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Open research questions in Diabetes Management and Research

55 unresolved questions extracted from the limitations and future-work sections of 913 Diabetes Management and Research papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • However, with universal access now available, there is limited research on how diabetes teams across Aotearoa NZ are now providing nutrition and carbohydrate counting education to meet the needs of youth using diabetes technology.

    Alongside technology: a qualitative study exploring the role of nutrition education in the care of youth with type 1 diabetes in Aotearoa New Zealand · 2026 · DOI

  • Key next steps center on three priorities. First, developing and openly releasing implementable subtype classifiers that can be computed directly from routinely captured EHR elements (e.g., age at diagnosis, BMI, HbA1c, fasting glucose, and where available C-peptide/insulin), with transparent feature definitions, transportable code, and prospective external validation across health systems. These tools should be coupled to routine recalibration and model-drift surveillance as laboratory platforms, prescribing patterns, and case-mix evolve. Second embedding cluster-stratified randomization in first-line and second-line therapy trials to test early insulin vs incretin-anchored care in SIDD. Third, advancing integrated multi-omic and longitudinal cohort efforts to define biologically grounded phenotypes that extend beyond static clustering, with endpoints that include mortality, complications, patient-reported outcomes, and cost-effectiveness particularly in populations such as South Asians where insulin-deficient phenotypes are common[8,9,12].

    Severe insulin-deficient diabetes: Updated review of epidemiology, biology, and clinical implications · 2026 · DOI

  • Third, paired-point counts per patient were uneven the hypoglycaemic range was sparsely sampled (9 pairs <54 mg/dL), limiting confidence in low-glucose accuracy initial two-center estimates.

    Initial Experience with a Novel 21-Day Continuous Glucose Monitoring System in Pediatric Type 1 Diabetic Patients: A Two-Center Initial Accuracy Evaluation · 2026 · DOI

  • trials, differences lower adherence and Major limitations identified in studies of CGM in type 1 diabetes include substantial heterogeneity among in study design and population characteristics, and potential bias from industry sponsorship. The exclusion of participants with the predominant use of HbA1c as a primary endpoint may reduce generalizability and fail to capture the full range of glycemic variability. Furthermore, the growing integration of CGM into automated insulin delivery systems reduces the re-levance of findings derived from studies assessing stand-alone monitoring [13].

    Continuous glucose monitoring in diabetes management – evidence, applications, and future perspectives: A comprehensive review of recent developments · 2026 · DOI

  • Background Continuous glucose monitoring systems (CGMS) are widely used in diabetes care, but their reliability for standardized food glycemic index (GI) measurement remains unclear.

    Evaluating the agreement of continuous glucose monitoring system with venous methods for glycemic index determination · 2026 · DOI

  • Although access to AID systems in Poland is gradu- ally improving, revisions to reimbursement criteria are crucial, as they currently remain largely restricted to patients under 26 years of age, limiting long-term use and leading many adults to revert to less effective thera- pies, such as MDI. Broader registration of newly emerg- ing devices is necessary; however, an independent, evidence-based evaluation by the PTD will be needed to guide clinical practice and prevent the increasing use of unregulated systems of questionable quality. Future guidelines should position AID as a standardized first-line option in T1D. Nevertheless, the usage of AID should be extended to other types of diabetes that require intensive insulin therapy, particularly type 2 diabetes. Given the increasing life expectancy and lon- ger diabetes duration, this population will constitute a growing group of insulin-dependent patients in the upcoming years. Further studies are required to define patient subgroups and clinical scenarios that benefit most from AID, as well as to develop precise treatment algorithms incorporating MDI, SAP, and AID, including recommendations for special populations (children, pregnant women, elderly). Standardized national quali- fication criteria for AID would provide equal access. Additionally, as patient data are increasingly stored in cloud-based systems, improved data storage and cybersecurity are warranted. Moreover, national AID- -treated patient registries are essential for personalized, safe, and evidence-based therapy.

    An Overview of Automated Insulin Delivery (AID) Systems in Poland in 2025 — Principles, Available Technologies and Future Perspectives · 2026 · DOI

  • Although the present study is novel in that it focuses on a specific age group of young adults, it has several limitations. Firstly, the vast majority of the studies included in the review were based on survey methods and instruments that rely on the subjective feelings of respondents, which carry a high risk of inaccuracy. Another limitation is the uneven quality of the selected publications. Some studies may not have accounted for potential confounders, while other studies may have accounted for potential intervening variables, which may lead to bias.

    Quality of life of patients with type 1 diabetes – a systematic review · 2026 · DOI

  • Several limitations should be acknowledged when interpreting the findings of this review. A substantial proportion of the included evidence is derived from post hoc analyses of randomized trials, which, although methodologically robust in outcome ascertainment and follow-up, remain observational with respect to hypoglycemia as the exposure of interest. Residual confounding, therefore, remains a concern across all study designs, since hypoglycemia is more likely to occur in patients with advanced disease, insulin use, renal impairment, heart failure, or other features that independently increase cardiovascular risk. In addition, the potential for reverse causation cannot be excluded, whereby underlying clinical instability may predispose to both hypoglycemia and adverse cardiovascular outcomes. There was also variability across studies in the definitions of hypoglycemia, particularly for non-severe events, as well as heterogeneity in patient populations, baseline cardiovascular risk, and treatment context. Finally, although several plausible biological pathways support the observed associations, direct mechanistic confirmation in clinical settings remains limited, which constrains stronger inferences regarding causality.

