Effects of Patient-Driven Lifestyle Modification Using Intermittently Scanned Continuous Glucose Monitoring in Patients With Type 2 Diabetes: Results From the Randomized Open-label PDF Study

Workplace-based continuous glucose monitoring with structured education for pre-diabetes and type 2 diabetes: A prospective community cohort study

AIMS

We investigated the effect of continuous glucose monitoring (CGM) with personalised structured education on patients with type 2 diabetes (T2D) and pre-diabetes in a workplace setting.

MATERIALS AND METHODS

This 8-week prospective study enrolled adults with T2D or pre-diabetes at Samsung Electronics Device Solutions between March and September 2023. Participants underwent CGM (Freestyle Libre) for 2 weeks and received personalized structured education on diet and physical activity. The primary outcome was the change in HbA1c level at 8 weeks compared with baseline. Secondary outcomes included changes in fasting blood sugar (FBS), lipid profile, weight and patient-related outcome measures (PROMs) at 8 weeks and longer.

RESULTS

Among 234 participants (161 T2D and 73 pre-diabetes), significant improvements were observed in the T2D group patients in terms of HbA1c (6.9% ± 1.2%-6.5% ± 0.8%), FBS (128.4 ± 36.9-117.6 ± 22.2 mg/dL), weight (81.9 ± 13.5-80.7 ± 13.6 kg) and low-density lipoprotein (LDL) cholesterol (106.0 ± 41.5 to 95.1 ± 35.9 mg/dL) (all p < 0.001) levels. Meanwhile, patients with pre-diabetes showed significant improvements in weight (79.7 ± 14.0-78.5 ± 13.9 kg) and LDL cholesterol (124.5 ± 32.8-113.8 ± 29.1 mg/dL) (all p < 0.001), with no significant changes in HbA1c or FBS. These improvements were maintained during follow-up check-ups after a mean of 6.4 months. Participants in both groups demonstrated improvements in their PROMs.

CONCLUSIONS

Among adults with T2D and pre-diabetes, the use of CGM with structured education in a workplace-based setting helped with weight loss and improved LDL cholesterol levels in both groups, while also improving glycaemia in patients with T2D.

Flash glucose monitoring for Indigenous Australians with type 2 diabetes: a randomised pilot and feasibility study

BACKGROUND

Flash glucose monitoring (FGM) can improve diabetes management, but no randomised controlled trials (RCTs) of FGM have been undertaken in Indigenous Australian populations. This study aimed to assess the feasibility of performing a RCT of FGM in Indigenous Australians with type 2 diabetes.

METHODS

In this open-labelled pilot RCT, Indigenous adults with type 2 diabetes were randomised to FGM or standard care for 6 months. Eligible participants were being treated with injectable diabetes medications and had a glycosylated haemoglobin (HbA1c) ≥ 7.0%. The feasibility outcome was the proportion of participants completing the trial, and the primary outcome for the future trial was change in HbA1c from baseline to 6 months. Secondary outcomes included change in time spent in target blood glucose (4.0-10.0 mmol/L), safety (hypoglycaemic episodes), and quality of life (EuroQol 5-dimension 3-level (EQ-5D-3L) score).

RESULTS

Of 126 screened individuals, 74 were eligible, 40 (54%) were randomised, and 39 (97.5%) completed the study. Participants' baseline characteristics were similar between the FGM and usual care groups, except for sex and body mass index. No between-group differences were observed for the following: change in HbA1c; percentage of time spent in target blood glucose (4.0-10.0 mmol/L), low glucose (< 3.9 mmol/L), and high glucose (> 15.0 mmol/L); or EQ-5D-3L scores. No severe hypoglycaemic episodes occurred.

CONCLUSIONS

This is the first pilot RCT of FGM in Indigenous Australians with type 2 diabetes. The results support a larger RCT.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR12621000021875), retrospectively registered on 14 January 2021.

