Journal of Diabetes Science and Technology最新文献

{"title":"Parents' Fear of Hypoglycemia and Its Association With Diabetes Treatment Modality, Management, and Outcomes in Young Children With Type 1 Diabetes: A Danish Cross-Sectional Study.","authors":"Nanna Lind, Patricia DeCosta, Lene Lyngsøe, Nanja Holland Hansen, Jannet Svensson","doi":"10.1177/19322968261474527","DOIUrl":"10.1177/19322968261474527","url":null,"abstract":"<p><strong>Background: </strong>Parental fear of hypoglycemia (FoH) may influence diabetes management, family well-being, and perceptions of safety in young children with type 1 diabetes (T1D). The aim was to describe FoH among parents of young children with T1D using a validated version of the Children's Hypoglycemia Index (CHI) and to examine parent-level differences, interparent agreement, and associations with clinical parameters, treatment modality, and glycemic outcomes of their children.</p><p><strong>Methods: </strong>Cross-sectional cohort linking parent-reported questionnaire data with clinical and device-derived data. Analyses were conducted at the individual parent level and dyadic (parent-pair) level. Parental agreement was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analyses to evaluate mean differences and variability. Associations with HbA1c and continuous glucose monitoring metrics were analyzed using mixed-effect models adjusted for age, sex, and automated insulin delivery (AID) use.</p><p><strong>Results: </strong>Among 135 children (mean age 6.8 ± 2.1 years; HbA1c 6.8% ± 0.7%; 89.6% using AID), mothers reported higher CHI scores than fathers (β = .35- .58, <i>P</i> < .001-.003), except for behavioral fear. The ICC indicated low parental agreements (0.00-0.38), reflecting substantial within-family variability. The Bland-Altman analyses showed higher mean scores among mothers, but wide limits of agreement, indicating inconsistent differences within dyads. No associations were detected between CHI and HbA1c, continuous glucose monitoring (CGM) metrics (time in range [TIR], time below range [TBR]), treatment modality, or child characteristics.</p><p><strong>Conclusions: </strong>Although mothers reported higher FoH at the group level, low agreement indicates that FoH varies within families. No association with glycemic outcomes was observed, although interpretations are limited by high AID use and low HbA1c variability. Individual assessment of FoH in both parents may be clinically relevant.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261474527"},"PeriodicalIF":4.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721862","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":"Dietary Quality at Breakfast and Advanced Hybrid Closed-Loop System Metrics in Pregnancies Complicated by Type 1 Diabetes: A Pilot Study.","authors":"Alessandro Roberto Dodesini, Cristina Belussi, Silvia Bonfadini, Rosalia Bellante, Roberto Trevisan","doi":"10.1177/19322968261472900","DOIUrl":"10.1177/19322968261472900","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261472900"},"PeriodicalIF":4.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724793","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":"Real-World Outcomes of Automated Insulin Delivery Use in Hospitalized Adults With Diabetes.","authors":"Kathleen R Ruddiman, Joni K Evans, Joseph A Aloi, Chinenye Usoh, Catherine Price","doi":"10.1177/19322968261473583","DOIUrl":"10.1177/19322968261473583","url":null,"abstract":"<p><strong>Background: </strong>Automated insulin delivery (AID) systems are increasingly used by individuals living with diabetes in the outpatient setting, but data on their safety and effectiveness during hospitalizations remains limited. The objective is to evaluate the use and efficiency of AID systems in hospitalized adults with diabetes.</p><p><strong>Methods: </strong>We performed a retrospective cohort study based on electronic health record data from hospital admissions of 316 patients with diabetes using insulin pumps. Automated insulin delivery and continuous glucose monitor use, insulin pump continuation, length of stay (LOS), and glycemic outcomes among the cohort were analyzed. The primary aims of the study were to describe rates of insulin pump continuation and reasons associated with removal, and rates of pump reinitiation. Secondary outcomes included effects of insulin pump removal and prompt endocrinology consultation on inpatient glycemic outcomes and LOS.</p><p><strong>Results: </strong>Insulin pumps were continued in 64.2% of all admissions. The most common reason for pump discontinuation was surgery (30.1%). Length of stay was longer when pumps were removed (8.3 vs 4.7 days, <i>P</i> < .001) and when endocrinology consultation occurred more than 24 hours after admission (<i>P</i> < .001). Insulin pump continuation was associated with lower hyperglycemia (glucose >180 mg/dL) rates without an increase in hypoglycemia (glucose <70 mg/dL) in both critical and noncritical care settings.</p><p><strong>Conclusions: </strong>Continuation of insulin pumps was associated with improvement in hyperglycemia without increased hypoglycemia risk and with shorter LOS in the hospital. Standardized institutional policies including prompt glycemic management team consultation may help expand safe continuation of AID during hospitalizations.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261473583"},"PeriodicalIF":4.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673688","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":"Automated Insulin Delivery in Very Young Children: The Next Challenge Is Access.","authors":"Hussein Zaitoon","doi":"10.1177/19322968261473289","DOIUrl":"10.1177/19322968261473289","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261473289"},"PeriodicalIF":4.