AIMS:Few studies have examined menopause's impact on health outcomes in women living with Type 1 diabetes mellitus (T1D). We compared physical, diabetes-related, and psychosocial outcomes between premenopausal and postmenopausal women with T1D. METHODS:A cross-sectional analysis of 211 women aged 40-60 years from the BETTER registry (121 premenopausal; 90 postmenopausal). Outcomes included physical complications (retinopathy, neuropathy, cardiovascular disease [CVD], falls), diabetes management (HbA1c, insulin doses, hypoglycemia, medication), and psychosocial outcomes (depressive symptoms, fear of hypoglycemia [FOH]). Overlap weighting balanced covariates between groups; weighted regression models estimated associations as risk ratios (RR) for binary and mean differences (MD) for continuous outcomes (95% CI). RESULTS:In weighted models, postmenopausal women had higher risks of CVD (RR 3.31 [1.07-10.23]), neuropathy (RR 2.22 [1.17-4.21]), retinopathy (RR 2.20 [1.15-4.23]), falls (RR 2.64 [1.73-4.03]), and moderate-to-severe depressive symptoms (RR 1.48 [1.01-2.17]), and lower odds of antihypertensive (RR 0.57 [0.38-0.84]) and lipid-lowering prescriptions (RR 0.68 [0.54-0.86]), and elevated diabetes distress (RR 0.80 [0.68-0.95]). Insulin doses, HbA1c, hypoglycemia frequency, and FOH did not differ. CONCLUSIONS:Postmenopausal women with T1D showed less favourable physical and psychosocial health profiles than premenopausal women, underscoring the need for prospective studies to clarify these associations.

Incorporating sex-specific factors in diabetes research and treatment is essential for advancing precision medicine. There are critical gaps in understanding and applying sex-related differences. Female-specific diabetes pathophysiology manifests in three major areas: life cycle phases (including puberty, pregnancy, and menopause), lifestyle factors (such as responses to nutrition and physical activity), and insulin pharmacology. These elements significantly affect insulin sensitivity and glycemic control in women, yet are frequently underrepresented or ignored in both research and clinical practice. Greater research and clinical focus across these domains is needed to better understand and address sex-based differences in diabetes. Identifying and filling evidence gaps will support more systematic and effective care.

The benefits of exercise and physical activity (PA) for people living with diabetes are clear. However, current exercise recommendations do not take into consideration the potential impact of female-specific hormonal changes across the lifespan on the glycemic response to exercise. Moreover, the impact of life phases on barriers to participation in exercise and PA for women compared to men with diabetes is not well described. In this narrative review we have synthesized the literature to date regarding the interaction of female sex hormone variations (menarche and the menstrual cycle, pregnancy, and the menopausal transition) with glycemic management in the context of exercise for females with type 1 and type 2 diabetes. We also evaluated PA behaviours and barriers to participation in exercise and PA among individuals with diabetes identifying as women. We observed a lack of evidence regarding the impact of female-specific hormonal changes on the glycemic response to exercise among females with diabetes, with a particular paucity of studies during pregnancy and postpartum and for the menopausal transition. In this study we demonstrate that additional research is required to understand the influence of exercise on glucose management for females with diabetes across the lifespan, with the aim to provide safe and effective exercise recommendations and to encourage equitable participation in exercise and PA for females and women with diabetes throughout life.