Use of technology in prediabetes and precision prevention

Controlling the epidemic of diabetes is an urgent global healthcare challenge. The low uptake of diabetes prevention programs highlights difficulties in scalability, partly due to the need for intensive face-to-face contact and its impact on healthcare resource utilization. In this narrative review, we will summarize the latest evidence in technology-assisted lifestyle interventions. We will appraise evidence of digital diabetes prevention programs that use internet platforms or text messaging tools to support information delivery, lifestyle coaching, or peer support. We will also discuss the use of wearables, including physical activity trackers and continuous glucose monitoring (CGM) as part of lifestyle intervention. Experience from diabetes highlights the potential for CGM as a motivational tool to promote lifestyle change. The integration of digital data may facilitate earlier detection of prediabetes, sub-phenotyping, and personalized nutritional predictions. We will highlight major gaps in research and the need for rigorous clinical trials to evaluate the acceptability and cost-effectiveness of integrating technologies as part of a multicomponent strategy in diabetes prevention.

Impact of Continuous Glucose Monitoring Versus Blood Glucose Monitoring to Support a Carbohydrate-Restricted Nutrition Intervention in People with Type 2 Diabetes

Introduction: Low- and very-low-carbohydrate eating patterns, including ketogenic eating, can reduce glycated hemoglobin (HbA1c) in people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) has also been shown to improve glycemic outcomes, such as time in range (TIR; % time with glucose 70-180 mg/dL), more than blood glucose monitoring (BGM). CGM-guided nutrition interventions are sparse. The primary objective of this study was to compare differences in change in TIR when people with T2D used either CGM or BGM to guide dietary intake and medication management during a medically supervised ketogenic diet program (MSKDP) delivered via continuous remote care. Methods: IGNITE (Impact of Glucose moNitoring and nutrItion on Time in rangE) study participants were randomized to use CGM (n = 81) or BGM (n = 82) as part of a MSKDP. Participants and their care team used CGM and BGM data to support dietary choices and medication management. Glycemia, medication use, ketones, dietary intake, and weight were assessed at baseline (Base), month 1 (M1), and month 3 (M3); differences between arms and timepoints were evaluated. Results: Adults (n = 163) with a mean (standard deviation) T2D duration of 9.7 (7.7) years and HbA1c of 8.1% (1.2%) participated. TIR improved from Base to M3, 61-89% for CGM and 63%-85% for BGM (P < 0.001), with no difference in change between arms (P = 0.26). Additional CGM metrics also improved by M1, and improvements were sustained through M3. HbA1c decreased by ≥1.5% from Base to M3 for both CGM and BGM arms (P < 0.001). Diabetes medications were de-intensified based on change in medication effect scores from Base to M3 (P < 0.001). Total energy and carbohydrate intake decreased (P < 0.001), and participants in both arms lost clinically significant weight (P < 0.001). Conclusion: Both the CGM and BGM arms saw similar and significant improvements in glycemia and other diabetes-related outcomes during this MSKDP. Additional CGM-guided nutrition intervention research is needed.

An overview of the FreeStyle Libre monitoring system for individuals with type 1 and type 2 diabetes

INTRODUCTION

Diabetes is a chronic disease with high prevalence, necessitating advanced technology to achieve glycemic targets and reduce complications. Continuous glucose monitoring (CGM) has become a cornerstone in diabetes management, with the Freestyle Libre (FSL) systems being some of the most widely used devices.

AREAS COVERED

This review focuses on FSL systems, each including an all-in-one sensor and transmitter, a handheld reader and a Mobile Medical App (MMA). Glucose data are uploaded to a dedicated cloud-based platform for analysis. Over the years, FSL has evolved with new features offering valuable support for individuals with diabetes, caregivers, and healthcare providers. Clinical trials and real-world studies have demonstrated efficacy and safety across diverse populations, including individuals with type 1 and type 2 diabetes, adolescents, and pregnant women with diabetes.

EXPERT OPINION

FSL is a user-friendly system that meets the needs of patients and healthcare providers. The MMA allows a review of glucose metrics and pattern identification, and supports educational strategies and patient-tailored treatment. Future advancements, including ketone monitoring, integration with wearables and other devices, and telemedicine applications, will further optimize diabetes care and prevention.

