AIMS: CGM devices report glucose only within fixed limits (typically 40-400 mg/dL; 2.2-22.2 mmol/L), truncating extreme values to a boundary ('capping'). We characterised prevalence, duration, and consequences of capping...AIMS: CGM devices report glucose only within fixed limits (typically 40-400 mg/dL; 2.2-22.2 mmol/L), truncating extreme values to a boundary ('capping'). We characterised prevalence, duration, and consequences of capping in type 1 diabetes trial data. METHODS: We analysed 46,990,617 CGM readings from 948 participants across four publicly available clinical trial datasets (Dexcom G4 Platinum or G6 sensors). Capping prevalence, run duration, and associations with age, HbA1c, and sex were characterised across all datasets. In the 77 participants of the Replace-BG trial, CGM-plus-blood glucose monitor (BGM) arm, CGM-derived metrics were compared with contemporaneous BGM measurements across 1162 non-overlapping 14-day windows. RESULTS: Between 93.5% and 100% of participants had at least one capped reading, and capped values comprised 0.47-0.98% of all readings. In the three datasets for which duration could be calculated, over 70% of upper-cap runs exceeded 15 min and over one third exceeded 60 min. Upper-limit capping was inversely associated with age (Spearman ρ -0.20 to -0.47, p ≤ 0.002) in three of the datasets, and positively associated with baseline HbA1c (ρ 0.39-0.62, p < 0.001) in all four datasets. A within-participant analysis showed that capping burden did not predict CGM-BGM divergence in any summary metric (all p > 0.2), and a systematic CGM-BGM offset in mean glucose and time in range (TIR) reflected the physiological lag between blood and interstitial fluid rather than capping artefact. CONCLUSIONS: Sensor limit capping is near-universal in type 1 diabetes, produces sustained periods of right-censored glucose data disproportionately affecting younger participants, and does not substantially distort standard summary metrics at the population level. Clinicians and trialists should be aware that CGM data can confirm extreme glucose events but cannot quantify their severity.
AIMS: Insulin signalling in the brain is crucial for systemic metabolic regulation and cognitive function. In some individuals, these effects are reduced, a phenomenon referred to as brain insulin resistance (BIR). This...AIMS: Insulin signalling in the brain is crucial for systemic metabolic regulation and cognitive function. In some individuals, these effects are reduced, a phenomenon referred to as brain insulin resistance (BIR). This condition may contribute to the elevated risk of cognitive decline and dementia in diabetes, yet its prevalence, mechanisms, and clinical relevance remain poorly understood. The BIR-BrainHealth study aims to (i) quantify BIR in adults with type 1 diabetes, type 2 diabetes, and without diabetes; (ii) assess its associations with cerebrovascular function and cognitive performance; and (iii) identify biomarkers that reflect BIR. METHODS: BIR-BrainHealth is a multicentre prospective cohort study with baseline cross-sectional analyses conducted in Denmark and Germany. We plan to recruit a total of 150 adults (≈50 per group) who will undergo detailed metabolic and cognitive phenotyping, multimodal neuroimaging, and extensive biomarker profiling. Brain insulin response is assessed by cerebral blood flow changes to intranasal insulin administration measured by perfusion-weighted MRI. Additional MRI scans will be used for assessments of cerebrovascular reactivity, neurovascular coupling, blood-brain barrier integrity, and hypothalamic responses during an oral glucose tolerance test. Blood, urine, and faecal samples are collected in a biobank. CONCLUSIONS: BIR-BrainHealth will provide insight into how diabetes affects brain insulin signalling and cerebrovascular health, and how these alterations relate to cognitive performance. These findings will establish a robust foundation for future mechanistic and translational research, with the potential to advance strategies for monitoring and preventing cognitive decline. TRIAL REGISTRATION:ISRCTN: ISRCTN15687967 and ClinicalTrials.gov: NCT07374705.
