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 HbA_1c 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 HbA_1c 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. Graphical Abstract

Continuous glucose monitoring (CGM) has emerged as a complementary and more dynamic method for evaluating glycemic control in people with diabetes. Relevant studies examining the association between CGM parameters, including time in range (TIR), glycemic variability (GV), and time in tight range (TITR), and diabetic nephropathy, retinopathy, and neuropathy, were reviewed. Evidence consistently demonstrates that lower TIR and TITR, as well as higher GV, are associated with increased risk and severity of microvascular complications in both type 1 and type 2 diabetes. Studies employing corneal confocal microscopy and sudomotor function testing further support these associations for small‐fibre neuropathy. Although CGM‐guided therapy improves TIR and GV, data directly linking optimisation of these metrics to reduced complication rates remain limited. Most available studies are cross‐sectional or retrospective, with short CGM durations and heterogeneous methodologies. CGM‐derived indices provide valuable insights into glycemic quality beyond HbA1c and may serve as complementary tools for early risk stratification and individualised management of diabetic microvascular disease. However, prospective and interventional trials are required to confirm whether improving CGM metrics can translate into clinically meaningful reductions in microvascular morbidity. Broader access to CGM and standardisation of its key metrics will be essential to fully realise its potential in modern diabetes care.

Introduction: Continuous glucose monitoring (CGM) provides real-time glucose data that has revolutionized outpatient diabetes care; however, its impact on inpatient care remains limited, likely due to the lack of standardized CGM-based insulin titration protocols, implementation strategies, and proper familiarity with the technology, among others. Methods: A systematic literature search was conducted on October 15, 2024, using PubMed and Embase, without a restriction on publication date. The search focused on CGM-based insulin titration protocols and related implementation strategies in non-intensive care unit (non-ICU) settings. This systematic review was registered with PROSPERO (RD42024596819). Results: A total of 7625 references were screened. Nine protocols for inpatient CGM-based insulin titration and related implementation strategies were identified. Six protocols recommended a weight-based basal-bolus insulin regimen. Insulin titration on basal and bolus insulin was mostly done daily based on either clinical discretion or clearly defined insulin titration protocols. All protocols employed a hybrid approach, utilizing both CGM and finger prick glucose testing to guide glucose management. Diabetes-trained staff oversaw CGM-based insulin titration and glucose management in 5 protocols. CGM alarm settings varied widely, with hyperglycemic alarm thresholds between >13.9 and >22.2 mmol/L and hypoglycemia alarm thresholds between <3.9 and <5.0 mmol/L. Conclusion: We observed considerable variation in the detail and clarity provided by the reviewed protocols. This highlights the need for standardized operational protocols for CGM-based insulin titration and related implementation strategies to implement CGM effectively in non-ICU settings.

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 prevalence of metabolic diseases including type 2 diabetes (T2D), obesity and non-alcoholic fatty liver disease (NAFLD) increases globally. This highlights an unmet need for identifying optimal therapies for the management of these conditions. Tirzepatide is a novel dual incretin receptor agonist (twincretin) that activates both glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors. The aim of this narrative review was to examine the impact of novel twincretins, focusing on tirzepatide, on the management of a wide spectrum of metabolic diseases. Data from preclinical and clinical trials have shown that twincretins significantly reduce blood glucose levels in T2D, and tirzepatide is the first agent of this class that has been approved for the management of T2D. Additionally, the beneficial impact of tirzepatide on weight reduction has been corroborated in several studies, showing that this agent can achieve substantial and sustained weight loss in obese patients with or without T2D. Data also suggest that tirzepatide could be a promising drug for hepatic steatosis reduction in individuals with NAFLD. The remarkable effects of tirzepatide on glycaemic control, weight loss and liver-related outcomes have posed new research questions that are likely to lead to further advancements in the treatment of T2D, obesity and related metabolic disorders.

Objective: To evaluate longitudinal real-world outcomes in adults with type 1 diabetes initiating hybrid closed loop (HCL). Methods: Adults with type 1 diabetes, managed with an insulin pump and intermittently scanned continuous glucose monitoring with hemoglobin A1c (HbA1c) ≥8.5% (69 mmol/mol), were started on HCL between August and December 2021 as part of the National Health Service England HCL pilot. We collected outcomes, including change in HbA1c, sensor glucometrics, Gold score (hypoglycemia awareness), diabetes distress score, acute event rates, and user opinion of HCL. Results: In total, 420 HCL users across 30 diabetes centers in the United Kingdom were included (median age 40 [interquartile range or IQR 29–50] years, 68% female, 85% White British). Over a median follow-up of 12 months (IQR 8–28) (range 6–38 months), mean adjusted HbA1c reduced by 1.4% (95% confidence interval [CI] −1.5, −1.3; P < 0.001) (16 mmol/mol [95% CI −17, −14]; P < 0.001). Time in range (70–180mg/dL) increased from 33.7% to 60.4% ( P < 0.001). The proportion of individuals achieving HbA1c ≤7.5% (58 mmol/mol) increased from 0% to 33.1% ( P < 0.001). Diabetes distress score reduced (−1.1; 95% CI −1.3, −1.0; P < 0.001) and Gold score reduced (−0.4; 95% CI −0.5, −0.2; P < 0.001). The percentage of individuals with impaired hypoglycemia awareness (Gold score ≥4) decreased (16.6% [baseline] vs. 9.2% [follow-up]; P < 0.001). Almost all participants stated that HCL had a positive impact on quality of life (94.5%; 361/382). The number of hospital admissions was low. Conclusions: Long-term real-world use of HCL is associated with sustained improvements in glycemic and person-reported outcomes in adults with type 1 diabetes and above-target HbA1c levels.