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Anthony Martin Toroitich,1,2 Louise Dunford,3 Rachel Armitage,4 Sangeeta Tanna2 1Trade Affairs Department, Pharmacy and Poisons Board, Nairobi, Kenya; 2Leicester School of Pharmacy, De Montfort University, Leicester, UK; 3Leicester School of Allied Health Sciences, De Montfort University, Leicester, UK; 4Faculty of Health and Life Sciences, De Montfort University, Leicester, UKCorrespondence: Anthony Martin Toroitich, Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester, LE1 9BH, UK, Tel +254724065344, Email P2539250@my365.dmu.ac.ukAbstract: Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.Keywords: substandard and falsified medicines, pharmacy practice, regulation, pharmaceutical supply chain more...

Sharukh Zuberi, Shaneil Tanna Faculty of Medicine, Imperial College London, London, UKWe read with great interest the study by Olasoji1 exploring the mistreatment of medical students by the bedside. As senior medical students at Imperial College London (ICL), we have had many teaching sessions and therefore have first-hand experience on this matter of “toxic teaching”.1 View the original paper by Olasoji. more...

Ravina Tanna,1,* Nikhil Patel,1,* Sameera Tanna21Imperial College School of Medicine, Imperial College London, South Kensington, 2King's College London Medical School, King's College London, London Bridge, London, UK *These authors contributed equally to this workWe read with great interest Sheikh et al’s study1 on factors contributing to lack of interest in research among medical students in Pakistan. As students in London, UK, we agree that there are a number of barriers preventing medical students engaging in research activities, such as underestimating the importance of research and difficulties making contacts with academics in order to undertake a project.View original article by Sheikh et al more...

This paper evaluates the exchange rate mechanisms embodied in current large-scale models of the UK economy, and develops a new specification that is econometrically preferable. The models considered are those of the London Business School (LBS), National Institute of Economic and Social Research (NIESR), Liverpool University Research Group in Macroeconomics (LPL), Bank of England (BE) and Her Majesty's Treasury (HMT), as deposited with the ESRC Macroeconomic Modelling Bureau in late 1988/early 1989; the HMT model was also publicly released at that time (November 1988).[1] The models differ in their treatment of the exchange rate, and their overall properties also differ, as described by Fisher et al. (1989). Given the exchange rate's central role as a transmission mechanism these findings are not unconnected, and much of the absolute difference in the response of key endogenous variables in full model simulations can be explained by differences in real exchange rates. For example, whereas the estimated response of GDP to a _GCP_2bn (1989 prices) increase in government expenditure varies across the models by a factor of five in standard simulations, from 0.17 to 0.85% after five * The authors are grateful to the Editor and two anonymous referees for helpful comments, to Stephen Hall (Bank of England) for assistance in the preparation of an earlier version of the paper, and to the Economic and Social Research Council for its support. At the suggestion of the Editor, the detailed statistical results on which Sections II and III are based have been placed in a Technical Appendix, available from the authors on request. 1 One year later, the main features of these models discussed in this paper had not changed. years, the response is approximately 0.5% in each of the four quarterly models when the real exchange rate is not allowed to deviate from its base-run values. Analysis of the exchange rate equations of the major UK macroeconometric models shows that, wher... [ABSTRACT FROM AUTHOR] more...

Frieze patterns (in the sense of Conway and Coxeter) are related to cluster algebras of type A and to signed continuant polynomials. In view of studying certain classes of cluster algebras with coefficients, we extend the concept of signed continuant polynomial to define a new family of friezes, called c-friezes, which generalises frieze patterns. Having in mind the cluster algebras of finite type, we identify a necessary and sufficient condition for obtaining periodic c-friezes. Taking into account the Laurent phenomenon and the positivity conjecture, we present ways of generating c-friezes of integers and of positive integers. We also show some specific properties of c-friezes. more...

Sequential changes in soil properties along forest, grassland, degraded laud and desert ecosystems, with different vulnerabilities to degradation, were assessed to understand the process for the developmentof desert-like landscapes in semi-arid zone of Saurashtra region of Gujarat state of India. The concentration of fine soil particles (clay and silt) decreased whereas, it increased for sand particles with the deterioration of ecosystem. Bulk density was maximum at degraded land ecosystem and consequently pore space was minimum. Water holding and field capacity of soil, decreased with the degradation of ecosystem and exhibited a positive correlation with the clay content of soil. Eventually, desertification causes progressive drier condition of soil. The amount of soil macroaggregates was positively related with clay content of soil. The concentration of organic carbon, total nitrogen and available phosphorus significantly decreased whereas, concentration of calcium, magnesium, potassium and sodium significantly increased with the deterioration of ecosystem. The reduction of concentration of organic carbon, total nitrogen and available phosphorus and increase of concentration of sodium, potassium and calcium were related with the reduction of the amount of soil macroaggregatea. The concentration of zinc and manganese increased whereas, it decreased for iron with the degradation of ecosystem. Electrical conductivity and pH of soil increased suggesting that soil salinity develops with desertification. [ABSTRACT FROM AUTHOR] more...

