OBJECTIVES:Recent clinical guidelines recommend screening for fear of hypoglycemia (FOH) as it is a known barrier in type 1 diabetes (T1D) management. Thus, this study proposes a one-item screening question to identify people living with T1D for whom FOH is a barrier to achieving glycemic targets and well-being. METHODS:Cross-sectional analysis using self-reported data from an online registry of people living with T1D. The one-item screening question "[Does] fear of hypoglycemia represent a barrier for you to achieve optimal blood sugar levels?" was validated by evaluating its association with glycemic outcomes (hemoglobin A1c [HbA1c]) and Hypoglycemia Fear Survey-II scores using regression models while adjusting for gender, hypoglycemia history, and hypoglycemia confidence. RESULTS:Among 1437 adults (mean age: 44.3 ± 15.1 years), 43% responded "yes" to the screening question (FOH + group). Participants in the FOH + group were more likely to self-identify as women, use medication to treat depression or anxiety, and report lower hypoglycemia confidence. The FOH + group had on average 0.48% [0.12, 0.83] higher HbA1c levels and were less likely to report reaching the recommended target HbA1c ≤ 7.0% (30% compared to 47%; P < .001). These associations remained significant even after adjusting for gender, hypoglycemia history, and hypoglycemia confidence. Hypoglycemia Fear Survey-II scores were significantly higher in the FOH + group (total score coefficient: 11.0 [9.1, 12.8]). CONCLUSIONS:As FOH remains under-assessed clinically, a validated one-item screening question can facilitate targeted and individualized clinical discussions for efficient recommendations and therapeutic adjustments.

BACKGROUND:Advanced diabetes technologies are standard of care for people with Type 1 diabetes (T1D). However, inequitable access contributes to disparities in outcomes. PURPOSE:To characterise barriers and enablers to the use of advanced diabetes technologies among individuals with T1D and to synthesise these determinants using the Theoretical Domains Framework. DATA SOURCES:EMBASE, Cochrane, PubMed, and MEDLINE were systematically searched from January 1, 2000, to September 30, 2025. STUDY SELECTION:We included studies of any design examining characteristics associated with the use of insulin pumps, continuous glucose monitors (CGM), or automated insulin delivery (AID) in T1D. DATA EXTRACTION:Two reviewers independently screened and extracted data using a standardised tool. Determinants were categorised as non-modifiable or potentially modifiable barriers or enablers. Modifiable determinants were mapped to TDF domains to enable theory-informed synthesis. DATA SYNTHESIS:Of 3081 citations identified, 303 studies (1 864 469 participants) were included. Non-modifiable determinants most frequently associated with technology use included racial/ethnic minority status (n = 90), age (n = 53), sex (n = 36), and socioeconomic status (n = 40). Potentially modifiable determinants clustered primarily within six TDF domains, most commonly Environmental Context and Resources, Social Influences, Knowledge, Skills, Beliefs about Consequences, and Emotions. Within these domains, key barriers included financial constraints (n = 117), provider gatekeeping and clinic processes (n = 43), and physical burden or body image concerns (n = 41). Key enablers included supportive patient-provider relationships and shared decision-making (n = 42), patient education and knowledge of device benefits (n = 40), and proactive provider engagement (n = 24). LIMITATIONS:A large proportion of abstracts (35.3% overall; 70.6% of interventions), potential publication bias, exclusion of grey literature, predominance of US-based studies (62.4%), and few AID-only studies (6.9%) may limit generalisability. CONCLUSIONS:Barriers to diabetes technology use map to key TDF domains, with structural factors predominating. Multilevel interventions targeting health system processes, provider practices, and education are needed to improve equitable uptake.

