Journal of Diabetes Science and Technology最新文献

{"title":"Updated Calibration Algorithm Improves Analytical Accuracy of a Continuous Glucose Monitoring System.","authors":"Julia K Mader, Delia Waldenmaier, Wiebke Mueller-Hoffmann, Katrin Mueller, Michael Angstmann, Gerhard Vogt, Cosima C Rieger, Manuel Eichenlaub, Thomas Forst, Guido Freckmann","doi":"10.1177/19322968261489630","DOIUrl":"10.1177/19322968261489630","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261489630"},"PeriodicalIF":4.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Technology in the Primary Care Setting: An American Diabetes Association Scientific Statement.","authors":"Osagie Ebekozien, Halis K Akturk, Joseph A Aloi, Natalie Bellini, Benjamin M Bluml, Veronica J Brady, Doreen Cassarino, Stephen C Clement, Carla Demeterco-Berggren, Katherine Claire D'Onfro, Dianna Isaacs, Christopher W Jones, Paige Johnson, Zachary Johnson, David Kerr, Collin Kruczek, Sandra Leal, Janice MacLeod, Thomas W Martens, Eden Miller, Medha N Munshi, Cara E Orr, Sean M Oser, Francisco Prieto, Viral N Shah, Jay Shubrook, Elias S Siraj, Ryan Smith, Pamela L Stamm, Sean Sullivan, Cyril Ubiem, Eugene Wright","doi":"10.1177/19322968261489568","DOIUrl":"10.1177/19322968261489568","url":null,"abstract":"<p><p>Most diabetes care is delivered in primary care, yet diabetes technologies remain inconsistently integrated. Workforce, training, time, data infrastructure, and insurance barriers contribute to inequitable access and adoption. This scientific statement provides evidence-informed recommendations for integrating diabetes technology into primary care practices. The American Diabetes Association (ADA) convened an interdisciplinary panel that met in person at the Diabetes Technology Meeting in October 2025. Panelists reviewed available evidence, published between 2020 and 2025, on diabetes technology implementation in primary care, with a focus on clear statements and recommendations addressing technology access and adoption, team-based workflows, continuous glucose monitoring, connected insulin delivery, and implementation barriers and opportunities. Virtual meetings were convened over the next 2 months to further develop and finalize statements and recommendations. Together, the ADA and interdisciplinary panel developed 16 consensus statements and 10 key recommendations. Diabetes technologies can be safely and effectively integrated into primary care practices when supported by standardized workflows, appropriate training, defined team roles, and access to specialty expertise. Equitable implementation also requires addressing coverage, affordability, digital literacy, broadband access, interoperability, and workforce development. Integrating diabetes technology into primary care is feasible and necessary to advance equitable, person-centered, data-informed care. Health systems, practices, payors, professional organizations, manufacturers, and policymakers should align resources, training, workflows, payment, and infrastructure to support sustainable implementation and improve outcomes for people with diabetes.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261489568"},"PeriodicalIF":4.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Glucose Data to Distress: Recognizing Anxiety Related to Continuous Glucose Monitoring.","authors":"Peihong Chen, Shan Zhang, Limei Zheng, Yinfang Tu, Haifeng Xu, Haoyong Yu","doi":"10.1177/19322968261489628","DOIUrl":"10.1177/19322968261489628","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261489628"},"PeriodicalIF":4.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Technology in the School Setting for Preschool-Aged Children.","authors":"Raquel M Gupta, Daniel J DeSalvo, Kelly Hicks, Sarah R Kelly, Serife Uysal-Demiroz, Crystal Woodward, Sarah K Lyons","doi":"10.1177/19322968261486007","DOIUrl":"10.1177/19322968261486007","url":null,"abstract":"<p><p>Diabetes technology has transformed the management of type 1 diabetes (T1D) and improved glycemic outcomes, yet preschool-aged children with T1D remain a uniquely vulnerable population. Complete dependence on caregivers and practical considerations such as limited body surface area and skin sensitivity create distinct barriers to effective technology use. These challenges are often compounded by the transition to daycare or school setting, where disruption in diabetes care coordination between home and classroom can compromise glycemic outcomes. This review synthesizes the evidence for diabetes technology use, summarizes the current guidelines, provides practical considerations, and reviews guidance for training protocols and competency requirements in the educational setting. School-based legal protections are discussed, including Section 504 plans and Individualized Education Programs, which should outline the diabetes-related accommodations required in the school setting in alignment with the Diabetes Medical Management Plan. Targeted interventions to improve training of school/daycare staff, facilitate communication across home and school settings, and address disparities in technology access are essential to optimize care and improve long-term health outcomes.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261486007"},"PeriodicalIF":4.