Objective: This study compares unregulated open-source (OS) automated insulin delivery (AID) systems and commercial-AID (C-AID) systems regarding glucose management, patient-reported outcomes (PROs), and safety among adults with type 1 diabetes (T1D). Methods: We conducted a 12-week, prospective, observational, noninferiority, comparative, real-world study involving 78 adults with T1D and having used an AID system for ≥3 months (26 OS-AID and 52 C-AID users). A total of 4-week data from a blinded continuous glucose monitor was used to assess the effectiveness in glucose management (primary outcome: 24 h time in range [TIR%] for 4 weeks, with a noninferiority margin of 5%). Results: Our study suggested that OS-AIDs were noninferior to C-AIDs regarding the 24 h TIR% (78.3% [standard deviation or SD 11.0] vs. 71.2% [SD 10.9], mean difference 7.2% [95.08% confidence interval or CI: 1.9% to 12.5%], P < 0.001), even after adjusting for various confounding factors. OS-AIDs spent more time in hypoglycemia (<3.9 mmol/L) than C-AIDs (3.9% [SD 3.1] vs. 1.8% [SD 1.3], P < 0.001) yet within the recommended range. OS-AID users reported less fear of hypoglycemia, while other PRO measures (diabetes distress, hypoglycemia awareness, sleep, fear of hypoglycemia, treatment satisfaction, and overall quality of life) were not different between groups. No severe hypoglycemia or diabetic ketoacidosis was reported in either group, with a similar occurrence rate of technical issues during the 12-week study period. Conclusions: OS-AIDs are safe and noninferior to C-AIDs for TIR% among adults with T1D in real-world settings. Both OS-AID and C-AID systems can be considered for T1D management.

Aims:The prevalence of overweight and obesity in people with type 1 diabetes has increased significantly, presenting additional psychosocial challenges that vary by gender. This study investigates the relationship between BMI and psychosocial outcomes in adult men and women with type 1 diabetes. Methods:This cross-sectional analysis used data from people with type 1 diabetes in the BETTER registry, stratified by gender and categorized into BMI groups (<25, 25-29.9, ≥ 30 kg/m2). Psychosocial outcomes included depression, diabetes distress, and stigmatization related to diabetes. One-way ANOVA assessed differences between BMI groups by gender. Multivariable logistic regression then analyzed gender differences within each BMI group, adjusting for age and HbA1c. Results:Among 1028 participants (66 % women, mean BMI 26.4 ± 5.1 kg/m2, mean age 45.4 ± 15.0 years), 460 adults (45 %) had a BMI < 25, 356 (35 %) between 25-29.9, and 212 (21 %) ≥ 30 kg/m2. Women in the ≥ 30 kg/m2 group, compared to the < 25 kg/m2 group, had more symptoms of depression, more drug prescriptions for depression/anxiety, and higher diabetes distress (p < 0.001 for all). In men, psychosocial outcomes did not differ significantly across BMI groups. Multivariable regression showed women were more likely than men to report prescriptions for depression/anxiety and high diabetes distress, particularly in the higher BMI groups. Conclusions:In adults living with type 1 diabetes, higher BMI is associated with adverse psychosocial outcomes, particularly in women. Gender-specific interventions addressing mental health, stigma, and weight management could be beneficial to improve overall well-being.

People living with cystic fibrosis (pwCF) homozygous for F508del present more severe phenotypes. PwCF with compound heterozygous genotypes F508del /A455E and F508del /L206W may have milder cystic fibrosis (CF) phenotypes. We compared F508del homozygotes and common compound heterozygotes (F508del and a second pathogenic variant) in adult patients. Nutritional, pulmonary function and glucose homeostasis indices data were collected from the prospective Montreal CF cohort. Two-hundred and three adults with CF having at least one F508del variant were included. Individuals were divided into subgroups: homozygous F508del/F508del (n=149); F508del/621+1G>T (n=17); F508del/711+1G>T (n=11); F508del/A455E (n=12); and F508del/L206W (n=14). Subgroups with the F508del/L206W and F508del/A455E had a lower proportion with pancreatic exocrine insufficiency (p<0.0001), a higher fat mass (p<0.0001), and lower glucose area under the curve (AUC) (p=0.027). The F508del/L206W subgroup had significantly higher insulin secretion (AUC; p=0.027) and body mass index (p<0.001). Pulmonary function (FEV1) was significantly higher for the F508del/L206W subgroup (p<0.0001). Over a median of 7.37 years, the risk of developing CFRD in 141 patients was similar between groups. PwCF with heterozygous F508del/L206W and F508del/A455E tended to have pancreatic exocrine sufficiency, better nutritional status, improved pulmonary function and better diabetogenic indices, but this does not translate into lower risk of CF-related Diabetes.

