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Background: Meeting glycemic recommendations is challenging for youth with type 1 diabetes. Diabetes technology, including continuous glucose monitoring (CGM) and hybrid closed-loop (HCL) automated insulin delivery systems, significantly increase achievement of glycemic targets; however, many youth struggle to sustain use of early HCL systems. Nocturnal alarm fatigue contributes to disrupted sleep and device discontinuation., Methods: We examined the frequency and causes of nocturnal (10:00 p.m. to 6:00 a.m.) alarms in pediatric patients ( N = 76, median age 14.5 years [interquartile range 11.8-17.0 years, range 7-24 years]) starting on a first-generation HCL system in a prospective observational study. Device data were analyzed with linear mixed-effects models to examine change across time at 3-month intervals for 12 months., Results: At baseline (HCL system in nonautomated mode), participants averaged 3.3 ± 0.6 alarms per night. In the 2 weeks after starting HCL (automated) mode, alarm frequency significantly increased to 5.4 ± 0.5 times per night ( P <0.001). Alarm frequency decreased through the remainder of the observational period; however, CGM sensor and HCL system use also declined. The types of alarms were evenly distributed among sensor maintenance, sensor threshold, pump, and HCL-specific alarms., Conclusion: These data show that HCL system nocturnal alarms are frequent and may be barriers to sleep quality and device use. Further research is needed to assess the impact of diabetes technology on sleep and to determine method to improve sleep quality with technology use., Competing Interests: C.B. is a consultant/speaker for Insulet. L.H.M. has received speaking/consulting honoraria from Dexcom and Tandem Diabetes Care and also consults for Beta Bionics and Capillary Biomedical. R.P.W. has received research funding from Dexcom, Eli Lilly, and Tandem Diabetes Care; conference travel support from Dexcom and Eli Lilly; consulting honoraria from Eli Lilly; and speaker honoraria from Dexcom. G.P.F. conducts research sponsored by and has been a consultant/speaker for Abbott, Beta Bionics, Dexcom, Insulet, Medtronic, and Tandem Diabetes Care. No other potential conflicts of interest relevant to this article were reported., (© 2024 by the American Diabetes Association.)

Objective: β-Cell dysfunction and insulin resistance magnify the risk of kidney injury in type 2 diabetes. The relationship between these factors and intraglomerular hemodynamics and kidney oxygen availability in youth with type 2 diabetes remains incompletely explored., Research Design and Methods: Fifty youth with type 2 diabetes (mean age ± SD 16 ± 2 years; diabetes duration 2.3 ± 1.8 years; 60% female; median HbA1c 6.4% [25th, 75th percentiles 5.9, 7.6%]; BMI 36.4 ± 7.4 kg/m2; urine albumin-to-creatinine ratio [UACR] 10.3 [5.9, 58.0] mg/g) 21 control participants with obesity (OCs; age 16 ± 2 years; 29% female; BMI 37.6 ± 7.4 kg/m2), and 20 control participants in the normal weight category (NWCs; age 17 ± 3 years; 70% female; BMI 22.5 ± 3.6 kg/m2) underwent iohexol and p-aminohippurate clearance to assess glomerular filtration rate (GFR) and renal plasma flow, kidney MRI for oxygenation, hyperglycemic clamp for insulin secretion (acute C-peptide response to glucose [ACPRg]) and disposition index (DI; ×103 mg/kg lean/min), and DXA for body composition., Results: Youth with type 2 diabetes exhibited lower DI (0.6 [0.0, 1.6] vs. 3.8 [2.4, 4.5] × 103 mg/kg lean/min; P < 0.0001) and ACPRg (0.6 [0.3, 1.4] vs. 5.3 [4.3, 6.9] nmol/L; P < 0.001) and higher UACR (10.3 [5.9, 58.0] vs. 5.3 [3.4, 14.3] mg/g; P = 0.003) and intraglomerular pressure (77.8 ± 11.5 vs. 64.8 ± 5.0 mmHg; P < 0.001) compared with OCs. Youth with type 2 diabetes and OCs had higher GFR and kidney oxygen availability (relative hyperoxia) than NWCs. DI was associated inversely with intraglomerular pressure and kidney hyperoxia., Conclusions: Youth with type 2 diabetes demonstrated severe β-cell dysfunction that was associated with intraglomerular hypertension and kidney hyperoxia. Similar but attenuated findings were found in OCs., (© 2024 by the American Diabetes Association.)