Impact of real-time glucose monitoring using FreeStyle Libre 3 on glycaemia in type 2 diabetes managed with basal insulin plus SGLT2 inhibitor and/or GLP-1 agonist: the FreeDM2 randomised controlled trial protocol

INTRODUCTION

Effective management of type 2 diabetes mellitus (T2DM) consists of lifestyle modification and therapy optimisation. While glycaemic monitoring can be used as a tool to guide these changes, this can be challenging with self-monitoring of blood glucose (SMBG). The FreeStyle Libre 3 (FSL3) is a real-time continuous glucose monitoring (CGM) system designed to replace SMBG. The evidence for the benefit of CGM in people with T2DM on non-intensive insulin regimens is limited. This study aims primarily to assess the glycaemic impact of FSL3 in people with suboptimally controlled T2DM treated with basal-only insulin regimens plus sodium-glucose cotransporter-2 (SGLT-2) inhibitor and/or glucagon-like peptide (GLP)-1 agonist.

METHODS AND ANALYSIS

This is an open-label, multicentre, parallel design, randomised (2:1) controlled trial. Recruitment has been offered across 24 clinical centres in the UK and nationally through self-referral. Adults with T2DM treated with basal-only insulin regimens plus SGLT-2 inhibitor and/or GLP-1 agonist and with screening HbA1c from ≥59 mmol/mol to ≤97 mmol/mol are included. Eligible participants will be randomised to either FSL3 (intervention) for 32 weeks or continuation of SMBG (control). The study is split into two phases, each of 16 weeks duration: phase 1 consisting of self-management with basal-insulin self-titration and phase 2 where additional therapies may be initiated. Control group participants may subsequently enter an optional extension phase to receive FSL3. The primary endpoint is the difference between treatment groups in mean change from baseline in HbA1c at 16 weeks. Secondary outcomes include HbA1c at 32 weeks, CGM-based metrics, therapy changes, physical activity levels and psychosocial measures. An economic evaluation for costs and patient outcomes will be undertaken.

ETHICS AND DISSEMINATION

The study was approved by the Health Research Authority, Health and Care Research Wales and the West Midlands-Edgbaston Research Ethics Committee (reference: 23/WM/0092). Study results will be disseminated in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05944432.

SECONDARY IDENTIFYING NUMBER

Identifier assigned by the sponsor: ADC-UK-PMS-22057.

PROTOCOL VERSION

Revision D. Dated, 13 December 2024.

A Randomized Clinical Trial of a Culturally Tailored Diabetes Education Curriculum With and Without Real-Time Continuous Glucose Monitoring in a Latino Population With Type 2 Diabetes: The CUT-DM With Continuous Glucose Monitoring Study

BACKGROUND

Data on culturally tailored diabetes education with and without real-time continuous glucose monitoring (RT-CGM) in Latinos with type 2 diabetes, who are not on intensive insulin management, is lacking.

RESEARCH DESIGN AND METHODS

This is an open-label randomized control trial of Latinos with uncontrolled (HbA1c > 8.0%) type 2 diabetes conducted in a Federally Qualified Health Center (FQHC). All participants received 12 one-hour culturally tailored education sessions. Patients were randomized (1:1) to education sessions only (blinded CGM) or cyclic (50 days wear: 10 days on, 7 days off) RT-CGM. The primary outcome was a change in HbA1c from baseline to 12 weeks in those with or without CGM. Secondary outcomes included 24-week HbA1c, CGM, and metabolic parameters.

RESULTS

Participants (n = 120) were 46 years old on average, 44% female, 98% preferred Spanish language, 30% with income <$25,000, 68% uninsured and 26% using basal insulin only. Mean 1-hour session attendance and RT-CGM wear was 7.0 (±4.4) and 27.9 (±20.5) days, respectively. Mean baseline HbA1c was 10.5% (±1.8). HbA1c reduced by 1.9% (95% confidence interval [CI]: 1.5-2.3) overall (P < .001). Participants in the RT-CGM group reduced HbA1c at 12 weeks by 2.3% (95% CI: 1.5-3.2) compared to 1.5% (95% CI: 0.6-2.3) in the blinded CGM group (P =.04). At 24 weeks, overall HbA1c reduction was maintained but between-group differences attenuated.

