Self-monitoring of glycaemia is a cornerstone of diabetes management, particularly for people using insulin. Traditionally, glucose monitoring involved finger-pricking and measuring capillary blood glucose concentration. Continuous glucose monitors (CGMs) have revolutionised self-monitoring of glucose levels. These devices provide continuous interstitial fluid glucose measurements, including trend arrows and alarms to alert the person if glucose levels are outside predetermined ranges. The increased reliance on CGM metrics for clinical decisions to manage diabetes necessitates the consideration and implementation of minimum standards that device manufacturers should meet to demonstrate safety, precision and accuracy. This statement provides recommendations to ensure that CGM devices that are approved for the Australian and New Zealand markets meet/exceed these minimum standards of accuracy, to provide health professionals and people living with diabetes the confidence to manage their glucose levels effectively.

OBJECTIVE Following the demonstrated improvement in pregnancy glycemia with Control-IQ™ closed-loop in the CIRCUIT trial, we compared intrapartum and early postpartum glycemic effectiveness and safety with standard-care in type 1 diabetes. RESEARCH DESIGN AND METHODS The primary outcome of this pre-specified analysis was percentage of time in pregnancy-specific glucose-range(63–140 mg/dL) during the 24 hours prior to childbirth, measured by continuous glucose monitoring. A key secondary outcome was percentage of time <70 mg/dL in the first postpartum week, with additional secondary outcomes including continuous glucose monitoring metrics through 6 weeks postpartum. Analyses were adjusted for baseline measure, insulin delivery mode, and site. RESULTS In the intrapartum period (24 hours before delivery), 39 of 44 (89%) participants continued closed-loop. Intravenous insulin was used intrapartum by one (2%) closed-loop participant, and 20 (45%) standard-care participants (p<0.001). Intrapartum closed-loop users spent more time in pregnancy-specific glucose-range (79.6% vs. 64.8%) than the standard-care group (mean adjusted difference 13.2 percentage points;95% CI 5.2,21.2). In the first postpartum week, the closed-loop group spent less time <70 mg/dL(1.7% vs. 3.2%; mean adjusted difference -1.8 percentage points;95%CI -0.9 to -2.7) compared to the standard-care group. No maternal severe hypoglycemia occurred in the closed-loop group while one episode occurred in the standard-care group postpartum. No diabetic ketoacidosis occurred in either group. CONCLUSIONS Use of this closed-loop system resulted in superior intrapartum and early postpartum glycemia compared to standard-care, without safety concerns. Together with previous results, this supports use of this closed-loop system throughout pregnancy, labor, and the early postpartum period.

Introduction and Objective: Medical nutrition therapy underpins GDM management, yet evidence-based guidelines are needed. Greater morning insulin resistance often results in post-breakfast hyperglycemia in GDM. A low glycemic load (GL) diet reduces glucose concentrations and need for pharmacotherapy in GDM, but the impact of targeting breakfast only is unknown. In a randomized cross-over trial, we compared the effects of a low vs high GL breakfast (LGL-B vs HGL-B) on breakfast 1-h postprandial glucose (PPG) and 24-h glycemic variability (GV) (primary outcomes) within GDM women. Methods: Women were provided a LGL-B (245 kcal; carbohydrate: 10.9g) and HGL-B (247 kcal; carbohydrate: 43.4g) for 7d separated by a 7d washout. Fasting blood was drawn on day 1 and 7; a masked continuous glucose monitor was worn. PPG and GV (% coefficient of variation [%CV]) were averaged over 7d. Mixed effect models with Bonferroni corrections were conducted to compare between intervention effects within women. Results: Thirty women with diet managed GDM (median 34.5 yrs, BMI 28.1 kg/m2) were randomized (26 wks’ gestation). Compared to HGL-B, LGL-B decreased 1-h PPG (mean 134 mg/dL [95% CI 129, 140] vs 89 mg/dL [84, 94]) and 24-h %CV (19.5 [18.1, 21.0] vs 16.6 [15.2, 18.1]) (both p<0.001). Triglycerides decreased over 7d on LGL-B and increased on HGL-B (time x intervention; p=0.047). There was no difference in ketones, satiety, or acceptability. Conclusion: Within women with GDM, a LGL-B improves breakfast PPG, GV, and potentially triglycerides. This approach may be a simple dietary recommendation to improve glycemia and reduce need for pharmacotherapy in women with GDM. Disclosure J. Burk: None. G.P. Ross: None. S. Colagiuri: None. G.D. Brinkworth: None. P.J. Taylor: None. E.G. Dunn: None. S. Hagen-Lillevik: None. M. Hivert: None. T.L. Hernandez: None. A. Sweeting: None. Funding Sydney Local Health District, Sydney Institute for Women, Children and their Families Seed Funding Grant 2022