BACKGROUND: We compared characteristics of adults with insulin-treated diabetes using continuous subcutaneous insulin infusion (CSII) versus multiple daily insulin injections (MDI) during admission with acute coronary sy...BACKGROUND: We compared characteristics of adults with insulin-treated diabetes using continuous subcutaneous insulin infusion (CSII) versus multiple daily insulin injections (MDI) during admission with acute coronary syndrome (ACS) and identified factors associated with in-hospital mortality among CSII users. METHODS: This retrospective cohort study used the Myocardial Ischaemia National Audit Project, a registry of ACS admissions in England and Wales. Adults aged ≥18 years with confirmed ACS and insulin-treated diabetes were classified as CSII or MDI users. Baseline characteristics were compared. Gradient boosting machine (GBM) modelling and multivariable logistic regression evaluated mortality predictors among CSII users. RESULTS: The cohort included 3321 CSII users and 30,593 MDI users. In-hospital mortality was higher among CSII users (11.4% vs. 5.1%; p < 0.001). CSII users had higher rates of cardiogenic shock (4.8% vs. 1.3%), pulmonary oedema (12.1% vs. 8.3%), poor left ventricular systolic function (23.5% vs. 19.7%), and STEMI (32.2% vs. 20.5%). Cardiogenic shock was the strongest predictor of mortality (adjusted OR 10.46, 95% CI 6.95-15.81), followed by poor left ventricular function (OR 4.15, 95% CI 2.69-6.53), basal crepitations (OR 1.94, 95% CI 1.40-2.67) and pulmonary oedema (OR 1.56, 95% CI 1.05-2.28). Higher systolic blood pressure was associated with lower mortality (OR 0.86 per 10 mmHg, 95% CI 0.82-0.90). The GBM model achieved an AUC of 0.85 and a Brier score of 0.088. CONCLUSIONS: CSII users admitted with ACS represented a more complex group with haemodynamic compromise and higher unadjusted mortality. Findings predominantly reflect the open-loop CSII era and may not generalise to contemporary hybrid closed-loop systems.
AIMS: Dyslipidaemia in youth with type 1 diabetes mellitus (T1D) is emerging as an important modifiable cardiovascular risk factor. International consensus guidelines to screen this entity have evolved over time. To furt...AIMS: Dyslipidaemia in youth with type 1 diabetes mellitus (T1D) is emerging as an important modifiable cardiovascular risk factor. International consensus guidelines to screen this entity have evolved over time. To further evaluate this in an Australian context, we investigated adherence to such guidelines over the course of patient care. Additionally, once a diagnosis of dyslipidaemia was made, the trajectory and clinical management of these patients were explored. METHODS: A retrospective audit was undertaken in paediatric patients diagnosed with T1D. Clinical and ancillary laboratory data were collected. RESULTS: Of the 335 patients identified, 263 (78%) followed initial lipid screening guidelines. Mean interval of testing was 17 months (SD 8 months), rather than the recommended 5-year interval. One or more abnormal lipid test parameters were identified in 55% (n = 183/335) of individuals. Average age at diagnosis of dyslipidaemia was 15.6 years (SD 2.0 years). In this cohort, 69 individuals (25%, 69/280) had an abnormal low-density lipoprotein-cholesterol (LDL-C) level, of whom 15 individuals (n = 15/69, 22%) had a level > 3.4 mmol/L, and 4 individuals had a level > 4.1 mmol/L (4/69, 6%). Only 1 of the 69 individuals was referred to a dietician. No patient was commenced on pharmacotherapy. CONCLUSION: Overall, our data indicate low adherence to international guidelines for dyslipidaemia screening and management. The reasons for this cannot be defined by a retrospective study but may reflect low clinician confidence, competing therapeutic priorities or difficulty in following current guidelines.
This editorial argues that hypoglycaemia self care should move beyond 'any sugar will do' and define what good recovery after treatment should involve. It proposes recovery-focused standards using CGM metrics, such as ti...This editorial argues that hypoglycaemia self care should move beyond 'any sugar will do' and define what good recovery after treatment should involve. It proposes recovery-focused standards using CGM metrics, such as time-in-range and repeat lows after treatment, alongside participant-reported recovery, so existing and emerging approaches, including MESH formulations, can be evaluated fairly against modern evidence-based standards.
