OBJECTIVE:To assess the effect of an early, electronic specialist-led model of inpatient diabetes care on glycemic outcomes following discharge and rates of treatment intensification. METHODS:The STOIC-D trial has demonstrated early, electronic specialist-led care by an inpatient diabetes service reduces inpatient hyperglycemia. This follow-up study assessed glycemic outcomes following discharge in a subgroup of 360 STOIC-D trial patients with admission glycated hemoglobin (HbA1c) ≥ 7% and alive 1 year following hospitalization. First available HbA1c between 3 and 15 months following discharge was collected. Multivariable logistic regression identified predictors of clinically significant reduction in HbA1c, defined as ≥0.5%. Multivariable linear regression assessed correlation of baseline characteristics with change in HbA1c. Multivariable logistic regression identified predictors of treatment intensification in hospital. RESULTS:The early intervention arm experienced a greater HbA1c reduction following hospitalization (0.4% [3.9 mmol/mol] vs -0.04% [-0.4 mmol/mol]) compared with preadmission (P = .02). Clinically significant reduction in HbA1c occurred more frequently in the intervention arm (45% vs 31% [P = .01], adjusted odds ratio [aOR] 1.8; 95% CI, 1.1-2.9). Adjusted multivariable linear regression demonstrated inclusion in the intervention arm correlated with proportional reduction in posthospitalization HbA1c. Treatment intensification was more common in the intervention compared with control (36% vs 19% [P = .002], aOR 2.2 [95% CI: 1.3-3.6]). In a subanalysis of participants with admission HbA1c of 7% to 8.5%, age <75 years, the aOR for treatment intensification with early intervention was 4.0 (95% CI, 1.6-11.1). CONCLUSION:Treatment intensification and posthospitalization HbA1c improved following intervention with an early, electronic specialist-led consultation in hospital.

AIMS:Haptoglobin (HP) 2-2 phenotype has been suggested as a risk factor for cardiovascular disease (CVD) and to modulate fenofibrate benefit on CVD risk in Type 2 diabetes. However, little is known as to whether HP levels modulate CVD risk and fenofibrate response. METHODS AND RESULTS:Haptoglobin phenotype and levels were determined in 8047 Fenofibrate Intervention and Event Lowering in Diabetes trial participants at baseline and randomization (after a 16 week run-in period, including a 6 week fenofibrate therapy) and their association with new on-trial total CVD events over 5 years was assessed. Higher baseline HP levels were associated with total CVD events in the placebo group {n = 4030, hazard ratio [95% confidence interval (CI)] = 1.30 [1.02-1.66] for HP level Tertile 3 vs. Tertile 1, P = 0.035}. This was driven by participants with HP 1-1 phenotype (P for interaction = 0.011). Participants with the lowest baseline HP level tertile and HP 1-1 phenotype tended to have the lowest CVD risk, whereas CVD risk was similar in other participants, regardless of HP phenotype and levels. Fenofibrate benefit on total CVD events did not differ significantly by HP phenotypes, baseline HP level tertiles, or tertiles of change in HP levels by fenofibrate during active run-in. CONCLUSION:Higher baseline HP levels were associated with a higher CVD risk, especially in participants with HP 1-1 phenotype. A lower CVD risk is found only in Type 2 diabetes participants with both the HP 1-1 phenotype and low baseline HP levels. Fenofibrate benefits on CVD risk reduction did not differ by HP levels or phenotype. LAY SUMMARY:We evaluated the relationship of different forms or phenotypes of the blood protein, haptoglobin, and its circulating levels with the risk of developing CVD and fenofibrate benefit in patients with Type 2 diabetes, and showed that both HP phenotype and levels are important to assess CVD risk in patients with Type 2 diabetes, although fenofibrate did not modulate CVD risk via HP phenotype or level.Higher baseline HP levels were associated with higher CVD risk, especially in participants with HP 1-1 phenotype.Fenofibrate benefit on CVD did not differ by HP phenotype and baseline or change in HP levels.

This cohort study examines whether there is a temporal association between SARS-CoV-2 infection and the development of islet autoimmunity among Australian children with a first-degree relative with type 1 diabetes.

