Daniel A. Hochfellner

Background: Algorithm-based insulin dosing systems are increasingly used in hospitals and have shown the potential to efficiently and safely enable glycemic control. The goal of this study was to evaluate glycemic control using the ultralong-acting basal insulin degludec (IDeg) in combination with insulin aspart (IAsp) within an algorithm-driven electronic clinical decision support system (cDSS) in inpatients with type 2 diabetes (T2D). Methods: In this non-controlled single-arm pilot study, an electronic, algorithm-based cDSS was applied for the management of insulin treatment in an internal general ward. Thirty hospitalized patients with T2D (18 female, age 74.1 ± 10.9 years, HbA1c 72.4 ± 22.3 mmol/mol, BMI 28.6 ± 5.6 kg/m², diabetes duration 13.2 ± 11.6 years, creatinine 1.5 ± 1.2 mg/dL, length of hospital stay 9.1 ± 4.0 days) were included in the study. Capillary blood glucose (BG) was evaluated four times daily using a point-of-care device integrated into the hospital information system. In addition, all participants received a blinded continuous glucose monitoring (CGM; Abbott Freestyle Libre Pro) system. The primary endpoint was defined as the percentage of BG measurements within the target range of 3.9–7.8 mmol/L. Results: Overall, 722 BG values and 17,242 CGM data points were available. Of those, 52.2% and 55.0% were in the specified target area (3.9–7.8 mmol/L), respectively. Mean BG prior to study start was 11.9 ± 4.4 mmol/L and improved to 7.5 ± 1.9 mmol/L and 7.4 ± 1.4 mmol/L after 6 and 10 days of treatment. BG < 3.9, <3.0 and <2.2 mmol/L was 1.25%, 0.28% and 0%, respectively. Adherence to the total daily insulin dose suggested by the cDSS was 94.2%, and 99.5% of all basal and 85.3% of all bolus insulin suggestions were accepted by the nurses in charge. Basal-bolus therapy using the cDSS covered 85% of the participants’ total hospital stay. Conclusions: Glycemic control using IDeg within an algorithm-driven cDSS could effectively and safely be achieved in the hospital and was highly accepted.

Background: Long-term glycemic control in type 1 diabetes (T1D) varies substantially among affected individuals, but the role of baseline characteristics at diagnosis and their association with later glycemic control remain incompletely understood. Identifying early predictors of glycemic control may facilitate timely, individualized therapeutic interventions. Methods: We retrospectively analyzed electronic health records of individuals with newly diagnosed T1D between 2001 and 2022 to assess anthropometric and metabolic parameters at the first presentation of the condition across age groups and determine predictors of glycated hemoglobin (HbA_1c) trajectories over 24 months. The multicentric cohort, which comprised people who were diagnosed with T1D in the Austrian federal state of Styria, was classified as children (1c levels over 24 months. However, after adjustment for important covariates, only younger age remained a significant predictor of inferior glycemic control over 24 months, emphasizing the importance of structured, age-appropriate follow-up care. Conclusions: Younger age at T1D diagnosis independently predicts suboptimal glycemic trajectories over the first two years after T1D onset. Early identification may enable targeted, age-specific interventions to improve long-term outcomes.