Introduction and Objective: The efficacy of hybrid closed-loop insulin therapy (HCL) in pregnancy varies by system. Our objective was to assess the efficacy in pregnancy of a HCL that is in common use outside of pregnancy. Methods: This multicenter, open-label trial randomized pregnant women with type 1 diabetes (T1D) and early pregnancy A1C of 6.2-10%, at 14 sites in Canada and Australia, to start HCL (t:slim X2 insulin pump with Control-IQ technology with Dexcom G6 sensor) by 16 weeks gestation or continue with standard care with continuous glucose monitoring (CGM). Use of the lowest target range (sleep activity) was recommended throughout the day and night with the optional use of the highest target range for exercise. The primary outcome was the percentage of time that glucose was in the pregnancy range of 63 to 140mg/dL [3.5 to 7.8mmol/L] (TIRp) as measured by CGM from 16 to 34weeks +6days gestation adjusted for site, baseline TIRp and baseline mode of insulin delivery, using intention-to-treat principles. Secondary outcomes included time above 140mg/dL (7.8mmol/L), time below 63mg/dL (3.5mmol/L), mean glucose, safety events and pregnancy outcomes. Results: A total of 91 women (mean ± SD: age 31.7 ± 5.2 years, diabetes duration 19.0 ± 8.1 years, early pregnancy A1C 7.4 ± 1.0%) were randomized (46 to HCL and 45 to standard care). The mean adjusted TIRp was 12.6 percentage points (95% CI 9.9,15.2; p<0.001) higher in HCL than standard care (65.4 ± 9.5% versus 50.3 ± 13.9%, respectively) with 11.4 percentage points less time above range (95% CI 8.6,14.2 p<0.001) and 1.04 percentage points less time below 63mg/dL (95%CI 0.6,1.48 p<0.001). The adjusted mean glucose was 11.2mg/dL (0.62 mmol/L) lower with HCL versus standard care (95%CI 7.2,16.2 p<0.001). There was 1 episode of severe hypoglycemia with HCL and 0 with standard care and 2 episodes of diabetic ketoacidosis in each of the trial arms. Conclusion: This HCL resulted in 3 more hours/day spent in TIRp in T1D pregnancy compared to standard care. No safety concerns arose. L.E. Donovan: Other Relationship; Medtronic, Dexcom, Inc., Tandem Diabetes Care, Inc, Inner Analytics. P. Lemieux: Advisory Panel; Dexcom, Inc. A. Dunlop: None. J.M. Yamamoto: Other Relationship; Abbott. H.R. Murphy: Research Support; Abbott, Dexcom, Inc. Advisory Panel; Medtronic, Ypsomed AG. Speaker's Bureau; Eli Lilly and Company, Dexcom, Inc., Ypsomed AG, Novo Nordisk, Sanofi. D. Simmons: Research Support; Novo Nordisk, AMSL. Other Relationship; Abbott, Abbott, Boehringer-Ingelheim. Speaker's Bureau; Ascensia Diabetes Care. R.C. Bell: None. K. Chaput: None. J.L. Benham: None. G.P. Ross: None. K. Nerenberg: None. K. Mohammad: None. B.A. Perkins: Other Relationship; Abbott, Novo Nordisk, Sanofi. Advisory Panel; Abbott, Insulet Corporation, Sanofi, Novo Nordisk, Nephris, Vertex Pharmaceuticals Incorporated. Research Support; Novo Nordisk. J.E. Booth: None. H.N. Ntanda: None. G. Tomlinson: None. D. Feig: Other Relationship; Novo Nordisk. Consultant; Ypsomed. Diabetes Canada (OG-3-21-5570-LD); Australia Medical Research Future Fund (MRFF); lnternational Clinical Trial Collaboration (2022/MRF2023992)