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663967","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":"Retrospective Validation of a Stage 5 Decision Support Algorithm Using Clinical Trial Data From Stage 4 Smart Insulin Pens.","authors":"Jee Hee Yoo, Seohyun Kim, Younghoon Kim, Sang-Man Jin, Jae Hyeon Kim","doi":"10.1177/19322968261471490","DOIUrl":"10.1177/19322968261471490","url":null,"abstract":"<p><strong>Background: </strong>We evaluated whether the frequency of algorithm-generated coaching events, a decision support system (DSS) integrated with a smart insulin pen (SIP), differed according to glycemic outcomes, thereby establishing the algorithmic foundation.</p><p><strong>Methods: </strong>This retrospective analysis evaluated continuous glucose monitoring (CGM) and SIP data from a 12-week randomized controlled trial (NCT06406439) involving individuals with diabetes managed with multiple daily injections (MDI). A total of 338 biweekly CGM profiles from 58 participants were analyzed. For each 14-day period, the coaching event frequency was calculated across 9 predefined coaching categories.</p><p><strong>Results: </strong>Frequencies of hyperglycemia-related coaching (time in range [TIR]: 18.8 vs 34.8; time above range [TAR > 180 mg/dL]: 18.3 vs 33.8) and missed bolus events (TIR: 7.6 vs 11.2; TAR: 7.0 vs 11.1) were significantly higher in profiles not meeting hyperglycemia-related CGM targets (all <i>P</i> < .001). Both coaching categories demonstrated good discrimination for TIR and TAR target achievement (all area under the curve [AUC] > 0.7). Frequency of missed basal detection also showed significant associations with achievement of TIR and TAR targets (all <i>P</i> < .05). The hypoglycemia coaching group effectively discriminated the absence of nocturnal time below range <54 mg/dL (AUC = 0.740). Basal insulin titration coaching frequencies were associated with nocturnal mean glucose changes (all <i>P</i> < .005). Real-time insulin and correction factor reduction recommendations were independently associated with deterioration in TIR and TAR metrics (all <i>P</i> < .05).</p><p><strong>Conclusions: </strong>The frequency of algorithm-based coaching events served as a robust indicator of glycemic control. These findings validate Stage 5 SIP-integrated DSS and suggest its potential utility in identifying unresolved glycemic issues in individuals treated with MDI.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261471490"},"PeriodicalIF":4.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663945","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":"Real Life Analysis of Simplified Carbohydrate Announcement in Patients With Type 1 Diabetes Using a Patch Pump With Automated Insulin Delivery.","authors":"Natalia Baczewska, Sylvie Villar-Fimbel, Stephanie Lambert-Porcheron, Florence Authier, Charles Thivolet","doi":"10.1177/19322968261469204","DOIUrl":"10.1177/19322968261469204","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261469204"},"PeriodicalIF":4.9,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663937","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":"Skin Reactions With Continuous Glucose Monitoring Systems: Real-World Survey Data Highlight an Underappreciated Clinical Challenge.","authors":"Birgit Olesen, Dominic Ehrmann, Bernhard Kulzer, Norbert Hermanns, Lutz Heinemann","doi":"10.1177/19322968261473290","DOIUrl":"10.1177/19322968261473290","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261473290"},"PeriodicalIF":4.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648731","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":"Distribution of Hypo- and Hyperglycemic Event Duration in Type 1 Diabetes Using Automated Insulin Delivery.","authors":"Ermina Bach, Sanne Fisker, Mia Christensen, Bo Martin Bibby, Klavs Würgler Hansen","doi":"10.1177/19322968261471164","DOIUrl":"10.1177/19322968261471164","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the distribution and duration of hypo- and hyperglycemic events in type 1 diabetes using automated insulin delivery (AID).</p><p><strong>Methods: </strong>Continuous glucose monitoring data over 60 days were obtained from 83 users of the Tandem Control IQ (CIQ) insulin pump and 65 users of the MiniMed 780G (MM) system, all with active sensor time >70%. The frequency and duration of consensus-defined hypoglycemic (<70 mg/dL) and hyperglycemic (>180 mg/dL) events were calculated. Hypoglycemic event duration was analyzed in 5-minute increments from 15 to 120 minutes, and hyperglycemic event duration in 15-minute increments from 15 to 430 minutes.</p><p><strong>Results: </strong>The median number of hypoglycemic events per 60 days was 28 (interquartile range [IQR] 11-45) for CIQ and 23 (IQR 13-40) for MM (<i>P</i> = .31). The median duration of hypoglycemic events was 30 (IQR 20-45) minutes with CIQ and 35 (IQR 25-50) minutes with MM, corresponding to a 15% longer duration with MM than with CIQ (MM/CIQ ratio 1.15, 95% confidence interval [CI], 0.10-0.23, <i>P</i> < .001). The median duration of hyperglycemic events was 90 (IQR 45-180) minutes with CIQ and 85 (IQR 45-165) minutes with MM, with no statistically significant difference between systems (MM/CIQ ratio of 0.95 [95% CI, 0.86-1.05], <i>P</i> = .33)Conclusion:Analysis of the duration and distribution of hypo- and hyperglycemic events complements standard time-in-range metrics. In this study, 1 AID system was associated with a longer duration of hypoglycemic events despite similar overall exposure to hypoglycemia.