Introduction and Objective: Mitochondrial dysfunction contributes to cardiovascular and microvascular disease risks in type 2 diabetes (T2D). This study investigates whether mitochondrial DNA copy number (mtDNA-CN) in whole blood can serve as a biomarker for these complications. Methods: mtDNA-CN was measured in the DNA extracted from whole blood samples of 497 T2D adults from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial. The relationship of mtDNA-CN with cardiovascular and microvascular complications over 5 years was assessed. Results: The cohort (29.8 % women, mean(SD) age 62(7) years, HbA1c 7.1(1.4)%) showed no variation in mtDNA-CN by sex. There were no significant associations of mtDNA-CN with traditional risk factors of age, BMI, HbA1c, diabetic duration (P>0.05), but mtDNA-CN correlated with eGFR (Pearson r = 0.117, P = 0.009) and plasma uric acid (Pearson r = -0.114, P = 0.012). mtDNA-CN was not related to new on-trial total CVD events, but inversely associated with new on-trial total microvascular events (Table 1). Conclusion: Mitochondrial DNA copy number could serve as a biomarker for assessing microvascular disease risk in T2D patients. A. Mangani: None. A.S. Januszewski: None. K. Ong: None. H. Francis: None. R.L. O'Connell: None. L. Li: None. D. Sullivan: Other Relationship; Amgen Inc. Research Support; Arrowhead Pharmaceuticals, Inc. Other Relationship; Novartis Pharmaceuticals Corporation, Merck Sharp & Dohme Corp. Research Support; Ionis Pharmaceuticals. R.S. Scott: None. P.G. Colman: None. A. Jenkins: Advisory Panel; Abbott. Speaker's Bureau; GlaxoSmithKline plc. Research Support; Abbott, Metronics, Ypsomed AG, Insulet Corporation, Jaeb Center for Health Research, Endogenex, Hemsley Charitable Trust. Speaker's Bureau; CSL Seqirus. Research Support; AbbVie Inc, National Institutes of Health, Juvenile Diabetes Research Foundation (JDRF). A.C. Keech: Research Support; Abbott, Amgen Inc, ASPEN Australia, Mylan. Speaker's Bureau; Novartis AG, Pfizer Inc. Research Support; Kowa Company, Ltd. Speaker's Bureau; Sanofi. Research Support; AbbVie Inc, Viatris Inc. Laboratoires Fournier, Dijon, France and the National Health and MedicalResearch Council of Australia (457103, 1024105, 1037786, 1105467, 1121272, 1137071 and 2018537)

The vaginal microbiome has been linked to adverse pregnancy outcomes, which are markedly increased in women with type 1 diabetes. To investigate this relationship, we profiled the vaginal microbiome in pregnant women with and without type 1 diabetes, and in relation to pre-term birth (PTB) and pre-eclampsia (PE) in women with type 1 diabetes. Bacterial and fungal microbiomes were analysed by 16S rRNA gene and internal transcribed spacer 1 sequencing, respectively, in the third trimester of 310 pregnancies (160 with type 1 diabetes) for bacteria, and 147 pregnancies (70 with type 1 diabetes) for fungi. The vaginal microbiome was altered by type 1 diabetes in pregnancy, with an increase in the bacterial species Lactobacillus iners and Lactobacillus jensenii, and in the anaerobic genera Gardnerella, Anaerococcus, Prevotella, Dialister, Peptoniphilus and others that are associated with vaginal dysbiosis. In addition, the abundance of the fungal species Malassezia restricta was increased in women with type 1 diabetes. These changes were associated with increased risks of PTB and PE. PTB was associated with higher bacterial alpha diversity, decreased abundance of Lactobacillus reuteri, and increased abundance of Malassezia fungal genus, family Malasseziaceae and order Malasseziales. PE was associated with higher bacterial alpha diversity, increased abundance of Gardnerella vaginalis and decreased abundance of Candida albicans. Adverse pregnancy outcomes in women with type 1 diabetes are reflected by distinct changes in the vaginal microbiome. This highlights the importance of monitoring and managing the vaginal microbiome in high-risk pregnancies, particularly those complicated by type 1 diabetes. Early detection and treatment of risk-associated taxa, e.g. G. vaginalis in the case of PE, could potentially improve vaginal health and pregnancy outcomes in women with type 1 diabetes.