CONCLUSIONS

In a Latino type 2 diabetes population that was primarily noninsulin-requiring, virtually delivered, culturally tailored education improved HbA1c, with RT-CGM conferring greater improvement. RT-CGM should be an adjunctive therapy to diabetes education, irrespective of insulin use but continued cyclic CGM use may be needed for sustained effect.

Effects of intermittently scanned continuous glucose monitoring on body weight and glycemic variability in individuals with overweight and impaired glucose tolerance or mild diabetes: A pilot randomized controlled trial

OBJECTIVE

To investigate the effect of visualizing blood glucose variability by intermittently scanned continuous glucose monitoring (isCGM) on weight reduction in overweight individuals with impaired glucose tolerance (IGT) or mild type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Forty overweight (BMI, ≥25 kg/m2) individuals with IGT or T2DM (drug naïve; HbA1c, ≤7.0 %) were included in this 24-week randomized controlled trial. Participants were randomly assigned to the control group (diet and exercise therapy) or the isCGM group (diet and exercise therapy plus isCGM). The primary endpoint was the change in body weight during the 24-week intervention period.

RESULTS

One participant in the isCGM group withdrew consent. We therefore analyzed 19 individuals in the isCGM group and 20 in the control group. Baseline BMI was significantly higher in the isCGM group (35.2 ± 5.7 kg/m²) compared to the control group (31.6 ± 6.8 kg/m²). Weight change in the isCGM and control groups (-1.8 and -2.2 kg) did not differ. However, the change in coefficient of variation (-0.9 and 2.9 %) of sensor glucose differed significantly between the two groups. isCGM scan frequency was positively correlated with time above range (TAR) during the first month, positively correlated with the change in protein intake, and negatively correlated with that in TAR.

CONCLUSION

While isCGM use in overweight individuals with IGT or mild T2DM did not reduce body weight, it might have influence dietary behavior. The negative correlation between scan frequency and TAR, and the positive correlation between scan frequency and protein intake suggest that self-awareness of glucose fluctuations contributed to behavioral change.

The efficacy of using continuous glucose monitoring as a behaviour change tool in populations with and without diabetes: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Continuous glucose monitoring (CGM) holds potential as a precision public health intervention, offering personalised insights into how diet and physical activity affect glucose levels. Nevertheless, the efficacy of using CGM in populations with and without diabetes to support behaviour change and behaviour-driven outcomes remains unclear. This systematic review and meta-analysis examines whether using CGM-based feedback to support behaviour change affects glycaemic, anthropometric, and behavioural outcomes in adults with and without diabetes.

METHODS

Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Elsevier Embase, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global were searched through January 2024. Eligible studies were randomised controlled trials in adults that implemented CGM-based feedback in at least one study arm compared to a control without CGM feedback. Dual screening, data extraction, and bias assessment were conducted independently. Mean differences in outcomes between intervention and comparison groups were analysed using generic inverse variance models and random effects. Robustness of pooled estimates from random-effects models was considered with sensitivity and subgroup analyses.

RESULTS

Twenty-five clinical trials with 2996 participants were included. Most studies were conducted in adults with type 2 diabetes (n = 17/25; 68%), followed by type 1 diabetes (n = 3/25, 12%), gestational diabetes (n = 3/25, 12%), and obesity (n = 3/25, 12%). Eleven (44%) studies reported CGM-affiliated conflicts of interest. Interventions incorporating CGM-based feedback reduced HbA1c by 0.28% (95% CI 0.15, 0.42, p < 0.001; I2 = 88%), and increased time in range by 7.4% (95% CI 2.0, 12.8, p < 0.008; I2 = 80.5%) compared to arms without CGM, with non-significant effects on time above range, BMI, and weight. Sensitivity analyses showed consistent mean differences in HbA1c across different conditions, and differences between subgroups were non-significant. Only 4/25 studies evaluated the effect of CGM on dietary changes; 5/25 evaluated physical activity.

CONCLUSIONS

This evidence synthesis found favourable, though modest, effects of CGM-based feedback on glycaemic control in adults with and without diabetes. Further research is needed to establish the behaviours and behavioural mechanisms driving the observed effects across diverse populations.