The Goldberg method is a statistical approach suggested for identifying implausible energy intakes (EI) in nutritional epidemiology. However, estimating physical activity levels (PAL), required for the method, is challenging. We quantified the accuracy of the Goldberg method combined with PAL derived from the Sedentary Time and Activity Reporting Questionnaire (Goldberg-PALSTAR-Q). Total energy expenditure derived from doubly labeled water (TEEDLW) was the comparator. Between 2009 and 2011, men (n=40) and women (n=59) completed a two-week DLW protocol, a food frequency questionnaire, and the STAR-Q. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the Goldberg-PALSTAR-Q were determined. Fifty-eight percent of men and women were classified as EI under-reporters by the Goldberg-PALSTAR-Q compared with 60% of men and 56% of women by TEEDLW. Among men, sensitivity, specificity, PPV, NPV and accuracy and 95% confidence intervals were 88% (68%-97%), 87% (61%-98%), 91% (72%-99%), 81% (56%-94%), and 87% (72%-95%), respectively; and among women 79% (62%-90%), 69% (50%-84%), 77% (60%-88%), 72% (52%-86%), and 75% (62%-84%), respectively. In studies where objective EI measures are lacking, the Goldberg method and individual-level questionnaire-derived PALs provide a viable option in sensitivity analyses exploring the influence of implausible EIs on diet and health-related associations.

The objective of this randomised crossover study was to determine, in adults with type 1 diabetes, whether the glycaemic effects of high-intensity interval exercise (HIIE) vs moderate-intensity continuous exercise (CONT) differ between the postprandial (PP, higher insulin-on-board) and postabsorptive (PA) states. Twenty physically active adults (inclusion criteria: type 1 diabetes for >1 year, 18–55 years old; nine female; mean ± SD age 33.4 ± 9.4 years) completed four iso-mechanical 25 min cycling sessions (HIIE-PA and HIIE-PP including 1’-1’ bouts at 100 https://entrepot.recherche.data.gouv.fr/ platform ( https://doi.org/10.57745/YGYJSH ) with no time limit scheduled. The only restriction on the use of the data will be for commercial purposes.

AIMS:The Behaviors, Therapies, TEchnologies and hypoglycemic Risk in Type 1 diabetes (BETTER) registry collects patient-reported outcomes and experiences on individuals living with type 1 diabetes in Canada. The objective of our study was to describe the management of type 1 diabetes reported by parents of children and young adolescents (< 14 years of age) enrolled in the BETTER registry. MATERIALS AND METHODS:We conducted a cross-sectional evaluation using self-reported data collected from April 2019 to October 2024. Parents of children and adolescents < 14 years self-registered and provided written online informed consent. As of October 2024, 699 children and adolescents < 14 years of age and living with type 1 diabetes were enrolled. RESULTS:Children had a mean age of 8.8 ± 3.1 years old with a diabetes duration of 2.3 ± 2.7 years, 44.9% were female, and 85.0% were of European ancestry. More than 80% used a continuous glucose monitoring system and 38.3% used an insulin pump. Most recent HbA1c ≤ 7% was reported by 15.9% of participants. At least 1 episode of level 2 hypoglycemia (glucose levels < 3.0 mmol/L, with ability to self-treat) in the last month was reported by 72.5% of participants, with a median number of episodes (interquartile range) of 5 (2, 10). The occurrence of level 3 hypoglycemia (low glucose, requiring help from another person, use of glucagon, hospitalization, or loss of consciousness) in the last 12 months was reported by 8.6% of participants. Among these, the median number of episodes was 1 (1, 3). CONCLUSIONS:Our results indicate that, despite a wide use of continuous glucose monitoring, the occurrence of hypoglycemia is still high and the proportion of children and adolescents reaching the HbA1c target is low.

The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. ClinicalTrials.gov Identifier: NCT03574597