Hyperglycemia-related pregnancy complications occur in 50% of pregnant women with type 1 diabetes. Closed-loop insulin systems improve glycemia outside of pregnancy but have had limited testing in pregnancy. To assess the efficacy of a closed-loop system in pregnancy. Open-label trial enrolling pregnant women with type 1 diabetes at 14 clinical centers in Canada and Australia before 14 weeks’ gestation with follow-up until 6 weeks postpartum. Enrollment occurred between June 2021 and July 2024 and follow-up was completed in March 2025. Participants were randomized 1:1 to closed-loop therapy (n = 46) or standard care (insulin pump or multiple daily insulin injections) (n = 45) with continuous glucose monitoring. The primary outcome was the percentage of time spent in the pregnancy-specific glucose range (63-140 mg/dL), measured by continuous glucose monitoring from 16 to 34 weeks’ gestation. Among 94 enrolled participants, 3 experienced pregnancy loss prior to randomization, 91 were randomized (mean age, 31.7 [SD, 5.2] years; early pregnancy hemoglobin A 1c , 7.4% [SD, 1.0%]), and 88 were included in the primary analysis. The mean percentage of time spent in the pregnancy-specific glucose range from 16 to 34 weeks’ gestation was 65.4% in the closed-loop group and 50.3% in the standard care group (mean adjusted difference, 12.5 [95% CI, 9.5-15.6] percentage points; P < .001). There was 1 episode of severe hypoglycemia in the closed-loop group, and there were 2 episodes of diabetic ketoacidosis in the closed-loop group and 1 in the standard care group. Pregnant women with type 1 diabetes using a closed-loop system spent significantly more time in the pregnancy-specific glucose range than those receiving standard care. These findings support the use of this closed-loop system in pregnant women with type 1 diabetes. ClinicalTrials.gov Identifier: NCT04902378

