BACKGROUND:Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases in Sweden. Continuous glucose monitoring (CGM) is an increasingly important alternative to self-monitoring of blood glucose (SMBG), particularly for people receiving insulin. OBJECTIVES:To summarize the evidence for CGM in insulin-treated T2DM and conduct a policy landscape analysis of national and local guidelines to explore access to CGM in Sweden relative to other countries. METHODS:A scoping review was conducted to identify evidence on the clinical, patient, and economic value of CGM, supplemented with searches of Swedish and European guidelines. Current recommendations for CGM in T2DM in Sweden were compared with European-wide and country-specific recommendations. Regional recommendations and funding processes within Sweden were reviewed to examine heterogeneity in local access to CGM. RESULTS:Across international and Swedish studies, CGM was associated with improved clinical outcomes compared with SMBG, both for people with intensive insulin-treated T2DM and those on basal insulin only. The clinical benefits likely translate into fewer long-term diabetes complications and reduced resource utilization and budget impact versus SMBG. Health economic evaluations show that CGM can be considered a cost-effective intervention for all individuals treated with insulin in Sweden. European-wide guidance supports consideration of CGM for all insulin-treated individuals, but access in Sweden remains limited outside of the high-risk intensive insulin-treated population. This is exacerbated by regional heterogeneity in access, which partly stems from the attribution of budget responsibility to individual primary care units. CONCLUSIONS:The benefits associated with CGM show that an expansion of the Swedish recommendations to cover all insulin-treated people with T2DM is warranted. Persistent regional disparities must be addressed to ensure equitable access to care for people with T2DM in Sweden. The establishment of dedicated funding mechanisms within primary care should be considered to promote more equitable and sustainable access.

BACKGROUND:Automated insulin delivery (AID) systems integrate continuous glucose monitoring (CGM) and insulin pumps with algorithms that adjust insulin delivery. While randomized controlled trials (RCTs) demonstrate improvements in glycemic outcomes with AID, large-scale real-world data (RWD) analyses are needed to evaluate performance in routine care. METHODS:This retrospective, registry-based cohort study included adults (≥18 years) with type 1 diabetes (T1D) in the Swedish National Diabetes Register (NDR) from 2014 to 2024. Hemoglobin (Hb)A1c values were averaged per person-year and aggregated by clinic. Insulin delivery/glucose monitoring combinations included multiple daily injections (MDIs) with blood glucose meter (MDI-BG), MDI with CGM (MDI-CGM, reference), conventional continuous subcutaneous insulin infusion with blood glucose meter (CSII-BG), CSII with CGM (CSII-CGM), and AID systems (Tandem Control-IQ technology, Medtronic 670G, and Medtronic 780G). Mixed-model regression assessed HbA1c outcomes, with treatment, year, age, diabetes duration, gender, body mass index, physical activity level, smoking habits, and clinic size as fixed effects; with random effects for clinics; and weighting by clinic sample size. RESULTS:After adjusting for the covariates, AID systems were associated with significantly lower HbA1c compared with MDI-CGM: β = -4.0 mmol/mol (95% confidence interval [CI] -4.3 to -3.7, P < 0.001), with individual system effects, Tandem Control-IQ technology β = -4.8 mmol/mol (95% CI -5.2 to -4.5, P < 0.001), Medtronic 780G β = -3.1 (-3.5 to -2.7, P < 0.001), and Medtronic 670G β = -2.9 (95% CI -3.5 to -2.4, P < 0.001). CSII-CGM also outperformed MDI-CGM: β = -1.7 mmol/mol (95% CI -1.9 to -1.4, P < 0.001). Differences between the Tandem and Medtronic AID systems were significant (P < 0.001). CONCLUSIONS:In a nationwide RWD analysis, AID use was consistently associated with clinically and statistically significant HbA1c reductions in adults with T1D, with the greatest effect for Tandem Control-IQ technology. These findings align with RCTs and international RWD, supporting AID as a preferred technology in routine diabetes care for T1D.

