{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:16:02Z","timestamp":1792844162497,"version":"4.5.0"},"reference-count":56,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cognitive impairment and glycemic control have a bidirectional association. Understanding the impact of continuous glucose monitoring (CGM) vs self-monitoring of blood glucose (SMBG) is important for treating older adults with Alzheimer disease and related dementias (ADRD) and diabetes that is treated with insulin.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the risks of glycemic outcomes and related adverse events between CGM users and prevalent SMBG users in insulin-treated older adults with ADRD and diabetes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective, prevalent\u2013new user cohort study utilized a nationwide, 15% random sample of Medicare claims data (Parts A, B, and D) from January 2016 to December 2020 to ensure balanced cohorts. Insulin-treated older adults (\u226566 years) with ADRD and diabetes were included. Individuals in hospice care or with a professional CGM use were excluded. Analysis was carried out from August 2023 to December 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Therapeutic CGM use vs prevalent SMBG use.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes included hypoglycemia hospitalizations, hyperglycemia crisis, and all-cause mortality; falls and all-cause hospitalizations were secondary outcomes. Upper respiratory tract infections served as a negative control outcome. A 1:1 propensity score matching with a 0.25 caliper was carried out for confounding control. Cox proportional hazards models were used for outcome analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In this cohort of 2022 insulin-treated older adults with diabetes and ADRD (1011 CGM users and 1011 SMBG users; mean [SD] age, 76.4 [6.7] years; 1133 female [56.0%]), CGM use was significantly associated with lower risk of all-cause hospitalization (hazard ratio [HR], 0.86; 95% CI, 0.76-0.96) and mortality (HR, 0.57; 95% CI, 0.48-0.67) compared with SMBG use. CGM use had lower point estimates for hypoglycemia hospitalization (HR, 0.66; 95% CI, 0.40-1.08) and falls (HR, 0.86; 95% CI, 0.68-1.08) and higher point estimates for hyperglycemia crisis (HR, 1.38; 95% CI, 0.99-1.94) vs SMBG use, but these findings were not significant. Exploratory subgroup analyses showed varied benefits. The negative control outcome showed no significant differences across analyses.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of insulin-treated older adults with ADRD and diabetes, CGM use was associated with improved long-term clinical outcomes. Pragmatic (ie, evaluating the effectiveness of healthcare interventions in everyday settings) trials are needed to validate these findings and to assess the feasibility of CGM use in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.41939","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T16:00:17Z","timestamp":1764691217000},"page":"e2541939","source":"Crossref","is-referenced-by-count":10,"title":["Continuous Glucose Monitoring in Insulin-Treated Older Adults With Diabetes and Alzheimer Disease and Related Dementias"],"prefix":"10.1001","volume":"8","author":[{"given":"Pareeta","family":"Kotecha","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Donahoo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven T.","family":"DeKosky","sequence":"additional","affiliation":[{"name":"McKnight Brain Institute, University of Florida, Gainesville"},{"name":"Department of Neurology, College of Medicine, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Health Data Science, School of Medicine, Indiana University, Indianapolis"},{"name":"Regenstrief Institute, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingchuan","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"issue":"1","key":"zoi251144r3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/01.SMJ.0000077061.01235.42","article-title":"Medical comorbidity in Black and White patients with Alzheimer\u2019s disease.","volume":"97","author":"Zamrini","year":"2004","journal-title":"South Med J"},{"issue":"1","key":"zoi251144r4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1111\/j.1532-5415.2005.00543.x","article-title":"Comorbidity profile of dementia patients in primary care: are they sicker?","volume":"54","author":"Schubert","year":"2006","journal-title":"J Am Geriatr Soc"},{"issue":"14","key":"zoi251144r5","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.1001\/jamainternmed.2013.6176","article-title":"Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus.","volume":"173","author":"Yaffe","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi251144r6","doi-asserted-by":"publisher","first-page":"787","DOI":"10.2337\/dc11-1855","article-title":"Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial.","volume":"35","author":"Punthakee","year":"2012","journal-title":"Diabetes