Diabetes technology & therapeutics最新文献

{"title":"Long-Term Patterns in Automated Insulin Delivery and Carbohydrate Announcement: A 24-Month Follow-Up.","authors":"Estelle Godard, Alfred Penfornis, Coralie Amadou","doi":"10.1177/15209156251362499","DOIUrl":"https://doi.org/10.1177/15209156251362499","url":null,"abstract":"<p><p>We evaluated long-term (24 months) consistency in carbohydrate counting and meal announcements among Control-IQ users using two parameters: auto-bolus percentage (i.e., automatic correction boluses divided by total boluses) and daily carbohydrate announcement (DCA). In this single-center retrospective cohort study (October 2021-October 2024), we analyzed trends in auto-bolus percentage-alongside DCA and metabolic control-and its associations with age, sex, DCA, and time in range (TIR) using mixed-effects linear models. Among 2751 person-quarters (57% women, mean age 37 years), the mean auto-bolus percentage was 61% and increased by 0.4% per quarter (<i>P</i> < 0.001). DCA declined from 132 to 100 g/day, while TIR slightly decreased from 61% to 58%. Auto-bolus percentage was inversely associated with age, TIR, and DCA, with the latter association strengthening over time. The modest change in TIR suggests sustained effectiveness of automated insulin delivery despite decreasing carbohydrate reporting-likely reflecting adaptive user behavior.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714975","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 Metrics and Continuous Glucose Monitoring-Based Hypoglycemia, Including Duration, in Individuals with Type 1 Diabetes Switching to Once-Weekly Insulin Icodec: A Post Hoc Evaluation of ONWARDS 6.","authors":"Thomas Danne, Susanne Engberg, Concetta Irace, Maiken Ina Siegismund Kjaersgaard, David C Klonoff, Chantal Mathieu, Sara Kehlet Watt, David Russell-Jones","doi":"10.1177/15209156251359319","DOIUrl":"10.1177/15209156251359319","url":null,"abstract":"<p><p><b><i>Background:</i></b> Post hoc evaluation of ONWARDS 6 assessed continuous glucose monitoring (CGM) metrics and CGM-based hypoglycemia with once-weekly insulin icodec (icodec) and once-daily insulin degludec (degludec) in adults with type 1 diabetes. <b><i>Methods:</i></b> Open CGM data were collected throughout ONWARDS 6. During weeks 0-4, 22-26, and 48-52, time in range (TIR; 3.9-10.0 mmol/L), time above range (TAR; >10.0 mmol/L), and time below range (TBR; <3.9 and <3.0 mmol/L) were assessed by treatment day after icodec injection or degludec titration. Rates of CGM-based clinically significant hypoglycemic episodes (<3.0 mmol/L for ≥15 consecutive min) and durations of CGM-based hypoglycemic episodes (<3.9 mmol/L) and CGM-based periods <3.0 mmol/L were reported (baseline to weeks 26 and 57). <b><i>Results:</i></b> Although rates of overall CGM-based clinically significant hypoglycemia were statistically significantly higher with icodec than degludec from baseline to week 26 and week 57, estimated rate ratios (icodec/degludec) for CGM-based clinically significant hypoglycemic episodes were lower than those estimated from self-measured blood glucose (SMBG) data from baseline to week 26 (1.38 vs. 1.88) and to week 57 (1.28 vs. 1.79). Observed percentage of TIR was highest on days 2-4 after icodec injection with a concomitant reduction in TAR and an increase in TBR. Median duration of CGM-based hypoglycemic episodes was comparable between treatment arms from baseline to week 26 (icodec: 35 min; degludec: 30 min) and to week 57 (35 min for both treatments). Median duration of CGM-based periods <3.0 mmol/L was the same for both treatments at week 26 and week 57 (25 min). <b><i>Conclusion:</i></b> In adults with type 1 diabetes, estimated rate ratios for CGM-based clinically significant hypoglycemia were lower than those estimated from SMBG data, although still favoring degludec with estimated rate ratios of 1.28-1.38. CGM metrics varied by treatment day after icodec injection, but median duration of CGM-based hypoglycemia was comparable between treatment arms.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759442","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 Safety and Effectiveness of U200 Insulin Use in Automated Insulin Delivery Systems in Adolescents and Young Adults with Type 1 Diabetes.","authors":"Patricia Y Chu, Neha Parimi, Risa M Wolf, Elizabeth A Brown, Andrea Kelly, Brynn E Marks","doi":"10.1177/15209156251359167","DOIUrl":"10.1177/15209156251359167","url":null,"abstract":"<p><p>Limited insulin pump cartridge volumes can present challenges to automated insulin delivery (AID) system use for adolescents and young adults (AYA) with type 1 diabetes (T1D) and high insulin requirements. We assessed the real-world safety and effectiveness of U200 concentrated insulin use in AID (U200-AID) among AYAs with T1D. We conducted a two-center, retrospective cohort study assessing glycemia, pump utilization, and safety outcomes pre-/post-U200-AID. Among 50 AYAs initiating U200-AID (age 15.4 years, T1D duration 5.5 years, hemoglobin A1c 8.5%), time in range (70-180 mg/dL) increased (44.6% ± 12.6% vs. 48.9% ± 11.4%, <i>P</i> = 0.012) and time below range (<70 mg/dL) did not change significantly. Days between cartridge changes increased (2.2 ± 0.5 vs. 3.0 ± 0.5 days, <i>P</i> < 0.001) despite increased total daily insulin dose (102.6 ± 23.5 vs. 125.8 ± 38.9 U100 insulin units, <i>P</i> < 0.001). No severe hypoglycemia or diabetic ketoacidosis occurred (median follow-up 290 days [interquartile range 227, 476]). These data suggest that U200-AID is a viable option for individuals with T1D and high insulin requirements.