Jennifer V.E. Brown, Ramzi A. Ajjan, Najma Siddiqi, Peter A. Coventry
People with serious mental illness (SMI) experience a disproportionately high prevalence of type 2 diabetes and a reduced life expectancy of 15 to 20 years. While continuous glucose monitoring (CGM) has revolutionised diabetes self-management in the general population, its feasibility and acceptability among individuals living with co-existing SMI remain largely unexamined. The study was embedded within the DIAMONDS feasibility study. Community-dwelling adults with SMI and type 2 diabetes (N = 21 eligible) were invited to wear a blinded CGM sensor (FreeStyle LibrePro) for 14 days. Quantitative metrics evaluated uptake, wear duration, data completeness, and adverse events. Semi-structured qualitative interviews (n = 9) explored user experiences. The qualitative analysis used a hybrid human-AI framework approach to map findings onto the Theoretical Framework of Acceptability (TFA) and the Theoretical Domains Framework (TDF), followed by data integration using a convergence coding matrix. Sixteen participants agreed to wear the device (76.2% uptake), achieving a mean wear duration of 11 days. Of the returned sensors with data, 92.8% captured ≥5 days of readings, and no adverse events were reported. Qualitative analysis demonstrated highly positive affective attitudes and a significantly lower perceived burden compared with traditional finger-stick testing, despite minor challenges with sensor adhesion. Cross-framework integration revealed that high acceptability was driven by the device’s low-friction physical layout, positive participant beliefs about data consequences, and alignment with a proactive, research-contributing identity. The use of blinded CGM is both feasible and acceptable for people living with SMI and type 2 diabetes. These findings offer a robust foundation for developing structured, low-burden, and theory-informed physical health interventions aimed at closing the mortality gap in this underserved population.
Amerigo Rossi, Mónica O. Rossi, Aurelina C. Jiménez, Ali Boolani
Examine the associations between demographic, behavioral, and psychosocial characteristics and fasting blood glucose among adults with type 2 diabetes (T2D) at a regional diabetes clinic in the Dominican Republic (DR). This cross-sectional study enrolled 65 adults with T2D who received care from a non-profit regional diabetes clinic in the DR. Participants completed interviewer-administered questionnaires to assess sleep quality, perceived stress, diet quality, health-related quality-of-life, and physical activity (PA). Fasting blood glucose was measured using capillary testing by a clinic nurse. A complete-case network analysis was conducted to examine conditional associations among study variables. Only 15 participants (23%) had fasting blood glucose within the 80–130 mg•dL -1 target range for people with T2D, with significantly higher levels among men (243 ± 93 vs. 170 ± 64 mg•dL -1, p<0.001). Participants reported poor sleep quality (98%), moderate-to-high stress (97%), and low consumption of fruits and vegetables. Although 95% of participants met or exceeded recommended PA volume, activity was primarily from occupational and household tasks performed at light-to-moderate intensity. PA was the most connected variable within the network, and was inversely related to fasting blood glucose. In this resource-constrained DR clinic sample, poor fasting blood glucose coexisted with substantial sleep, stress, and diet deficiencies, despite substantial low-to-moderate-intensity PA. The network findings support diabetes self-management interventions to improve physical activity, sleep hygiene, stress reduction, and diet education, to improve glycemic control in low- and middle-income countries. Future prospective network analyses may identify context-specific behavioral targets for improving glycemic control in similar populations.