TRIAL REGISTRATION

CRD42024514135.

Patient-reported outcomes in studies of diabetes technology: What matters

In recent years, diabetes technologies have revolutionized the care of people with type 1 diabetes (T1D). Emerging evidence suggests that people with type 2 diabetes (T2D) can experience similar benefits from these advances in technology. While glycaemic outcomes are often a primary focus, the lived experience of the person with diabetes is equally important. In this review, we describe the impact of diabetes technologies on patient-reported outcome measures (PROMs). We highlight that most of the published studies investigated PROMs as secondary outcomes. Continuous glucose monitoring systems may have an important role in improving PROMs in individuals with T1D, which may be driven by the prevention or proactive management of hypoglycaemia. In people with T2D, continuous glucose monitoring may also have an important role in improving PROMs, particularly in those treated with insulin therapy. The impact of insulin pumps on PROMs seems positive in T1D, while there is limited evidence in T2D. Studies of hybrid closed-loop therapies suggest increased treatment satisfaction, improved quality of life and decreased diabetes-related distress in T1D, but it is unclear whether these benefits are because of a 'class-effect' or individual systems. We conclude that PROMs deserve a more central role in trials and clinical practice, and we discuss directions for future research.

The use of technology in type 2 diabetes and prediabetes: a narrative review

The increasing incidence of type 2 diabetes, which represents 90% of diabetes cases globally, is a major public health concern. Improved glucose management reduces the risk of vascular complications and mortality; however, only a small proportion of the type 2 diabetes population have blood glucose levels within the recommended treatment targets. In recent years, diabetes technologies have revolutionised the care of people with type 1 diabetes, and it is becoming increasingly evident that people with type 2 diabetes can also benefit from these advances. In this review, we describe the current knowledge regarding the role of technologies for people living with type 2 diabetes and the evidence supporting their use in clinical practice. We conclude that continuous glucose monitoring systems deliver glycaemic benefits for individuals with type 2 diabetes, whether treated with insulin or non-insulin therapy; further data are required to evaluate the role of these systems in those with prediabetes (defined as impaired glucose tolerance and/or impaired fasting glucose and/or HbA1c levels between 39 mmol/mol [5.7%] and 47 mmol/mol [6.4%]). The use of insulin pumps seems to be safe and effective in people with type 2 diabetes, especially in those with an HbA1c significantly above target. Initial results from studies exploring the impact of closed-loop systems in type 2 diabetes are promising. We discuss directions for future research to fully understand the potential benefits of integrating evidence-based technology into care for people living with type 2 diabetes and prediabetes.

Perspective of Continuous Glucose Monitoring-Based Interventions at the Various Stages of Type 2 Diabetes

Continuous glucose monitoring (CGM) is now advocated for the clinical management of individuals with type 1 diabetes (T1D). However, this glucose monitoring strategy is not routinely used in type 2 diabetes (T2D), given the large population, significant cost implications and relatively limited supporting evidence. T2D is a more heterogenous condition compared with T1D with various glucose lowering therapies that do not necessarily require CGM to ensure within target glucose levels. While all individuals with T2D may benefit from CGM at certain time points, the whole T2D population does not necessarily require this technology continuously, which should be prioritized based on patient benefit and cost effectiveness. In this pragmatic opinion piece, we describe the rationale and evidence for CGM use in different subgroups of individuals with T2d, divided according to the stage of the condition, glycemic therapies, presence of diabetes complications, or associated co-morbidities. We discuss a total of 16 T2D subgroups and provide a clinical view on CGM use in each, based on current evidence while also highlighting areas of knowledge gaps. This work provides health care professionals with a simple guide to CGM use in different T2D groups and gives suggestion for future studies to justify expansion of this technology.

Leveraging continuous glucose monitoring as a catalyst for behaviour change: a scoping review

BACKGROUND

Amidst the escalating prevalence of glucose-related chronic diseases, the advancements, potential uses, and growing accessibility of continuous glucose monitors (CGM) have piqued the interest of healthcare providers, consumers, and health behaviour researchers. Yet, there is a paucity of literature characterising the use of CGM in behavioural intervention research. This scoping review aims to describe targeted populations, health behaviours, health-related outcomes, and CGM protocols in randomised controlled trials (RCTs) that employed CGM to support health behaviour change.