Care"},{"issue":"9","key":"zoi251144r7","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1007\/s00125-009-1437-1","article-title":"Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle diabetes study.","volume":"52","author":"Bruce","year":"2009","journal-title":"Diabetologia"},{"issue":"1","key":"zoi251144r8","doi-asserted-by":"crossref","first-page":"S266","DOI":"10.2337\/dc25-S013","article-title":"13. Older adults: standards of care in diabetes\u20142025.","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"issue":"1","key":"zoi251144r9","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.2337\/dc25-S004","article-title":"4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes\u20142025.","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"issue":"Suppl 1","key":"zoi251144r10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4158\/EP15672.GLSUPPL","article-title":"American association of clinical endocrinologists and american college of endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015.","volume":"21","author":"Handelsman","year":"2015","journal-title":"Endocr Pract"},{"issue":"11","key":"zoi251144r11","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1111\/jgs.12514","article-title":"Guidelines abstracted from the American Geriatrics Society Guidelines for improving the care of older adults with diabetes mellitus: 2013 update.","volume":"61","author":"Moreno","year":"2013","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"zoi251144r12","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1001\/jamainternmed.2014.7345","article-title":"Potential overtreatment of diabetes mellitus in older adults with tight glycemic control.","volume":"175","author":"Lipska","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi251144r13","doi-asserted-by":"publisher","first-page":"224","DOI":"10.2337\/ds16-0035","article-title":"Management of adults with diabetes and cognitive problems.","volume":"29","author":"Hopkins","year":"2016","journal-title":"Diabetes Spectr"},{"issue":"4","key":"zoi251144r14","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1001\/archinternmed.2010.539","article-title":"Frequent hypoglycemia among elderly patients with poor glycemic control.","volume":"171","author":"Munshi","year":"2011","journal-title":"Arch Intern Med"},{"issue":"1","key":"zoi251144r15","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1186\/s12902-023-01472-6","article-title":"High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway.","volume":"23","author":"Fl\u00f8de","year":"2023","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"zoi251144r16","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s12916-021-02065-7","article-title":"Risk of incident fractures in individuals hospitalised due to unexplained syncope and orthostatic hypotension.","volume":"19","author":"Johansson","year":"2021","journal-title":"BMC Med"},{"issue":"8","key":"zoi251144r17","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1111\/acem.13414","article-title":"Outcomes of patients with syncope and suspected dementia.","volume":"25","author":"Holden","year":"2018","journal-title":"Acad Emerg Med"},{"issue":"2","key":"zoi251144r18","doi-asserted-by":"publisher","first-page":"196","DOI":"10.4158\/EP15640.OR","article-title":"Association between hypoglycemia and fall-related fractures and health care utilization in older veterans with type 2 diabetes.","volume":"22","author":"Zhao","year":"2016","journal-title":"Endocr Pract"},{"issue":"9","key":"zoi251144r19","doi-asserted-by":"publisher","first-page":"2060","DOI":"10.2337\/dc20-0316","article-title":"Severe hypoglycemia and risk of falls in type 2 diabetes: the atherosclerosis risk in communities (ARIC) study.","volume":"43","author":"Lee","year":"2020","journal-title":"Diabetes Care"},{"issue":"1","key":"zoi251144r21","doi-asserted-by":"publisher","first-page":"104","DOI":"10.2337\/dc17-1669","article-title":"The association of severe hypoglycemia with incident cardiovascular events and mortality in adults with type 2 diabetes.","volume":"41","author":"Lee","year":"2018","journal-title":"Diabetes Care"},{"issue":"2","key":"zoi251144r22","doi-asserted-by":"publisher","first-page":"156","DOI":"10.14336\/AD.2014.0330","article-title":"Hypoglycemia in older people\u2014a less well recognized risk factor for frailty.","volume":"6","author":"Abdelhafiz","year":"2015","journal-title":"Aging Dis"},{"issue":"2","key":"zoi251144r23","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1001\/jamainternmed.2013.12956","article-title":"Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study.","volume":"174","author":"Huang","year":"2014","journal-title":"JAMA Intern Med"},{"issue":"15","key":"zoi251144r24","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1001\/archinte.163.15.1825","article-title":"Hypoglycemia as a predictor of mortality in hospitalized elderly patients.","volume":"163","author":"Kagansky","year":"2003","journal-title":"Arch Intern