Diabetes technology & therapeutics最新文献

{"title":"Update on Management of Gestational Diabetes Mellitus and the Role of Continuous Glucose Monitor Technology.","authors":"Amber Lachaud, Celeste Durnwald","doi":"10.1089/dia.2025.0148","DOIUrl":"https://doi.org/10.1089/dia.2025.0148","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) complicates 5%-25% of pregnancies worldwide and is the most prevalent metabolic complication of pregnancy. Risk factors for GDM include maternal obesity, advanced maternal age, family history of type 2 diabetes mellitus (T2DM), diagnosis of Polycystic ovarian syndrome (PCOS), and a prior history of GDM. GDM has both implications for the pregnant person and the offspring with increased risks of adverse pregnancy outcomes as well as increased chance of developing T2DM later in life. The first-line treatment for GDM includes behavior modification followed by pharmacologic therapy with insulin being preferred medication of choice. Standard of care for the management of continuous glucose monitors (CGM) currently includes self-monitored blood glucoses or finger sticks 4× per day and this can increase stress and anxiety in pregnancies. Continuous glucose monitorings have been used commonly in nonpregnant diabetic patients and patients with type 1 diabetes but their use in patients with GDM are increasing. Although there are no specific Continuous glucose monitoring targets for patients with GDM, CGMs have been used to help determine normative data in patients without GDM, which has helped provide expert opinion on GDM targets. In research studies, CGMs have also been used to explore glycemic profiles for patients early in pregnancy who go on to develop GDM as well as looking at adverse pregnancy outcomes in patients with higher Continuous glucose monitoring metrics. Using CGMs has the potential to provide more information about glycemia, ultimately leading to treatment recommendations in patients with GDM with the ultimate goal to improve adverse pregnancy outcomes and improve health and well-being at large.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Utility Analysis of the MiniMed<b>™</b> 780G Advanced Hybrid Closed-Loop System Versus Intermittently Scanned Continuous Glucose Monitoring with Multiple Daily Insulin Injections in People with Type 1 Diabetes in France.","authors":"Helene Hanaire, Asli Zeynep Ozdemir Saltik, Richard F Pollock, Neesha Nanu, Clea Sambuc, Apolline Grangeon, Simona De Portu, Pierre Koch, Ohad Cohen, Charles Thivolet","doi":"10.1089/dia.2025.0100","DOIUrl":"https://doi.org/10.1089/dia.2025.0100","url":null,"abstract":"<p><p><b><i>Background and Aims:</i></b> Advanced hybrid closed-loop (AHCL) automated insulin delivery systems such as the MiniMed™ 780G have been shown to result in substantial improvements in disease management in people living with type 1 diabetes. The aim of the analysis was to assess the cost utility of the MiniMed 780G system compared with intermittently scanned continuous glucose monitoring (is-CGM) and multiple daily insulin injections (MDI) in people living with type 1 diabetes in France, to estimate the incremental cost-utility ratio (ICUR) and inform decision-making. <b><i>Methods:</i></b> The analysis was performed using the CORE Diabetes Model (version 9.5) and clinical input data were sourced from a randomized controlled trial, with glycated hemoglobin reductions of 1.54% (16.8 mmol/mol) and 0.2% (2.18 mmol/mol) assumed for the MiniMed 780G arm and is-CGM + MDI arm, respectively. The analysis was conducted from a national payer perspective over a 40-year time horizon; future costs and clinical outcomes were discounted at 2.5% per annum. <b><i>Results:</i></b> In the base case analysis, use of the MiniMed 780G system was associated with a mean gain in quality-adjusted life expectancy of 2.26 quality-adjusted life years (QALYs) compared with is-CGM + MDI (16.33 QALYs vs. 14.07 QALYs), while mean direct lifetime costs were EUR 78,509 higher (EUR 215,037 vs. EUR 136,528), resulting in an ICUR of EUR 34,732 per QALY gained. Findings from sensitivity analyses showed that analyses were robust to changes in assumptions in most input parameters. <b><i>Conclusions:</i></b> In people with type 1 diabetes in France not achieving glycemic target levels at baseline, the use of the MiniMed 780G system was projected to lead to substantial improvements in quality-adjusted life expectancy compared with continued use of is-CGM + MDI, with an ICUR of EUR 34,732 per QALY gained.