OBJECTIVES:To explore dietary intake, diet-related challenges in glucose management and perceived needs for dietary support among Swedish adults with type 1 diabetes (T1D). DESIGN:Cross-sectional observational study based on an electronic survey that included the validated Meal-Q food frequency questionnaire and additional questions on dietary habits and management. Participant characteristics were retrieved from the Swedish National Diabetes Register. Descriptive and correlation analyses were conducted. SETTING:Three diabetes specialist clinics in Sweden. PARTICIPANTS:375 adults with T1D. MAIN OUTCOME MEASURES:Dietary intake and diet-related challenges in glucose management. RESULTS:A total of 191 persons (mean age 48 years; 48% female) consented to participate. The mean (SD) glycated haemoglobin A1c was 56 (13) mmol/mol, mean glucose 8.8 (2.2) mmol/L, time in range (TIR) 64% (18%) and BMI 27 (4.3) kg/m²; 41% used insulin pumps. Mean carbohydrate intake was 183 g/day (41% of energy, E%). Fibre intake was 23 g/day (3.1 g/MJ), and saturated fat intake was 29 g/day (15 E%), both inconsistent with dietary recommendations. About half (51%) found carbohydrate counting challenging, with 53% estimating carbohydrate intake visually and only 18% using advanced methods. Additionally, 48% reported reducing carbohydrate intake, and 61% avoided certain carbohydrate-rich foods due to glucose management difficulties. Approximately 40% of participants reported insufficient dietary guidance from their healthcare providers since diagnosis, 33% expressed interest in further dietitian support and 39% believed dietary changes could improve glucose control. CONCLUSIONS:Participants reported lower fibre intake and higher saturated fat intake compared with dietary guidelines. Many found carbohydrate counting and carbohydrate-rich meals challenging. One-third expressed a wish for additional dietary support. These findings highlight the importance of improving access to tailored dietary counselling in routine T1D care.

Objectives With as few as 5% of available medications being adequately monitored, tested and labelled with safety information for use in breastfeeding women there is a great need to monitor and evaluate the potential risk of transfer of medicines to the infant. We demonstrate here how a low-intervention clinical trial may be designed in order to provide evidence of transfer.   The primary objective of this demonstration study is to determine the concentration of metformin in the plasma of breastfed infants to lactating women being treated for type 2 diabetes. The secondary objective is to determine the concentration of metformin in breast milk and maternal plasma and the milk-to-plasma ratio of the mothers and to calculate the average daily infant dose (ADID) and relative infant dose (RID).   Methods The study has a low intervention clinical trial design in the sense that breast milk and blood will be collected merely to study excretion of metformin into breastmilk and transferal to her child. Participation in the study will not decide or in any other way interfere with patients’ treatment as prescribed by their physician. Only patients that already have been assigned treatment with metformin by their physician will be approached and asked for participation. All procedures for blood collection will follow established clinical routines at the clinical sites. The sampling will take place ≈ 6-8 weeks postpartum.    Results Up to date (13 March) 18 women and infants have been recruited and sampled. Recruitment is ongoing.    Conclusions An evaluation of pharmacokinetic results as well as clinical experiences related to recruitment and sampling will be systematically conducted upon completion of the study, which is estimated to conclude by the end of 2025. Preliminary experiences suggest that the primary challenge for a study of this nature is recruiting a sufficient number of participants. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial The clinical trial protocol is available via the Clinical Trial Information System at the European Medicine Agency (No. 2022-501693-19-00). ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study has been approved as a low-intervention clinical trial by the Swedish Medical Product Agency (Publicly available in CTIS (EU CT no. 2022-501693-19-00 and registered in EUPAS 105190) which includes an approval by the Swedish Ethical Review Authority. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

