bims-glumda 2025-07-13 papers

bims-glumda

Biomed News

on CGM data in management of diabetes

Issue of 2025–07–13
nine papers selected by
Mott Given

Considerations With Using a CGM in Older Individuals.
Technical Innovations for Deploying Implantation of an Implanted Continuous Glucose Monitor.
Time to Plan for Continuous Glucose Monitoring in Dialysis-Dependent Kidney Failure.
Association between recent real-life exposure to hypoglycaemia and cognitive function during hypoglycaemia in people with type 1 diabetes: Findings from the Hypo-RESOLVE clamp study.
Optimal model-based insulin bolus advisor for subjects with type 1 diabetes using continuous glucose monitoring.
Partial starch substitution with resistant starch lowers postprandial glucose and glycaemic variability in people with type 2 diabetes.
An integrated dual-signal self-powered flexible sensor based on ferrocene-mediated biofuel cell for glucose detection.
Sustained HbA1c Improvements Over 36 Months in Youth in the Teamwork, Targets, Technology, and Tight Control (4T) Study.
Microneedle-based integrated pharmacokinetic and pharmacodynamic evaluation platform for personalized medicine.

Sr Care Pharm. 2025 Jul 01. 40(7): 283-287

Considerations With Using a CGM in Older Individuals.

Maria Tadros, Hayley Sewell, Katherine S O'Neal.

Continuous glucose monitors (CGMs) have undergone tremendous improvements over the last decade and have become a crucial tool in day-to-day diabetes management. Despite technological advancements and their proven benefits, barriers exist that may impede the use of CGMs in older adults. However, these barriers can be overcome with proper education and a support system. The purpose of this article is to highlight the common barriers associated with continuous glucose monitoring and to present approaches to overcoming these barriers for older adults.The authors conducted a PubMed search using the following terms: continuous glucose monitoring, type 2 diabetes, limitations, continuous glucose monitoring adherence, age: 65+, continuous glucose monitoring challenges age: 65+, use of CGM in elderly patients with type 2 diabetes, and barriers to use CGM in elderly patients with type 2 diabetes. They also obtained guideline information from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinology (AACE) on the use of CGMs in older individuals.Older adults may face several issues that could keep them from starting or continuing to use CGMs. These include lack of insurance coverage and concerns about cost, poor health numeracy and literacy, doubts about their ability to use CGMs, and lack of exposure to technology. Approaches such as assistance programs and comprehensive, hands-on education and training can help improve their ability, confidence, and willingness to use a CGM.CGMs have revolutionized the management of diabetes in older adults by alerting them to trends and fluctuations in their real-time glucose levels, which can be used to adjust their medications and prevent glycemic variation. Identifying an individual's specific barriers and then employing approaches to overcome them is crucial to empowering patients to benefit from CGM technology, optimize their overall diabetes management, and prevent complications. A patient must feel empowered and invested in managing their diabetes using their personal insights and the information and education they receive to guide care decisions.

DOI: https://doi.org/10.4140/TCP.n.2025.283
J Diabetes Sci Technol. 2025 Jul 08. 19322968251356504

Technical Innovations for Deploying Implantation of an Implanted Continuous Glucose Monitor.

Baudolino Mussa, Mariagrazia Tammaro, Barbara Defrancisco.



Keywords:  continuous glucose monitoring; diabetes technology implementation; implantable glucose sensor; procedural optimization; surgical technique

DOI:  https://doi.org/10.1177/19322968251356504
J Am Soc Nephrol. 2025 Jul 10.

Time to Plan for Continuous Glucose Monitoring in Dialysis-Dependent Kidney Failure.

Klara R Klein, Jennifer E Flythe.



Keywords:  chronic hemodialysis; diabetes; dialysis access; dialysis volume; diuretics; hemodialysis; patient-centered care; pharmacology

DOI:  https://doi.org/10.1681/ASN.0000000794
Diabetes Obes Metab. 2025 Jul 11.