AIMS: A thematic review that identifies and summarises available evidence for people with Type 1 diabetes (T1D) continuing automated insulin delivery (AID) systems in the hospital setting, primarily with a focus on asses...AIMS: A thematic review that identifies and summarises available evidence for people with Type 1 diabetes (T1D) continuing automated insulin delivery (AID) systems in the hospital setting, primarily with a focus on assessing the in-hospital safety and efficacy of AID use. METHODS: A thematic review was conducted searching Embase, MEDLINE and EBSCO for English language publications from 2014 to 2025 using keywords including AID system brands and terms related to insulin pumps and to inpatients. Eligible studies included original research, retrospective observational studies and case reports and series. RESULTS: Of 1043 articles identified, 1037 did not meet the inclusion criteria. Six articles were reviewed in detail, and a further two papers were identified by screening the reference list of the six papers. There is a paucity of evidence, with heterogeneous methodology regarding the safety and efficacy of continuing AID in hospitalised people with T1D. Results support the feasibility of continuing AID use from the ambulatory to the inpatient setting in hospitalised people with T1D. There is a trend towards improved time in recommended glucose ranges or mean glucose levels without increased hypoglycaemia. There were no adverse glucose outcomes or diabetic ketoacidosis reported. CONCLUSIONS: Whilst continuing AID in the inpatient setting appears promising, our review identified significant heterogeneity in patient populations, device types, as well as limited data on healthcare professional perspectives and person-reported outcomes. Further studies and guidelines are merited. Until then, inpatient use of AID should be guided by specialist diabetes healthcare teams with expertise in diabetes technology.
BACKGROUND: Real-world performance of the Tandem Mobi insulin pump with Control-IQ+ technology has been evaluated in small early access studies, but data from larger populations with long-term use has yet to be presented...BACKGROUND: Real-world performance of the Tandem Mobi insulin pump with Control-IQ+ technology has been evaluated in small early access studies, but data from larger populations with long-term use has yet to be presented, especially with the use of newer sensors and newly indicated populations. METHODS: The Tandem Mobi insulin pump with Control-IQ+ technology paired with the Dexcom G7 continuous glucose monitor (CGM) was evaluated in 29,265 users of the combined system, for a median of 5.1 months of use per user. Users had to have at least 30 days of use of the combined system in the Tandem Source web application to be included in the analysis. Customer service check-in surveys that were performed as part of routine postmarket surveillance activities were also analyzed. RESULTS: CGM availability exceeded 95% for all age groups, with an overall median 97.8%. Median time in closed loop was 94.1%, demonstrating strong reliability of the CGM connection in real-world settings. Median time in range 3.9-10.0 mmol/L was 70.8% for adults, 62.3% for children age 6-17 years old and 59.5% for children 2-5 years old. Time <3.9 mmol/L was low at 1.4%. Postmarket surveillance surveys completed by 1941 of these users reported high satisfaction with pump usability, CGM connectivity and the automated insulin delivery algorithm. CONCLUSIONS: These findings demonstrate safe and effective use of the Tandem Mobi insulin pump with Control-IQ+ technology paired with the Dexcom G7 sensor in the at-home, unsupervised setting.
Vidou A, Pit-Ten Cate IM, Campbell FM
… +10 more, Ware J, Hovorka R, Wilińska ME, Schierloh U, Hofer SE, Fröhlich-Reiterer E, Rami-Merhar B, Kapellen TM, de Beaufort C, KidsAP Consortium
AIMS: To examine parental expectancies regarding automated insulin delivery (AID) during extended home use of CamAPS FX hybrid closed-loop (HCL) in very young children with type 1 diabetes (T1D). METHODS: Parents of 64 y...AIMS: To examine parental expectancies regarding automated insulin delivery (AID) during extended home use of CamAPS FX hybrid closed-loop (HCL) in very young children with type 1 diabetes (T1D). METHODS: Parents of 64 young children aged 1-7 with T1D participated in a multinational randomised crossover trial and an 18-month HCL extension phase. Glycaemic outcomes (HbA1c) were recorded, and parental expectancies were assessed using the INSPIRE questionnaire, which evaluates parents' perceptions and expectations of AID systems. Assessments were conducted at baseline, during the HCL clinical trial phase and after the 18-month extension phase in the home environment. Linear mixed models were used to analyse outcomes across time. RESULTS: HCL use during the clinical trial phase improved HbA1c (baseline: 56.03 ± 7.31 mmol/mol [7.3%] vs. clinical trial: 50.78 ± 6.90 [6.8%]; p < 0.001), with benefits sustained over the 18-month extension period (49.00 ± 6.63 [6.8%]; p = 0.45). Parental expectancies did not change during the clinical trial phase (baseline: 44.78 ± 34.70 vs. clinical trial: 42.10 ± 38.11; p = 0.629, d = 0.05) but increased markedly after 18 months of home use (89.83 ± 9.35; p < 0.001, d = 1.14). CONCLUSIONS: Prolonged HCL use supports sustained glycaemic benefits while parental positive expectancies regarding AID increase over time. These findings suggest that parental trust develops through experience-dependent adaptation shaped by the combination of stable glycaemic outcomes and sustained real-world use and is important for continued engagement with AID. CLINICAL TRIAL REGISTRATION: NCT03784027; ClinicalTrials.gov.