ObjectiveThis study aimed to evaluate the effect of a 50% reduction in preprandial bolus insulin (50%-B) on plasma glucose (PG) responses during postprandial exercise of continuous moderate intensity (CONT) and intermittent high intensity (INT) in individuals with type 1 diabetes (T1D).MethodsSixteen adults with T1D (31% male), treated with multiple daily insulin injections (MDI), participated in a randomized crossover study comprising four experimental conditions, separated by a washout period of at least 48 hours. Participants performed two 30-minute, preceded by a 3-minute warm-up without weights:• CONT: continuous cycling at 60% of maximal aerobic power (MAP).• INT: 2-minute intervals alternating between 40% and 80% of MAP, repeated for 7 intervals, with the last interval adjusted so that the total exercise time is exactly 30 minutes. Each exercise modality was performed under two insulin conditions: a full preprandial bolus (100%-B) and a 50% reduction (50%-B). Plasma glucose, insulin, and cortisol were measured before, during, and after exercise. Linear mixed models were used to analyze temporal changes and condition effects.ResultsBlood glucose decreased significantly over time for both exercise types (p < 0.001). During CONT, the decline in PG was similar between doses (Δ100%-B: –3.01 ± 2.96 vs. Δ50%-B: –2.82 ± 2.28 mmol/L; p = 0.18), However, the nadir PG was higher with 50%-B compared to 100%-B (8.59 ± 4.07 vs. 5.69 ± 3.06 mmol/L, respectively; β = +2.91 mmol/L; p = 0.026), and hypoglycemia was less frequent (2 vs. 18 episodes; p = 0.028). During INT, PG decreased less with 50%-B than with 100%-B (Δ: –2.03 ± 1.63 vs. –3.62 ± 2.76 mmol/L; p = 0.022), with no hypoglycemic episodes under 50%-B compared to six with 100%-B. Mean PG remained higher with 50%-B across both exercise types (p < 0.01). Plasma insulin decreased over time (p = 0.038) regardless of bolus condition, while cortisol increased more during INT with 100%-B than with 50%-B (p = 0.02).ConclusionsReducing the preprandial bolus insulin by 50% effectively attenuates exercise-induced declines in plasma glucose and substantially reduces hypoglycemia risk, particularly during intermittent high-intensity exercise. These results emphasize the clinical relevance of personalized insulin adjustments to enhance metabolic safety during exercise in individuals with T1D.

OBJECTIVE:This study aimed to compare 2 post-exercise glucose management approaches in type 1 diabetes patients using continuous subcutaneous insulin infusion. METHODS:A group of 46 adults and adolescents underwent a 60-minute ergocycling session at 60% of their VO2peak at 4 pm After the exercise, participants were randomly assigned to post-exercise glucose management strategies: The first strategy involved a 20% reduction in basal insulin infusion rate for 10 h, along with a 20% reduction in the dinner insulin bolus. The second strategy consisted of consuming a post-exercise snack with 50% of their usual insulin bolus, followed by an evening snack without insulin bolus. RESULTS:During the 13-hours of recovery (5 PM to 6 AM post-exercise), there were no significant differences between the 2 strategies in terms of time spent within blood glucose levels of 4.0-10.0 mmol/l (54.4 ± 26.2 vs 57.7 ± 25.9%) and time spent below 4.0 mmol/l (1.8 ± 5.9 vs 5.5 ± 9.2%), this difference did not reach statistical significance, likely due to high interindividual variability as reflected by the large standard deviations. However, the time to first hypoglycemic event (eg, time from exercise end to first interstitial glucose <4.0 mmol/L) was significantly longer with the basal insulin reduction strategy (140 vs 83 min, P= .04), indicating a clinically meaningful advantage in delaying post-exercise hypoglycemia. CONCLUSIONS:Both strategies were comparably effective in maintaining similar blood glucose stability during the 13-hours recovery period post-exercise. However, the basal insulin reduction strategy significantly delayed the onset of the first hypoglycemic episode, suggesting a potential advantage for post-exercise hypoglycemia management.

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

AIMS:Some studies have explored associations between physical activity (PA) and hypoglycaemia in real-life in type 1 diabetes (T1D) but without fully accounting for two major confounders, diet and insulin. We aimed to identify thresholds of PA characteristics, insulin, and carbohydrates associated with dysglycaemia across the exercise-recovery cycle in children with T1D. MATERIALS AND METHODS:Continuous glucose monitoring and accelerometry data, self-reported PA sessions (timing, duration and perceived intensity), diet (timing, type and quantity; optional photographs) and insulin data (doses and timing; corrective/meal boluses and basal insulin) were collected in 36 children with T1D (11.9 ± 3.3 years, injections or open-loop pumps) over seven free-living days. Accelerometer data were analysed for periods corresponding to self-reported PA sessions. Ensemble machine-learning models classified hypoglycaemia (< 70 mg/dL) and hyperglycaemia (> 180 mg/dL) during three phases: PA, 2-h post-exercise (early recovery), overnight. Shapley analysis identified risk and protection thresholds of features with high importance. RESULTS:Models achieved moderate to strong performance (AUC: 0.65-0.99; F1-score: 0.62-0.95) across outcomes and phases. Insulin boluses > 11% of total daily dose within 4-h pre-exercise and > 17% during early recovery were associated with hypoglycaemia risk during PA and early recovery respectively. Carbohydrate intake showed collinearity with insulin, resulting in complex associations with glycaemia. Self-reported PA > 80 min was associated with hypoglycaemia risk during PA, while accumulating > 15 min of accelerometer-derived vigorous PA was actually protective against early recovery hypoglycaemia. Multiple daily sessions were associated with nocturnal hyperglycaemia protection. CONCLUSIONS:Phase-specific thresholds across exercise and insulin domains associated with exercise-related dysglycaemia were identified.