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Severe and Level 2 Hypoglycemia and Associated Risk Factors in Adults with Type 1 Diabetes Using Hybrid Closed-Loop Insulin Pumps.","authors":"Micah Devore, Emily Hepworth, Annika Agni, Wen Ye, Stephanie A Amiel, Simon J Fisher, Yu Kuei Lin","doi":"10.1089/dia.2025.0126","DOIUrl":"https://doi.org/10.1089/dia.2025.0126","url":null,"abstract":"<p><p><b><i>Background:</i></b> Despite advances in diabetes technologies, severe hypoglycemia (SH) and level 2 hypoglycemia (Lv2Hypo) persist among hybrid closed-loop (HCL) insulin pump users. This study assessed the relationship of impaired awareness of hypoglycemia (IAH) and other patient characteristics with SH and Lv2Hypo in HCL insulin pump users with type 1 diabetes. <b><i>Methods:</i></b> A cross-sectional survey assessed 6-month SH history, hemoglobin A1C, IAH (using the Hypoglycemia Awareness Questionnaire), and 30-day continuous glucose monitoring (CGM) data among adult HCL insulin pump users recruited from a national U.S. type 1 diabetes patient registry. Analyses included logistic regression, <i>t</i>-tests, and Chi-square tests. <b><i>Results:</i></b> Of 601 participants (female: 54%; mean age: 43), IAH and higher glucose coefficients of variation (CVs) were associated with both SH and spending ≥1% of time in Lv2Hypo (<i>P</i>s < 0.05). Individuals with SH were further characterized as having spent more time with glucose levels >180 mg/dL and >250 mg/dL and having a lower education level (<i>P</i>s < 0.05). CGM hypoglycemia measures were not associated with SH. Age and diabetes duration were not associated with experiencing SH or spending ≥1% of time in Lv2Hypo. Participants who both experienced SH and spent ≥1% of time in Lv2Hypo showed trends toward exhibiting the most severe IAH and the highest glucose CVs. <b><i>Conclusions:</i></b> Among adults with type 1 diabetes using HCL insulin pumps, IAH and higher glucose CVs are risk factors of experiencing SH and Lv2Hypo. Hyperglycemia and lower education level are also associated with a higher risk for experiencing SH.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Accuracy of Continuous Glucose Monitoring During Intensive Hematological Care: A Prospective Study.","authors":"Marieke Tienstra, Riemer A Been, Janneke W de Boer, Reinold O B Gans, André P van Beek, Hilde A M Kooistra, Valerie R Wiersma, Omar G Mustafa, Pratik Choudhary, Tom van Meerten, Peter R van Dijk","doi":"10.1089/dia.2025.0232","DOIUrl":"https://doi.org/10.1089/dia.2025.0232","url":null,"abstract":"<p><p><b><i>Background:</i></b> Patients treated for a hematological malignancy are susceptible to hyperglycemia, which can negatively affect treatment outcomes. Therefore, close monitoring of glucose levels is crucial. Data demonstrated that capillary measurement methods underreport hyperglycemic episodes compared with continuous glucose monitoring (CGM). However, the accuracy of CGM during intensive hematological treatments, and the associated metabolic and hemostatic imbalances, is unknown, which we aim to investigate in the current study. <b><i>Methods:</i></b> For the analysis, data collected during a prospective study that compared CGM with capillary point-of-care (POC) glucose measurements in adult patients hospitalized for intensive hematological care with three different treatment modalities, namely chimeric antigen receptor T-cell therapy, allogeneic stem cell transplantation (allo-SCT), or autologous stem cell transplantation (auto-SCT), were used. POC and CGM