Santova A, Neuman V, Amaratunga SA
… +10 more, Drnkova L, Kavciak L, Neumanova M, Jagiellova E, Nesvadbova M, Kolouskova S, Obermannova B, Pruhova S, Sumnik Z, Plachy L
AIMS: Managing diabetes during exercise remains challenging, particularly in settings of sustained physical activity such as diabetes-camps. This study aimed to evaluate the efficacy and safety of a diabetes-camp protoco...AIMS: Managing diabetes during exercise remains challenging, particularly in settings of sustained physical activity such as diabetes-camps. This study aimed to evaluate the efficacy and safety of a diabetes-camp protocol including an adaptive algorithm for prandial bolus reduction and the use of automated insulin delivery (AID) exercise modes in children with type 1 diabetes (CwD). METHODS: Data from two 7-day camps for 77 CwD aged 8-14 years using 780G, Control-IQ, or CamAPS were evaluated. Exercise modes were active throughout each camp, and meal boluses were adjusted by an adaptive algorithm. Continuous glucose monitoring metrics were evaluated and compared among AID systems and the 14-day pre-camp period. Hypoglycemia episodes and carbohydrates were recorded. RESULTS: Median time in range (TIR) was 80% during the camps, with time below range 3% (level 1; TBR1) and 1% (level 2; TBR2). Participants experienced a median of 2 hypoglycemia episodes/day. No severe hypoglycemia or diabetic ketoacidosis occurred. Median prandial bolus reduction in comparison with the calculated bolus was 45% (range 10-110%). Outcomes were similar across AID systems. TIR increased (80% vs. 78%, p = 0.015) and TBR rose modestly (TBR1 3% vs. 2%, p < 0.001; TBR2 1% vs. 0%, p = 0.002) compared to the pre-camp period. CONCLUSIONS: The protocol provided a safe and effective option to achieve glycemic targets across assessed AID systems during sustained physical activity at diabetes camps.
OBJECTIVE: This systematic review aimed to systematically evaluate the methodological quality and predictive performance of existing prognostic models for diabetic kidney disease (DKD) outcomes. METHODS: A systematic sea...OBJECTIVE: This systematic review aimed to systematically evaluate the methodological quality and predictive performance of existing prognostic models for diabetic kidney disease (DKD) outcomes. METHODS: A systematic search of PubMed, Web of Science, Cochrane Library, Ovid Embase, China National Knowledge Infrastructure (CNKI), Wanfang, Vip and SinoMed was conducted from database inception to 30 April 2026. Two reviewers independently screened studies, extracted data using the CHARMS checklist and assessed risk of bias with PROBAST. RESULTS: A total of 27 studies were included, comprising 80 prediction models. Among them, two were prospective studies and 25 were retrospective studies. The primary outcomes included renal-related events, all-cause mortality and cardiovascular endpoints. Twenty-two studies used traditional regression methods, five applied machine learning algorithms and four combined both approaches for model development. The most frequently used predictors were age, estimated glomerular filtration rate (eGFR), urine-albumin-creatinine ratio (UACR), urinary total protein (UTP), body mass index (BMI), haemoglobin and systolic blood pressure (SBP). Only eight studies performed external validation, and most models showed acceptable discrimination, with area under the curve (AUC)/C-statistic ranging from 0.70 to 0.90. All studies were judged to have a high risk of bias, and 21 were considered to have high concerns regarding applicability, mainly due to single-centre design and restrictive inclusion criteria. CONCLUSIONS: Current DKD prognostic models demonstrate acceptable discrimination but lack adequate calibration and external validation, highlighting the need for more rigorous study designs to enhance reliability and clinical applicability.