OBJECTIVE:Continuous glucose monitoring is recommended for pregnant women with type 1 diabetes, due to associations with decreased hemoglobin A1c and large for gestational age. However, its benefit in type 2 diabetes and gestational diabetes is not established. This systematic review and meta-analysis compared usage of continuous glucose monitoring to self-monitoring of blood glucose both across and within diabetes in pregnancy and determined which glucose metrics are associated with perinatal outcomes, to potentially inform treatment targets in diabetes in pregnancy. DATA SOURCES:We searched Medline, Embase, CENTRAL, CINAHL, and Scopus, from January 2003 to August 2024. STUDY ELIGIBILITY CRITERIA:Randomized controlled trials and quasi-experimental studies comparing continuous glucose monitoring with self-monitoring of blood glucose in diabetes in pregnancy were included. STUDY APPRAISAL AND SYNTHESIS METHODS:Randomized controlled trials and quasi-experimental studies were analyzed separately. Data were extracted on continuous glucose monitoring metrics, hemoglobin A1c, rates of cesarean delivery, large for gestational age, small for gestational age, neonatal hypoglycemia, and neonatal intensive care unit admission, summarized as mean differences or odds ratios with 95% confidence intervals and 95% prediction intervals. Prespecified subgroup analyses were undertaken by diabetes in pregnancy subtype, including duration of continuous glucose monitoring use (continuous vs intermittent) for large for gestational age. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS:Across diabetes in pregnancy, continuous glucose monitoring (vs self-monitoring of blood glucose) decreased hemoglobin A1c (mean difference, -0.22% [95% confidence interval, -0.37, -0.08]) (7 randomized controlled trials, moderate-certainty evidence). Within diabetes in pregnancy, continuous glucose monitoring use (vs self-monitoring of blood glucose) showed similar but stronger benefits in both type 1 diabetes when used throughout pregnancy (hemoglobin A1c mean difference, -0.18% [95% confidence interval, -0.36, 0.00]; large for gestational age odds ratio, 0.51 [0.28, 0.90]) (1 randomized controlled trial, high-certainty evidence), and gestational diabetes when used intermittently (hemoglobin A1c mean difference, -0.18 [95% confidence interval, -0.33, -0.02]) (5 randomized controlled trials, moderate-certainty evidence) and large for gestational age (odds ratio, 0.46 [0.26, 0.81]) (1 quasi-experimental study, low-certainty evidence), with insufficient data for continuous glucose monitoring benefit in type 2 diabetes. Increased pregnancy %time-in-range (type 1 diabetes) and decreased mean sensor glucose (type 1 diabetes/gestational diabetes) were associated with decreased large for gestational age. CONCLUSION:Usage of continuous glucose monitoring (vs self-monitoring of blood glucose) reduces hemoglobin A1c and possibly large for gestational age across diabetes in pregnancy. Greatest benefit was evidenced in type 1 diabetes, followed by gestational diabetes, although continuous glucose monitoring duration differed. Mean sensor glucose and pregnancy %time-in-range are important continuous glucose monitoring metrics for reducing large for gestational age.

Importance:Hyperglycemia-related pregnancy complications occur in 50% of pregnant women with type 1 diabetes. Closed-loop insulin systems improve glycemia outside of pregnancy but have had limited testing in pregnancy. Objective:To assess the efficacy of a closed-loop system in pregnancy. Design, Setting, and Participants:Open-label trial enrolling pregnant women with type 1 diabetes at 14 clinical centers in Canada and Australia before 14 weeks' gestation with follow-up until 6 weeks postpartum. Enrollment occurred between June 2021 and July 2024 and follow-up was completed in March 2025. Interventions:Participants were randomized 1:1 to closed-loop therapy (n = 46) or standard care (insulin pump or multiple daily insulin injections) (n = 45) with continuous glucose monitoring. Main Outcomes and Measures:The primary outcome was the percentage of time spent in the pregnancy-specific glucose range (63-140 mg/dL), measured by continuous glucose monitoring from 16 to 34 weeks' gestation. Results:Among 94 enrolled participants, 3 experienced pregnancy loss prior to randomization, 91 were randomized (mean age, 31.7 [SD, 5.2] years; early pregnancy hemoglobin A1c, 7.4% [SD, 1.0%]), and 88 were included in the primary analysis. The mean percentage of time spent in the pregnancy-specific glucose range from 16 to 34 weeks' gestation was 65.4% in the closed-loop group and 50.3% in the standard care group (mean adjusted difference, 12.5 [95% CI, 9.5-15.6] percentage points; P < .001). There was 1 episode of severe hypoglycemia in the closed-loop group, and there were 2 episodes of diabetic ketoacidosis in the closed-loop group and 1 in the standard care group. Conclusion and Relevance:Pregnant women with type 1 diabetes using a closed-loop system spent significantly more time in the pregnancy-specific glucose range than those receiving standard care. These findings support the use of this closed-loop system in pregnant women with type 1 diabetes. Trial Registration:ClinicalTrials.gov Identifier: NCT04902378.