Association between recent real-life exposure to hypoglycaemia and cognitive function during hypoglycaemia in people with type 1 diabetes: Findings from the Hypo-RESOLVE clamp study.

Hypo‐RESOLVE consortium

   AIMS: Cognitive decline during hypoglycaemia poses a risk for severe hypoglycaemia among people with type 1 diabetes, as it may compromise the ability to self-treat and recover. Antecedent hypoglycaemia has been associated with blunted counterregulatory responses to subsequent hypoglycaemia, but whether hypoglycaemia-induced cognitive dysfunction is subject to such a process of habituation is unclear. We investigated the association between recent real-life exposure to hypoglycaemia recorded by continuous glucose monitoring (CGM) and cognitive function during a hypoglycaemic clamp.
MATERIALS AND METHODS: Forty-two people with type 1 diabetes were given open intermittently scanned CGM (Freestyle Libre 1®) to record real-life hypoglycaemia for a week before participating in a hyperinsulinaemic-euglycaemic-hypoglycaemic clamp (mean ± SD) (2.8 ± 0.1 mmol/L). We assessed cognitive function at baseline and during hypoglycaemia using four validated tests: Paced Auditory Serial Addition Test (PASAT) and three subtasks of Test of Attentional Performance (TAP)-Alertness, Verbal Flexibility, and Working Memory.
RESULTS: Hypoglycaemia exposure (glucose <3.9 mmol/L) in the week before the clamp averaged 5.8 (3.1-8.8) events/week. In response to hypoglycaemia during the clamp, cognitive function declined for all cognitive function tests (all p < 0.01). No associations were identified between exposure to CGM-recorded hypoglycaemia prior to the clamp and changes in cognitive function during the clamp procedure, when adjusting for sex, age, diabetes duration, HbA1c and hypoglycaemia awareness status in linear regression analyses.
CONCLUSIONS: Our findings indicate that recent real-life CGM-recorded hypoglycaemia is not associated with cognitive decline during clamped hypoglycaemia in people with type 1 diabetes. This suggests that cognitive decline during hypoglycaemia is not susceptible to habituation.

Keywords:  cognitive decline; cognitive function; continuous glucose monitoring; hyperinsulinaemic‐hypoglycaemic clamp; hypoglycaemia; type 1 diabetes

DOI:  https://doi.org/10.1111/dom.16587
Comput Biol Med. 2025 Jul 09. pii: S0010-4825(25)00859-5. [Epub ahead of print]196(Pt A): 110508

Optimal model-based insulin bolus advisor for subjects with type 1 diabetes using continuous glucose monitoring.

Martin Dodek, Eva Miklovičová.

  This paper presents an optimal model-based bolus advisor aimed at improving insulin therapy for individuals with type 1 diabetes who actively utilize continuous glucose monitoring systems. The proposed approach serves as an advanced advisory system, facilitating decision-making for insulin administration. Unlike traditional artificial pancreas systems, which rely on continuous insulin delivery and equidistant control decisions at each sampling interval, this bolus advisor considers sparse and impulse-like insulin administration without the basal component, solely disturbance-triggered to optimally reject the carbohydrate intake. This bolus advisor generates personalized recommendations for the timing and dosage of insulin administration, informed by real-time glycemia measurements. The methodology considers a linear discrete-time state space model and an optimization problem based on a quadratic summation criterion to minimize the area of deviation of the preprandial-postprandial glycemia response from the target glycemia response. It can be seen as a constrained bivariate optimization problem with real-valued and integer decision variables. The proposed algorithm for constrained optimization is based on sequential quadratic interpolation and Karush-Kuhn-Tucker conditions, with the solution obtained by Newton's method. In order to take into account the past input activity and the glycemia measurements, the state of the system is estimated by the Kalman filter and involved in the problem formulation, providing feedback from the subject. The effectiveness of the proposed bolus advisor is validated through simulation experiments, showcasing its potential to enhance glycemic control and improve the overall management of type 1 diabetes.