Aims: This expert consensus reviews the reality of primary care clinical management of people with type 2 diabetes (T2D) on non-intensive insulin therapy, with an emphasis on the use of continuous glucose monitoring (CGM) technology for effective care in this participant group. Here, we identify key unmet needs for skills and systems development within this frontline healthcare setting, along with major challenges and opportunities associated with managing these changes effectively., Methods: The authors participated in two primary care consensus panels held on 28 November 2023 and on 21 May 2024. The focus for these expert panels was to understand the unmet needs within primary care to manage adults with T2D treated with non-intensive insulin therapy and incorporating the use of CGM systems. A Delphi Survey was undertaken among a wider group of Primary Care Diabetes Technology Network members in the United Kingdom, to understand prevalent attitudes to management of adults with T2D on insulin and using CGM in primary care. Based on these activities, a series of consensus statements were tested in a second Delphi Survey., Results: The activities described, involving primary care healthcare professionals (HCPs) with expertise in diabetes management, identified a series of training and educational needs within UK general practice that are central to skills development for the care of adults with T2D on insulin therapy and the application of CGM technology. Potential barriers to effective primary care management of people with T2D using CGM devices were identified. Areas of concern included confidence in national and local guidelines for the management of T2D using CGM systems, lack of experience on the part both of HCPs and people with T2D, clinical workflows and systems, as well as inbuilt resistance to change among primary care teams. However, the expert group were clear that the goal of providing care for people with T2D on non-intensive insulin therapy using CGM technology as standard of care could be met (94.3%, n = 33). This will deliver clinical benefits for people with T2D, and improvements to clinical workflows in primary care. Cost-savings to the health service were also identified as an outcome., Conclusions: The need to adapt to the management of people with T2D on insulin therapy puts significant pressure on current workflows and skills for primary care teams. Steps in overcoming these immediate pressures, to ensure effective clinical management of people with T2D, are discussed, along with a series of consensus statements that identify the key areas of change to manage. Ultimately, the great majority of expert primary care HCPs were confident or very confident that using CGM technology will become the standard of care for people with T2D treated with insulin in primary care., (© 2024 The Author(s). Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.) more...

Background: Hospital outbreaks caused by Mycobacteroides abscessus complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population., Aim: To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated M. abscessus complex cases in an inpatient cardiothoracic transplant population., Methods: We extracted clinical characteristics from patients with M. abscessus pre-outbreak (March 2018 to December 2020) and during the outbreak (January 2021 to June 2022) from the electronic medical record. A multi-disciplinary team conducted the outbreak investigation and devised a mitigation strategy to implement at our institution., Findings: The baseline incidence of healthcare-associated M. abscessus was 0.11 cases per 10,000 patient-days; this increased to 0.24 cases per 10,000 patient-days during the outbreak. There were 1/9 (11%) cardiothoracic transplant patients in the pre-outbreak group compared with 7/12 (58%) during the outbreak, and respiratory specimen types compromised 6/9 (67%) of M. abscessus results in the pre-outbreak group compared with 10/12 (83%) during the outbreak. Among the clinical care activities involving water, a variety of water sources were utilized, including filtered and tap water. The incidence of healthcare-associated M. abscessus subsequently decreased to 0.06 cases per 10,000 patient-days after implementing an outbreak-mitigation strategy of sterile water precautions., Conclusions: Robust educational efforts from a multi-disciplinary team on eliminating exposure to tap water were effective measures to reduce healthcare-associated M. abscessus incidence at our institution. Non-tuberculous mycobacteria infection surveillance, targeted education, and water mitigation strategies may be beneficial preventative strategies for other lung transplant centres facing similar issues., Competing Interests: Conflict of interest statement M.P.A. is a consultant for Abbvie. M.G.I. declares that research support from GSK was paid to Northwestern; received consulting fees from Adagio Therapeutics, ADMA Biologics, Adamis Pharmaceuticals, AlloVir, Atea, Cidara Therapeutics, Genentech/Roche, Janssen, Shionogi, Takeda, Telaris, and Eurofins Viracor; and payment for participating in data safety monitoring boards or advisory boards from Adamis Pharmaceuticals, AlloVir, National Institutes of Health, CSL Behring, Janssen, Merck, Seqirus, Takeda, and Talaris; all of these ended December 2022; he also receives author royalties from UpToDate, which is ongoing; M.G.I. also serves as Chair of the International Society for Influenza and other Respiratory Virus Diseases Antiviral Group and was Editor-in-Chief of Transplant Infectious Disease. All other authors report no conflicts of interest relevant to this article., (Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.) more...