Introduction & Objective: Although the association between psychosocial outcomes and a higher BMI is well known in the general population, there are few studies among people living with type 1 diabetes (PwT1D). The aim of this study is to investigate the associations between psychosocial outcomes and BMI groups or waist circumference (WC), for men and women. Methods: A cross-sectional analysis of the BETTER registry based on patient-reported outcomes of adult PwT1D (BMI n=1028; WC n=435) stratified by gender and classified into three BMI groups: <25 (Group A); 25-29 (Group B); ≥30 (Group C) kg/m2 and WC groups: <88/<102 and ≥88/≥102cm (women/men respectively). Student’s T-tests, one-way ANOVAs, and χ2 logistic regression searched for associations between BMI or WC groups and psychosocial outcomes: depression, diabetes distress (DD), and diabetes-related stigmatization. Results: Of the 1028 PwT1D, 66% were women and the average BMI, WC, age, T1D duration were: 26 kg/m2, 92 cm, 45 years, and 24 years, respectively. For BMI classes, 460 adults (45%) were in group A, 356 (35%) group B, and 212 (21%) group C. Women in group C, compared to group A, had more symptoms of depression (p<0.001), more prescriptions for depression (p<0.001), and reported higher DD (p<0.001). Women in group B and C reported feeling more stigmatized due to their diabetes (p<0.001) than those in group A. There were no differences between BMI classes in men, and they reported fewer symptoms of depression and lower DD and diabetes stigmatization than women. In women, 148 (52%) had a WC <88 and 135 (48%) ≥88 cm, while 104 men (68%) had a WC <102 and 48 (32%) ≥102 cm. There were no differences between WC groups in women. Compared to the WC<102 group, men with a WC≥102 cm had more symptoms of depression and more prescriptions for depression (p<0.016). Conclusion: In adult PwT1D, less favorable psychosocial outcomes are associated with a BMI ≥30 kg/m2 in women and WC ≥102 cm in men. A. Bonhoure: Consultant; Dexcom, Inc. M. Lalanne-Mistrih: Other Relationship; Novo Nordisk, SANOFI AVENTIS FRANCE, ViiV Health Care, SOS Oxygene Antilles, MEDICALIA, SEPRODOM Antilles, DINNO SANTE. M.K. Talbo: None. V. Boudreau: None. V. Messier: None. A. Bandini: None. L. Secours: None. M. Payette: None. S. Fontaine: None. A. Brazeau: Other Relationship; Dexcom, Inc. Research Support; Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation (JDRF), Diabète québec, Fonds de recherche du Québec en Santé. R.P.R. Rabasa-Lhoret: Other Relationship; Abbott, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Dexcom, Inc. Research Support; Diabetes Canada. Other Relationship; Eli Lilly and Company. Research Support; Cystic Fibrosis Canada, Canadian Institutes of Health Research, FFRD - Fondation Francophone pour la Recherche du Diabète. Other Relationship; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Other Relationship; Novo Nordisk, GlaxoSmithKline plc. Consultant; HLS Therapeutics Inc., Insulet Corporation. Speaker's Bureau; CPD Networks. Other Relationship; Medtronic. Consultant; Pfizer Inc. Speaker's Bureau; Tandem Diabetes Care, Inc. Other Relationship; Sanofi. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; SFD - Société Francophone du Diabète.

ABSTRACTAimsThe prevalence and associations of overweight and obesity in Canadian adult people living with type 1 diabetes (PWT1D) are poorly documented. In a cohort of PWT1D patients, this study assesses (i) overweight and obesity frequencies and associated PWT1D clinicodemographic characteristics, (ii) diabetes characteristics, and (iii) the use of noninsulin adjunctive agents.Materials and MethodsCross‐sectional analysis of self‐reported data from the BETTER registry: 1091 adult PWT1D (aged 44.4 ± 15.0 years; 32% HbA1c<7% [53 mmol/mol]) classified by BMI classes: underweight combined with normal weight, overweight, or obesity. Bivariate analyses were used to identify associations between BMI classes, diabetes characteristics, complications, and treatments.ResultsOverweight and obesity affected 34.6% and 19.8% of participants. Compared to underweight + normal weight, PWT1D with overweight/obesity was associated with male sex, higher age, lower education level, longer diabetes duration, and higher total insulin doses and use of cardiorenal therapies (all p < 0.001). Compared to other PWT1D, those living with obesity reported higher HbA1c (p < 0.05), less frequent hypoglycemia (p < 0.05), more cardiovascular diseases (p < 0.003), retinopathy, neuropathy, depression treatment as well as noninsulin adjunctive agent use (all p < 0.001). Logistic regression showed that living with overweight/obesity was associated with male sex, being treated for cardiorenal therapies, depression, diabetes duration, and total daily insulin doses.ConclusionsOverweight or obesity affects over half of adult PWT1D in the Canadian BETTER registry and is associated with higher HbA1c levels, higher total daily insulin doses, more chronic diabetes complications and noninsulin adjunctive agent use, a worse cardiometabolic profile, and lower hypoglycemia frequency.

