Aug 2026· Innere Medizin· 0 citations· 13 references
Medicine
TL;DR
A practice-oriented evaluation of the indications, clinical benefits, and safety of modern diabetes technologies and suggests that technologies should be offered according to individual needs, abilities, preferences, and life circumstances and implemented early, including at the time of diagnosis.
Randomized and real-world studies demonstrate that AID systems significantly improve A1C and time in range while minimizing hypoglycemia, without increasing treatment complexity or patient burden, and position AID as a practical and effective strategy to overcome long-standing therapeutic inertia in type 2 diabetes.
Z. Tariq, Grazia Aleppo, Anders L Carlson et al.· Endocrine Practice· 0 citations
BACKGROUND
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.
METHODS
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.
RESULTS
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, P < .001) and when endocrinology consultation occurred more than 24 hours after admission (P < .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.
CONCLUSIONS
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.
Kathleen R Ruddiman, J. Evans, Joseph A. Aloi et al.· Journal of Diabetes Science...· 0 citations
To evaluate efficacy and safety of continuous glucose monitoring (CGM) and automated insulin delivery (AID) in infants. A retrospective multicenter study (13 centers) of 76 children diagnosed with antibody-positive type 1 diabetes before age 2. Outcomes at 12 months were compared between AID users (n = 47) and multiple daily injections (MDI)/SAP users (n = 29). AID systems included Medtronic 780 G (38%), Tandem Control-IQ (38%), and CamAPS FX (24%). CGM median wear time was 97.0% (93.3; 98.1). AID users achieved significantly higher TIR (65% vs. 56%, P = 0.041) and time in tight range (TITR) (42% vs 32.5%, P = 0.038). In multivariable regression, AID was the sole independent predictor of lower HbA1c (P = 0.035). Zero severe hypoglycemia (SH) events occurred in the AID group (vs. 7.1% in MDI/SAP). Use of CGM is safe in very young children, with AID systems proving superior to traditional therapy. This real-world evidence supports incorporating AID consideration into future international guidelines from the time of pediatric diagnosis.
M. Marigliano, A. Scaramuzza, C. Arnaldi et al.· Diabetes Technology & Therap...· 0 citations
INTRODUCTION
Clinical inertia and the complexity of basal insulin titration are major barriers to optimal glycemic control in adults with type 2 diabetes (T2D). A prototype of the Dexcom Smart Basal system known as basal therapy optimization (BTO), a continuous glucose monitoring (CGM)-informed basal insulin optimization system, was evaluated for its efficacy, safety, and impact on patient-reported outcomes (PRO).
METHODS
In this prospective, single-arm study, 14 adults with T2D (three initiating and 11 optimizing basal insulin) used the BTO system. The study consisted of three phases: a ten-day baseline, up to 35 days of active titration, and a 20-day post-titration follow-up. Outcomes included change in CGM-derived glycemic metrics (mean glucose, time in range [TIR], time above range [TAR], time below range [TBR]), fasting blood glucose (FBG), and PROs (diabetes treatment satisfaction, glucose monitoring satisfaction, and patient-doctor depth of relationship) assessed using validated questionnaires. Safety was also assessed by the number of adverse events.
RESULTS
All participants completed the study. The BTO system generated 401 insulin dose recommendations, with 96.5% accepted by the healthcare provider. After BTO-guided titration, mean glucose decreased by median (IQR) 26.3 (- 64.6, - 6.0) mg/dl (p = 0.0031), TIR 70-180 mg/dl increased by 16.0 (2.5, 43.7) percentage points (p = 0.0017), TAR > 180 mg/dl decreased by 15.9 (- 43.7, - 2.5) percentage points (p = 0.0017), and TBR < 70 mg/dl remained low (0.0-0.1%), with no clinically significant change in TBR. Median FBG decreased by 17.8 (- 54.4, 2.3) mg/dl (p = 0.052). No BTO- or study-related- adverse or severe adverse events were reported. Treatment satisfaction was significantly higher; median post-titration Diabetes Treatment Satisfaction Questionnaire (DTSQ) Change score was 17 (14, 18) on a scale ranging from - 18 to 18 and was significantly different from baseline DTSQ status score (p = 0.001). High satisfaction with glucose management and strong patient-provider relationships were preserved. Three illustrative cases highlighted successful insulin dose optimization through dose increases or decreases.
CONCLUSIONS
CGM-informed basal insulin optimization with a prototype of Dexcom Smart Basal was associated with improvements in glycemic control and treatment satisfaction in adults with T2D, with a favorable safety profile. The system may help overcome clinical inertia and support individualized insulin titration in real-world settings.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT07681375 (Submitted for retrospective registration on 1/28/2026 and registered on 7/1/2026).
S. Oser, C. Crystal, K. Hames et al.· Diabetes Therapy· 0 citations
The successful management of type-1 diabetes (T1D) and insulin-dependent type-2 diabetes depends on the ability to accurately calibrate bolus and basal insulin doses, and minimize the time spent with high postprandial blood glucose (BG) levels while avoiding dangerously low hypoglycemic excursions. Precise calibration of the insulin pump helps with successful disease management; however, people with T1D may still experience prolonged, potentially damaging BG levels due to postprandial highs. Insulin pumps offer large, currently underexploited degrees of freedom in insulin delivery, which can have a dramatic impact on average postprandial BG levels. Building on existing models of the glucose-insulin system, we first propose a simple, automated, and individualized insulin-pump calibration system based on a series of measures taken before and a few hours after carbohydrate ingestion. We then modulate the shape of pre-meal insulin dosing to explicitly reduce postprandial BG levels while minimizing the likelihood of dangerously low BG. Such an optimal insulin delivery time course can potentially improve postprandial BG levels and rapidly bring BG to the target level. We evaluated our methods in 20 patients over 4 days, with BG levels sampled frequently.
I. Aganj, N. Bryant, Leah (Morgan) Panaro et al.· medRxiv· 0 citations
In recent years, continuous glucose monitoring (CGM) systems have become increasingly common and more widely available for people with diabetes. A variety of devices appearing on the market, together with their increasing integration with other tools (insulin pumps, watches, and smartphone applications), require medical personnel to have a solid basic knowledge of CGMs, continuous follow-up, updated expertise extending beyond the local market, and a future-oriented perspective. Additionally, low-quality products without proper evaluation, which do not meet the standards established by diabetes societies, become available to patients. To provide an extended background on CGM technology principles, basic knowledge of results presentation, and interpretation according to recommendations, this review presents the most common devices, along with a cost-effectiveness analysis and a critical assessment. Furthermore, future perspectives are discussed, including AI technologies and modern solutions to enhance user comfort.
Oskar Kublin, D. Filipowicz, Mariusz Stępień· Archives of Medical Science· 0 citations