Keywords:  Bolus calculator; Diabetes mellitus; Insulin treatment; Karush–Kuhn–Tucker conditions; Model-based design; Newton’s method; Optimization

DOI:  https://doi.org/10.1016/j.compbiomed.2025.110508
Diabet Med. 2025 Jul 09. e70079

Partial starch substitution with resistant starch lowers postprandial glucose and glycaemic variability in people with type 2 diabetes.

Sineaid M Collins, M Bernadette Egan, Martin B Whyte, M Denise Robertson.

   AIMS: Approximately 40% of the caloric intake of the UK diet consists of starch. Most of which is readily digestible, thereby raising blood glucose. However, resistant starch (RS) evades metabolism in the small intestine, and in healthy adults, partial substitution of the diet with RS lowers postprandial glycaemia. The effect of RS in adults with type 2 diabetes is unknown.
METHODS: We investigated the effect of substituting ~15% of dietary starch with RS on glycaemic measures in adults with type 2 diabetes in a controlled but free-living setting. This was a single-blinded, crossover design, comparing 4-day RS and control diets. Proportions of resistant and digestible starch in identical food products were the only difference. IPro™2 continuous glucose monitors captured glycaemic excursions and glycaemic variability.
RESULTS: Twenty adults with type 2 diabetes, HbA1c (52 ± 2 mmol/mol; 6.9 ± 0.3%), age 58 ± 11 years, were enrolled, with 95% completing arms. Mean amplitude of glycaemic excursion (MAGE) was lower over lunch with RS (0.94 mmol/L; p = 0.004), as was SD glucose (0.31 mmol/L; p = 0.027), and peak glucose (0.94 mmol/L; p = 0.028). RS prolonged the time it took glucose to peak by 18 min at lunch (p = 0.046) and 28 min at dinner (p = 0.002). Time in range (TIR; glucose 3.9-10.0 mmol/L) was 7.8% greater with RS (p = 0.021).
CONCLUSION: Substituting a proportion of starch with RS lowers blood glucose without changing the sensory attributes of foods significantly. There is potential to develop a functional diet for adults with type 2 diabetes to aid glycaemic control.

Keywords:  HbA1c; cardio‐vascular disease; functional foods; postprandial glucose; resistant starch; starch substitution; type 2 diabetes

DOI:  https://doi.org/10.1111/dme.70079
Analyst. 2025 Jul 10.

An integrated dual-signal self-powered flexible sensor based on ferrocene-mediated biofuel cell for glucose detection.

Zheng Wang, Maruf Ahmed, Jiayuan Zhu, Ying-Zhuo Shen, Meijuan Zhao, Wei Liu, Xiao-Ya Hu, Qin Xu.

Continuous glucose level monitoring is essential for the effective treatment of diabetes and overall metabolic health, requiring advanced sensing technologies that provide precise, reliable, and sustained performance in physiological situations. This study presents an integrated enzymatic dual-signal self-powered flexible sensor based on ferrocene-mediated glucose biofuel cells (BFCs), allowing rapid glucose detection through dual signal transduction of current and electrochromic response. The anode (flexible Au/CNT-rGO paper films), functionalized with glucose oxidase/ferrocene (GOD/Fc), catalyzes glucose oxidation to gluconate and generates electrons and outputs the current signal, where Fc facilitates electron transport to mitigate oxygen dependency. The cathode (ITO/PET) provides a visual signal with chitosan@prussian (CS@PB) nano-composite integrated as an electrochromic region. The sensor exhibits a low detection limit of 0.018 mM and a linear detection range from 0.1 to 80 mM, with excellent selectivity and stability. In addition, clinical serum glucose and urine testing experiments validated the sensor's efficacy, demonstrating its potential for biomedical research and clinical applications. The sensor's self-power generation and dual-signal readout provide a promising platform for the development of point-of-care (POC) devices tailored for personalized metabolic health assessment.