BACKGROUND & AIMS:Cystic fibrosis (CF)-related diabetes (CFRD), a common comorbidity in CF, is often preceded and characterized with elevated postprandial glycemic (PPG) excursions. In the general population, the consumption of a pre-meal protein snack and/or physical activity (PA) hinder the elevation of PPG levels. Our objective is to evaluate the effect of a pre-meal snack and/or post-meal PA on PPG excursions in CF. METHODS:This is a double-blinded randomized controlled crossover interventional study in 14 adults with CF, with 4 interventions: placebo pre-meal snack + no PA (control: CTL), pre-meal soy snack + no PA (SK), placebo pre-meal snack + PA (PA), and pre-meal soy snack + PA (SK + PA). The pre-meal soy snack or placebo beverage (vanilla flavoured water) is served at 8 AM, followed by a standardized breakfast at 9 AM and, postprandially, 5 repeated bouts of 3-min walk every 30 min or sedentary activity. Blood glucose and insulin were measured every 15-30 min during the interventions. RESULTS:Plasma glucose (PG) was higher 30 min after snack consumption compared to placebo beverage. One-hour post-breakfast, PG levels were lower during both PA interventions than with sedentary behavior. However, the overall 3 h post-breakfast glucose area under the curve (AUC) was similar between interventions. Post-breakfast 3 h insulin AUC was significantly lower during the SK + PA intervention compared to the sedentary behavior interventions. CONCLUSION:Repeated short bouts of post-meal physical activity may positively impact PPG control in adults with CF, with or without the addition of a pre-meal soy snack. A pre-meal snack alone does not improve PPG.

Purpose of Review Maintaining positive health behaviours promotes better health outcomes for people with type 1 diabetes (T1D). However, implementing these behaviours may also lead to additional management burdens and challenges. Diabetes technologies, including continuous glucose monitoring systems, automated insulin delivery systems, and digital platforms, are being rapidly developed and widely used to reduce these burdens. Our aim was to review recent evidence to explore the influence of these technologies on health behaviours and well-being among adults with T1D and discuss future directions. Recent Findings Current evidence, albeit limited, suggests that technologies applied in diabetes self-management education and support (DSME/S), nutrition, physical activity (PA), and psychosocial care areas improved glucose outcomes. They may also increase flexibility in insulin adjustment and eating behaviours, reduce carb counting burden, increase confidence in PA, and reduce mental burden. Summary Technologies have the potential to promote health behaviours changes and well-being for people with T1D. More confirmative studies on their effectiveness and safety are needed to ensure optimal integration in standard care practices.

The relative contributions of insulin secretory defects and insulin resistance to cystic fibrosis-related diabetes (CFRD) are poorly understood. We have previously characterized a low insulinogenic index is a risk factor for the progression to CFRD. We aimed to 1) determine which indices of insulin resistance predict progression to CFRD, and 2) to model the relative contributions of insulin secretory function and insulin resistance to the risk of CFRD.