measurements were performed concurrently. Accuracy was assessed using mean and median absolute relative difference (MARD), Diabetes Technology Society (DTS) Error Grid analysis as well as percentages of values within 15%/15, 20%/20, and 30%/30 mg/dL. <b><i>Results:</i></b> A total of 60 patients (28% female, median age 64 [58-68] years and 10% with a history of diabetes mellitus) were included, yielding 1999 matched measurement pairs. The overall mean ARD was 21.5%, whereby the lowest mean ARD was observed during allo-SCT (18.3%) and the highest mean ARD during auto-SCT (27.1%). The percentages of glucose values within 15%/15, 20%/20, and 30%/30 mg/dL agreements were 38.1%, 51.1%, and 75.1%. The DTS Error Grid analysis showed good clinical accuracy with 99.6% of pairs within zone A + B. <b><i>Conclusions:</i></b> Despite the relative high MARD, the use of CGM is unlikely to result in harmful insulin dosing errors and seems feasible to use during intensive hematological care.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring in Type 1 Diabetes, Type 2 Diabetes, and Diabetes During Pregnancy: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.","authors":"Evangelos C Rizos, Georgios Markozannes, Nikolaos Charitakis, Panagiotis Filis, Anastasia E Stoimeni, Kirsten Nørgaard, Evangelia E Ntzani, Konstantinos K Tsilidis","doi":"10.1089/dia.2024.0599","DOIUrl":"10.1089/dia.2024.0599","url":null,"abstract":"<p><p><b><i>Background:</i></b> Continuous glucose monitoring (real-time CGM [RT-CGM] and retrospective [professional] CGM [non-RT-CGM]) is an emerging tool to assess glucose levels and variability. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of RT/non-RT-CGM on type 1 (T1D), type 2 (T2D), and diabetes in pregnancy (DiP) compared with self-monitoring of blood glucose (BGM). <b><i>Methods:</i></b> We searched PubMed/EMBASE/Cochrane Central Register of Controlled Trials until October 2024. The coprimary outcomes were the weighted mean change differences (WMCDs and absolute differences) from baseline in glycated hemoglobin (HbA1c) and in time in range (TIR%), time below range (TBR%), and time above range (TAR%). <b><i>Results:</i></b> A total of 64 RCTs were analyzed: (1) RT-CGM/T1D: CGM was superior to BGM for HbA1c reduction (WMCD -0.24, 95% confidence interval [CI]: -0.35; -0.14, <i>I</i>²= 71%), decrease in TBR <70 mg/dL (WMCD -2.41, 95% CI: -3.46; -1.35, <i>I</i>²= 96%), decrease in TBR < 54 mg/dL (WMCD -1.18 95% CI: -1.9; -0.47, <i>I</i>²= 97%), decrease in TAR >180 mg/dL (WMCD -2.99, 95% CI: -5.28; -0.71, <i>I</i>² = 92%), decrease in TAR >250 mg/dL (WMCD -3.99, 95% CI: -5.76; -2.21, <i>I</i>²= 92%), and increase in TIR 70-180 mg/dL (WMCD 5.57, 95% CI: 4.13; 7.01, <i>I</i>²= 84%); (2) RT-CGM/T2D: CGM was superior to BGM for HbA1c reduction (WMCD -0.40, 95% CI: -0.55; -0.24, <i>I</i>²= 52%), decrease in TAR > 180 mg/dL (WMCD -6.32, 95% CI: -9.87; -2.78, <i>I</i>²= 84%), decrease in TAR > 250 mg/dL (WMCD -5.73, 95% CI: -8.96; -2.49, <i>I</i>²= 89%), and increase in TIR 70-180 mg/dL (WMCD 5.46, 95% CI: 2.76; 8.16, <i>I</i>²= 69%); (3) RT-CGM/DiP: CGM was superior to BGM for TIR 63-140 mg/dL (WMCD: 17.77, 95% CI: 4.17; 31.36, <i>I</i>²= 92%). No benefit was shown for HbA1c, TBR < 63 mg/dL, TAR > 140 mg/dL, and most of the maternal and neonatal outcomes of interest; (4) Non-RT CGM: HbA1c significantly decreased with non-RT CGM compared with BGM in T2D (WMCD -0.35, 95% CI: -0.5; -0.2, <i>I</i>²= 19%). <b><i>Discussion:</i></b> In T1D and T2D, RT-CGM decreased HbA1c and increased time in target range for glycemia (70-180 mg/dL) while decreasing time spent in hypoglycemia (T1D) and time in hyperglycemia (T1D, T2D).</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"537-552"},"PeriodicalIF":5.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Pancreas: The First 20 Years.","authors":"Francis J Doyle, Boris P Kovatchev","doi":"10.1089/dia.2025.0134","DOIUrl":"https://doi.org/10.1089/dia.2025.0134","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":"27 S3","pages":"S1-S8"},"PeriodicalIF":5.