Objective: To determine the incidence of venous thromboembolism in patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy in UK gynecological cancer centers. Secondary outcomes included incidence and timing of venous thromboembolism since cancer presentation, impact on cancer treatment, and mortality., Methods: All UK gynecological cancer centers were invited to participate in this multi-center retrospective audit through the British Gynecological Cancer Society. Data were captured on all patients undergoing neoadjuvant chemotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian cancer within a 12-month period during 2021-2022. Patients on anticoagulation prior to cancer presentation were excluded. Patients who were diagnosed with venous thromboembolism between cancer presentation and commencing neoadjuvant chemotherapy were also excluded from our analysis of venous thromboembolism rates from neoadjuvant chemotherapy., Results: Fourteen UK gynecological cancer centers returned data on 660 eligible patients. The median age was 67 years (range 34-96). In total, 131/660 (19.8%) patients were diagnosed with venous thromboembolism from cancer presentation until discharge following cytoreductive surgery. Between commencing neoadjuvant chemotherapy and post-operative discharge, 65/594 (10.9%) patients developed venous thromboembolism (median 11.3%, IQR 5.9-11.3); 55/594 (9.3%) during neoadjuvant chemotherapy, 10/594 (1.7%) during post-operative admission. There was no significant difference across centers (p=0.47). Of these 65 patients, 44 (68%) were diagnosed with pulmonary embolism and 30 (46%) with deep-vein thrombosis (nine had both), including in major abdominal/pelvic vessels, with 36 (55%) presenting symptomatically and 29 (45%) diagnosed incidentally on imaging. Venous thromboembolism resulted in mortality (n=3/65, 5%), and delays/changes/cancelation of treatment (n=18/65, 28%)., Conclusion: Across a large, representative sample of UK gynecological cancer centers, one in five patients undergoing neoadjuvant chemotherapy were diagnosed with a potentially preventable venous thromboembolism, including one in nine diagnosed after commencing chemotherapy. This led to adverse clinical consequences for one third, including delay to oncological treatment and mortality. This high venous thromboembolism rate justifies the consideration of thromboprophylaxis in this patient group., Competing Interests: Competing interests: MT declares research funding from Thrombosis UK and Anthos, has received speaker fees from Bayer, Sanofi and Anthos, served on advisory boards for Ablynx, Sanofi and Bayer, consultancy for Bayer and Anthos, and is the senior author for the British Society of Haematology Guideline - Cancer-associated venous thrombosis in adults (second edition). SO and RM acknowledge funding outside this work from the Rosetrees trust. RM declares research funding from Barts Charity, the Eve Appeal, NHS Innovation Accelerator, British Gynaecological Cancer Society, GSK and Yorkshire Cancer Research outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honoraria for advisory board membership from Astrazeneca, MSD, EGL, GSK. RM is the Topic Advisor for the NICE Guideline [GID-NG10225] -- Ovarian cancer: identifying and managing familial and genetic risk. NeR is supported by a NES/CSO Postdoctoral Clinical Lectureship Scheme – PCL/23/03 from the Chief Scientist Office Scotland. The other authors declare no conflicts of interest., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...

Poor-quality, substandard and falsified, medicines pose a significant public health threat, particularly in low-middle-income countries. A retrospective study was performed on Kenya's Pharmacovigilance Electronic Reporting System (2014-2021) to characterize medicine quality-related complaints and identify associations using disproportionality analysis. A total of 2767 individual case safety reports were identified, categorized into medicines with quality defects (52.1%), suspected therapeutic failure (41.6%), and suspected adverse drug reactions (6.3%). Predominantly reported were antineoplastic agents (28.6%), antivirals (11.7%), and antibacterial agents (10.8%) potentially linked to non-adherence to good manufacturing practices, inappropriate usage and supply chain degradation. Notably, analgesics (8.2%), and medical devices (3.5%) notified had quality defects, predominantly from government health facilities (60.0%). Antineoplastic agents (20.2%) and antivirals (3.7%) were frequently reported from suspected therapeutic failures and suspected adverse drug reactions, respectively, across both private for-profit facilities (26.5%) and not-for-profit facilities (5.4%). Underreporting occurred in unlicensed health facilities (8.1%), due to unawareness and reporting challenges. Pharmacists (46.1%), and pharmaceutical technicians (11.7%) predominantly reported quality defects, while medical doctors (28.0%) reported suspected therapeutic failures. Orally administered generic medicines (76.9%) were commonly reported, with tablets (5.8%) identified as potential sources of suspected adverse drug reactions, while quality defects were notified from oral solutions, suspensions, and syrups (7.0%) and medical devices (3.9%). The COVID-19 pandemic correlated with reduced reporting possibly due to prioritization of health surveillance. This study provides valuable evidence to supporting the use of medicine quality-related complaints for proactive, targeted regulatory control of high-risk medicines on the market. This approach can be strengthened by employing standardized terminology to prioritize monitoring of commonly reported suspected poor-quality medicines for risk-based sampling and testing within the supply chain., (© 2024. The Author(s).) more...