OBJECTIVE Type1Screen offers islet autoantibody testing to Australians with a family history of type 1 diabetes (T1D) with the dual aims of preventing diabetic ketoacidosis (DKA) and enabling use of disease-modifying therapy. We describe screening and monitoring outcomes 2 years after implementing in-home capillary blood spot sampling. RESEARCH DESIGN AND METHODS Data from 2,064 participants who registered between July 2022 and June 2024 were analyzed: 1,507 and 557 chose blood spot and venipuncture screening respectively. We compared baseline characteristics and outcomes for 1,243 participants (967 blood spot and 276 venipuncture) whose samples were tested by June 2024. RESULTS One blood spot and five venous participants reported unsuccessful sample collections. The median (quartile 1, quartile 3) age of blood spot registrants was lower (12.1 [7.1, 27.1] vs. 17.2 [9, 38.4] years; P < 0.0001), and a higher proportion lived in regional Australia (39% vs. 29%; P = 0.0037). Among 72 participants (5.9%) with a positive screening test, 5 screened by blood spot and 2 by venipuncture had no autoantibodies on confirmatory testing. Blood spot screening identified the expected 2.1% prevalence of multiple autoantibodies and a 2.5% prevalence of a single autoantibody compared with 1.5% and 4.1%, respectively, for venipuncture screening. Clinical diabetes developed in 12 participants. All had screened positive and none had DKA. CONCLUSIONS Type1Screen has national reach. In-home blood spot screening is feasible, particularly for younger participants living regionally, and identifies the expected prevalence of preclinical T1D. The lower cost, increased convenience, and greater reach of blood spot screening could help meet increasing demand for early T1D diagnosis.

OBJECTIVE:To characterize longitudinal continuous glucose monitoring (CGM) data in young children with presymptomatic type 1 diabetes. RESEARCH DESIGN AND METHODS:Between 2021 and 2024, children in the Australian ENDIA study with persistent multiple islet autoimmunity underwent blinded CGM assessments every 3-6 months. CGM-derived metrics (SD sensor glucose, coefficient of variation, mean sensor glucose, and percent CGM time >7.8 mmol/L [140 mg/dL]) were determined for each child by time from islet autoantibody detection. RESULTS:A total of 178 CGM assessments were analyzed for 36 children (median [Q1, Q3] age at first assessment 4.5 [3.5, 6.0] years) who underwent a median of 5.5 (2.0, 7.0) assessments of 11 (9, 15) days duration each. High within-person variability was observed in serial CGM metrics, including percent CGM time >7.8 mmol/L (140 mg/dL) (intraclass correlation coefficient 0.30). CONCLUSIONS:Further research is needed to inform interpretation of CGM-derived metrics in young children with presymptomatic type 1 diabetes.

Objective Type1Screen offers islet autoantibody testing to Australians with a family history of type 1 diabetes (T1D) with the dual aims of preventing diabetic ketoacidosis (DKA) and enabling use of disease-modifying therapy. We describe screening and monitoring outcomes two years after implementing in-home capillary blood spot sampling. Research design and methods Data from 2064 participants who registered between July 2022 and June 2024 were analyzed: 1507 and 557 chose blood spot and venipuncture screening respectively. We compared baseline characteristics and outcomes for 1243 participants (967 blood spot and 276 venipuncture) whose samples were tested by June 2024. Results Unsuccessful sample collections were reported by 1 blood spot and 5 venous participants. The median [Q1, Q3] age of blood spot registrants was lower (12.1 [7.1, 27.1] v 17.2 [9, 38.4] years; p<0.0001) and a higher proportion lived in regional Australia (39% v 29%; p=0.0037). Seventy-two participants (5.9%) had a positive screening test, of whom 5 screened by blood spot and 2 by venipuncture had no autoantibodies on confirmatory testing. Blood spot screening identified the expected 2.1% prevalence of multiple autoantibodies and a 2.5% prevalence of a single autoantibody compared to 1.5% and 4.1%, respectively, for venipuncture screening. Twelve participants developed clinical diabetes. All had screened positive and none had DKA. Conclusions Type1Screen has national reach. In-home blood spot screening is feasible, particularly for younger participants living regionally, and identifies the expected prevalence of preclinical T1D. The lower cost, increased convenience and greater reach of blood spot screening could help meet increasing demand for early T1D diagnosis.