Background: People with type 1 diabetes generally view it easier to exercise when having continuous information of the glucose levels. We evaluated whether patients with type 1 diabetes managed with multiple daily insulin injections (MDI) exercised more after initiating continuous glucose monitoring (CGM) and whether the improved glycemic control and well-being associated with CGM translates into improved blood lipids and markers of inflammation. Method: The GOLD trial was a randomized cross-over trial over 16 months where patients used either CGM or capillary self-monitoring of blood glucose (SMBG) over six months, with a four-month wash-out period between the two treatment periods. We compared grade of physical activity, blood lipids, apolipoproteins, and high-sensitivity C-reactive protein (hsCRP) levels during CGM and SMBG. Results: There were 116 patients with information of physical activity estimated by the International Physical Activity Questionnaire (IPAQ) during both CGM and SMBG. No changes were found during CGM or SMBG, IPAQ scores 3305 versus 3878 ( P = .16). In 136 participants with information of blood lipid levels with no change in lipid-lowering medication during the two treatment periods, HbA1c differed by 4.2 mmol/mol (NGSP 0.39%) between SMBG and CGM treatment ( P < .001). No significant changes existed in low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B1, or hsCRP, during CGM and SMBG. Conclusion: Although many patients experience it easier to perform physical activity when monitoring glucose levels with CGM, it does not influence the amount of physical activity in persons with type 1 diabetes. Blood lipids, apolipoprotein, and hsCRP levels were similar during CGM and SMBG.

Previous studies have shown that individuals with similar mean glucose levels (MG) or percentage of time in range (TIR) may have different HbA1c values. The aim of this study was to further elucidate how MG and TIR are associated with HbA1c. Data from the randomised clinical GOLD trial (n=144) and the follow-up SILVER trial (n=98) of adults with type 1 diabetes followed for 2.5 years were analysed. A total of 596 paired HbA1c/continuous glucose monitoring measurements were included. Linear mixed-effects models were used to account for intra-individual correlations in repeated-measures data. In the GOLD trial, the mean age of the participants (± SD) was 44±13 years, 63 (44

Aim: To evaluate whether both bolus insulin injection frequency and smart pen engagement were associated with changes in glycaemic control, using real-world data from adults with type 1 diabetes (T1D).Materials and methods: Adults using a smart pen (NovoPen 6) to administer bolus insulin (fast-acting insulin aspart or insulin aspart) alongside continuous glucose monitoring were eligible for inclusion. Smart pen engagement was characterized by number of days with pen data uploads over the previous 14 days. Glycaemic control was evaluated by analysing glucose metrics.Results: Overall, data from 1194 individuals were analysed. The number of daily bolus injections was significantly associated with time in range (TIR; 3.9-10.0 mmol/L [70-180 mg/dL]; P < 0.0001). Individuals administering, on average, three daily bolus insulin injections had an estimated 11% chance of achieving >70% TIR. The probability of achieving >70% TIR increased with the mean number of daily bolus injections. However, the percentage of TIR was lower on days when individuals administered higher-than-average numbers of injections. The observed mean number of daily bolus injections administered across the study population was lower than the optimal number required to reach glycaemic targets (4.8 injections vs. 6-8 injections). Smart pen engagement was significantly associated with improved TIR.Conclusions: Glycaemic control was associated with daily bolus insulin injection frequency and smart pen engagement. A treatment regimen combining an optimal bolus injection strategy, and effective smart pen engagement, may improve glycaemic control among adults with T1D.

Background: The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. Methods: The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R-2-decomposition was used to understand which variables contributed most to treatment satisfaction. Results: A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. Conclusions: While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.

IntroductionTo improve the utilization of continuous- and flash glucose monitoring (CGM/FGM) data we have tested the hypothesis that a machine learning (ML) model can be trained to identify the most likely root causes for hypoglycemic events.MethodsCGM/FGM data were collected from 449 patients with type 1 diabetes. Of the 42,120 identified hypoglycemic events, 5041 were randomly selected for classification by two clinicians. Three causes of hypoglycemia were deemed possible to interpret and later validate by insulin and carbohydrate recordings: (1) overestimated bolus (27%), (2) overcorrection of hyperglycemia (29%) and (3) excessive basal insulin presure (44%). The dataset was split into a training (n = 4026 events, 304 patients) and an internal validation dataset (n = 1015 events, 145 patients). A number of ML model architectures were applied and evaluated. A separate dataset was generated from 22 patients (13 'known' and 9 'unknown') with insulin and carbohydrate recordings. Hypoglycemic events from this dataset were also interpreted by five clinicians independently.ResultsOf the evaluated ML models, a purpose-built convolutional neural network (HypoCNN) performed best. Masking the time series, adding time features and using class weights improved the performance of this model, resulting in an average area under the curve (AUC) of 0.921 in the original train/test split. In the dataset validated by insulin and carbohydrate recordings (n = 435 events), i.e. 'ground truth,' our HypoCNN model achieved an AUC of 0.917.ConclusionsThe findings support the notion that ML models can be trained to interpret CGM/FGM data. Our HypoCNN model provides a robust and accurate method to identify root causes of hypoglycemic events.