We explore the effects of stress on silicon donor bound exciton (D^0X) transitions in bulk silicon and in microfabricated silicon devices. We first study D^0X transitions in an isotopically purified silicon-28 bulk doped sample under controlled uniaxial stress, confirming the validity of existing models in the low strain (≲ 10^-5) regime. We then demonstrate the localised photoconductive detection of a few thousand donors illuminated by a 1078 nm resonant laser with 4 μ m spot focused on a microfabricated device consisting of an implanted phosphorus layer between a pair of metallic contacts. We observe local variations in the strained exciton peak splitting from 10 μ eV to 200 μ eV, and obtain scanning microscopy stress maps in good agreement with finite-element-model thermal stress simulations. Our results suggest a potential use of donor bound excitons for in-situ stress sensing, and demonstrate pathways for the miniaturisation of D^0X photoconductive detection.

Aims: Pregnancies are increasingly affected by young-onset type 2 diabetes mellitus (YT2DM), an aggressive phenotype associated with a higher vascular risk profile compared to type 1 diabetes mellitus (T1DM). We compared pregnancy outcomes to illuminate areas where differing management guidance might be needed. Methods: This retrospective single-centre study (2010 2019) included 259 singleton pregnancies affected by pregestational T1DM (N = 124) or YT2DM (N = 135) diagnosed at < 40 years. Primary outcomes included preterm delivery, large for gestational age (LGA) infants, and pre-eclampsia. Results: The YT2DM cohort were older, with more obesity, greater apparent sociodemographic disadvantage, and lower measures of pregnancy preparedness. Overweight/obesity were also prevalent in the T1DM cohort (46 % affected). The second/third trimester mean HbA1c measurements were significantly higher in the T1DM cohort. Pre-eclampsia and preterm delivery rates were similar between the cohorts. Significantly lower rates of LGA infants, NICU admission, neonatal hypoglycaemia, and neonatal respiratory distress were seen in the YT2DM cohort (p < 0.05 for all). Conclusions: In pregnancy, YT2DM appears to be the lower-risk cohort compared to T1DM despite higher obesity rates. Gaps in achieving glycaemic targets exist for both subtypes but particularly for T1DM. The relative impact of increasing BMI in pregnancies affected by T1DM requires further elucidation.

Background:Both obesity and sleep disorders are common among women during pregnancy. Although prior research has identified a relationship between obesity and sleep disorders, those findings are from women later in pregnancy. Objective:To explore the relationships between self-reported sleep duration, insufficient sleep and snoring with body mass index (BMI) among multiethnic women at risk of gestational diabetes mellitus (GDM)in early pregnancy. Methods:Cross-sectional study of baseline data from women at risk of GDM enrolled in the Treatment of BOoking Gestational diabetes Mellitus (TOBOGM) multicentre trial across 12 Australian/Austrian sites. Participants completed a questionnaire before 20 weeks' gestation to evaluate sleep. BMI <25 kg/m2 served as the reference group in multivariable logistic regression. Results:Among the 2865 women included, the prevalence of overweight and obesity classes I-III was 28%, 19%, 11% and 12%, respectively. There was no relationship between sleep duration and BMI. The risk of insufficient sleep >5 days/month was higher in class II and class III obesity (1.38 (1.03-1.85) and 1.34 (1.01-1.80), respectively), and the risk of snoring increased as BMI increased (1.59 (1.25-2.02), 2.68 (2.07-3.48), 4.35 (3.21-5.88) to 4.96 (3.65-6.74), respectively)). Conclusions:Obesity is associated with insufficient sleep among pregnant women at risk of GDM. Snoring is more prevalent with increasing BMI.