METHODS

We searched Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global from inception to January 2024 for RCTs of behavioural interventions conducted in adults that incorporated CGM-based biological feedback. Citation searching was also performed. The review protocol was registered ( https://doi.org/10.17605/OSF.IO/SJREA ).

FINDINGS

Collectively, 5389 citations were obtained from databases and citation searching, 3995 articles were screened, and 31 were deemed eligible and included in the review. Most studies (n = 20/31, 65%) included adults with type 2 diabetes and reported HbA1c as an outcome (n = 29/31, 94%). CGM was most commonly used in interventions to target changes in diet (n = 27/31, 87%) and/or physical activity (n = 16/31, 52%). 42% (n = 13/31) of studies provided prospective CGM-based guidance on diet or activity, while 61% (n = 19/31) included retrospective CGM-based guidance. CGM data was typically unblinded (n = 24/31, 77%) and CGM-based biological feedback was most often provided through the CGM and two-way communication (n = 12/31, 39%). Communication typically occurred in-person (n = 13/31, 42%) once per CGM wear (n = 13/31; 42%).

CONCLUSIONS

This scoping review reveals a predominant focus on diabetes in CGM-based interventions, pointing out a research gap in its wider application for behaviour change. Future research should expand the evidence base to support the use of CGM as a behaviour change tool and establish best practices for its implementation.

TRIAL REGISTRATION

doi.org/10.17605/OSF.IO/SJREA.

Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system

OBJECTIVE

To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM.

METHODS

An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American.

RESULTS

The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM.

CONCLUSION

Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.

Intermittently scanned continuous glucose monitoring provides no benefit over structured self-monitoring of blood glucose in type 2 diabetes not on prandial insulin, in the context of diabetes self-management education: GLucose monitoring programme SingaporE (GLiMPSE)

OBJECTIVE

We evaluated the impact of intermittently scanned continuous glucose monitoring(is-CGM)over self-monitoring of blood glucose(SMBG) in the context of diabetes self-management education (DSME) in sub-optimally controlled type 2 diabetes(T2D) in a multi-ethnicsetting.

RESEARCH DESIGN AND METHOD

Randomized-controlled, open-label trial (NCT04564911), of T2D with HbA1c ≥ 7.5-≤10 %, on oral agents with/without basal insulin was carried out. Intervention arm received 6 weeks(w) continuous is-CGM, followed by one is-CGM/month till 24w. Control arm was advised to perform 4 SMBG/day. Educationwas delivered at weeks 0, 2, 8, 16.

PRIMARY OUTCOME

Change in HbA1c from baseline at 24w. Modified intention-to-treat (mITT) analysis with linear mixed-effect model for repeated measurementswas performed.

RESULTS

176 subjects, age 55 ± 10.7 years(y), DM duration 11 ± 7.3y, BMI 27.8 ± 5.9 kg/m2, 58 % Male, 29.5 % basal insulin users were analysed. Within each arm,from baseline to 24w, mean HbA1c decreasedby -0.6 % (-6.6.mmol/mol, p-value < 0.01)and weight decreased(isCGM: -1.44 kg; SMBG: -1.25 kg, both p < 0.01). These changes were sustained to one year. However, there wasno significant difference in these parameters between arms (p-value > 0.05).

CONCLUSION

In the context of DSME, use of either SMBG or is-CGM led to improved glycaemia and reduced weight over a period of 24 weeks, sustained to one year.