Med"},{"key":"zoi251144r25","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1222409","article-title":"Association of hypoglycaemia with the risks of arrhythmia and mortality in individuals with diabetes\u2014a systematic review and meta-analysis.","volume":"14","author":"Li","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"10","key":"zoi251144r26","doi-asserted-by":"publisher","first-page":"4795","DOI":"10.1111\/dom.15842","article-title":"Continuous glucose monitoring and all-cause mortality in insulin-using population with diabetes and cognitive impairment.","volume":"26","author":"Kotecha","year":"2024","journal-title":"Diabetes Obes Metab"},{"key":"zoi251144r27","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jbi.2016.12.005","article-title":"Accuracy of an automated knowledge base for identifying drug adverse reactions.","volume":"66","author":"Voss","year":"2017","journal-title":"J Biomed Inform"},{"issue":"3","key":"zoi251144r28","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1093\/aje\/kwad201","article-title":"The state of use and utility of negative controls in pharmacoepidemiologic studies.","volume":"193","author":"Zafari","year":"2024","journal-title":"Am J Epidemiol"},{"issue":"3","key":"zoi251144r29","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/EDE.0b013e3181d61eeb","article-title":"Negative controls: a tool for detecting confounding and bias in observational studies.","volume":"21","author":"Lipsitch","year":"2010","journal-title":"Epidemiology"},{"issue":"7","key":"zoi251144r30","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glae096","article-title":"Validation of a rule-based ICD-10-CM algorithm to detect fall injuries in medicare data.","volume":"79","author":"Ganz","year":"2024","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"1","key":"zoi251144r31","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jcjd.2021.04.006","article-title":"Sodium-glucose cotransporter-2 inhibitors and risk of diabetic ketoacidosis among adults with type 2 diabetes: a systematic review and meta-analysis.","volume":"46","author":"Colacci","year":"2022","journal-title":"Can J Diabetes"},{"issue":"8","key":"zoi251144r32","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.9679","article-title":"Measurement of fall injury with health care system data and assessment of inclusiveness and validity of measurement models.","volume":"2","author":"Min","year":"2019","journal-title":"JAMA Netw Open"},{"key":"zoi251144r33","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1472-6823-8-4","article-title":"Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits.","volume":"8","author":"Ginde","year":"2008","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"zoi251144r36","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1089\/dia.2022.0377","article-title":"Assessment of glucose monitoring adherence in Medicare beneficiaries with insulin-treated diabetes.","volume":"25","author":"Puckrein","year":"2023","journal-title":"Diabetes Technol Ther"},{"issue":"9","key":"zoi251144r37","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1002\/pds.5083","article-title":"Time-related biases in pharmacoepidemiology.","volume":"29","author":"Suissa","year":"2020","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"10","key":"zoi251144r38","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1093\/aje\/kwi307","article-title":"Survival bias associated with time-to-treatment initiation in drug effectiveness evaluation: a comparison of methods.","volume":"162","author":"Zhou","year":"2005","journal-title":"Am J Epidemiol"},{"issue":"5","key":"zoi251144r40","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1007\/s11606-010-1609-1","article-title":"Healthy user and related biases in observational studies of preventive interventions: a primer for physicians.","volume":"26","author":"Shrank","year":"2011","journal-title":"J Gen Intern Med"},{"issue":"7","key":"zoi251144r41","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1093\/gerona\/glx229","article-title":"Measuring frailty in Medicare data: development and validation of a claims-based frailty index.","volume":"73","author":"Kim","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"5","key":"zoi251144r43","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"3","key":"zoi251144r44","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies.","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"issue":"19","key":"zoi251144r45","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1002\/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B","article-title":"Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.","volume":"17","author":"D\u2019Agostino","year":"1998","journal-title":"Stat Med"},{"issue":"1","key":"zoi251144r46","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s11657-020-00748-x","article-title":"A comparison of the Cox model to the Fine-Gray model for survival analyses of re-fracture rates.","volume":"15","author":"Nolan","year":"2020","journal-title":"Arch