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Aim: To understand experiences of using second‐generation advanced hybrid closed‐loop (AHCL) therapy in adolescents and young adults with chronically elevated glucose levels who were previously using multiple daily injections (MDI) therapy. Method: Semi‐structured interviews with participants aged 13–25 years, on AHCL therapy for 3 months as part of a single‐arm prospective study. Key inclusions: HbA1c ≥69 mmol/mol (8.5%); diabetes duration ≥1 year; and using MDI therapy prior to the study. Qualitative content analysis was used to identify themes and subthemes. Results: Interviews were conducted among 14 participants with mean age 19.4 ± 4.3 years and mean baseline HbA1c 90 ± 25 mmol/mol (10.4 ± 4.5%). Three themes were identified: (1) substantially improved glucose levels improved perceptions of overall health; (2) features of AHCL aid in adoption and ongoing self‐management; and (3) burden of care was reduced through automation of insulin delivery. Overall, there were positive impacts on physical, mental and social well‐being. Participants were willing to overlook minor frustrations with AHCL because of the vast benefits that they had experienced. Four participants reported transient pseudo‐hypoglycaemia: symptoms of hypoglycaemia when objectively measured glucose was in the clinically recommended range (3.9–10 mmol/L, 70–180 mg/dL). Conclusion: Transition to AHCL therapy positively impacted diabetes management in adolescents and youth with chronically elevated glucose levels. It appears to create a window of opportunity in which youth may re‐engage with diabetes management. Pseudo‐hypoglycaemia can occur during the transition to AHCL. This could be a barrier to AHCL uptake and is likely to require individualised support. [ABSTRACT FROM AUTHOR]

Aims: To investigate the impact of real‐time continuous glucose monitoring (rtCGM) on glycaemia in a predominantly indigenous (Māori) population of adults with insulin‐requiring type 2 diabetes (T2D) in New Zealand. Methods: Twelve‐week, multicentre randomised controlled trial (RCT) of adults with T2D using ≥0.2 units/kg/day of insulin and elevated glycated haemoglobin (HbA1c) ≥64 mmol/mol (8.0%). Following a 2‐week blinded CGM run‐in phase, participants were randomised to rtCGM or control (self‐monitoring blood glucose [SMBG]). The primary outcome was time in the target glucose range (3.9–10 mmol/L; TIR) during weeks 10–12, with data collected by blinded rtCGM in the control group. Results: Sixty‐seven participants entered the RCT phase (54% Māori, 57% female), median age 53 (range 16–70 years), HbA1c 85 (IQR 74, 94) mmol/mol (9.9 [IQR 8.9, 10.8]%), body mass index (36.7 ± 7.7 kg/m2). Mean (±SD) TIR increased from 37 (24)% to 53 (24)% [Δ 13%; 95% CI 4.2 to 22; P = 0.007] in the rtCGM group but did not change in the SMBG group [45 (21)% to 45 (25)%, Δ 2.5%, 95% CI −6.1 to 11, P = 0.84]. Baseline‐adjusted between‐group difference in TIR was 10.4% [95% CI −0.9 to 21.7; P = 0.070]. Mean HbA1c (±SD) decreased in both groups from 85 (18) mmol/mol (10.0 [1.7]%) to 64 (16) mmol/mol (8.0 [1.4]%) in the rtCGM arm and from 81 (12) mmol/mol (9.6 [1.1]%) to 65 (13) mmol/mol (8.1 [1.2]%) in the SMBG arm (P < 0.001 for both). There were no severe hypoglycaemic or ketoacidosis events in either group. Conclusions: Real‐time CGM use in a supportive treat‐to‐target model of care likely improves glycaemia in a population with insulin‐treated T2D and elevated HbA1c. [ABSTRACT FROM AUTHOR]