Introduction & Objective: In females living with T1D (FwT1D), the impact of the menstrual cycle on glucose fluctuations is not well known. Our aim is to examine the relationship between the menstrual cycle phases, glycemic fluctuations and insulin needs in FwT1D. Methods: This is a preliminary analysis of observational data over 3 menstrual cycles in eumenorrheic FwT1D. The menstrual cycle was split into 3 phases: follicular, periovulatory, and luteal phases. Included participants (n=15) shared their CGM and daily insulin (total, basal and bolus) data. CGM data were used to calculate mean glucose, coefficient of variance (CV), and time below (TBR), in (TIR), and above (TAR) range. One-way repeated-measures ANOVAs with Bonferroni post-hoc tests were used to compare glycemia, glycemic variation and insulin doses across the 3 menstrual cycle phases. Results: Of the 15 FwT1D, 14 (93%) did not use hormonal contraception. Participants were (mean ± SD) 37.2 ± 5.9 years old, with a BMI of 25.7 ± 4.6 kg/m2, an HbA1c of 6.5 ± 0.7%, and diabetes duration of 19.3 ± 10.6 years. Glycemic and insulinemic data across the 3 cycle phases can be found in Table 1. Conclusion: In FwT1D, the luteal phase of the menstrual cycle is associated with higher glucose levels, more time spent in hyperglycemia, and greater insulin needs compared to the follicular and periovulatory phases. Disclosure A. Bonhoure: Consultant; Dexcom, Inc. J.E. Yardley: Speaker's Bureau; Dexcom, Inc. Research Support; LifeScan Diabetes Institute. V. Boudreau: None. V. Messier: None. E. Nguyen: None. A. Brazeau: Other Relationship; Dexcom, Inc. Research Support; Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation (JDRF), Diabète québec, Fonds de recherche du Québec en Santé. R.P.R. Rabasa-Lhoret: Other Relationship; Abbott, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Dexcom, Inc. Research Support; Diabetes Canada. Other Relationship; Eli Lilly and Company. Research Support; Cystic Fibrosis Canada, Canadian Institutes of Health Research, FFRD - Fondation Francophone pour la Recherche du Diabète. Other Relationship; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Other Relationship; Novo Nordisk, GlaxoSmithKline plc. Consultant; HLS Therapeutics Inc., Insulet Corporation. Speaker's Bureau; CPD Networks. Other Relationship; Medtronic. Consultant; Pfizer Inc. Speaker's Bureau; Tandem Diabetes Care, Inc. Other Relationship; Sanofi. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; SFD - Société Francophone du Diabète.

Background Adult people living with Cystic Fibrosis (CF) undergo annual screening for CF-related diabetes. These tests represent a burden and can lead to undesirable effects resulting in low adherence. The objectives of this study were to 1) compare gold-standard in-hospital oral glucose tolerance testing (OGTT) with at-home options, and 2) evaluate acceptability of at-home options. Methods A total of 34 adults living with CF undertook 3 types of OGTTs in standardized conditions within two weeks: 1) in a hospital using a 75 g glucose beverage, 2) at home with the same glucose beverage, and 3) at home using a standardized quantity of candy. Glucose levels were measured prior to the OGTT, after 1 and 2 hours. Concordance of glucose measurement, side effects and general appreciation were assessed across the three options. Results Mean blood glucose was comparable among the three tests. Glucose tolerance categorization (normal, impaired glucose tolerance, or diabetes) was concordant with the hospital reference test in 59 % of participants for the glucose beverage and 75 % for the candies. Side effects were mild with all types of OGTTs, and 94 % of participants preferred the home options. Among the at-home OGTTs, the glucose beverage was preferred to the candy option. Conclusions Home-based OGTT could be an alternative to gold standard hospital-based OGTT testing, improving adherence to annual testing and reducing costs. However, the discrepancy between various OGTT testing methods could lead to diagnosis dilemma. This approach should be tested on a larger sample size.

We aim to compare Health Canada approved commercial automated insulin delivery (AID) systems with unregulated open-source do-it-yourself (DIY)-AID systems for glucose management among adult people with type 1 diabetes (PWT1D) in real-life conditions.