Background The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders. Aim The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs. Method and material In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed. Results Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’. Conclusion Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

This study utilized continuous glucose monitoring data to analyze the effects of switching to treatment with fast-acting insulin aspart (faster aspart) in adults with type 1 diabetes (T1D) in clinical practice. A noninterventional database review was conducted in Sweden among adults with T1D using multiple daily injection (MDI) regimens who had switched to treatment with faster aspart as part of basal-bolus treatment. Glycemic data were retrospectively collected during the 26 weeks before switching (baseline) and up to 32 weeks after switching (follow-up) to assess changes in time in glycemic range (TIR; 70–180 mg/dL), mean sensor glucose, glycated hemoglobin (HbA1c) levels, coefficient of variation, time in hyperglycemia (level 1, > 180 to ≤ 250 mg/dL; level 2, > 250 mg/dL), and time in hypoglycemia (level 1, ≥ 54 to < 70 mg/dL; level 2, < 54 mg/dL) (ClinicalTrials.gov Identifier NCT03895515). Overall, 178 participants were included in the study cohort. The analysis population included 82 individuals (mean age 48.5 years) with adequate glucose sensor data. From baseline to follow-up, statistically significant improvements were reported for TIR (mean increase 3.3

Objective: Continuous Glucose Monitoring (CGM) reduces HbA1c and timespent in hypoglycemia in persons with type 1 diabetes treated with multipledaily insulin injections (MDI) when evaluated over shorter time periods. It isunclear to what extent CGM improves and helps to maintain glucose control,treatment satisfaction, diabetes distress, hypoglycemic concerns and overallwell-being over longer periods of timeResearch design and methods: The GOLD trial was a randomized crossover trialperformed over 16 months of CGM treatment in persons with type 1 diabetes treatedwith MDI. Persons completing the trial (n=141) were invited to participate inthe current SILVER extension study in which 107 patients continued CGMtreatment over 1 year along with the support of a diabetes nurse every 3months. Results: The primary endpoint, change in HbA1c over 1.0-1.5 years CGMuse compared with previous self-monitoring of blood glucose (SMBG) during GOLD,showed a decrease in HbA1c of 0.35% (95% CI 0.19-0.50), p<0.001. Time spentin hypoglycemia <3.0 mmol/l (54 mg/dl) and <4.0 mmol/l (72 mg/dl)decreased from 2.1% to 0.6% (p<0.001) and from 5.4% to 2.9% (p<0.001),respectively. Overall well-being (WHO-5, p=0.009), treatment satisfaction(DTSQ, p<0.001) and hypoglycemic confidence (p<0.001) increased, whilehypoglycemic fear (HFS-Worry, p=0.016) decreased and diabetes distress tendedto decrease (PAID, p=0.06). Fromrandomization and screening in GOLD, HbA1c was lowered by 0.45% (p<0.001)and 0.68% (p<0.001) after 2.3 and 2.5 years, respectively. Conclusions: The SILVER study supports beneficial long-term effects from CGM onHbA1c, hypoglycemia, treatment satisfaction, well-being and hypoglycemicconfidence in persons with T1D managed with MDI.

Aim To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. Materials and Methods We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (>4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. Results Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = -0.52; P < .0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% (>4.7 mmol/mol) than with self-measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% (>4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L (P = .016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire. Conclusion The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision-makers for reimbursement and diabetes guidelines.