DOI: https://doi.org/10.1039/d5an00633c
J Clin Endocrinol Metab. 2025 Jul 10. pii: dgaf397. [Epub ahead of print]

Sustained HbA1c Improvements Over 36 Months in Youth in the Teamwork, Targets, Technology, and Tight Control (4T) Study.

Priya Prahalad, Victoria Y Ding, Dessi P Zaharieva, Ananta Addala, Ramesh Johari, David Scheinker, Korey K Hood, Manisha Desai, David M Maahs.

   CONTEXT: Youth with type 1 diabetes (T1D) struggle to meet and sustain hemoglobin A1c (HbA1c) targets. Youth enrolled in the Pilot 4T Study improved HbA1c by 0.5%, compared to historical controls at 1-year.
OBJECTIVE: To assess 3 years of glycemic outcomes in the Pilot 4T Study.
DESIGN: The Pilot 4T Extension cohort was prospectively followed to determine changes in HbA1c and continuous glucose monitoring (CGM) metrics over 3 years.
SETTING: Stanford Medicine Children's Health Diabetes Clinic.
PATIENTS OR OTHER PARTICIPANTS: Youth with T1D in the Pilot 4T Study enrolled in the extension phase.
INTERVENTION: Youth started CGM in the first month of diabetes diagnosis, received intensified education and remote patient monitoring (RPM) weekly for the first year of diabetes diagnosis and monthly RPM in the extension phase.
MAIN OUTCOME MEASURE: HbA1c and CGM metrics over the first 3 years of diagnosis.
RESULTS: In the Pilot 4T cohort, 78.5% (n=102) of participants enrolled in the study extension phase and were followed through 3 years. The adjusted difference in HbA1c at 3 years was 1.2% (95% CI 0.7-1.7%) lower in the Pilot 4T cohort than in the Historical cohort. In the Pilot 4T cohort, 68% and 37% met the <7.5% and <7% HbA1c targets at 3 years, respectively, compared to 37% and 20% in the Historical cohort.
CONCLUSIONS: Youth with T1D in the Pilot 4T extension phase sustained improvements in HbA1c over 3 years. Focusing resources on intensive management during the first year after T1D diagnosis may impact long-term glycemia.

Keywords:  Diabetes Technology; Health Care Delivery; Pediatric Diabetes; Type 1 Diabetes

DOI:  https://doi.org/10.1210/clinem/dgaf397
Nat Commun. 2025 Jul 07. 16(1): 6260

Microneedle-based integrated pharmacokinetic and pharmacodynamic evaluation platform for personalized medicine.

Jian Yang, Xia Gong, Ying Zheng, Hong Duan, Shuijin Chen, Tong Wu, Changqing Yi, Lelun Jiang, Hossam Haick.

Precision and personalized medicine for disease management necessitates real-time, continuous monitoring of biomarkers and therapeutic drugs to adjust treatment regimens based on individual patient responses. This study introduces a wearable Microneedle-based Continuous Biomarker/Drug Monitoring (MCBM) system, designed for the simultaneous, in vivo pharmacokinetic and pharmacodynamic evaluation for diabetes. Utilizing a dual-sensor microneedle and a layer-by-layer nanoenzyme immobilization strategy, the MCBM system achieves high sensitivity and specificity in measuring glucose and metformin concentrations in skin interstitial fluid (ISF). Seamless integration with a smartphone application enables real-time data analysis and feedback, fostering a pharmacologically informed approach to diabetes management. The MCBM system's validation and in vivo trials demonstrate its precise monitoring of glucose and metformin, offering a tool for personalized treatment adjustments. Its proven biocompatibility and safety suit long-term usage. This system advances personalized diabetes care, highlighting the move towards wearables that adjust drug dosages in real-time, enhancing precision and personalized medicine.

DOI: https://doi.org/10.1038/s41467-025-61549-9