Aims: To describe the impact of a 12‐month intervention using intermittently scanned continuous glucose monitoring (isCGM) on glycaemic control and glucose test frequency in adolescents and young adults with type 1 diabetes (T1D) and high‐risk glycaemic control (HbA1c ≥75 mmol/mol [≥9.0%]). Methods: In total, 64 young people (aged 13–20 years, 16.6 ± 2.1 years; 48% female; 41% Māori or Pacific ethnicity; mean diabetes duration 7.5 ± 3.8 years) with T1D were enrolled in a 6‐month, randomized, parallel‐group study comparing glycaemic outcomes from the isCGM intervention (n = 33) to self monitoring blood glucose (SMBG) controls (n = 31). In this 6‐month extension phase, both groups received isCGM; HbA1c, glucose time‐in‐range (TIR), and combined glucose test frequency were assessed at 9 and 12 months. Results: At 12 months, the mean difference in HbA1c from baseline was −4 mmol/mol [−0.4%] (95% confidence interval, CI: −8, 1 mmol/mol [−0.8, 0.1%]; p = 0.14) in the isCGM intervention group, and −7 mmol/mol [−0.7%] (95% CI: −16, 1 mmol/mol [−1.5, 0.1%]; p = 0.08) in the SMBG control group. No participants achieved ≥70% glucose TIR (3.9–10.0 mmol/L). The isCGM intervention group mean rate of daily glucose testing was highest at 9 months, 2.4 times baseline rates (p < 0.001), then returned to baseline by 12 months (incidence rate ratio = 1.4; 95% CI: 0.9, 2.1; p = 0.091). Conclusions: The use of isCGM in young people with high‐risk T1D resulted in transient improvements in HbA1c and glucose monitoring over a 9‐month time frame; however, benefits were not sustained to 12 months. [ABSTRACT FROM AUTHOR]

Aims: To investigate the experiences of parents caring for young children with type 1 diabetes type 1 diabetes using a do‐it‐yourself continuous glucose monitor (DIYrtCGM) in a supported setting. Methods: Exit interviews were conducted with parents from 11 families at the end of the MiaoMiao study: a randomised cross‐over trial focusing on parental fear of hypoglycaemia. Technical support was provided to participants while using DIYrtCGM during the trial. A convenience sampling approach was used to recruit parents. An in‐depth, semi‐structured interview approach was used. Thematic analysis was used to identify key themes and subthemes. Results: Parents identified that remote monitoring enabled proactive management and that overall alarms/glucose alerts were useful. Some parents reported reductions in anxiety, increased independence for their child, and improvements in the child–parent relationship. However, parents also reported regular signal loss with DIYrtCGM, along with complicated apps and challenges troubleshooting technical problems. Despite this, nine of the 11 families continued to use the system after the end of the trial. Conclusions: Do‐it‐yourself continuous glucose monitoring (CGM) was on balance beneficial for the parents interviewed. However, while access to CGM shifted the burden of care experienced by parents, burden did not significantly reduce for all parents, as the improved glycaemic control that they achieved was accompanied with the responsibility for continually monitoring their child's data. Supported use of do‐it‐yourself CGM may be an achievable, cost‐effective option for parents caring for children with type 1 diabetes in countries without funded access to CGM. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions To identify from a parental perspective facilitators and barriers of effective implementation of advanced hybrid closed‐loop (AHCL) therapy in children and adolescents with type 1 diabetes (T1D) with elevated glycaemia.Semi‐structured interviews were conducted with parents of participants while in a post‐trial extension phase of the CO‐PILOT randomized controlled trial. The Capability, Opportunity, Motivation, Behaviour Model and Theoretical Domain Framework informed the interviews and framework analysis.Eleven parents of 9 children and adolescents were interviewed. The median age of their children and adolescents was 14.2 years (IQR 13.3–14.7) with median HbA1c 78 mmol/mol (IQR 75–86) (9.3% IQR 9–10) before starting AHCL. Facilitators of implementing AHCL therapy included the following: (1) knowledge acquired from training, (2) establishing routines and action plans, (3) remote glucose monitoring, (4) achievement of glycaemic goals through automation, (5) children/adolescents' capability to use AHCL independently, (6) improved outcomes incentivized continued AHCL, (7) optimism about sustained improvements and (8) social support from healthcare providers, school staff, peers and parents. Barriers to AHCL implementation included the following: (1) challenges with device usability, (2) need for technical support, (3) forgotten knowledge and skills, (4) non‐adherence to best practices, (5) negative social influences, (6) physical and psychosocial burden and (7) negative emotions.This study provides comprehensive insights into parental perspectives of influences on implementing AHCL therapy in children and adolescents with elevated glycaemia. As parents remain key partners in diabetes care, these findings inform successful implementation of AHCL and development of future diabetes technology. [ABSTRACT FROM AUTHOR]