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Time-in-Range and Time-in-Tight-Range with Retinopathy Progression in the Virtual Diabetes Control and Complications Trial Continuous Glucose Monitoring Dataset.","authors":"Benjamin Lobo, Lauren Kanapka, Boris P Kovatchev, Craig Kollman, Roy W Beck","doi":"10.1089/dia.2025.0033","DOIUrl":"10.1089/dia.2025.0033","url":null,"abstract":"<p><p><b><i>Background:</i></b> In a prior work, a virtual continuous glucose monitoring (CGM) trace was generated for each of the 1441 participants in the landmark Diabetes Control and Complications trial (DCCT). These new data allow us to compare whether time-in-tight-range (TITR) is a better predictor of diabetic microvascular complications (specifically retinopathy development or progression) than time-in-range (TIR). <b><i>Methods:</i></b> Discrete Cox proportional hazard models were used to calculate the hazard ratios (HRs) for the development/progression of retinopathy. <b><i>Results:</i></b> For a 1.0 standard deviation (SD) change, the adjusted HR (95% confidence interval) was 2.67 (2.33-3.06) for TIR, 2.74 (2.36-3.18) for TITR, and 2.37 (2.13-2.65) for HbA1c; a similar pattern of results was obtained for a 0.5 SD change. Computing Harrell's C-statistic showed that a survival model adjusted for TIR, TITR, or HbA1c had similar predictive performance. <b><i>Conclusion:</i></b> The associations of TIR and TITR with retinopathy development or progression were similar to HbA1c in the virtual DCCT CGM dataset.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"558-561"},"PeriodicalIF":5.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of a Continuous Glucose Monitoring-Derived Glycation Ratio in the Development of Microvascular Complications.","authors":"Laura B Bovee, Theodore A Gooley, Jordan E Perlman, Irl B Hirsch","doi":"10.1089/dia.2024.0580","DOIUrl":"10.1089/dia.2024.0580","url":null,"abstract":"<p><p><b><i>Background:</i></b> Previous studies have evaluated the associations between HbA1c discordance and diabetes complications using indices of glycation. The ideal index would allow for identification of those at increased risk for microvascular complications. This analysis evaluates the association of a newly published index, the glycation ratio (GR), with diabetic retinopathy (DR) and diabetic kidney disease (DKD). <b><i>Methods:</i></b> This is a retrospective review of 661 patients with diabetes seen at the University of Washington. All patients used continuous glucose monitoring (CGM) before the study. Diabetes duration was greater than 20 years in 59%. Median age was 45 years. GR was defined as the ratio of the glucose management indicator (GMI) to the HbA1c. The associations of GR with microvascular complications were each assessed using logistic regression. <b><i>Results:</i></b> Modeling GR as a continuous linear variable, each increase in GR of 0.20 units was associated with a 38% relative reduction in the odds of DR (adjusted odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.45-0.86, <i>P</i> = 0.004] and a similar reduction in the odds of DKD (OR = 0.61; 95% CI: 0.41-0.93, <i>P</i> = 0.02). <b><i>Conclusions:</i></b> GR may be a useful marker for risk of diabetic microvascular complications. Longitudinal assessment will be required to see how well GR compares with GMI or HbA1c alone.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"553-557"},"PeriodicalIF":5.