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Contingency Management With Continuous Glucose Monitoring to Support Type 2 Diabetes Prevention and Care.","authors":"Jesse Dallery, Bengisu Tulu, Steven Jenkins, Rachael Fitzgerald, Arnie P Aldridge, Ian Duncan, David Kerr","doi":"10.1177/19322968261484170","DOIUrl":"10.1177/19322968261484170","url":null,"abstract":"<p><p>Diabetes prevention and care require recurring self-management behaviors whose benefits are often delayed and uncertain. Digital contingency management (CM), which arranges incentives contingent on objective evidence of behavior or outcomes, offers a scalable way to strengthen these behaviors. This commentary argues that continuous glucose monitoring (CGM) can transform CM for diabetes by enabling frequent, remote reinforcement of clinically meaningful proximal targets, including sensor wear, time in range, and other glucose-derived metrics. Emerging artificial intelligence tools may further personalize treatment during risk periods and tailor reinforcement schedules. Although cost-effectiveness data in diabetes are needed, the high clinical and economic burden of diabetes provides a strong rationale for evaluating CGM-linked CM as a scalable behavioral intervention. We discuss previous CM research, implementation readiness, and future research priorities.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261484170"},"PeriodicalIF":4.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of an Interstitial Continuous Glucose Management System in Critically Ill Patients: A Prospective Observational Study.","authors":"Marie Seret, Claire Dupuis, Vanessa Alves de Araújo, Claudio Annicchiarico, Gabriela Macedo, Caio Pinto Teixeira Araujo, Fabio Taccone, Miriam Cnop, Thomas Desaive, Vincent Uyttendaele, Jean-Charles Preiser","doi":"10.1177/19322968261486451","DOIUrl":"10.1177/19322968261486451","url":null,"abstract":"<p><strong>Introduction: </strong>Glycemic management in the intensive care unit (ICU) remains challenging because glucose levels fluctuate rapidly and monitoring is intermittent. Interstitial continuous glucose monitoring (CGM) could improve surveillance, but its performance during rapid glucose excursions remains uncertain. We assessed the accuracy of the Dexcom G7 CGM in critically ill patients under stable conditions and during intravenous glucose tolerance tests (IVGTT).</p><p><strong>Methods: </strong>We conducted a prospective ancillary study of the Determination of Insulin Resistance in ICU (DIRICU) study. Twenty critically ill adults with stress hyperglycemia, no prior diabetes, and expected ICU stay ≥5 days were included. A Dexcom G7 sensor was compared with arterial blood glucose measurements. Accuracy was assessed over the first 10 ICU days using paired measurements, mean bias, mean absolute relative difference (MARD), linear regression (<i>R</i>²), and Clarke error grid analysis, both outside and during IVGTT. A post hoc 20-minute temporal shift analysis was performed to account for delayed CGM peaks.</p><p><strong>Results: </strong>Outside IVGTT, 716 paired values showed moderate agreement with reference glucose (<i>R</i>² = .58, mean bias +11 mg/dL, MARD 17%), with 98.9% of values in Clarke zones A/B. During IVGTT, accuracy deteriorated markedly (1018 paired values): <i>R</i>² = .028, mean bias -34 mg/dL, MARD 24%, and only 80.3% of values in zones A/B, with 18.6% in zone D. After temporal shifting, performance improved (<i>R</i>² = .34, MARD 19%, 94.7% in zones A/B). No sensor-related adverse events occurred.</p><p><strong>Conclusions: </strong>Dexcom G7 showed acceptable accuracy during stable ICU conditions, but performance deteriorated during rapid glucose excursions. Hybrid monitoring strategies combining CGM with intermittent blood glucose confirmation may therefore be preferable in critically ill patients.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261486451"},"PeriodicalIF":4.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Automated Insulin Delivery Systems in Pregnant Individuals With Type 1 Diabetes: Practical Tips and System-Specific Workarounds.","authors":"Naseem Eisa","doi":"10.1177/19322968261463556","DOIUrl":"10.1177/19322968261463556","url":null,"abstract":"<p><strong>Background: </strong>Automated insulin delivery (AID) systems are increasingly used off-label in pregnancy for type 1 diabetes management, yet most current algorithms were not designed for the unique metabolic demands of gestation. This guide provides practical, evidence-based, and system-specific workarounds to safely optimise the six major commercial and open-source AID systems for use in pregnancy.</p><p><strong>Methods: </strong>This narrative review synthesises recommendations from major clinical practice guidelines (American Diabetes Association, Diabetes Canada), the 2026 international consensus statement on continuous glucose monitoring and AID use in pregnancy, and key findings from landmark clinical trials (CRISTAL, CIRCUIT, and AiDAPT). A targeted literature search of PubMed, Embase, and Cochrane Library (January 2018-February 2026) was performed using keywords, including 'automated insulin delivery', 'closed-loop', 'type 1 diabetes', and 'pregnancy'. Tips were derived from peer-reviewed studies, consensus guidelines, and clinical experience of the authors; the source of each tip is identified throughout the text.</p><p><strong>Results: </strong>A comprehensive set of 43 practical tips is presented, covering preconception optimisation, trimester-specific insulin adjustments, prandial management strategies, system-specific workarounds for Tandem Control-IQ, Medtronic 780G, Omnipod 5, twiist, CamAPS FX, and Do-It-Yourself Loop, and protocols for special situations including antenatal corticosteroid administration, labour and delivery, and the postpartum period.