AIMS: Diabetes mellitus is associated with perioperative dysglycaemia and post-operative complications. Aboriginal and Torres Strait Islander people have higher rates of diabetes mellitus and post-operative complications...AIMS: Diabetes mellitus is associated with perioperative dysglycaemia and post-operative complications. Aboriginal and Torres Strait Islander people have higher rates of diabetes mellitus and post-operative complications than non-Indigenous Australians, yet data on their perioperative glycaemic profiles are lacking. The aim of this study was therefore to comprehensively describe perioperative glycaemic profiles in Aboriginal and Torres Strait Islander people with diabetes mellitus. METHODS: We conducted a retrospective multicentre cohort study of 16,396 adults with diabetes mellitus undergoing surgery in South Australia (2018-2023). Patient demographics, comorbidities, anti-hyperglycaemic agents, glycated haemoglobin (HbA1c) levels, and perioperative blood glucose levels (BGL) were compared between Aboriginal and Torres Strait Islander people and non-Indigenous Australians using chi-squared tests for categorical data, and non-parametric tests for numerical data. RESULTS: Aboriginal and Torres Strait Islander people (n = 1065, 6.5% of the cohort) were younger (54.3 vs. 68.2 years, p < 0.001), more likely to be female (52.1% vs. 41.6%, p < 0.001), and experienced greater preoperative comorbidity (coronary artery disease: 26.8% vs. 14.8%, p < 0.001) (chronic kidney disease: 21.9% vs. 15.2%, p < 0.001) than non-Indigenous Australians. Although their pre-admission HbA1c was higher (68.5 mmol/L (8.4%) vs. 62.1 mmol/mol (7.8%), p < 0.001), their perioperative patient-day mean BGL (8.7 vs. 8.8 mmol/L, p = 0.032), glycaemic variability (coefficient of variation: 21.3% vs. 21.6%, p = 0.045) and perioperative glycaemic ratios (1.24 vs. 1.28, p = 0.382) were similar. However, higher rates of hypoglycaemia were observed amongst Aboriginal and Torres Strait Islander people (14.6% vs. 10.3%, p < 0.001), coinciding with greater inpatient use of sulphonylureas and insulin. CONCLUSIONS: Despite being 14 years younger and having greater preoperative comorbidity and higher HbA1c levels, Aboriginal and Torres Strait Islander people demonstrated higher rates of perioperative hypoglycaemia, but otherwise broadly comparable perioperative glycaemic profiles to their non-Indigenous Australian counterparts. Further research should ideally be Indigenous-led, and prospectively evaluate interventions to both reduce cumulative glycaemic burden and optimise perioperative glycaemia using modern diabetes technologies in Aboriginal and Torres Strait Islander people both with and without diabetes mellitus.
BACKGROUND: Traditional management of type 2 diabetes mellitus (T2DM) and pre-diabetes centres on HbA1c reduction, yet this single metric fails to capture glycaemic variability (GV)-an independent driver of β-cell dysfun...BACKGROUND: Traditional management of type 2 diabetes mellitus (T2DM) and pre-diabetes centres on HbA1c reduction, yet this single metric fails to capture glycaemic variability (GV)-an independent driver of β-cell dysfunction, endothelial damage, oxidative stress, inflammation and cardiovascular risk, even in the pre-diabetes stage. Unlike existing reviews that focus predominantly on T2DM or HbA1c-centric approaches, this perspective articulates a unified three-pillar closed-loop framework that integrates continuous glucose monitoring (CGM) across the entire pre-diabetes-to-remission continuum. PERSPECTIVE: We synthesize evidence from prospective cohorts, mechanistic studies, randomized controlled trials and real-world data to demonstrate that GV is a modifiable therapeutic target. CGM uniquely reveals dynamic glucose patterns invisible to HbA1c, enabling precise, real-time interventions that improve time in range (TIR), reduce GV and hypoglycaemia and support the achievement of clinical remission (HbA1c <48 mmol/mol (<6.5%) without glucose-lowering medication for ≥3 months) in subsets of patients. CONCLUSIONS: CGM-centred management of glycaemic stability offers a clinically actionable paradigm shift from static, average-glucose control to dynamic, precision-guided care. The proposed three-pillar framework-tiered personalized targets, data-driven intelligent decision support and empowered patient-clinician collaboration-provides a structured roadmap grounded in current evidence. Long-term outcomes in pre-diabetes, cost-effectiveness and global accessibility remain important areas for future investigation.