AIMS:Haptoglobin (HP) phenotype has been reported to modulate fenofibrate benefit on coronary artery disease in type 2 diabetes. It is unknown whether HP phenotype and levels modulate fenofibrate benefit on sight-threatening diabetic retinopathy (STDR). METHODS:In plasma from 8,047 Australasian adults with type 2 diabetes in the FIELD trial, HP phenotype was determined, and HP levels were measured at baseline and after six-week fenofibrate run-in. RESULTS:There were 307 new first on-trial STDR events over five years. Baseline HP levels and phenotype were not related to STDR risk. Fenofibrate benefit on STDR vs. placebo (-32 % overall), was greatest in participants with the lowest baseline HP level tertile (hazard ratio [95 % CI] 0.41 [0.26-0.65], vs. 0.82 [0.56-1.21] and 0.84 [0.56-1.27] for tertiles 2 and 3 respectively, P for heterogeneity = 0.019). During run-in, fenofibrate reduced HP levels by 20.7 %. However, fenofibrate benefit on STDR did not differ significantly by HP phenotype or change in HP levels during run-in after adjustment for confounding factors. CONCLUSIONS:Regarding STDR, fenofibrate benefit is greatest in type 2 diabetes patients with the lowest baseline HP levels, which may reflect patients more susceptible to oxidative retinal injury. All HP phenotypes benefit from fenofibrate.

CONTEXT:Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to health care-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear. OBJECTIVE:To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes. METHODS:Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019-March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for 9 clinical characteristics was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and prehospital treatment not adjusted for. The setting was the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were HAI, AKI, stroke, and mortality. RESULTS:Of 2558 included admissions, 1147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs 100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.05, P = .003), AKI (120 [10.5%] vs 59 [4.2%], aOR 1.07, 95% CI 1.05-1.09, P < .001), and stroke (10 [0.9%] vs 1 [0.1%], aOR 1.05, 95% CI 1.04-1.06, P < .001). CONCLUSION:In hospital inpatients (HbA1c ≤12.0%), irrespective of diabetes status and prehospital glycemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.

Aims: To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME- Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME- Q captures satisfaction with diabetes management irrespective of treatment modalities.Methods: The DME- Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre-randomization data (n = 149); responsiveness was examined using baseline and 26 -week followup data (n = 120).Results: Pre-randomization, participants' mean age was 44 +/- 12 years, 52% were women. HbA1c was 61 +/- 11 mmol/mol (7.8 +/- 1.0%), diabetes duration was 24 +/- 12 years and 47% used an insulin pump prior to the trial. A forced three-factor analysis revealed three expected domains, that is, 'Convenience', 'Effectiveness' and 'Intrusiveness', and a forced one-factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales (a range = 0.74-0.84) and 'Total satisfaction' (a = 0.85). Convergent validity was demonstrated with moderate correlations between DME- Q 'Total satisfaction' and diabetes distress (PAID: rs= -0.57) and treatment satisfaction (DTSQ; rs = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: rs = -0.16 and - 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher 'Effectiveness' and 'Total satisfaction' scores than those randomized to standard therapy.Conclusions: The 22 -item DME- Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME- Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings.

Older adults with type 1 diabetes may face challenges driving safely. Glucose "above-5-to-drive" is often recommended for insulin-treated diabetes to minimize hypoglycemia while driving. However, the effectiveness of this recommendation among older adults has not been evaluated. Older drivers with type 1 diabetes were assessed while using sensor-augmented insulin pumps during a 2-week clinical trial run-in. Twenty-three drivers (median age 69 years [interquartile range; IQR 65-72]; diabetes duration 37 years [20-45]) undertook 618 trips (duration 10 min [5-21]). Most trips (n = 535; 87%) were <30 min duration; 9 trips (1.5%) exceeded 90 min and 3 trips (0.5%) exceeded 120 min. Pre-trip continuous glucose monitoring (CGM) was >5.0 mmol/L for 577 trips (93%) and none of these had CGM <3.9 mmol/L during driving (including 8 trips >90 min and 3 trips >120 min). During 41 trips with pre-trip CGM ≤5.0 mmol/L, 11 trips had CGM <3.9 mmol/L. Seventy-one CGM alerts occurred during 60 trips (10%), of which 54 of 71 alerts (76%) were unrelated to hypoglycemia. Our findings support a glucose "above-5-to-drive" recommendation to avoid CGM-detected hypoglycemia among older drivers, including for prolonged drives, and highlight the importance of active CGM low-glucose alerts to prevent hypoglycemia during driving. Driving-related CGM usability and alert functionality warrant investigation. Clinical trial ACTRN1261900515190.

