Evaluation of Glycemia Risk Index and Continuous Glucose Monitoring Outcomes Following the Transition to an Advanced Hybrid Closed-Loop System in Type 1 Diabetes

Gregory GA, Robinson TIG, Linklater SE, Wang F, Colagiuri S, de Beaufort C, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol. 2022;10:741–60.

PubMed  Google Scholar 

Robert AA, Al-Dawish A, Mujammami M, Al Dawish MA. Type 1 diabetes mellitus in Saudi Arabia: a soaring epidemic. Int J Pediatr. 2018;2018:9408370.

PubMed  PubMed Central  Google Scholar 

Kahanovitz L, Sluss PM, Russell SJ. Type 1 diabetes – a clinical perspective. Point Care. 2017;16:37.

PubMed  PubMed Central  Google Scholar 

Speight J, Pouwer F. Type 1 diabetes. In: Cambridge handbook of psychology health and medicine. 3rd ed. Cambridge University Press; 2024. p. 477–80.

Google Scholar 

Longendyke R, Grundman JB, Majidi S. Acute and chronic adverse outcomes of type 1 diabetes. Endocrinol Metab Clin North Am. 2024;53:123–33.

PubMed  Google Scholar 

Committee ADAPP, ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, et al. 6. Glycemic goals and hypoglycemia: standards of care in diabetes—2024. Diabetes Care. 2024;47:S111-25. https://doi.org/10.2337/dc24-S006.

Google Scholar 

Mazzotta FA, Lucaccini Paoli L, Rizzi A, Tartaglione L, Leo ML, Popolla V, et al. Unmet needs in the treatment of type 1 diabetes: why is it so difficult to achieve an improvement in metabolic control? Nutr Diabetes. 2024;14:1–7.

Google Scholar 

Azar S, Maroun Abou Jaoude N, Kędzia A, Niechciał E. Barriers to type 1 diabetes adherence in adolescents. J Clin Med. 2024;13:5669.

CAS  PubMed  PubMed Central  Google Scholar 

Subramanian S, Baidal D, Skyler JS, Hirsch IB. The Management of Type 1 Diabetes. (2021) Available from: https://www.ncbi.nlm.nih.gov/books/NBK279114/

Sherr JL, Laffel LM, Liu J, Wolf W, Bispham J, Chapman KS, et al. Severe hypoglycemia and impaired awareness of hypoglycemia persist in people with type 1 diabetes despite use of diabetes technology: results from a cross-sectional survey. Diabetes Care. 2024;47:941–7.

CAS  PubMed  PubMed Central  Google Scholar 

Coleman SE, Caswell N. Diabetes and eating disorders: an exploration of ‘Diabulimia.’ BMC Psychol. 2020;8:101.

PubMed  PubMed Central  Google Scholar 

Rigo RS, Levin LE, Belsito DV, Garzon MC, Gandica R, Williams KM. Cutaneous reactions to continuous glucose monitoring and continuous subcutaneous insulin infusion devices in type 1 diabetes mellitus. J Diabetes Sci Technol. 2020;15:786.

PubMed  PubMed Central  Google Scholar 

Nakhleh A, Shehadeh N. Hypoglycemia in diabetes: an update on pathophysiology, treatment, and prevention. World J Diabetes. 2021;12:2036.

PubMed  PubMed Central  Google Scholar 

Ward CW, Lawrence MC. Insulin- pharmacology, therapeutic regimens and principles of intensive insulin therapy. Front Endocrinol (Lausanne) (2000) pp. 2. Available from: https://pubmed.ncbi.nlm.nih.gov/25905175/

Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, et al. The management of type 1 diabetes in adults. a consensus report by the American diabetes association (ada) and the European association for the study of diabetes (EASD). Diabetologia. 2021;64:2609.

PubMed  PubMed Central  Google Scholar 

Laffel LM, Sherr JL, Liu J, Wolf WA, Bispham J, Chapman KS, et al. Limitations in achieving glycemic targets from CGM data and persistence of severe hypoglycemia in adults with type 1 diabetes regardless of insulin delivery method. Diabetes Care. 2025;48:273–8. https://doi.org/10.2337/dc24-1474.

CAS  PubMed  Google Scholar 

Chico A, Moreno-Fernández J, Fernández-García D, Solá E. The hybrid closed-loop system tandem t:slim X2TM with control-IQ technology: expert recommendations for better management and optimization. Diabetes Ther. 2024;15:281–95. https://doi.org/10.1007/s13300-023-01486-2.

PubMed  Google Scholar 

Brown SA, Kovatchev BP, Raghinaru D, Lum JW, Buckingham BA, Kudva YC, et al. Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. New England J Med. 2019;381:1707–17.

CAS  Google Scholar 

Beck RW, Kanapka LG, Breton MD, Brown SA, Wadwa RP, Buckingham BA, et al. A meta-analysis of randomized trial outcomes for the t:slim X2 insulin pump with control-IQ technology in youth and adults from age 2 to 72. Diabetes Technol Ther. 2023;25:329–42.

PubMed  PubMed Central  Google Scholar 

Di Molfetta S, Di Gioia L, Caruso I, Cignarelli A, Green SC, Natale P, et al. Efficacy and safety of different hybrid closed loop systems for automated insulin delivery in people with type 1 diabetes: a systematic review and network meta-analysis. Diabetes Metab Res Rev. 2024;40:e3842.

PubMed  Google Scholar 

Piona C, Marigliano M, Roncarà C, Mozzillo E, Di Candia F, Zanfardino A, et al. Glycemia risk index as a novel metric to evaluate the safety of glycemic control in children and adolescents with type 1 diabetes: an observational, multicenter real-life cohort study. Diabetes Technol Ther. 2023;25:507–12.