Gastroparesis (impaired gastric motility) is a complication of type 1 diabetes that impacts glycemic management. Yet, little research exists on prandial insulin adjustment strategies to manage this complex condition. This study combines current literature with clinical and lived experiences to propose practical strategies for insulin adjustment for people with type 1 diabetes and gastroparesis. Methods A mixed-methods approach was used. PubMed and Scopus were searched in February 2025, and Canadian clinicians and people with type 1 diabetes were surveyed using the Delphi method. Consensus was set at ≥80% agreement. Findings from both the review and panel informed the proposed recommendations. Results Of 2750 studies retrieved, seven met the inclusion criteria. Common themes included post-meal insulin dosing, dose reductions, and use of dual wave or extended boluses with insulin pumps and automated insulin delivery (AID) systems. The expert panel included 42 clinicians and 6 people with type 1 diabetes with gastroparesis. The panel recommended splitting the insulin dose (25-70% with meal and the remaining dose after 2-4 hours or as needed) for injection or non-automated insulin pump users. For AID users, recommendations included smaller insulin doses with the meal and allowing AID algorithms to manage postprandial glycemia. Participants emphasized individualized strategies based on symptoms, gastric motility and glucose monitoring. Conclusion This study provides expert-informed strategies grounded in literature for adjusting prandial insulin when gastroparesis is present. The findings highlight the growing evidence that AID systems can reduce the burden associated with gastroparesis and continuous glucose monitoring can support timely dosing decisions.

Amidst the worldwide physician shortage, we share how realizing our vision can improve access to diabetes care. Central to this vision is a methodical process to assess each patient’s complexity in order to delegate their care within a medically-supervised interdisciplinary comprehensive care clinic.

Glucocorticoids (GCs) are widely utilised for the treatment of inflammatory and autoimmune conditions but often precipitate significant hyperglycaemia. People with type 1 diabetes (PWT1D) may be particularly affected due to the challenges of adjusting insulin dosing, for which recommendations remain unclear. Our aim is to synthesise the evidence on the glycaemic effects of GCs in PWT1D across various formulations, doses and administration routes, and to outline management strategies. In August 2025, a systematic search of MEDLINE, Embase and CENTRAL was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included adult PWT1D exposed to GCs and reported glycaemic outcomes and/or management strategies. Twenty-two studies were included, comprising 368 PWT1D. GC exposure was consistently associated with marked hyperglycaemia and increased insulin requirements. Oral and intravenous GC regimens required substantial insulin dose escalation, in many cases up to 70% from baseline. During pregnancy, antenatal corticosteroids were best managed with structured subcutaneous or intravenous insulin protocols. Local injectable GCs caused delayed but prolonged excursions and required careful blood glucose (BG) monitoring. Emerging data suggest that automated-insulin delivery (AID) systems attenuate BG elevation but still require user intervention. Thus, GC therapy in PWT1D destabilises glycaemic management, though impact and timing vary by formulation, dose, administration route, patient-specific factors and clinical context. Proactive, individualised insulin adjustments aligned with GC pharmacokinetics and frequent BG monitoring or continuous glucose monitor use represent the most practical current strategy. Further research is required to develop evidence-based guidelines and to clarify the role of AID.