Aims: Continuous glucose monitoring (CGM) systems are increasingly used, but their accuracy under flight‐conditions remains insufficiently studied. We assessed sensor accuracy of four CGMs during in‐flight (mid‐haul) and ground conditions. Materials and Methods: Participants ( n = 20) wore four sensors (Abbott Libre 3, Dexcom G7, Medtronic Simplera, and Sinocare iCan i3) in parallel, inserted 1 day prior to experiment. Capillary reference measurements were performed every 30 min. Accuracy evaluation included: proportion of CGM values within 10% of comparator glucose levels >100 mg/dL or within 10 mg/days of comparator levels ≤100 mg/dL (%10/10), along with %20/20 agreement rates, mean absolute relative difference (MARD), Consensus error grid. Results: Twenty participants with type 1 diabetes (age: 37.9 ± 12.8 years, HbA1c: 52.3 ± 4.9 mmol/mol, diabetes duration 19.25 ± 10.6 years) were included in the analysis. Data from 297 sensors with 3473 matched pairs (G7/Libre3/Simplera/i3) were analysed. The overall MARDs were: 9.5% ± 3.3% (G7), 9.6% ± 3.8% (Libre3), 19.9% ± 6.2% (Simplera) and 15.7% ± 6.6% (i3). Overall %20/20 and %10/10 agreement rates were 90.6%/70.2% (G7), 90.8%/66.8% (Libre3), 63.6%/37.8% (Simplera) and 72.5%/42.2% (i3) respectively. The proportion of values in Zones A and B of the Consensus error grid was 98.9% (G7), 99.0% (Libre 3), 94.5% (Simplera) and 97.5% (i3). Prandial state and flight phase had limited influence on the relative performance ranking of the devices. Conclusions: G7 and Libre3 showed consistently higher accuracy and clinical reliability across various phases of flight and ground conditions. Simplera and i3 exhibited greater variability in accuracy. These findings suggest that while modern CGMs could support diabetes management in aviation, individual system performance may differ under specific operational conditions.

Background: Automated insulin delivery systems (AID) are increasingly used by people living with type 1 diabetes, but their functionality during air travel remains insufficiently studied. Some concerns have arisen regarding safety using AID systems under flight conditions, particularly related to potential insulin delivery errors induced by cabin pressure changes. Methods: This study assessed the safety and efficacy commercial AIDs in 20 adults with type 1 diabetes (age: 37.9 ± 12.8 years, HbA1c: 52.3 ± 4.9 mmol/mol, TIR: 74 ± 9.8%, diabetes duration: 19.25 ± 10.6 years) during mid‐haul commercial flights and matched ground‐based conditions (MiniMed780G; Omnipod 5; Control‐IQ; and CamAPS FX with YpsoPump, n = 5 per system). Outcomes included time in range (TIR, 3.9–10.0 mmol/L), time in tight range (TITR, 3.9–7.8 mmol/L), time above range 1 (TAR1, 10.1–13.9 mmol/L), time above range 2 (TAR2, >13.9 mmol/L), time below range 1 (TBR1, 3.0–3.8 mmol/L), time below range 2 (TBR2, <3.0 mmol/L), and total daily insulin doses. Results: Overall TIR was 88.2 ± 13.5% in‐flight versus 82.1 ± 17.7% on‐ground. The mean difference in TIR was 4.6%, (95% CI: −5.0‐ 14.2). Other overall metrics (in‐flight versus on‐ground) were: TITR = 67.7 ± 19.4% vs. 64.2 ± 18.1%, TAR = 7.1 ± 10.5% vs. 12.0 ± 13.8% and TBR = 4.7 ± 7.2% vs. 5.9 ± 15.7%. Insulin delivery was slightly increased in‐flight (25.4 ± 17.6 IU vs. 18.7 ± 11.6 IU), driven by bolus dosing (17.8 ± 13.3 IU vs. 11.9 ± 6.6 IU). No episodes of level 2 hypoglycaemia, diabetic ketoacidosis, or device failure occurred. Conclusions: AID systems maintained robust glycaemic control and safety during commercial flights, comparable to ground‐based conditions. These data support the feasibility of in‐flight AIDs use and provide a basis for future regulatory and clinical practice updates. Larger, multicenter studies are needed to generalize findings.