Objectives: Our aim in this study was to identify challenges and gaps in Canadian practices in screening, diagnosis, and treatment of cystic fibrosis-related diabetes (CFRD), with the goal of informing a Canadian-specific guideline for CFRD. Methods: We conducted an online survey of health-care professionals (97 physicians and 44 allied health professionals) who care for people living with CF (pwCF) and/or CFRD (pwCFRD). Results: Most pediatric centres followed <10 pwCFRD and adult centres followed >10 pwCFRD. Children with CFRD are usually followed at a separate diabetes clinic, whereas adults with CFRD may be followed by respirologists, nurse practitioners, or endocrinologists in a CF clinic or in a separate diabetes clinic. Less than 25% of pwCF had access to an endocrinologist with a special interest or expertise in CFRD. Many centres perform screening oral glucose tolerance testing with fasting and 2-hour time points. Respon-dents, especially those working with adults, also indicate use of additional tests for screening not currently recommended in CFRD guidelines. Pediatric practitioners tend to only use insulin to manage CFRD, whereas adult practitioners are more likely to use repaglinide as an alternative to insulin. Conclusions: Access to specialized CFRD care may be a challenge for pwCFRD in Canada. There appears to be wide heterogeneity of CFRD care organization, screening, and treatment among health-care providers caring for pwCF and/or pwCFRD across Canada. Practitioners working with adult pwCF are less likely to adhere to current clinical practice guidelines than practitioners working with children.(c) 2023 Canadian Diabetes Association.

Objective: Measures of stimulated insulin secretion are emerging as important predictors of diabetes mel-litus in at-risk populations. We analyzed the utility of clinical estimates of insulin secretion in a prospec-tive cohort at risk for cystic fibrosis-related diabetes (CFRD).Methods: We divided the profiles of 189 people with CF (pwCF) followed longitudinally in the Montreal CF cohort (mean follow up 6.6 +/- 1.2 years) according to quartiles of the insulinogenic index (IGI; (I 30 -I0)/(G30-G0)); area under the curve for insulin normalized for glucose (AUCins/glu), and HOMA-B at baseline to compare clinical characteristics and risk of CFRD according to quartiles for each measure. We also compared characteristics of 40 pwCF found to have de novo CFRD at baseline.Results: At baseline, IGI and AUCins/glu were lower in subjects with de novo CFRD and those who later developed CFRD than those who never developed CFRD ( p < 0.0 0 01 for each). Subjects with the low-est quartiles of IGI, AUCins/glu, and AUCins/glu 0-30 had increased risk of developing CFRD by Kaplan-Meier analysis ( p = 0.0244, p = 0.0024, and p = 0.0338, respectively). There was no significant difference in risk between quartiles of HOMA-B. Subjects in the lowest quartile of IGI showed a significant increase in 2-hour OGTT glucose and AUCglu between the initial and final study visits ( p = 0.0027 and p = 0.0044, respectively).Conclusion: IGI is easily measured in a clinical setting and needs to be validated in prospective studies as a potential tool to improve risk stratification in CFRD with direct relevance to pathogenesis.(c) 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

OBJECTIVES:The classical glycosylated hemoglobin A1c threshold of 6.5% is an insensitive screening test for cystic fibrosis-related diabetes (CFRD). We sought to identify CF-specific A1C thresholds associated with 1) risk of progression to CFRD and 2) changes in body mass index (BMI) and forced expiratory volume (FEV1). METHODS:We studied the cross sectional and longitudinal associations between A1c, BMI, and FEV1 in 2 cohorts of 223 children (followed for up to 8 years) and 289 adults (followed for a mean of 7.5 ± 4.3 years) with CF but without diabetes at baseline and undergoing regular assessments including Oral Glucose Tolerance Test (OGTT). RESULTS:For the onset of OGTT-defined CFRD optimal A1c threshold was 5.9% in adults (sensitivity: 67% and specificity: 71%) and 5.7% for children (sensitivity: 60% and specificity: 47%). Kaplan-Meier analysis of progression to CFRD according to baseline A1C showed increased the risk of developing CFRD for A1c ≥ 6.0% in adults (P = 0.002) and ≥ 5.5% in children (p = 0.012). Temporal changes in BMI and FEV1 according to baseline A1C in adults were assessed with a linear mixed-effect model, BMI significantly increased over time in subjects with a baseline A1c < 6%, but those with a A1C ≥ 6.0% gained significantly less weight over time (P = 0.05). There was no difference in FEV1 according to baseline A1c category. CONCLUSION:An A1C above 6% may be associated with a high risk of developing CFRD and a lower probability of weight gain in both adults and children with CF.