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimum Continuous Glucose Monitor Data Required to Assess Glycemic Control in Youth with Type 1 Diabetes.","authors":"Sonia Gera, Andrew Rearson, Robert J Gallop, Brynn E Marks","doi":"10.1089/dia.2025.0173","DOIUrl":"https://doi.org/10.1089/dia.2025.0173","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Consensus guidelines recommend reviewing 14 days of continuous glucose monitor (CGM) data when assessing glycemia in people with type 1 diabetes (T1D). Adult studies have shown that 7 days of CGM data provide a reliable assessment of glycemia. <b><i>Objectives:</i></b> To understand the minimum amount of CGM data required to assess glycemia in the pediatric T1D population. <b><i>Methods:</i></b> Real-world Dexcom G6 CGM data were extracted from cloud-based CGM software for 8 time windows (3, 5, 7, 10, 14, 30, 60, and 90 days), all starting on March 1, 2023. Youth <21 years with T1D and ≥70% CGM active time in each window were included. Pearson correlation and interclass correlation coefficients (ICCs) between 14-day data and other windows were calculated. Differences in the percentage of youth within predetermined thresholds of 14-day CGM metrics (±0.3% glucose management indicator [GMI]; ±5% time in range [TIR]/time in tight range; ±1% time below range <70 and <54 mg/dL) were assessed using chi-squared analyses. Sub-analyses were conducted according to categorical groupings of 14-day TIR, coefficient of variation (CV), and age. <b><i>Results:</i></b> A total of 1316 youth were included (45.0% female, 76.9% non-Hispanic White, median age 14.6 years). Median 14-day CGM active time was 97.2% and GMI and TIR were 7.4% (7.0, 7.9) and 60.5% (48.6, 70.6), respectively. Pearson correlation coefficients and ICCs between 14-day and GMI and TIR for all 8 windows were >0.9; however, categorical agreement as defined by the percentage of subjects acceptable thresholds for GMI and TIR only exceeded 90% at 10 days. Although there was no difference in agreement for CGM metrics according to categorical groupings of age, agreement was stronger for youth with TIR ≥70% and CV <36%. <b><i>Conclusions:</i></b> Although 14 days of CGM data are considered the gold standard, assessing ∼9.6 days of data in youth with T1D provides a reliable assessment of glycemia. For youth with higher TIR (≥70%) and lower CV (<36%), 7-day CGM data may prove sufficient.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636519","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 Ketone Monitoring in Pregnancy.","authors":"Celeste Durnwald, Sarit Polsky","doi":"10.1089/dia.2025.0300","DOIUrl":"https://doi.org/10.1089/dia.2025.0300","url":null,"abstract":"<p><p>Diabetic ketoacidosis (DKA) occurring during pregnancy is an obstetric emergency that can result in significant adverse outcomes for both the pregnant person and the fetus. While DKA generally presents with glucose levels >250 mg/dL, up to 30% of DKA cases involve euglycemic DKA (euDKA) wherein glucose levels <200 mg/dL have been reported. However, detection and prevention of DKA in pregnancy can be challenging for both the pregnant individual and health care providers due to variable clinical presentations of the disease and the limitations of current ketone monitoring technologies. Abbott Diabetes Care (Alameda, CA) is developing a dual monitoring system that utilizes a single sensor to enable continuous monitoring of interstitial glucose and β-hydroxybutyrate, the primary metabolic product of blood ketones. This article reviews the challenges of monitoring ketones during pregnancy and discusses how continuous ketone monitoring could be considered for use in clinical practice once it becomes commercially available.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590670","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":"Finerenone in Type 1 Diabetes with Chronic Kidney Disease: A Case Series Demonstrating Reduced Albuminuria with Manageable Safety Profile.","authors":"Chuping Chen, Jiande Liu, Ping Zhu, Jianmin Ran","doi":"10.1177/15209156251359310","DOIUrl":"https://doi.org/10.1177/15209156251359310","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607784","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":"<i>Letter:</i> Tirzepatide in Type 1 Diabetic Obese Patient Using Hybrid Closed-Loop.","authors":"Maja Baretić","doi":"10.1089/dia.2025.0245","DOIUrl":"https://doi.org/10.1089/dia.2025.0245","url":null,"abstract":"","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":"144552588","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":"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":"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}