CAS  PubMed  Google Scholar 

Díaz-Soto G, Bahíllo-Curieses MP, Jimenez R, Nieto MDLO, Gomez E, Torres B, et al. The relationship between glycosylated hemoglobin, time-in-range and glycemic variability in type 1 diabetes patients under flash glucose monitoring. Endocrinol Diabetes y Nutr (English ed). 2021;68(465):71.

Google Scholar 

Al Hayek A, Al Mashali M, Al Dawish MA. Evaluation of glycemia risk index and continuous glucose monitoring-derived metrics in type 1 diabetes: a real-world observational study. J Diabetes Metab Disord. 2025;24:59.

CAS  PubMed  Google Scholar 

Al Hayek A, Al Dawish MA. Improvement of glycemia risk index and continuous glucose monitoring metrics during ramadan fasting in type 1 diabetes: a real-world observational study. J Diabetes Sci Technol. 2024. https://doi.org/10.1177/19322968241301750.

PubMed  PubMed Central  Google Scholar 

Panfil K, Vandervelden CA, Lockee B, Tallon EM, Williams DD, Lee JM. The glycemia risk index predicts performance of diabetes self-management habits in youth with type 1 diabetes mellitus. J Diabetes Sci Technol. 2024;18:779–86.

CAS  PubMed  PubMed Central  Google Scholar 

Klonoff DC, Wang J, Rodbard D, Kohn MA, Li C, Liepmann D, et al. A glycemia risk index (GRI) of hypoglycemia and hyperglycemia for continuous glucose monitoring validated by clinician ratings. J Diabetes Sci Technol. 2023;17:1226–42.

PubMed  Google Scholar 

Dunn TC, Ajjan RA, Bergenstal RM, Xu Y. Is it time to move beyond TIR to TITR? real-world data from over 20,000 users of continuous glucose monitoring in patients with type 1 and type 2 diabetes. Diabetes Technol Ther. 2024;26:203.

CAS  PubMed  PubMed Central  Google Scholar 

Passanisi S, Piona C, Salzano G, Marigliano M, Bombaci B, Morandi A, et al. Aiming for the best glycemic control beyond time in range: time in tight range as a new continuous glucose monitoring metric in children and adolescents with type 1 diabetes using different treatment modalities. Diabetes Technol Ther. 2024;26:161–6.

CAS  PubMed  Google Scholar 

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.

Google Scholar 

JAVA. Declaration of Helsinki world medical association declaration of Helsinki. Bull World Health Organ. 2013;79:373–4.

Google Scholar 

Böhm AK, Jensen ML, Sørensen MR, Stargardt T. Real-world evidence of user engagement with mobile health for diabetes management: longitudinal observational study. JMIR Mhealth Uhealth. 2020;8:e22212.

PubMed  PubMed Central  Google Scholar 

Pérez-López P, Férnandez-Velasco P, Bahillo-Curieses P, de Luis D, Díaz-Soto G. Impact of glucose variability on the assessment of the glycemia risk index (GRI) and classic glycemic metrics. Endocrine. 2023;82:560–8.

PubMed  PubMed Central  Google Scholar 

Barski L, Eshkoli T, Brandstaetter E, Jotkowitz A. Euglycemic diabetic ketoacidosis. Eur J Intern Med. 2019;63:9–14.

PubMed  Google Scholar 

Castorani V, Rigamonti A, Frontino G, Morotti E, Sandullo F, Scialabba F, et al. Turning the tides: achieving rapid and safe glucose control in adolescents with suboptimally controlled type 1 diabetes using advanced hybrid closed loop systems. Front Endocrinol (Lausanne). 2024;15:1243565.

PubMed  Google Scholar 

De Meulemeester J, Keymeulen B, De Block C, Van Huffel L, Taes Y, Ballaux D, et al. One-year real-world benefits of tandem control-IQ technology on glucose management and person-reported outcomes in adults with type 1 diabetes: a prospective observational cohort study. Diabetologia. 2025;68:948–60. https://doi.org/10.1007/s00125-025-06366-x.

PubMed  Google Scholar 

Graham R, Mueller L, Manning M, Habif S, Messer LH, Pinsker JE, et al. Real-world use of control-IQ technology is associated with a lower rate of severe hypoglycemia and diabetic ketoacidosis than historical data: results of the control-IQ observational (CLIO) prospective study. Diabetes Technol Ther. 2024;26:24–32.

CAS  PubMed  PubMed Central  Google Scholar 

Brown SA, Laffel LM, Akturk HK, Forlenza GP, Shah VN, Wadwa RP, et al. Randomized, crossover trial of control-IQ technology with a lower treatment range and a modified meal bolus module in adults, adolescents, children, and preschoolers with varying levels of baseline glycemic control. Diabetes Technol Ther. 2024;27:187–93.

PubMed  Google Scholar 

Piona C, Marigliano M, Mozzillo E, Di Candia F, Zanfardino A, Iafusco D, et al. High glycemic variability is associated with worse continuous glucose monitoring metrics in children and adolescents with type 1 diabetes. Horm Res Paediatr. 2021;94:369–73. https://doi.org/10.1159/000521430.

CAS  PubMed  Google Scholar 

Gómez AM, Henao DC, Imitola Madero A, Taboada LB, Cruz V, Robledo Gómez MA, et al. Defining high glycemic variability in type 1 diabetes: comparison of multiple indexes to identify patients at risk of hypoglycemia. Diabetes Technol Ther. 2019;21:430–9.

PubMed  Google Scholar 

Urakami T, Terada H, Tanabe S, Mine Y, Aoki M,

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