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Models, in Silico Trials, and Algorithms.","authors":"Ali Cinar, Ananda Basu, B Wayne Bequette, Marc D Breton, Bruce Buckingham, Eda Cengiz, Claudio Cobelli, Eyal Dassau, Francis J Doyle, Chiara Fabris, Andrea Facchinetti, Irl Hirsch, Roman Hovorka, Peter G Jacobs, Boris P Kovatchev, Chiara Dalla Man, Laurie Quinn, Jay Skyler","doi":"10.1089/dia.2025.18800.ac","DOIUrl":"https://doi.org/10.1089/dia.2025.18800.ac","url":null,"abstract":"<p><p>Artificial pancreas (AP) systems, also called automated insulin delivery systems, have improved the time in range of glucose levels, reduced the daily burden of the user for glucose regulation, and improved their quality of life. Several commercially available AP systems operate in hybrid closed-loop mode that requires manual information from the user for meals and exercise. This article summarizes the progress on mathematical models of glucose-insulin dynamics, continuous glucose monitoring systems, and insulin pumps that form the building blocks of AP systems, the shift from animal studies to in silico clinical trials that accelerated the rate of progress in AP technologies and the efforts for developing the next-generation AP systems, and the fully automated AP that eliminates manual inputs and mitigates the effects of disturbances to glucose homeostasis-meals, physical activities, acute stress, and variations in sleep characteristics. A section is devoted to discuss the unique glycemic management challenges faced by women with diabetes across the lifespan (menstrual cycle, menopause, pregnancy) and summarize progress made to reduce their impact on glycemic management.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":"27 S3","pages":"S21-S32"},"PeriodicalIF":5.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Meal Insulin Bolus Timing and Bedtime Snacking on Continuous Glucose Monitoring-Derived Glycemic Metrics in Hospitalized Inpatients.","authors":"Sara M Alexanian, Michael C Cheney, Jenny C Bello Ramos, Nicole L Spartano, Howard A Wolpert, Devin W Steenkamp","doi":"10.1089/dia.2025.0027","DOIUrl":"10.1089/dia.2025.0027","url":null,"abstract":"<p><p><b><i>Objective:</i></b> In hospitalized inpatients, timely administration of prandial insulin with meals is challenging. Furthermore, the glycemic impact of snacking after dinner (\"bedtime snacking\") without prandial insulin administration has not been previously explored. We present an analysis of the impact of delayed mealtime insulin administration and bedtime snacking on inpatient glycemic control. <b><i>Research Design and Methods:</i></b> We conducted a post hoc analysis from the In-Fi study: a randomized controlled trial comparing Fiasp versus insulin aspart (Novolog) in inpatients with type 2 diabetes. Glycemic outcomes were assessed using the Dexcom G6 PRO continuous glucose monitoring (CGM). We analyzed CGM and insulin administration data from 122 randomized subjects who completed the primary study protocol, which included wearing a CGM for ≥4 meals. This analysis evaluates the impact of delayed mealtime insulin administration and bedtime snacking on glucose control. <b><i>Results:</i></b> Four-hour postprandial time in range (TIR_70-180) was 48% for insulin boluses administered before meals (<i>n</i> = 149) versus 24% when a meal bolus was delayed for >5 min after a meal (mean delay 58.7 min; <i>n</i> = 112; <i>P</i> < 0.001). Bedtime snacking (9 pm-12 am) was associated with significantly higher fasting glucose the next morning (35.2 mg/dL, standard error [SE] = 15.4, <i>P</i> = 0.026) and with a reduced overnight (9 pm-6 am) TIR_70-180 (31.9%, SE = 8.06, <i>P</i> < 0.001), adjusting for bedtime sensor glucose. Bedtime snacking was associated with higher overnight glucose standard deviation (12.3 mg/dL, SE = 3.46, <i>P</i> < 0.001) and with higher overnight glucose percentage coefficient of variation (3.6%; SE = 1.7, <i>P</i> = 0.044), adjusting for initial bedtime sensor glucose. <b><i>Conclusions:</i></b> Delayed mealtime insulin administration and bedtime snacking without insulin administration are significant causes of postprandial and overnight hyperglycemia in hospitalized inpatients. Adjustments in mealtime insulin protocols, attention to food intake, and the potential inpatient adoption of technology, such as CGM and automated insulin delivery systems, are needed to address this shortcoming in inpatient diabetes care.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"511-516"},"PeriodicalIF":5.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}