INTRODUCTION:Type 2 diabetes in young adults (nominally, 18-30 years of age) is a more aggressive condition than that seen in older age, with a greater risk of major morbidity and early mortality. This first Australian consensus statement on the management of type 2 diabetes in young adults considers areas where existing type 2 diabetes guidance, directed mainly towards older adults, may not be appropriate or relevant for the young adult population. Where applicable, recommendations are harmonised with current national guidance for type 2 diabetes in children and adolescents (aged < 18 years). The full statement is available at https://www.diabetessociety.com.au, https://www.adea.com.au and https://www.apeg.org.au. MAIN RECOMMENDATIONS:Advice is provided on important aspects of care including screening, diabetes type, psychological care, lifestyle, glycaemic targets, pharmacological agents, cardiovascular disease risk management, comorbidity assessment, contraception and pregnancy planning, and patient-centred education. Special considerations for Aboriginal and Torres Strait Islander Australians are highlighted separately. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT:Management recommendations for young adults, which differ from those for adults, include: ▪screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus; ▪more stringent glucose targets (glycated haemoglobin ≤ 6.5% [≤ 48 mmol/mol]); ▪in the context of obesity or higher cardio-renal risk, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are preferred second line agents; ▪β-cell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated; ▪a blood pressure target of < 130/80 mmHg, as the adult target of ≤ 140/90 mmHg is too high; ▪absolute cardiovascular disease risk calculators are not likely to be accurate in this age group; early statin use should therefore be considered; and ▪a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.

BACKGROUND:The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (NPG). METHODS:Cross-sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. RESULTS:In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%-25% energy from protein and 15%-30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%-65% in 2019 vs. 20%-75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40-220 and 60-300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). CONCLUSIONS:Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake.

Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. GDM has long been associated with obstetric and neonatal complications primarily relating to higher infant birthweight and is increasingly recognized as a risk factor for future maternal and offspring cardiometabolic disease. The prevalence of GDM continues to rise internationally due to epidemiological factors including the increase in background rates of obesity in women of reproductive age and rising maternal age and the implementation of the revised International Association of the Diabetes and Pregnancy Study Groups' criteria and diagnostic procedures for GDM. The current lack of international consensus for the diagnosis of GDM reflects its complex historical evolution and pragmatic antenatal resource considerations given GDM is now 1 of the most common complications of pregnancy. Regardless, the contemporary clinical approach to GDM should be informed not only by its short-term complications but also by its longer term prognosis. Recent data demonstrate the effect of early in utero exposure to maternal hyperglycemia, with evidence for fetal overgrowth present prior to the traditional diagnosis of GDM from 24 weeks' gestation, as well as the durable adverse impact of maternal hyperglycemia on child and adolescent metabolism. The major contribution of GDM to the global epidemic of intergenerational cardiometabolic disease highlights the importance of identifying GDM as an early risk factor for type 2 diabetes and cardiovascular disease, broadening the prevailing clinical approach to address longer term maternal and offspring complications following a diagnosis of GDM.

BackgroundInternational studies examining maternal overweight and obesity have found GDM risk increases with increasing weight gain between pregnancies.AimThe study aimed to estimate the association between pre-pregnancy maternal body mass index (BMI), change in BMI between pregnancies and Gestational Diabetes Mellitus (GDM) amongst women with consecutive births in an Australian cohort.MethodsWe used a population cohort of women who had at least two consecutive singleton births between 2010 and 2017 in one NSW health district to investigate the risk of GDM in the pregnancy after the index pregnancy, BMI change between pregnancies and the impact of BMI change on risk of GDM.FindingsOf 10,074 women 1987 (16.7%) had no GDM in the index pregnancy but GDM in the subsequent one while 823 (8.2%) had GDM in both pregnancies. No change in BMI between pregnancies occurred in 47% of women, while 12% had a decrease and 41% an increase. After adjusting for socio-demographic characteristics and selected maternal and perinatal confounders, a reduction in BMI between births in women without GDM in the index pregnancy was associated with a 36% lower risk in GDM (aRR: 0.64; 95% CI: 0.49−0.85), while an increase in BMI was associated with increased risk of GDM with the greatest risk amongst those who gained 4+ kg/m² (aRR 2.27; 95%CI: 1.88–2.75).ConclusionInterpregnancy weight change is an important modifiable risk factor for the risk of GDM in a subsequent pregnancy. Clinical guidelines and health messages about interpregnancy weight change are important for all women.