Osteoporos"},{"issue":"8","key":"zoi251144r47","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1093\/gerona\/gly197","article-title":"Validation of a claims-based frailty index against physical performance and adverse health outcomes in the health and retirement study.","volume":"74","author":"Kim","year":"2019","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"1","key":"zoi251144r48","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1631\/jzus.B1300109","article-title":"Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy.","volume":"15","author":"Huang","year":"2014","journal-title":"J Zhejiang Univ Sci B"},{"key":"zoi251144r49","doi-asserted-by":"crossref","DOI":"10.1089\/dia.2025.0227","article-title":"Initiation of continuous glucose monitoring and mortality in type 2 diabetes.","author":"Reaven","year":"2025","journal-title":"Diabetes Technol Ther"},{"issue":"2","key":"zoi251144r50","doi-asserted-by":"crossref","first-page":"409","DOI":"10.2337\/dc11-0996","article-title":"The impact of frequent and unrecognized hypoglycemia on mortality in the ACCORD study.","volume":"35","author":"Seaquist","year":"2012","journal-title":"Diabetes Care"},{"issue":"4","key":"zoi251144r51","doi-asserted-by":"crossref","first-page":"854","DOI":"10.2337\/dc22-2189","article-title":"Initiation of continuous glucose monitoring is linked to improved glycemic control and fewer clinical events in type 1 and type 2 diabetes in the Veterans Health Administration.","volume":"46","author":"Reaven","year":"2023","journal-title":"Diabetes Care"},{"key":"zoi251144r52","doi-asserted-by":"crossref","DOI":"10.1016\/j.diabres.2023.110822","article-title":"Gender differences in reported frequency and consequences of hypoglycemia among adults living with type 1 diabetes: results from the BETTER registry.","volume":"202","author":"Talbo","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"issue":"6","key":"zoi251144r53","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/dom.12449","article-title":"Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials.","volume":"17","author":"Kautzky-Willer","year":"2015","journal-title":"Diabetes Obes Metab"},{"issue":"6","key":"zoi251144r54","doi-asserted-by":"crossref","first-page":"365","DOI":"10.7326\/M16-2855","article-title":"Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial.","volume":"167","author":"Beck","year":"2017","journal-title":"Ann Intern Med"},{"issue":"4","key":"zoi251144r55","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1001\/jama.2016.19975","article-title":"Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial.","volume":"317","author":"Beck","year":"2017","journal-title":"JAMA"},{"issue":"23","key":"zoi251144r56","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1001\/jama.2020.6928","article-title":"Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial.","volume":"323","author":"Pratley","year":"2020","journal-title":"JAMA"},{"key":"zoi251144r39","doi-asserted-by":"crossref","DOI":"10.1201\/9781003602477","volume-title":"Alzheimer Disease","author":"Kumar","year":"2025"},{"key":"zoi251144r1","unstructured":"U.S. Census Bureau. 2023 national population projections tables: main series. Updated February 12, 2025. Accessed October 3, 2025. https:\/\/www.census.gov\/data\/tables\/2023\/demo\/popproj\/2023-summary-tables.html"},{"key":"zoi251144r2","unstructured":"Centers for Disease Control and Prevention. Chronic disease indicators: older adults. Updated June 3, 2024. Accessed October 3, 2025. https:\/\/www.cdc.gov\/cdi\/indicator-definitions\/older-adults.html"},{"key":"zoi251144r20","unstructured":"U.S. Centers for Disease Control and Prevention. Older Adult Falls Data. Updated October 28, 2024. Accessed October 3, 2025. https:\/\/www.cdc.gov\/falls\/data-research\/index.html"},{"key":"zoi251144r34","unstructured":"Jarosek? S. Death information in the research identifiable Medicare data. Published November 9, 2022. Accessed October 3, 2023. https:\/\/resdac.org\/articles\/death-information-research-identifiable-medicare-data"},{"key":"zoi251144r35","unstructured":"Centers for Medicare & Medicaid Services. Glucose Monitors L33822. Updated October 9, 2024. Accessed October 3, 2025. https:\/\/www.cms.gov\/medicare-coverage-database\/view\/lcd.aspx?lcdid=33822"},{"key":"zoi251144r42","unstructured":"Kim? DH, Gautam? N. SAS programs\u2014claims-based frailty index version 15. Harvard Dataverse. Updated May 22, 2021. Accessed October 3, 2025. https:\/\/dataverse.harvard.edu\/dataset.xhtml?persistentId=doi:10.7910\/DVN\/HM8DOI?"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2842167\/kotecha_2025_oi_251144_1763745955.10762.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T16:00:23Z","timestamp":1764691223000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2842167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":56,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.41939","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,2]]}}}