Despite evidence of improved diabetes outcomes with diabetes technology such as continuous glucose monitoring (CGM) systems, insulin pumps, and hybrid closed-loop (HCL) insulin delivery systems, these devices are underutilized in clinical practice for the management of insulin-requiring diabetes. This low uptake may be the result of health care providers' (HCPs') lack of confidence or time to prescribe and manage devices for people with diabetes. We administered a survey to HCPs in primary care, pediatric endocrinology, and adult endocrinology practices in the United States. Responding HCPs expressed a need for device-related insurance coverage tools and online data platforms with integration to electronic health record systems to improve diabetes technology uptake in these practice settings across the United States., Competing Interests: L.H.M. has received research/education grants from Beta Bionics, Insulet, the Leona M. and Harry B. Helmsley Charitable Trust, the National Institutes of Health, and Tandem Diabetes Care. She has served as a consultant/speaker for Capillary Biomedical, Dexcom, and Tandem Diabetes Care and on an advisory board for Eli Lilly. As of January 2023, she is also employed by Tandom Diabetes Care. H.K.A. has received research grants from Dexcom, Eli Lilly, the Institute for the Advancement of Food and Nutrition Sciences, IM Therapeutics, Mannkind, Medtronic, REMD Biotherapeutics, and Senseonics. He has served as a consultant for Eli Lilly and on advisory boards for Ascensia and Mannkind. G.P.F. has received research grants from Abbott, Beta Bionics, Dexcom, Eli Lilly, Insulet, JDRF, Medtronic, and Tandem Diabetes Care and has served as a consultant/speaker for Abbott, Beta Bionics, Dexcom, Insulet, Eli Lilly, Medtronic, and Tandem Diabetes Care. S.M.O. has received research grants from the AAFP, the Colorado Department of Public Health & Environment, and the Leona M. and Harry B. Helmsley Charitable Trust. He has served on advisory boards for the ADA, ADCES, Cecelia Health, Dexcom, the Jaeb Center for Health Research, Medtronic, the National Committee on Quality Assurance, and Pendulum Therapeutics. S.P. has received research grants from Dexcom, Eli Lilly, JDRF, the Leona M. and Harry B. Helmsley Charitable Trust, Medtronic, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and Sanofi and has served on an advisory board for Medtronic. V.N.S. has received research grants from Dexcom, Eli Lilly, Insulet, JDRF, the National Institutes of Health, Novo Nordisk, and Tandem Diabetes Care. He has served as a consultant/speaker for Dexcom and Insulet and on advisory boards for DKSH Singapore, LifeScan, and Medscape. R.P.W. has received research grant support from Dexcom and Tandem Diabetes Care and has served as a consultant/speaker for Tandem Diabetes Care. T.K.O. has received research grants from Abbott, the AAFP, the Leona M. and Harry B. Helmsley Charitable Trust, the National Institute of Nursing Research, and NIDDK. She has served on advisory boards for ADA, ADCES, Cecelia Health, Dexcom, and the Jaeb Center for Health Research. No other potential conflicts of interest relevant to this article were reported., (© 2023 by the American Diabetes Association.)

Individuals with type 1 diabetes have higher rates of depression and suicidal ideation than the general population, and symptoms of depression are often associated with higher A1C levels and complications. This study evaluated mental health follow-up rates in youth and young adults with type 1 diabetes who screened positive for depressive symptoms or suicidal ideation and identified differences between those who obtained follow-up mental health care and those who did not. Specifically, males were less likely to obtain follow-up, and those who had mental health follow-up had decreasing A1C over the following year. These findings suggest increased assistance and monitoring are needed to ensure follow-up mental health care is obtained., (© 2022 by the American Diabetes Association.)