</p><p><strong>Conclusion: </strong>By combining a deep understanding of AID system limitations with proactive, data-driven clinical strategies, clinicians can help individuals living with type 1 diabetes safely navigate the complexities of pregnancy, improve glycaemic levels, and enhance maternal and neonatal safety.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261463556"},"PeriodicalIF":4.9,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement of Over-the-Counter Continuous Glucose Monitors With Capillary-Meter Glucose in Young Adults Without Diabetes.","authors":"Navneet Prakash, Andrea H Barrows, Matthew Stults-Kolehmainen, Andrew J Loza, Marcus W Kilpatrick, Garrett I Ash","doi":"10.1177/19322968261482150","DOIUrl":"10.1177/19322968261482150","url":null,"abstract":"<p><strong>Background: </strong>Over-the-counter continuous glucose monitors (OTC CGMs) are increasingly used by individuals without diabetes for lifestyle modification, weight management, athletics, and metabolic screening, and have potential as an affordable tool for glucose data collection in research. However, accuracy and agreement data in their intended populations are limited. No independent study has yet evaluated OTC CGM accuracy or agreement.</p><p><strong>Method: </strong>We evaluated OTC CGMs worn by participants (n = 39) without diabetes across sessions combining rest or exercise with placebo or sugar-sweetened drink consumption that mimic scenarios in which CGM values may be used to make health-related decisions. We assessed agreement with capillary-meter glucose, interparticipant differences in CGM performance, and delay of CGM recordings.</p><p><strong>Results: </strong>Overall mean absolute relative difference (MARD) was 12.9%, mean bias -4.8 mg/dL, and within-15%/15-mg/dL agreement 66.5%. Agreement was significantly worse under sugar than placebo consumption (MARD 15.3% vs 10.6%, <i>P</i> < .01). Exercise had no consistent effect. Disagreement increased with faster rates of change and, less consistently, higher glucose. A uniform 5-minute delay improved MARD to 11.2% (<i>P</i> < .001), and cross-correlation estimated a 6.2-minute population lag. Interparticipant agreement differed significantly, unattributable to measured biological variables. Participant/device identity explained direction of error more than magnitude. High-MARD participants did not have consistent high MARD across conditions. 13.8% of CGM-change-indicator directional arrows were classified as moderate to extreme risk.</p><p><strong>Conclusions: </strong>Over-the-counter continuous glucose monitors seemingly agreed with overall capillary glucose trends but were less reliable for exact-value agreement. They may aid lifestyle monitoring but warrant caution for diagnostic thresholds, real-time change-indicator use, and research.We analyze data from a clinical trial: ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT07255183?id=NCT07255183, NCT07255183.</p><p><strong>Clinical impact: </strong>Over-the-counter continuous glucose monitors are reaching patients through primary care recommendations and direct consumer purchase, often before any structured education on interpretation. This first independent evaluation in adults without diabetes shows that OTC CGMs agree reasonably well with capillary trends but are less reliable for exact values, particularly after carbohydrate intake, at higher glucose levels, and during rapid change. Clinicians can reasonably guide patients toward using OTC CGMs to observe postprandial trends and behavioral patterns that fingerstick logs cannot practically capture, while cautioning against threshold-based decisions such as hypoglycemia detection or self-screening for diabetes, which warrant confirmatory testing.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261482150"},"PeriodicalIF":4.9,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes and Driving: How Predictive Technologies Will Alter Ethical and Legal Responsibilities.","authors":"Sinead Prince, Jamie Walvisch, Matthew L Baum, Tasmia Hai, Danièle Pacaud, Julian Savulescu, Fergus Cameron","doi":"10.1177/19322968261468763","DOIUrl":"10.1177/19322968261468763","url":null,"abstract":"<p><p>In 2023, a 67-year-old man with long-standing type 1 diabetes experienced a severe hypoglycemic episode and drove into an outdoor dining area in Victoria, Australia, killing 5 people and injuring several others. Although the charges against the driver were dismissed, future cases involving new continuous glucose monitors enhanced with artificial intelligence that allow users to anticipate impairment before it occurs may have different outcomes. These biopredictive technologies transform hypoglycemia from a background risk into a more foreseeable event. This generates new conditional obligations to act on predictive warnings and, in some cases, obligations on those with higher risks to acquire such technologies. Furthermore, these individual responsibilities can generate corresponding state obligations to subsidize access and update licensing frameworks, ensuring safety without exacerbating inequity or stigma.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261468763"},"PeriodicalIF":4.9,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticipatory Communication About Diabetes Technology in Schools: An Inoculation Theory Approach.","authors":"Josh Compton","doi":"10.1177/19322968261484919","DOIUrl":"10.1177/19322968261484919","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261484919"},"PeriodicalIF":4.9,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}