Introduction: Women with inflammatory bowel disease (IBD) have been shown to have poorer outcomes in pregnancy, thus the importance of a multidisciplinary team (MDT) approach with suitable birth plans is vital during pregnancy for optimal outcomes. Aim(s): To characterise IBD women attending services for obstetrics care and identify outcomes in pregnancy and areas of improvement for patient management at our institute. Method(s): A retrospective analysis was conducted on women with IBD for pregnancy care in our tertiary hospital in 2019 and 2020. Of those booked in 2020, three are still to deliver. Antenatal data collected included: IBD medications, disease activity and number of appointments. Intrapartum data included: mode of delivery, complications during delivery and adverse outcomes. Result(s): The number of women with IBD in our service remained stable across 2019 (n=24) and 2020 (n=20). Forty-five percent of women had Crohn's disease, 45% Ulcerative Colitis and 10% were unclassified. Seventy-three percent of women were on biologic medication during pregnancy. The number of flares reduced from 2019 (n=8) to 2020 so far (n =2). The rate of caesarean sections was higher than the NHS average, 2 with a total of 43% (n =19) performed in women with IBD in 2019 and 2020, of which 42% (n =8) having had previous surgery for IBD and two requiring the involvement of colorectal surgeons. Five (26%) of the caesarean sections performed were as emergencies. Other complications included three placental abruptions and one third-degree tear with a forceps delivery. The rate of preterm birth was 16%. The number of virtual and face-to-face appointments was also recorded to assess for differences due to the COVID-19 pandemic. There was variation in the number of clinician appointments, and overall an increase in the number of virtual obstetric medicine appointments from 2019 (n=2%) to 2020 (n=29%) as well as obstetric appointments (2019, n=3%;2020, n=14%). Discussion/conclusion: This analysis has shown a high number of women with IBD delivering by caesarean section in pregnancy, including as emergencies. Birth planning during remission and management of IBD symptoms is essential in minimising adverse pregnancy outcomes. An increase in virtual appointments reflects the challenges of continuing to provide optimal care during pregnancy whilst accounting for changing healthcare provision during a pandemic. Constructing the MDT clinic with a clearer pathway and utilisation of virtual appointments is required to better streamline the service.

BACKGROUND/AIMS:To evaluate maternal birth and neonatal outcomes among women with gestational diabetes mellitus (GDM), but without specific medical conditions and eligible for vaginal birth who underwent induction of labour (IOL) at term compared with those who were expectantly managed. MATERIALS AND METHODS:Population-based cohort study of women with GDM, but without medical conditions, who had a singleton, cephalic birth at 38-41 completed weeks gestation, in New South Wales, Australia between January 2010 and December 2016. Women who underwent IOL at 38, 39, 40 weeks gestation (38-, 39-, 40-induction groups) were compared with those who were managed expectantly and gave birth at and/or beyond the respective gestational age group (38-, 39-, 40-expectant groups). Multivariable logistic regression analysis was used to assess the association between IOL and adverse maternal birth and neonatal outcomes taking into account potential confounding by maternal age, country of birth, smoking, residential location, residential area of socioeconomic disadvantage and birth year. RESULTS:Of 676 762 women who gave birth during the study period, 66 606 (10%) had GDM; of these, 34799 met the inclusion criteria. Compared with expectant management, those in 38- (adjusted odds ratio (aOR) 1.11; 95% CI, 1.04-1.18), 39- (aOR 1.21; 95% CI, 1.14-1.28) and 40- (aOR 1.50; 95% CI, 1.40-1.60) induction groups had increased risk of caesarean section. Women in the 38-induction group also had an increased risk of composite neonatal morbidity (aOR 1.10; 95% CI, 1.01-1.21), which was not observed at 39- and 40-induction groups. We found no difference between groups in perinatal death or neonatal intensive care unit admission for births at any gestational age. CONCLUSION:In women with GDM but without specific medical conditions and eligible for vaginal birth, IOL at 38, 39, 40 weeks gestation is associated with an increased risk of caesarean section.