Background: This observational study investigated whether the connected NovoPen(R) 6 could influence insulin regimen management and glycemic control in people with type 1 diabetes (T1D) using a basal-bolus insulin regimen and continuous glucose monitoring in a real-world setting. Methods: Participants from 12 Swedish diabetes clinics downloaded pen data at each visit (final cohort: n = 94). Outcomes included time in range (TIR; sensor glucose 3.9-10.0 mmol/L), time in hyperglycemia (>10 mmol/L), and hypoglycemia (L1: 3.0- <3.9 mmol/L; L2: <3.0 mmol/L). Missed bolus dose (MBD) injections were meals without bolus injection within -15 and +60 min from the start of a meal. Outcomes were compared between the baseline and follow-up periods (>= 5 health care professional visits). Data were analyzed from the first 14 days following each visit. For the TIR and total insulin dose analyses (n = 94), a linear mixed model was used, and for the MBD analysis (n = 81), a mixed Poisson model was used. Results: TIR significantly increased (+1.9 [0.8; 3.0](95% CI) h/day; P < 0.001) from baseline to follow-up period, with a corresponding reduction in time in hyperglycemia (-1.8 [-3.0; -0.6](95% CI) h/day; P = 0.003) and L2 hypoglycemia (-0.3 [-0.6; -0.1](95% CI) h/day; P = 0.005), and no change in time in L1 hypoglycemia. MBD injections decreased by 43% over the study (P = 0.002). Change in MBD injections corresponded to a decrease from 25% to 14% based on the assumption that participants had three main meals per day. Conclusions: Our study highlights the potential benefit on glycemic control and dosing behavior when reliable insulin dose data from a connected pen contribute to insulin management in people with T1D.

Objective:According to recent guidelines, individuals with type 1 diabetes shouldspend less than 4.0% per day with glucose levels <3.9 mmol/L (<70 mg/dL)and less than 1.0% per day <3.0 mmol/L (<54 mg/dL). Research methods: In the GOLD randomised cross-over trial,161 individuals with type 1 diabetes treated with multiple daily insulininjections (MDI) were randomised to Continuous Glucose Monitoring (CGM) orconventional therapy with self-monitoring of blood glucose (SMBG) and evaluatedover 16 months. We estimated the association between time spent inhypoglycaemia and various mean glucose and HbA1c levels. Results:Time spent in hypoglycaemia (<3.9 mmol/L and <3.0 mmol/L)increased significantly with lower mean HbA1c and mean glucose levels duringboth CGM and conventional therapy. During CGM, 24 (57.1%) individuals withHbA1c <7.5 % (<58 mmol/mol) had <1.0% time spent in hypoglycaemia<3.0 mmol/L and 23 (54.8%) had <4.0% time spent in hypoglycaemia <3.9 mmol/L.During CGM, mean time spent in hypoglycaemia for individuals with mean HbA1c7.0% (52 mmol/mol) was estimated to be 5.4% for <3.9 mmol/L and 1.5% for<3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%,respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% moretime with glucose levels <3.9 mmol/L and 2.8% more time <3.0 mmol/Lduring SMBG compared with CGM. Conclusions:Reaching current targets for time in hypoglycaemia and at the same timeHbA1c targets is challenging for type 1 diabetes patients treated with MDI bothwith CGM and SMBG monitoring. However, CGM is associated with considerably lesstime in hypoglycaemia than SMBG at a broad range of HbA1c levels and is crucialfor patients with MDI treatment to have a chance to approach hypoglycaemiatargets.

In this chapter we will present the Nordic experiences with clinical islet transplantation after starting The Nordic Network for Clinical Islet Transplantation in 2000. In addition, we will also present a local multidisciplinary effort organized as a Center of Excellence in Type 1 Diabetes. Over time islet transplantation has shifted from having been clinical research to becoming an established clinical activity. In the Nordic countries it is now considered as innovative rather than an experimental therapy. Islet transplantation is underused, technically complex, highly specialized, and with a need for multidisciplinary expertise, which is why it for the foreseeable future will continue to be centralized to a few centers to ensure high quality and continued development. The aim of our different networks, both local and regional, is to offer the best treatment for those patients for whom conventional treatment is inadequate and take advantage of the expertise distributed in several different disciplines.

Entrustable Professional Activities (EPAs) define observable key tasks that a doctor should be able to do independently after having completed a certain level of education. Progression is facilitat ...