Glucose in Motion: Characterizing Temporal Patterns in Real-World Glycemic Con-trol in A Large Observational Cohort

<jats:p>&lt;p dir="ltr"&gt;OBJECTIVE: To identify and characterize daily and weekly patterns in glycemic management in longitudinal real‑world CGM data from people with diabetes, in order to enhance clinical interpretation and support more effective personalized diabetes management.&lt;/p&gt;&lt;p dir="ltr"&gt;RESEARCH DEISGN AND METHODS: This observational, retrospective study used two independent multi-year real-world CGM cohorts (T1DiabetesGranada and Con-nected Pen), comprising 86,779 participants with diabetes, with mean age (SD) of 40.3 (15.8) and 44.0 (15.9), respectively, and a total of 21,011,021 measurement days. Weekly variations in CGM metrics and bolus insulin dose were examined using linear mixed-effects models, and daily temporal patterns were assessed. &lt;/p&gt;&lt;p dir="ltr"&gt;RESULTS: Weekly and daily glycemic patterns emerged. Mid‑week time in range was consistently higher (e.g., Wednesday: +0.96%-points [95% CI 0.93–0.99], p&lt;0.001), with deterioration during weekends and Mondays (e.g., Sunday: –1.74%-points [95% CI –1.77 to –1.72], p&lt;0.001), mirrored by shifts in other CGM metrics. Bolus insulin dose increased on weekend days (e.g., Sunday: +0.69 U [95% CI 0.64–0.74], p&lt;0.001). Daily analyses revealed distinct diurnal profiles, with the most favorable glycemic control during morning and midday hours on weekdays and con-sistently poorer control during evening and nighttime periods, particularly on week-ends.&lt;/p&gt;&lt;p dir="ltr"&gt;CONCLUSIONS: Daily and weekly glycemic patterns revealed statistically robust, and consistent temporal variations in glycemic control across two large real-world cohorts. Although the magnitude of these differences was small, the findings provide novel population-level evidence and underscore the value of longer-term CGM per-spectives in routine care.&lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;</jats:p>