Hypertension, a well-known cardiovascular disorder noticed by rise in blood pressure, poses a significant global health challenge. The development RNA interfering (RNAi)-based therapies offers a ground-breaking molecular tool, holds promise for addressing hypertension's intricate molecular mechanisms. Harnessing the power of small interfering RNA (siRNA), researchers aim to selectively target and modulate genes associated with hypertension. Furthermore, they aim to downregulate the levels of mRNA by activating cellular nucleases in response to sequence homology between the siRNA and the corresponding mRNA molecule. As a result, genes involved in the cause of disorders linked to a known genetic background can be silenced using siRNA strategy. In the realm of hypertension, siRNA therapy emerges as a potential therapy for prognostics, diagnostics and treatments. It plays an important role in execution of targeting suppression of genes involved in vascular tone regulation, sodium handling, and pathways contributing to high blood pressure. A clinical trial involving intervention like angiotensinogen siRNA (AGT siRNA) is currently being carried out to treat hypertension. Genetic correlations between uromodulin (UMOD) and hypertension are investigated as emerging Non AGT siRNA target. Furthermore, expression of UMOD is responsible for regulation of sodium by modulating the tumor necrosis factor-α and regulating the Na + -K + -2Cl-cotransporter (NKCC2) in the thick ascending limb, which makes it an important target for blood pressure regulation., Competing Interests: Declaration of competing interest The author's declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.) more...

Purpose of Review: Letermovir has changed the game of primary prophylaxis against cytomegalovirus (CMV) for hematopoietic stem cell transplant (HSCT) and more recently, solid organ transplant recipients. This is largely due to letermovir's similar efficacy in protecting against CMV reactivation and disease, along with its superior safety profile, notably reduced myelotoxicity, and lack of renal dose adjustment compared to standard agents like valganciclovir. This review will describe the potential benefits and clinical considerations of letermovir as prophylaxis among transplant recipients, with a focus on recent evidence describing nonviral outcomes of CMV., Recent Findings: Recent evidence has demonstrated improved safety (e.g., less myelosuppression) and tolerability with no difference in rates of CMV infection or disease in kidney transplant recipients given letermovir compared to valganciclovir. Real-world studies and meta-analyses in HSCT populations have explored various nonviral outcomes with letermovir use. Letermovir prophylaxis was associated with reduced mortality, lower rates of graft versus host disease, delayed CMV immune reconstitution, improved tolerability with extended durations, and decreased healthcare utilization., Summary: Letermovir is an effective antiviral agent for CMV prevention and has demonstrated enhanced safety, which may allow for extended durations of primary prophylaxis among transplant recipients along with other improved clinical outcomes by mitigating the indirect effects of CMV., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) more...

The immense scale and complexity of neuronal electron microscopy (EM) datasets pose significant challenges in data processing, validation, and interpretation, necessitating the development of efficient, automated, and scalable error-detection methodologies. This paper proposes a novel approach that employs mesh processing techniques to identify potential error locations near neuronal tips. Error detection at tips is a particularly important challenge since these errors usually indicate that many synapses are falsely split from their parent neuron, injuring the integrity of the connectomic reconstruction. Additionally, we draw implications and results from an implementation of this error detection in a semi-automated proofreading pipeline. Manual proofreading is a laborious, costly, and currently necessary method for identifying the errors in the machine learning based segmentation of neural tissue. This approach streamlines the process of proofreading by systematically highlighting areas likely to contain inaccuracies and guiding proofreaders towards potential continuations, accelerating the rate at which errors are corrected. more...