    Hypoglycemia and Long-Term Cardiovascular Outcomes in Diabetes Mellitus: A Systematic Review of Prognostic Evidence · 2026 · DOI

  • Future research should move beyond secondary and post hoc analyses and prioritize prospective studies in which hypoglycemia is explicitly treated as the primary exposure of interest rather than a treatment-related byproduct. Such studies would benefit from more precise characterization of event timing, severity, recurrence, and clinical context [18]. The integration of continuous glucose monitoring data is likely to be especially valuable, as it would permit more accurate quantification of hypoglycemic burden, nocturnal episodes, and glycemic variability, all of which may influence cardiovascular risk but are incompletely captured by conventional reporting methods. Further work is also needed to clarify threshold effects, including whether risk is driven predominantly by severity, frequency, or a combination of both, and to identify particularly vulnerable phenotypes such as patients with heart failure, chronic kidney disease, autonomic neuropathy, or established atherosclerotic cardiovascular disease [20]. Importantly, future studies should aim to distinguish more clearly between hypoglycemia as a causal trigger and as a prognostic marker through robust adjustment strategies, advanced causal inference methods such as marginal structural models or mediation analyses, and, where feasible, interventional designs. A more refined understanding of these subgroups may help determine whether hypoglycemia functions primarily as a modifiable trigger, a prognostic marker, or both.

    Hypoglycemia and Long-Term Cardiovascular Outcomes in Diabetes Mellitus: A Systematic Review of Prognostic Evidence · 2026 · DOI

  • Further research is needed to be aimed at improving the quality of medical care for patients with DM in the context of the humanitarian crisis caused by the armed conflict, there is a need to develop simplified, cost-effective models of monitoring the condition of patients, the quality of medical care and the availability of medicines to patients in this category.

    Management of type 1 type 2 diabetes mellitus in conditions of armed conflict · 2022 · DOI

  • In spite of the above the structure of the services provided varies widely from province to province, both in terms of the number of hospitalisations per 100,000 children, net migration rate, length of stay, and percentage of hospitalisations for acute complications.

    Pediatric diabetes care: inpatient care in the Maps of Health Needs of Poland in 2014 · 2019 · DOI

  • While evidence shows that female youth with type 1 diabetes are more prone to DEB compared to their peers without diabetes, little is known about male adolescents.

    Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth—Australia · 2017 · DOI

  • Research has not investigated the range of psychological reactions to insulin reactions, other than examining the specific fear of hypoglycemia (Cox, Irvine, Gonder-Frederick, Nowacek, & Butterfield, 1987; Green, Wysocki, & Reineck, 1990; Irvine, Cox, & Gonder-Frederick, 1994).

    Responses to Insulin Reactions and Long-Term Adaptation to Diabetes. (Insulin Reactions & Adaptation to Diabetes) · 2002

  • diabetic patients of the 28 7 In four of the remaining five cases we have not felt justified in drawing definite conclusions on the relative merits of the old and new types of insulin, since the possibility of control with a mixture of lente and ultra- lente has not yet been investigated.

    The New Insulins—Lente, Ultralente, and Semilente · 1953 · DOI

  • Of note, participants reported mixed results when using this approach (compared to individualised nutrition education), with low attendance to group sessions being a frequent challenge.

    Alongside technology: a qualitative study exploring the role of nutrition education in the care of youth with type 1 diabetes in Aotearoa New Zealand · 2026 · DOI

  • In low- and middle-income countries, especially those affected by humanitarian crises, analogue insulins may be helpful as proper diabetes care for this population remains challenging; yet, supporting evidence is lacking.

    Real-world comparative effectiveness of analogue and human insulin on glycemic control in children and adolescents with Type 1 diabetes in Lebanon using continuous glucose monitoring data · 2026 · DOI

  • Conclusions: A major limitation of the available evidence is the predominance of small, heterogeneous observational studies, which limits the strength and generalizability of therapeutic recommendations.

    Treatment Options for Patients with Maturity-Onset Diabetes of the Young (MODY): A Systematic Review of Literature: 2026 Update · 2026 · DOI

  • These findings emphasize that pharmacologic intensification alone is insufficient in geriatric diabetes care, and that systematic incorporation of geriatric assessment into routine management is essential for aligning therapy with patient capacity and vulnerability.

    Achievement of Glycated Hemoglobin Targets and Associated Factors in Older Adults with Type 2 Diabetes in Vietnam: a Cross-Sectional Study · 2026 · DOI

  • This counterin- tuitive pattern highlights a real-world paradox in the Vietnamese setting, where the addition of pharmaco- logic agents alone is insufficient to overcome the mul- tifaceted barriers to glycemic control in patients with more advanced or complex diseases.

    Achievement of Glycated Hemoglobin Targets and Associated Factors in Older Adults with Type 2 Diabetes in Vietnam: a Cross-Sectional Study · 2026 · DOI

  • However, the practical implementation of lifestyle modification or the use of metformin for treating prediabetes is inadequate and complicated by a lack of agreement on how to define the condition.

    Prediabetes and What It Means: The Epidemiological Evidence · 2020 · DOI

  • The urinary excretion rate of albumin varied widely and unpredictably throughout, while beta 2 microglobulin excretion remained normal and unchanged in both groups.

    Intermittent clinical proteinuria and renal function in diabetes: evolution and the effect of glycaemic control. · 1986 · DOI

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55 open questions have been extracted from the limitations and future-work passages of 913 Diabetes Management and Research papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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