AIMS: Glycaemic abnormalities during hospitalization are common and linked to morbidity and mortality, yet little is known about how deviations from guideline-recommended insulin dosing affect outcomes. The aim of this s...AIMS: Glycaemic abnormalities during hospitalization are common and linked to morbidity and mortality, yet little is known about how deviations from guideline-recommended insulin dosing affect outcomes. The aim of this study is to examine whether deviation from an expected insulin dose in non-critically ill hospitalized adults with type 2 diabetes, compared with guideline-concordant dosing, is associated with mortality, length of stay or dysglycaemias. METHODS: This retrospective cohort study included adults with type 2 diabetes hospitalized at a tertiary academic medical centre (2010-2025) who received ≥ 24 h of subcutaneous insulin. The expected total daily insulin dose (TDID) was calculated based on guideline-concordant dosing using the ADA-recommended range (0.3-0.6 units/kg/day), and the observed TDID was derived from medication records. Patients were classified as undertreated (< 0.3 units/kg/day), guideline-concordant (0.3-0.6 units/kg/day) or overtreated (> 0.6 units/kg/day). Outcomes included length of stay, and 30-day mortality, hypoglycaemia and hyperglycaemia. RESULTS: Among 3430 hospitalized adults with type 2 diabetes receiving subcutaneous insulin, 37.6% received guideline-concordant dosing, 43.7% were undertreated, and 18.7% were overtreated. Undertreatment was independently associated with increased 30-day mortality (aHR 1.273, 95% CI 1.024-1.583; p = 0.03), while overtreatment was not. Undertreated patients had more hyperglycaemia and longer hospital stays (p < 0.001), whereas hypoglycaemia rates were similar between groups. CONCLUSION: Deviation from guideline-based insulin dosing is common in hospitalized adults with type 2 diabetes. Undertreatment was associated with increased 30-day mortality and prolonged hospitalization. Monitoring insulin dose deviation may help identify patients at risk for adverse outcomes.
AIMS: Diabetes prevention programs (DPPs) that target the risk factors of type 2 diabetes (T2D) are critical for women with gestational diabetes mellitus (GDM). A new postpartum DPP developed in Toronto, Canada, has unde...AIMS: Diabetes prevention programs (DPPs) that target the risk factors of type 2 diabetes (T2D) are critical for women with gestational diabetes mellitus (GDM). A new postpartum DPP developed in Toronto, Canada, has undergone successful pilot and feasibility testing. Preparation is now underway to implement this multi-centre DPP in Ontario, Canada. We aimed to explore the perspectives and preferences of women with GDM to inform program refinements and implementation strategy design for this DPP. METHODS: We used qualitative descriptive methods to elicit the perspectives of women with GDM regarding preferences for a postpartum DPP. The results of semi-structured interviews were analyzed using directed content analysis. We mapped the resulting findings to the Capability, Opportunity, Motivation - Behavior (COM-B) Model of Behavior Change. RESULTS: We identified three findings and six sub-findings that coincided with the components and sub-components of the COM-B Model of Behavior Change: (1) Capability-(a) physical and (b) psychological, balancing the ability to make behavior changes and the emotional impact of those changes; (2) Opportunity-(a) physical and (b) social, considering physical limitations of behavior changes and participating in a community of new mothers; and (3) Motivation-(a) reflexive and (b) automatic, examining the reasons for avoiding diabetes and understanding the correlation between diet, physical activity and well-being. CONCLUSIONS: Women with GDM desire the support of a DPP to avoid diabetes that considers their unique needs. A tailored approach that accounts for the capabilities, opportunities and motivations distinct to new mothers may optimize DPP uptake and engagement.