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261471164"},"PeriodicalIF":4.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620235","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":"Adherence and Clinical Effectiveness of a Subcutaneous Insulin Clinical Decision Support Tool in Hospitalized Patients.","authors":"Benjamin Lalani, Mohammed S Abusamaan, Andrew P Demidowich, Mihail Zilbermint, Sudipa Sarkar, Nestoras Mathioudakis","doi":"10.1177/19322968261468379","DOIUrl":"10.1177/19322968261468379","url":null,"abstract":"<p><strong>Background: </strong>Inpatient hyperglycemia is common and associated with adverse outcomes. Subcutaneous insulin remains the mainstay of treatment for most non-critically ill patients, yet appropriate dosing is complex and prone to variation. Clinical decision support (CDS) tools may improve insulin prescribing, but few have been evaluated in real-world settings.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult inpatients with diabetes and hyperglycemia admitted to 2 academic medical centers between December 1, 2015, and July 30, 2018. We assessed uptake, effectiveness, and adherence to an optional subcutaneous insulin CDS tool embedded in the Epic electronic medical record (EMR). Propensity score matching with Crump trimming and 1:3 nearest-neighbor matching was used to compare glycemic outcomes between patients who used the tool within 24 hours of admission and matched controls.</p><p><strong>Results: </strong>Of 5485 eligible admissions, 662 (12.1%) involved tool use on day 1. Tool use was more common among patients with type 1 diabetes, chronic kidney disease, or higher baseline glucose and varied by diagnosis and provider type. Among matched patients (n = 1750), tool use was associated with greater odds of any euglycemia (70-180 mg/dL) on day 2 (75.1% vs 69.8%; odds ratio [OR] = 1.30, 95% CI = 1.04-1.63; <i>P</i> = .02). Mean glucose levels, hypoglycemia, and hyperglycemia did not differ significantly. Only 43.7% of patients for whom the tool was used received a total daily insulin dose within 20% of the user-selected dose.</p><p><strong>Conclusion: </strong>Use of an EMR-integrated insulin CDS tool was associated with modest glycemic improvements. Low adherence may have attenuated its clinical impact.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261468379"},"PeriodicalIF":4.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630635","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":"A First Exploratory Study of Glycemic Outcomes During Normobaric Hypoxia Simulating Moderate-Altitude Conditions in Men With Type 1 Diabetes Using Automated Insulin Delivery, With Biochemical Comparison to Healthy Individuals.","authors":"Łukasz Tota, Małgorzata Morawska-Tota, Sandra Mrozińska, Anna Juza, Katarzyna Cyranka, Tomasz Klupa, Bartłomiej Matejko","doi":"10.1177/19322968261464595","DOIUrl":"10.1177/19322968261464595","url":null,"abstract":"<p><strong>Background: </strong>Physical activity is essential in type 1 diabetes mellitus (T1DM) management, and hybrid closed-loop (HCL) insulin systems are now a preferred therapy. Data on the short-term metabolic effects of hypoxia remain limited.</p><p><strong>Methods: </strong>This study evaluated the MiniMed 780G (MM780G) system in 12 men with T1DM (mean age 40.2 ± 3.9 years; diabetes duration 22.3 ± 8.7 years; glycated hemoglobin 6.4 ± 0.6%) before, during, and after 48 hours of simulated normobaric hypoxia, with a secondary aim of comparing selected biochemical markers with 13 age- and body mass index-matched healthy men. All participants underwent a 48-hour exposure to normobaric hypoxia in a normobaric chamber, simulating an altitude of up to 3500 m a.s.l. while maintaining normal barometric pressure. A broad panel of endocrine, immunological, vascular, neurotrophic, gastrointestinal, and oxidative biomarkers was assessed to characterize whole-body adaptation to hypoxia.</p><p><strong>Results: </strong>Across the three study periods, a numerical difference was observed only for SD, which was higher after the test compared with the hypoxia period itself in this exploratory analysis. No significant differences were found in other glycemic indices, daily carbohydrate intake, total insulin delivery, or the proportion of insulin administered as boluses (borderline significance); however, all changes remained within recommended glycemic thresholds. Insulin-like growth factor 1 (IGF-1) levels, at both baseline and delta, tended to be higher in the T1DM group, while changes in E-selectin were more pronounced than in controls.</p><p><strong>Conclusions: </strong>In this exploratory study, 48-hour exposure to normobaric hypoxia simulating an altitude of 3500 m a.s.l. was not associated with statistically significant deterioration in glycemic control in men with well-controlled T1D treated with the MM780G system, with the exception of SD, suggesting that the recovery phase rather than the exposure period may represent the higher-risk window. However, this change did not translate into deviations from recommended glycemic ranges and warrants further investigation. Biomarker profiles revealed no significant differences in inflammation, stress response, or oxidative damage compared with healthy participants. Alterations in IGF-1 and E-selectin may indicate effective compensatory and adaptive mechanisms to moderate hypoxia in people with T1DM.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"19322968261464595"},"PeriodicalIF":4.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603477","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}