Objective: Type 2 diabetes (T2D) is a leading cause of end-stage kidney disease worldwide. Recent studies suggest a more aggressive clinical course of diabetic kidney disease in youth-onset compared with adult-onset T2D. We compared kidney structural lesions in youth- and adult-onset T2D to determine if youth onset was associated with greater early tissue injury., Research Design and Methods: Quantitative microscopy was performed on kidney tissue obtained from research kidney biopsies in 161 Pima Indians (117 women, 44 men) with T2D. Onset of T2D was established by serial oral glucose tolerance testing, and participants were stratified as youth onset (age <25 years) or adult onset (age ≥25 years). Associations between clinical and morphometric parameters and age at onset were tested using linear models., Results: At biopsy, the 52 participants with youth-onset T2D were younger than the 109 with adult-onset T2D (39.1 ± 9.9 vs. 51.4 ± 10.2 years; P < 0.0001), but their diabetes duration was similar (19.3 ± 8.1 vs. 17.0 ± 7.8 years; P = 0.09). Median urine albumin-to-creatinine ratio was higher in the youth-onset group (58 [25th-75th percentile 17-470] vs. 27 [13-73] mg/g; P = 0.02). Youth-onset participants had greater glomerular basement membrane (GBM) width (552 ± 128 vs. 490 ± 114 nm; P = 0.002) and mesangial fractional volume (0.31 ± 0.10 vs. 0.27 ± 0.08; P = 0.001) than adult-onset participants. Glomerular sclerosis percentage, glomerular volume, mesangial fractional volume, and GBM width were also inversely associated with age at diabetes onset as a continuous variable., Conclusions: Younger age at T2D onset strongly associates with more severe kidney structural lesions. Studies are underway to elucidate the pathways underlying these associations., (© 2022 by the American Diabetes Association.)

Objective: In cystic fibrosis (CF), hemoglobin A 1c (HbA 1c ) is thought to underestimate glycemia. However, few studies have directly assessed the relationship between HbA 1c and average glucose in CF. We determined the relationships among glycemic markers-HbA 1c , fructosamine (FA), glycated albumin (%GA), and 1,5-anhydroglucitol (1,5-AG)-and continuous glucose monitoring (CGM) in CF, hypothesizing that alternate markers would better predict average sensor glucose (ASG) than HbA 1c ., Research Design and Methods: CF participants and a group of healthy control subjects (HCs), ages 6-25 years, wore CGM for up to 7 days. Pearson correlations assessed the relationships between CGM variables and HbA 1c , FA, %GA, and 1,5-AG. The regression line between HbA 1c and ASG was compared in CF versus HC. Linear regressions determined whether alternate markers predicted ASG after adjustment for HbA 1c ., Results: CF ( n = 93) and HC ( n = 29) groups wore CGM for 5.2 ± 1 days. CF participants were 14 ± 3 years of age and 47% were male, with a BMI z score -0.1 ± 0.8 and no different from HCs in age, sex, or BMI. Mean HbA 1c in CF was 5.7 ± 0.8% (39 ± 9 mmol/mol) vs. HC 5.1 ± 0.2% (32 ± 2 mmol/mol) ( P < 0.0001). All glycemic markers correlated with ASG ( P ≤ 0.01): HbA 1c ( r = 0.86), FA ( r = 0.69), %GA ( r = 0.83), and 1,5-AG ( r = -0.26). The regression line between ASG and HbA 1c did not differ in CF versus HC ( P = 0.44). After adjustment for HbA 1c , %GA continued to predict ASG ( P = 0.0009) in CF., Conclusions: HbA 1c does not underestimate ASG in CF as previously assumed. No alternate glycemic marker correlated more strongly with ASG than HbA 1c . %GA shows strong correlation with ASG and added to the prediction of ASG beyond HbA 1c . However, we are not advocating use of HbA 1c for diabetes screening in CF based on these results. Further study will determine whether glycemic measures other than ASG differ among different types of diabetes for a given HbA 1c ., (© 2018 by the American Diabetes Association.)