AIMS: The type 1 diabetes population is ageing. Frailty is the age-related physiological decline that occurs across organ systems, increasing the body's vulnerability to stressors. Current consensus-based guidelines, der...AIMS: The type 1 diabetes population is ageing. Frailty is the age-related physiological decline that occurs across organ systems, increasing the body's vulnerability to stressors. Current consensus-based guidelines, derived from evidence in type 2 diabetes, prioritise hypoglycaemia avoidance, which increases falls, hospitalisation and mortality risk in older adults. This study assesses whether frailty is associated with increased hypoglycaemia in older adults with type 1 diabetes. MATERIALS AND METHODS: Participants were over 65, with type 1 diabetes, confirmed by C-peptide measurement. Frailty was categorized as robust, prefrail or frail as per Fried Frailty Phenotype (gait speed, weight loss, hand-grip strength, exhaustion and physical activity). Secondary analyses used Clinical Frailty Scale and Short Physical Performance Battery. Cognition was assessed using Montreal Cognitive Assessment score (MoCA). Blinded continuous glucose monitors (CGM), Dexcom G6/G7, were worn for 10 days. CGM metrics were compared between frailty categories, focusing on percentage time below range (%TBR). RESULTS: 83 participants met the inclusion criteria. 38 were robust (45.8%), 29 prefrail (34.9%) and 16 frail (19.3%). Frail participants were older, with more comorbidities and diabetes complications. Frailty was associated with higher HbA1c (p = 0.025) and lower MoCA scores (p = < 0.001). There was no difference between any CGM-derived glycaemic parameter across the frailty spectrum, regardless of frailty assessment used. CONCLUSIONS: While frailty is often associated with hypoglycaemia in diabetes, this was not demonstrated in our type 1 diabetes cohort. Raised HbA1c levels with frailty may reflect recommendations to relax glucose targets. However, no difference was found in %TBR with frailty.
AIMS: The Automated Insulin Delivery among Pregnant women with Type 1 diabetes (AiDAPT) trial demonstrated that using the CamAPS FX automated insulin delivery (AID) was associated with improved glycaemic outcomes. This s...AIMS: The Automated Insulin Delivery among Pregnant women with Type 1 diabetes (AiDAPT) trial demonstrated that using the CamAPS FX automated insulin delivery (AID) was associated with improved glycaemic outcomes. This study aimed to assess the clinical and economic impact of improving third-trimester HbA1c. METHODS: Using the AiDAPT data, a health economics model was built to estimate clinical outcomes and healthcare resource utilisation associated with third-trimester HbA1c categories (<42 mmol/mol, 42-53 mmol/mol, ≥53 mmol/mol). AiDAPT HbA1c distribution and associated clinical outcomes (obstetric: pre-eclampsia, delivery method; neonatal: length of stay in normal/critical/intensive care) were used to estimate perinatal complications. UK-specific healthcare costs were extracted from the NHS National Schedule and other published sources. Total costs to the UK healthcare system were estimated using an incremental 3.3 mmol/mol (0.3%) HbA1c reduction observed with CamAPS FX AID over Standard Care in AIDAPT. RESULTS: In the model, HbA1c improvement with CamAPS FX AID was associated with projected reductions in pre-eclampsia risk (-13%), high dependency neonatal care days (-16%), neonatal intensive care unit days (-12%) and clinic visits. The model projected cost reduction for the NHS healthcare system of £6,696,636 under conservative modelling assumptions, being cost saving at 96.8% of the simulations. The projected incremental cost difference per woman treated with CamAPS FX AID was -£1016, mainly derived from a modelled shift in the distribution of neonatal care, with reduced length of stay in high dependency neonatal intensive care. CONCLUSION: CamAPS FX AID improves third-trimester HbA1c with projected cost reductions for the UK healthcare system.