Effectiveness and Safety of the Intermittently Scanned Continuous Glucose Monitoring System FreeStyle Libre 2 in Patients with Type 2 Diabetes Treated with Basal Insulin or Oral Antidiabetic Drugs: An Observational, Retrospective Real-World Study

Intermittently Scanned Continuous Glucose Monitoring (isCGM) devices are increasingly being used in patients with type 2 diabetes mellitus (T2DM) on insulin therapy for their benefits regarding disease management. Evidence of isCGM use in patients with T2DM on basal or non-insulin therapy is lacking. This study aimed at assessing the efficacy and safety of isCGM in this population. This was an observational, retrospective, real-world study enrolling patients with T2DM who were starting the use of isCGM. Data from medical records (i.e., demographics, clinical characteristics, laboratory assessments, and isCGM metrics) were collected over three time periods (baseline, 3 and 6 months). The endpoints were glycated haemoglobin (HbA1c) changes and changes in isCGM metrics as defined by the International Consensus from baseline to 3 months and 6 months. Overall, 132 patients were included (69.5% male; mean age 68.2 ± 11.0 years; mean disease duration 19.0 ± 9.4 years; 79.7% on basal insulin ±non-insulin therapy; mean baseline HbA1c 8.1% ± 1.3%). The estimated mean change in HbA1c was statistically significant at three (-0.4 ± 1.0%; p = 0.003) and six months (-0.6 ± 1.3%; p < 0.0001). In conclusion, isCGM proved to be effective and safe in improving glycaemic control in patients with T2DM on basal insulin or non-insulin therapy.

Diabetic stem cell therapy and nanomedicine: advancements in treating diabetes

Objectives

In recent years, significant advancements have been made in the field of medical sciences, particularly in the treatment of diabetes using innovative methods. Diabetes, a chronic metabolic disorder considered by elevated blood glucose levels, disturbs millions of people worldwide.

Methods

Conventional treatments for diabetes have shown limited success in providing long-term solutions, leading researchers to explore alternative therapies such as diabetic stem cell therapy and nanomedicine. In this article, we delve into the promising potential of these cutting-edge treatments and their impact on diabetes management.

Results

Several achievements have been obtained to treat diabetes type I by merging nanomedicine and cell therapy such as insulin-loaded exosomes and nanoparticles loaded with different drugs. For instance, by engineering exosomes with specific nanocarriers, researchers can precisely deliver some molecules to target cells, promoting tissue repair and regeneration.

Conclusions

It seems that using nanomedicine and cell therapy, we can explore the inventive way for a future somewhere diabetes is no longer a problem for millions, and people can hold a great quality life.

Graphical Abstract

Blood glucose monitoring devices: current considerations

Measuring blood glucose concentrations via capillary (fingerprick) blood glucose monitoring or continuous (interstitial) glucose monitoring is an important aspect of management for many people with diabetes. Blood glucose monitoring informs patient self-management strategies, which can improve the patient's engagement in their own care and reduce barriers to achieving recommended blood glucose targets. Blood glucose monitoring also informs clinician-guided management plans. Compared to capillary blood glucose monitoring, continuous glucose monitoring in people using insulin significantly improves glycaemic metrics and is associated with improved patient-reported outcomes. Even with good glycaemic metrics, patients using continuous glucose monitoring should still have access to capillary blood glucose monitoring for correlation of hypoglycaemic readings when accuracy may be compromised or if there is a malfunction with the continuous blood glucose monitor.

Dementia in Diabetes: The Role of Hypoglycemia

Hypoglycemia, a common consequence of diabetes treatment, is associated with severe morbidity and mortality and has become a major barrier to intensifying antidiabetic therapy. Severe hypoglycemia, defined as abnormally low blood glucose requiring the assistance of another person, is associated with seizures and comas, but even mild hypoglycemia can cause troubling symptoms such as anxiety, palpitations, and confusion. Dementia generally refers to the loss of memory, language, problem-solving, and other cognitive functions, which can interfere with daily life, and there is growing evidence that diabetes is associated with an increased risk of both vascular and non-vascular dementia. Neuroglycopenia resulting from a hypoglycemic episode in diabetic patients can lead to the degeneration of brain cells, with a resultant cognitive decline, leading to dementia. In light of new evidence, a deeper understating of the relationship between hypoglycemia and dementia can help to inform and guide preventative strategies. In this review, we discuss the epidemiology of dementia among patients with diabetes, and the emerging mechanisms thought to underlie the association between hypoglycemia and dementia. Furthermore, we discuss the risks of various pharmacological therapies, emerging therapies to combat hypoglycemia-induced dementia, as well as risk minimization strategies.