Background Diabetes is a major cardiovascular risk factor. Although aspirin is recommended for secondary prevention, its role in primary prevention among patients with diabetes remains unclear. The APPEASED trial aimed to evaluate aspirin’s pharmacokinetics and pharmacodynamics in this population. Methods In this single-arm, open-label trial, 50 patients with type 2 diabetes and no evidence of atherosclerotic disease, received 81 mg of enteric-coated aspirin once daily for 7 days. Platelet function was assessed at baseline and on day 7 using light transmission aggregometry in response to arachidonic acid (primary endpoint) and measurement of circulating thromboxane B2 (TxB2) level (secondary endpoint). Oxidative stress markers, COX-1 acetylation, and COX-2 expression were also measured to explore mechanisms of on-treatment platelet reactivity. Results Ten participants (20%) exhibited high on-treatment platelet reactivity 24 hours after 6 days of aspirin. However, all showed complete platelet inhibition 2 hours after observed ingestion on day 7. Despite variability in platelet reactivity, COX-1 acetylation and TxB2 suppression were consistent across participants. No significant differences were found in oxidative stress markers or COX-2 expression. Conclusion In patients with type 2 diabetes in primary prevention, low-dose enteric-coated aspirin consistently achieved platelet inhibition shortly after ingestion, 20% of participants showed incomplete inhibition at 24 hours, despite adequate COX-1 acetylation and TxB2 suppression. These findings suggest that alternative aspirin regimens may be needed to ensure continuous platelet inhibition and optimize cardiovascular prevention in this high-risk population.

In-hospital standard of care for people living with diabetes (PLWD) is based on capillary blood glucose to activate hypoglycemia treatment protocols. PLWD on non-critical care wards often prefer to keep their continuous glucose monitor (CGM) on for their sense of agency. This systematic review assessed the CGM accuracy in the hypoglycemic range for these PLWD. Databases were searched from 2012 to August 2025. We included studies of adult PLWD on non-critical care wards, with CGM levels below 70 mg/dL (3.9 mmol/L) that were compared with paired reference blood glucose levels. Nine included studies reported on 465 hypoglycemic CGM and reference blood glucose pairs. The mean and median absolute relative differences ranged from 7.6% to 53.3%, and from 11.7% to 38.5%, respectively. The methods for pairing CGM with reference blood glucose varied. In eight studies, the mean absolute relative differences between hypoglycemia range CGM and paired reference blood glucose results were greater than 15%. These high mean absolute relative differences suggest that hypoglycemic range CGM results are too inaccurate to guide in-hospital diabetes therapy.

Aims: In people with type 1 diabetes, physical activity provides important health benefits but is mainly limited by fear of hypoglycaemia. Daily step count is a simple indicator of ambulatory activity. This study examined associations between step count and health indicators. Materials and Methods: Adults from the Behaviours, Therapies, Technologies and Hypoglycaemic Risk in Type 1 Diabetes registry wore a validated pedometer (PiezoRxD (R)) for 7-12 days and were classified based on mean daily steps: <7000 (group 1), 7000-10 000 (group 2), and >10 000 (group 3). Between-group comparisons used analysis of variance and chi-square/Fisher's tests with Bonferroni correction. Multivariable models adjusted for potential confounders. Results: A total of 383 participants (333 T1D, 50 latent autoimmune diabetes) were included (group 1: 163; group 2: 125; group 3: 95). Mean age was 46.7 +/- 13.3 years, 63% were women, diabetes duration was 24.2 +/- 15.6 years, and body mass index (BMI) 26.1 +/- 4.5 kg/m(2). Overall, 43.6% had glycated haemoglobin (HbA1c) <= 7%. A higher proportion of participants in groups 2 and 3 had HbA1c <= 7% compared with group 1. Level 1 and 2 hypoglycaemia frequency did not differ significantly across groups. Groups 2 and 3 had lower waist circumference than group 1, and group 3 additionally had lower BMI and a lower proportion of depression/anxiety medication use. Conclusions: Among adults living with type 1 diabetes, higher daily step counts were associated with more favourable glycaemic and anthropometric profiles, as well as lower use of depression/anxiety medication without evidence of increased hypoglycaemia. Causality cannot be inferred, and reverse causation is possible.