PhD Scientific Days 2026

Theoretical and Translational Medicine 2.

Temporal patterns of self-monitored blood glucose in patients on intensive insulin therapy: Diurnal, weekly and seasonal variation

Name of the presenter

Menyhárt, Adrienn

Institute/workplace of the presenter

SE Belgyógyászati és Onkológiai Klinika

Authors

Adrienn Menyhárt¹, Tamás Ferenci^2,3, Attila Berey⁴, Péter Markovich⁴, Viktor Horváth¹, Dóra Marietta Balogh¹, Karola Osgyán¹, Levente Kovács², Péter Kempler*¹
1: Department of Internal Medicine and Oncology, Semmelweis University, Budapest
2: Physiological Controls Research Center, Óbuda University, Budapest
3: Department of Statistics, Corvinus University of Budapest
4: Di-Care Zrt., Budapest

Text of the abstract

Introduction
Glycemic control in patients treated with intensive insulin therapy is influenced not only by treatment-related factors but also by physiological rhythms and behavioral patterns. While circadian variation in glucose metabolism is well described, large-scale real-world evidence on combined diurnal, weekly, seasonal and holiday-related glucose dynamics remains limited. Understanding these temporal patterns may improve interpretation of glycemic instability and support time-aware diabetes management strategies.

Aims
To characterize temporal patterns in self-monitored blood glucose (SMBG) among patients on intensive insulin therapy and to evaluate how these patterns are modified by age and major holiday periods.

Methods
This retrospective observational study analyzed 46.7 million SMBG measurements from 31,023 individuals in the nationwide MÉRY Diabetes Database (2010–2024). Temporal predictors included secular trend, hour of day, day of week, day of year, major holiday periods (Christmas, Easter) and the COVID period. Generalized additive models (GAMs) were applied to estimate nonlinear temporal effects and their interaction with age.

Results
Glucose levels demonstrated pronounced diurnal, weekly and seasonal variation. Morning nadirs and evening peaks were observed, with higher values during weekends compared with weekdays. Autumn–winter months were associated with elevated glucose levels relative to spring–summer. Christmas and Easter showed additional short-term increases. Younger individuals exhibited higher mean glucose levels and greater amplitude of diurnal and seasonal fluctuations.

Conclusion
In patients treated with intensive insulin therapy, blood glucose levels follow predictable multi-scale temporal rhythms shaped by physiological, behavioral and environmental influences. Identification of systematic temporal glucose variation in a large real-world cohort highlights the importance of age-sensitive and time-aware approaches to diabetes management and provides clinically relevant context for interpreting glycemic instability and its potential long-term consequences.

Funding: This research received no external funding.