews thematically to identify additional trends related to the context of use and the consequences of issues reported by the users.
Results: The reviews focused on key features that users found the most important, including device integrations (n=259, 43%), tracking (n=194, 32.2%), data logging (n=86, 14.3%), and notifications (n=70, 11.6%). We found that 327 (54.3%) of the reviews were negative versus 187 (31.1%) positive and 88 (14.6%) neutral or mixed, and the majority of reviews (n=378, 62.8%) mentioned issues. The biggest issues related to device integrations included inability to connect with external devices (n=95, 25.1%), inability to store, manage, or access data (n=49, 22%), unreliable notifications and alerts (n=35, 9.2%), issues caused by or related to software updates (n=31, 8.5%), hardware issues (n=24, 6.4%), and issues with accessing the app, related services, or associated hardware (n=12, 3.2%).
Conclusions: Apps for diabetes management are a useful part of self-care only if they are reliable and trustworthy, reduce burden, and increase health benefits. Our results provide a useful overview of desired features for diabetes apps alongside key issues for existing integrations and highlight the future challenges for artificial pancreas system development.

Keywords:  diabetes mellitus; health apps; mHealth; mobile apps; mobile health; self-management; user experience

DOI:  https://doi.org/10.2196/62926
J Mater Chem B. 2025 May 29.

Promoting the signal reliability of non-invasive biosensors via a N-doped graphene quantum dot modified Prussian blue analogue protective layer for glucose monitoring.

Yi-Hao Chiu, Mia Rinawati, Ling-Yu Chang, Sofiannisa Aulia, Chieh Li, Ping-Chen Shi, Kuan-Jung Chen, Wei-Hsiang Huang, Hitoshi Mizuguchi, Min-Hsin Yeh.

Precise and reliable wearable biosensors are essential for diabetes tracking, enhancing result accuracy for patients. Prussian blue (PB) has been the subject of numerous studies in biosensor development due to its high efficiency in hydrogen peroxide reduction. However, PB's limited stability, especially in neutral pH environments, constrains its practical application. A promising approach is to combine PB with its analogues (PBA), offering a protective layer over PB, though at the cost of reduced sensitivity due to blocked active sites. In a pioneering way, this study incorporates N-doped graphene quantum dots (NGQDs) into the protective layer of PBA to address these issues, in conjunction with a PB sensing layer, to develop a wearable biosensor that possesses exceptional stability and accuracy in detection. The NGQDs facilitated the surface reconstruction of PBA driven by a strong electrostatic interaction mechanism, which can notably increase its hydrophilicity for enabling improved H2O2 transport. Through these sequential methods, the surface properties of PBA were successfully improved, resulting in a substantial rise in the overall sensor sensitivity of 221.29 ± 1.77 μA mM-1 cm-2 for H2O2 detection, close to the pristine PB one (247.87 ± 5.35 μA mM-1 cm-2). Furthermore, the glucose detection sensitivity was significantly enhanced by the immobilization of glucose oxidase (GOx) on the electrode (90.49 ± 1.08 μA mM-1 cm-2). In a sequence, this nanomaterial demonstrated outstanding stability with a current density retention rate of 87.37% over long-term operation at a specific concentration, and the sensitivity remained at 88.17% under repeated use. Therefore, our NGQDs/PBA/PB nanocomposite offers a durable, high-performance solution for non-invasive glucose monitoring in human sweat, advancing the development of next-generation wearable biosensors for continuous diabetes management.

DOI: https://doi.org/10.1039/d5tb00497g
ACS Sens. 2025 May 28.

Wearable Wireless Patch with Unidirectional Microfluidic Chamber for Enzyme-Free Glucose Monitoring in Sweat.

Yong Yang, Wei Huang, Xiaoling Lei, Yuan Ai, Can Sheng, Dongliang Zhang, Shizhao Wang, Fang Dong, Sheng Liu.

  Conventional glucose sensors based on biological enzymes are prone to interference in complex environments, particularly for wearable sweat monitoring. Although synthetic nanozymes exhibit higher stability, they often require highly alkaline conditions to achieve optimal performance, limiting their application in wearable devices. To address this challenge, this study presents a novel enzyme-free wearable wireless patch capable of real time, in situ monitoring of glucose concentrations in sweat. The device employs a microfluidic channel to collect sweat, where solid NaOH is dissolved to create the required alkaline environment. Subsequently, the sweat enters a detection chamber, where two-dimensional nickel-based organic framework nanoflowers modified with gold nanoparticles (Au-NPs/Ni-BDC NFs) serve as the sensing layer, enabling highly sensitive and stable glucose detection. Integrated temperature and pH sensors provide real time calibration to ensure measurement accuracy, while a Tesla valve prevents the backflow of alkaline solution to the skin. A custom-designed smartphone application facilitates real-time analysis of sweat glucose levels during physical activity, by managing signal acquisition, processing, and wireless communication. Through in situ pretreatment of sweat within the microfluidic channel and cooperative operation with a sensor array, this study effectively overcomes key challenges in enzyme-free glucose sensing for wearable devices. The proposed system demonstrates significant potential for future health monitoring, particularly for real-time tracking during exercise and daily activities.

Keywords:  Continuous glucose monitoring; Enzyme-free sensing; Flexible; Sweat biomarkers; Wearable electronic devices

DOI:  https://doi.org/10.1021/acssensors.5c00592