Dietary patterns characterised by high intakes of vegetables may lower the risk of pre-eclampsia and premature birth in the general population. The effect of dietary patterns in women with type 1 diabetes, who have an increased risk of complications in pregnancy, is not known. The aim of this study was to investigate the relationship between dietary patterns and physical activity during pregnancy and maternal complications and birth outcomes in women with type 1 diabetes. We also compared dietary patterns in women with and without type 1 diabetes. Diet was assessed in the third trimester using a validated food frequency questionnaire in participants followed prospectively in the multi-centre Environmental Determinants of Islet Autoimmunity (ENDIA) study. Dietary patterns were characterised by principal component analysis. The Pregnancy Physical Activity Questionnaire was completed in each trimester. Data for maternal and birth outcomes were collected prospectively. Questionnaires were completed by 973 participants during 1124 pregnancies. Women with type 1 diabetes (n=615 pregnancies with dietary data) were more likely to have a ‘fresh food’ dietary pattern than women without type 1 diabetes (OR 1.19, 95

Objective Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with pre-symptomatic type 1 diabetes and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally followed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to 10 years. Research Design and Methods Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched controls underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose standard deviation (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL) and percent time above 7.8 mmol/L (140mg/dL) were determined and examined for between group differences. Results The mean(SD) age of PM Ab+ and Ab- children was 4.4(1.8) and 4.7(1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median[Q1,Q3] sensor wear period of 12.5[9.0, 15.0] days. PM Ab+ children had higher median[Q1,Q3] SDSGL (1.1[0.9,1.3] vs 0.9[0.8,1.0] (mmol/L); p<0.001) and CEV (17.3[16.0,20.9] vs 14.7[12.9,16.6](%); p<0.001). Percent time >7.8 mmol/L was greater in PM Ab+ children (median[Q1,Q3] 8.0 [4.4, 13.0] vs 3.3[1.4, 5.3] (%); p=0.005). Mean SGL did not differ significantly between groups (p=0.10). Conclusions CGM is feasible and well tolerated in very young type 1 diabetes at-risk children. Very young PM Ab+ children have increased SDSGL, CEV and percent time >7.8 mmol/L, consistent with prior studies involving older participants.

The B‐cell lymphoma 2 (BCL2) family members, BCL2‐associated protein X (BAX) and BCL2 homologous antagonist killer (BAK), are required for programmed cell death via the mitochondrial pathway. When cells are stressed, damaged or redundant, the balance of power between the BCL2 family of proteins shifts towards BAX and BAK, allowing their transition from an inactive, monomeric state to a membrane‐active oligomeric form that releases cytochrome c from the mitochondrial intermembrane space. That oligomeric state has an essential intermediate, a symmetric homodimer of BAX or BAK. Here we describe crystal structures of dimers of the core domain of BAX, comprising its helices α2–α5. These structures provide an atomic resolution description of the interactions that drive BAX homo‐dimerisation and insights into potential interaction between core domain dimers and membrane lipids. The previously identified BAK lipid‐interacting sites are not conserved with BAX and are likely to determine the differences between them in their interactions with lipids. We also describe structures of heterodimers of BAK/BAX core domains, yielding further insight into the differences in lipid binding between BAX and BAK.