Background: To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. Methods: A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. Results: The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8–57.3%), metformin alone in 18.8% (0.4–43.7%), and metformin and insulin in 10.1% (1.5–23.4%); when compared between sites, all p < 0.001. Birth was by elective caesarean in 12.1% (3.6–23.7%) or emergency caesarean in 9.5% (3.5–21.2%) (all p < 0.001). Preterm births (<37 weeks) ranged from 3.7% to 9.4% (p < 0.05), large for gestational age 10.3–26.7% (p < 0.001), admission to special care nursery 16.7–25.0% (p < 0.001), and neonatal hypoglycaemia (<2.6 mmol/L) 6.0–27.0% (p < 0.001). Many women with T1D and T2D had limited pregnancy planning including first trimester hyperglycaemia (HbA1c > 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). Conclusion: Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.

Aims: To assess differences in knowledge and beliefs about pregnancy in women with diabetes. Methods: Questions were from the Australian 'Contraception, Pregnancy & Women's Health' survey. Women (18-50 years) were eligible if pregnant or planning pregnancy. Knowledge and beliefs items were adapted from the Reproductive Health and Behaviours Questionnaire. Results: Compared to women with type 2 diabetes (n = 103), women with type 1 diabetes (n = 526) had higher scores for knowledge about pregnancy in diabetes (type 1 diabetes 9.8 +/- 2.4 vs. type 2 diabetes 7.7 +/- 3.1), beliefs about benefits (type 1 diabetes 18.4 +/- 2.2 vs. type 2 diabetes 17.2 +/- 3.3), cues-to-action (type 1 diabetes 2.7 +/- 1.4 vs. type 2 diabetes 1.5 +/- 1.3) and self-efficacy (type 1 diabetes 22.6 +/- 5.5 vs. type 2 diabetes 20.2 +/- 6.1 (all p < 0.001) regarding preparing for pregnancy. Major knowledge gaps were the need for higher dose folate compared to women without diabetes and uncertainty about breastfeeding recommendations. Women with type 1 diabetes believed more strongly in the benefits of 'close to target' glucose levels prior to pregnancy and using contraception to prevent unplanned pregnancy; they also felt more confident to access pre-pregnancy care and to wait for optimal glycaemia before pregnancy. Women with type 2 diabetes were less aware of contraceptive choices, and risks associated with hyperglycaemia before or early in pregnancy. Conclusions: The findings highlighted main gaps in knowledge and beliefs about planning for pregnancy. Especially in type 2 diabetes, there is a need for evidence-based messaging and strategies addressing these gaps, to raise understanding to prepare for future pregnancies.

INTRODUCTION:Type 1 diabetes presents significant challenges for optimal management. Despite intensive glycaemic control being the standard of care for several decades, glycaemic targets are infrequently achieved and the burden of complications remains high. Therefore, the advancement of diabetes management technologies has a major role in reducing the clinical and economic impact of the disease on people living with type 1 diabetes and on health care systems. However, a national framework is needed to ensure equitable and sustainable implementation of these technologies as part of holistic care.MAIN RECOMMENDATIONS:This consensus statement considers technologies for insulin delivery, glucose sensing and insulin dose advice that are commercially available in Australia. While international position statements have provided recommendations for technology implementation, the ADS/ADEA/APEG/ADIPS Working Group believes that focus needs to shift from strict trial-based glycaemic criteria towards engagement and individualised management goals that consider the broad spectrum of benefits offered by technologies.CHANGES IN MANAGEMENT AS RESULT OF THIS STATEMENT:This Australian consensus statement from peak national bodies for the management of diabetes across the lifespan outlines a national framework for the optimal implementation of technologies for people with type 1 diabetes. The Working Group highlights issues regarding equity of access to technologies and services, scope of clinical practice, credentialling and accreditation requirements, regulatory issues with "do-it-yourself" technology, national benchmarking, safety reporting, and ongoing patient advocacy.