Emilia Bjergskov Pedersen, Pernille Bech Flarup, Louise Norman Jespersen, Mette Due-Christensen, Julie Christine Antvorskov, Flemming Pociot, Dan Grabowski
Type 1 Diabetes (T1D) is a chronic and demanding condition. In recent years, the development of immunomodulatory therapies has increased interest in early detection programs, which may delay disease onset and enable psychological preparedness. However, such programs also introduce new psychosocial considerations. This study explores how first-degree relatives of individuals with T1D perceive and experience participation in an early detection program. Semi-structured interviews were conducted with 28 adults aged 18–42 years participating in a Danish early detection program for T1D (DiaUnion). Data were analyzed using reflexive thematic analysis to explore patterns related to risk perception and meaning-making. The analysis identified three main themes. First, narrative understanding of diabetes based on parental experience illustrates how perceptions of risk are shaped by family narratives and lived experiences. Second, general understanding of diabetes shows that perceptions are often informed by personal beliefs rather than biomedical knowledge. Third, interpretation of the screening result demonstrates that results are frequently downplayed and assigned limited personal significance. Across themes, participants actively constructed meaning around their risk through coping strategies such as normalization, reframing, and emphasizing controllability, which contributed to a generally low perceived risk. Risk perception among first-degree relatives is shaped by pre-existing personal and familial narratives, which influence how screening results are interpreted. Early detection programs should therefore move beyond standardized communication and adopt more individualized approaches that account for participants’ existing frameworks of understanding and coping.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), is the hepatic presentation of metabolic syndrome. It shares the common pathophysiology of insulin resistance with type 2 diabetic mellitus (T2DM). The aim of this study was to establish the predictive ability of non-invasive liver fat indices—Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), Visceral Adiposity Index (VAI), Triglyceride and Glucose Index (TyG), and NAFLD-Liver Fat Score (NAFLD-LFS)—to determine fatty liver among patients with T2DM. A cross-sectional analytical study was conducted on 260 newly diagnosed patients with type 2 diabetes. Anthropometric measurements were taken, while ultrasound scan was performed to determine fatty liver; its grade and blood samples were used to determine biochemical parameters. Liver fat index scores were calculated using standardized equations and analyzed using the statistical software SPSS version 23.0. The incidence of MASLD among patients with T2DM was 69.2%. Three of the liver fat indices—FLI, HSI, and NAFLD-LFS—showed strong statistically significant correlations (p < 0.001) with liver ultrasonographic findings while the remaining indices—VAI and TyG—showed moderately significant correlations (p < 0.01). The cutoff values, sensitivities, and specificities of each index were determined by receiver operating characteristic (ROC) curve analysis. FLI showed the highest diagnostic performance [area under the curve (AUC) = 0.947; 95% confidence interval (CI): 0.923–0.971] with 75% sensitivity and 100% specificity with a cutoff value of 46.12. Both HSI (AUC = 0.847; 95% CI: 0.812–0.902) and NAFLD-LFS (AUC = 0.847; 95% CI: 0.800–0.894) showed good diagnostic performance with sensitivities of 68.3% and 76.1%, specificities of 95.5% and 85%, and cutoff values of 37.02 and 0.906, respectively. A moderate diagnostic performance was observed in the remaining indices: TyG (AUC = 0.707; 95% CI: 0.642–0.772) and VAI (AUC = 0.670; 95% CI: 0.602–0.739). Based on the multivariable logistic regression analysis, both FLI [adjusted odds ratio (aOR) = 1.144, 95% CI: 1.090–1.201, p ≤ 0.001] and HSI (aOR = 1.366, 95% CI: 1.157–1.614, p ≤ 0.001) were able to independently predict the presence or absence of fatty liver. The current study showed that all five liver fat indices have the ability to predict the presence or absence of fatty liver among patients with T2DM. FLI and HSI showed the highest performance among the five indices, which can be used as screening tools for fatty liver more efficiently. The findings provide reliable alternative methods for detecting fatty liver in a resource-limited clinical setting simplifying patient management.
Continuous glucose monitoring (CGM) has transformed diabetes management by providing real-time glucose measurements and supporting improved glycemic control. Consequently, the methodological quality of CGM accuracy studies has become increasingly important for clinicians, regulatory agencies, and healthcare decision-makers. The recent real-world evaluation of the Sinocare iCan i3 CGM system provides valuable evidence regarding device performance under routine clinical conditions. However, several methodological aspects warrant further consideration before the reported findings can be generalized to clinical practice. This perspective critically examines key aspects of CGM validation, including study design, selection of the reference glucose measurement, statistical methodology, temporal pairing strategies, sensor survival analysis, potential sponsorship-related bias, and interpretation of clinical accuracy metrics. We also discuss additional methodological considerations that were not fully addressed in the original publication, including uncertainty estimation, subgroup analyses, longitudinal sensor performance, missing-data mechanisms, and reproducibility assessment. Finally, we propose recommendations aimed at improving the methodological rigor of future real-world CGM validation studies and facilitating meaningful comparisons across CGM technologies.