A library of 4-substituted quinolines was synthesised based on the structural features of the privileged 4-(benzylthio)-6-methoxy-2-methylquinoline scaffold. Quinoline-based chemical probes have proven to be effective anti-tuberculosis agents with the ability of inhibiting components of Mycobacterium tuberculosis (MTB) respiratory chain including the b subunit of the cytochrome bc 1 complex. Novel 4-(arylalkyl)-thio, -oxy and sulfoxy-quinoline analogues were tested for their ability to inhibit the growth of MTB H37Rv and QcrB mutant strains, and the compounds mode of action was investigated. Members of the 4-subtituted thio- and sulfoxyquinoline series exhibited significant growth inhibitory activity in the high nanomolar range against wild-type MTB and induced depletion of intracellular ATP. These probes also showed reduced potency in the QcrB T313I mutant strain, thus indicating the cytochrome bc 1 oxidase complex as the molecular target. Interestingly, new 4-(quinolin-2-yl)oxy-quinoline 4i was more selective for the QcrB T313I strain compared to the wild-type strain., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) more...

Background: Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control., Methods: Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI)., Results: Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL ( p < 0.0001). TIR and GMI improved from 70.50 (50.75 to 83.50) % to 75.00 (58.25 to 89.00) % ( p = 0.0001) and 6.64 (6.13 to 7.35) % to 6.23 (5.74 to 6.86) % ( p < 0.0001) respectively. TAR reduced significantly from 17.00 (4.25 to 38.0) % to 6.00 (1.25 to 26.0) % ( p < 0.0001). No significant increase in TBR was observed ( p = 0.198)., Conclusion: Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D., Competing Interests: Conflict of interestAS is CEO and Co-founder of Fitterfly Healthtech Pvt Ltd. RV, SJ, SM, SB and RR are paid employees at Fitterfly., (© The Author(s), under exclusive licence to Research Society for Study of Diabetes in India 2022.) more...

Background: Digital therapeutic platforms facilitate health care through patient-centered strategies based on multidisciplinary teams and shared decision-making. Such platforms can be used for developing a dynamic model of diabetes care delivery, which can help in improving glycemic control by promoting long-term behavior changes in people with diabetes., Objective: This study aims to evaluate the real-world effectiveness of the Fitterfly Diabetes CGM digital therapeutics program for improving glycemic control in people with type 2 diabetes mellitus (T2DM) after the completion of 90 days in the program., Methods: We analyzed deidentified data of 109 participants in the Fitterfly Diabetes CGM program. This program was delivered through the Fitterfly mobile app coupled with continuous glucose monitoring (CGM) technology. This program consists of 3 phases: the first phase is observation, wherein the patient's CGM readings are observed for 7 days (week 1); the second phase is the intervention; and the third phase aims at sustaining the lifestyle modification introduced during the second phase. The primary outcome of our study was the change in the participants' hemoglobin A 1c (HbA 1c ) levels after program completion. We also evaluated the changes in participant weight and BMI after the program, changes in the CGM metrics in the initial 2 weeks of the program, and the effects of participant engagement in the program on improving their clinical outcomes., Results: At the end of the 90 days of the program, the mean HbA 1c levels, weight, and BMI of the participants were significantly reduced by 1.2% (SD 1.6%), 2.05 (SD 2.84) kg, and 0.74 (SD 1.02) kg/m 2 from baseline values of 8.4% (SD 1.7%), 74.45 (SD 14.96) kg, and 27.44 (SD 4.69) kg/m 2 in week 1, respectively (P<.001). The average blood glucose levels and time above range values showed a significant mean reduction by 16.44 (SD 32.05) mg/dL and 8.7% (SD 17.1%) in week 2 from week 1 baseline values of 152.90 (SD 51.63) mg/dL and 36.7% (SD 28.4%), respectively (P<.001 for both). Time in range values significantly improved by 7.1% (SD 16.7%) from a baseline value of 57.5% (SD 25%) in week 1 (P<.001). Of all the participants, 46.9% (50/109) showed HbA 1c reduction ≥1% and 38.5% (42/109) showed weight loss ≥4%. The average number of times the mobile app was opened by each participant during the program was 108.80 (SD 127.91) times., Conclusions: Our study shows that participants in the Fitterfly Diabetes CGM program showed a significant improvement in their glycemic control and reduction in weight and BMI. They also showed a high level of engagement with the program. Weight reduction was significantly associated with higher participant engagement with the program. Thus, this digital therapeutic program can be considered as an effective tool for improving glycemic control in people with T2DM., (©Shilpa Joshi, Ritika Verma, Tejal Lathia, Chitra Selvan, Snehal Tanna, Amit Saraf, Mangesh Tiwaskar, Alok Modi, Sanjay Kalra, Vasudevarao K, Manoj Chitale, Forum Malde, Mohammed Abdul Khader, Arbinder Kumar Singal. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 03.05.2023.) more...