Objective: To investigate the effect of early intervention with an electronic specialist-led ‘proactive’ model of care on glycaemic and clinical outcomes. Research Design and Methods: The STOIC-D Surgery randomised controlled trial was performed at the Royal Melbourne Hospital. Eligible participants were adults admitted to a surgical ward during the study with either known diabetes or newly-detected hyperglycaemia (at least one random blood glucose result ≥ 11.1 mmol/L). Participants were randomised 1:1 to standard diabetes care or the intervention consisting of an early consult by a specialist inpatient diabetes team utilising electronic tools for patient identification, communication of recommendations, and therapy intensification. The primary outcome was median patient-day mean glucose (PDMG). The key secondary outcome was incidence of healthcare-associated infection (HAI). Trial registration: ACTRN12620001303932. Results: Between February 12, 2021, and December 17, 2021, 1371 admissions met inclusion criteria with 680 assigned to early intervention and 691 to standard diabetes care. Baseline characteristics were similar between groups. The early intervention group achieved a lower median PDMG of 8.2 mmol/L (interquartile range [IQR] 6.9-10.0 mmol/L) compared with 8.6 mmol/L (IQR 7.2-10.3 mmol/L) in the control group for an estimated difference of -0.3 mmol/L (95% confidence interval [95%CI] -0.4 to -0.2 mmol/L, p<0.0001). The incidence of HAI was lower in the intervention group (77 [11%] vs. 110 [16%]), for an absolute risk difference of -4.6% (95%CI -8.2 to -1.0, p=0.016). Conclusions: In surgical inpatients, early diabetes management intervention with an electronic specialist-led diabetes model of care reduces glucose and HAI.

AimTo explore parents’ experiences of using continuous glucose monitoring (CGM) in their young children with early-stage type 1 diabetes, being followed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study.MethodsParents of children with persistent islet autoimmunity who enrolled in the ENDIA CGM sub-study were invited to participate in an optional interview. Semi-structured phone interviews were conducted by a single researcher using an interview guide developed by a multi-disciplinary team. Interviews were conducted following a single CGM monitoring period and prior to parents receiving feedback on their child’s glycemic status. Following transcription, thematic analysis was conducted to determine common themes.ResultsNine parents (8 mothers, 1 father) were interviewed corresponding to ten children, with a mean (SD) age of 5.6 (2.2) years, who wore CGM for 97 (0.1)% of the time during their monitoring period. Three main themes were identified: (1) Information empowers and helps to reduce uncertainty; (2) Families’ acceptance of using CGM; and (3) Involvement in research provides support and preparation for the unknown.ConclusionsParents reported a positive experience of their young child wearing blinded CGM, and the children tolerated wearing CGM very well. Parents were empowered by knowing they would receive information on their child’s glucose levels and patterns and felt well supported. This study provides novel insights into parents’ experiences of using CGM in very young children with early-stage type 1 diabetes.

Dysglycemia among drivers with type 1 diabetes (T1D) is associated with impaired driving performance, and glucose levels "above 5 to drive" are often recommended for insulin-treated drivers. Evidence for diabetes treatments that support euglycemia while driving is minimal, particularly for older drivers. In this randomized, crossover trial involving adults aged ≥60 years with T1D, we used continuous glucose monitoring (CGM) during driving to compare the first-generation closed-loop automated insulin delivery (AID) versus a sensor-augmented pump therapy. There were 1894 trips undertaken by 8 drivers (median age 68 years [IQR: 64-70]). During AID versus sensor-augmented pump, time in range >5.0-10.0 mmol/L was greater (100% [0-100] vs. 81% [0-100]; P = 0.033) and fewer trips had any CGM >16.7 mmol/L (3.5% vs. 6.4%; P = 0.006). Three percent of all trips included CGM <3.9 mmol/L, with no between-stage difference (3.0% vs. 3.5%; P = 0.52). System alerts occurred in 10% of all trips, with no between-stage difference (9% vs. 11%; P = 0.078). First-generation AID reduces hyperglycemic driving among older drivers with T1D, without increasing hypoglycemia. Developing dedicated "driving-mode" settings could prioritize safety while minimizing distraction. Trial Registration: ACTRN12619000515190.

Less than 20% of Australians with type 1 diabetes (T1D) meet recommended glucose targets. Technology use is associated with better glycaemia, with the most advanced being automated insulin delivery (AID) systems, which are now recommended as gold-standard T1D care. Our Australian AID trial shows a wide spectrum of adults with T1D can achieve recommended targets. Other studies, including lived experience data, are supportive. Insulin pumps are not subsidised for most Australian adults with T1D. We advocate change.