Background: In critically ill patients, deviations in glucose levels may lead to significant harm to individuals with and without diabetes. Although subcutaneous continuous glucose monitoring (scCGM) has proven beneficial for patients in standard wards, its implementation in critical care settings has been limited due to multiple factors, potentially resulting in inadequate glycemic control and consequent complications; here, intravascular systems (ivCGM) have the potential to overcome these limitations. Method: This single-center, open-label study, aimed to assess accuracy and safety of a novel intravenous glucose monitoring system in patients with and without diabetes, admitted to a cardiothoracic surgery intensive care unit. Glucose levels were continuously monitored for up to 72 hours in the predefined glucose range of 20 to 400 mg/dL and compared with arterial glucose measurements (blood gas analyses [BGAs]). Results: Twenty-eight participants successfully completed the study, allowing the collection of 1224 ivCGM/BGA data pairs. Due to the exploratory nature of the trial in this vulnerable patient population, no data pairs 250 mg/dL) were observed. A mean absolute relative difference (MARD) of 8.7 ± 7.8% was found, whereas the mean absolute difference (MAD) for values <100 mg/dL was 3.3 ± 2.7 mg/dL. In participants with diabetes (N = 8,332 ivCGM/BGA data pairs), MARD was 9.6 ± 8.1%. Diabetes Technology Society Error Grid (DTSEG) analysis revealed that all data pairs fell within clinically acceptable zones A and B. Notably, no serious adverse events associated with the device were observed during the study. Conclusion: The present findings indicate that the investigated intravenous glucose monitoring system provides accurate glucose monitoring and demonstrates its safety in critical care settings. This technology offers promise for improved glycemic management in critically ill patients, particularly those with diabetes, potentially mitigating the associated risks and complications.

The aim of this study was to evaluate the accuracy and usability of a novel continuous glucose monitoring (CGM) system designed for needle-free insertion and reduced environmental impact. We assessed the sensor performance of two GlucoMen^® Day CGM systems worn simultaneously by eight participants with type 1 diabetes. Self-monitoring of blood glucose (SMBG) was performed regularly over 14 days at home. Participants underwent two standardized, 5-h meal challenges at the research center with frequent plasma glucose (PG) measurements using a laboratory reference (YSI) instrument. When comparing CGM to PG, the overall mean absolute relative difference (MARD) was 9.7 [2.6–14.6]%. The overall MARD for CGM vs. SMBG was 13.1 [3.5–18.6]%. The consensus error grid (CEG) analysis showed 98% of both CGM/PG and CGM/SMBG pairs in the clinically acceptable zones A and B. The analysis confirmed that GlucoMen^® Day CGM meets the clinical requirements for state-of-the-art CGM. In addition, the needle-free insertion technology is well tolerated by users and reduces medical waste compared to conventional CGM systems.

Aim of this study was to evaluate the accuracy and usability of a novel continuous glucose moni-toring (CGM) system designed for needle-free insertion and reduced environmental impact. We assessed sensor performance of two GlucoMen® Day CGM systems worn simultaneously in eight participants with type 1 diabetes. Self-monitoring of blood glucose (SMBG) was performed reg-ularly over 14 days at home. Participants underwent two standardized 5-hour meal challenges with frequent plasma glucose (PG) measurements using a laboratory reference instrument at the research center. When comparing CGM to PG the overall mean absolute relative difference (MARD) was 9.7 [2.6-14.6]%. The overall MARD of CGM vs SMBG was 13.1 [3.5-18.6]%. In the consensus error grid (CEG) analysis, 98% of both CGM/PG and CGM/SMBG pairs were in the clinically acceptable zones A and B. The analysis confirms that GlucoMen® Day CGM meets the clinical requirements for state-of-the-art CGM. The needle-free insertion technology is well toler-ated by users and reduces medical waste compared to conventional CGM systems.

Glucocorticoids represent frequently recommended and often indispensable immunosuppressant and anti-inflammatory agents prescribed in various medical conditions. Despite their proven efficacy, glucocorticoids bear a wide variety of side effects among which steroid induced hyperglycaemia (SIHG) is among the most important ones. SIHG, potentially causes new-onset hyperglycaemia or exacerbation of glucose control in patients with previously known diabetes. Retrospective data showed that similar to general hyperglycaemia in diabetes, SIHG in the hospital and in outpatient settings detrimentally impacts patient outcomes, including mortality. However, recommendations for treatment targets and guidelines for in-hospital as well as outpatient therapeutic management are lacking, partially due to missing evidence from clinical studies. Still, SIHG caused by various types of glucocorticoids is a common challenge in daily routine and clinical guidance is needed. In this review, we aimed to summarize clinical evidence of SIHG in inpatient care impacting clinical outcome, establishment of diagnosis, diagnostic procedures and therapeutic recommendations.