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We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high‐quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of 'general' recommendations followed by 'specific' recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self‐management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self‐management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis. What's new?: This work represents the first diabetes guideline that makes both general and specific recommendations based on descriptive and functional characteristics of adults with type 1 diabetes.This is the first type 1 diabetes guideline that considers the needs of older adults with this condition.Recommendations are designed to provide a guide to allowing comprehensive assessment model and risk stratification approaches (including functional assessment) to be central features of management.The recommendations provide an individualized multidimensional integrated approach to the comprehensive management of type 1 diabetes in adults. [ABSTRACT FROM AUTHOR]

Introduction: To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. Methods: Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness. Results: Six months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA1c, from 8.6 (8.0-9.3)% [70 (64-78) mmol/mol] to 8.4 (7.9-8.9)% [68 (63-74) mmol/mol]; p\0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7-45.0) to 25.5 (14.0-30.2) units; p\0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs. Conclusion: In patients with T1D, switching to degludec was associated with an improvement in HbA1c and reductions in basal insulin dose severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings. [ABSTRACT FROM AUTHOR]

Lowering glucose levels, while avoiding hypoglycaemia, can be challenging in insulin-treated patients with diabetes. We evaluated the role of ambulatory glucose profile in optimising glycaemic control in this population. Insulin-treated patients with type 1 and type 2 diabetes were recruited into a prospective, multicentre, 100-day study and randomised to control (n = 28) or intervention (n = 59) groups. The intervention group used ambulatory glucose profile, generated by continuous glucose monitoring, to assess daily glucose levels, whereas the controls relied on capillary glucose testing. Patients were reviewed at days 30 and 45 by the health care professional to adjust insulin therapy. Comparing first and last 2 weeks of the study, ambulatory glucose profile–monitored type 2 diabetes patients (n = 28) showed increased time in euglycaemia (mean ± standard deviation) by 1.4 ± 3.5 h/day (p = 0.0427) associated with reduction in HbA1c from 77 ± 15 to 67 ± 13 mmol/mol (p = 0.0002) without increased hypoglycaemia. Type 1 diabetes patients (n = 25) showed reduction in hypoglycaemia from 1.4 ± 1.7 to 0.8 ± 0.8 h/day (p = 0.0472) associated with a marginal HbA1c decrease from 75 ± 10 to 72 ± 8 mmol/mol (p = 0.0508). Largely similar findings were observed comparing intervention and control groups at end of study. In conclusion, ambulatory glucose profile helps glycaemic management in insulin-treated diabetes patients by increasing time spent in euglycaemia and decreasing HbA1c in type 2 diabetes patients, while reducing hypoglycaemia in type 1 diabetes patients. [ABSTRACT FROM AUTHOR]

Delivering diabetes care to people who do not or cannot attend for appointments in primary care can be challenging. People in such hard-to-reach groups include individuals with mental health problems, those in prison, adolescents, homeless people and migrant ethnic groups. This article looks at the challenges of delivering diabetes care to people in hard-to-reach groups and reviews the evidence for improving their care. [ABSTRACT FROM AUTHOR]

The article presents a study of the effects of COVID-19 infection on the presentation, severity and management of diabetic ketoacidosis (DKA) in type 1 and type 2 diabetes patients at University Hospitals Birmingham in England during the pandemic. Topics discussed include the role of the presence of hyperglycaemia, ketosis and metabolic acidosis in DKA onset, lack of significant difference in DKA severity at presentation, and higher rate of type 2 diabetes among COVID-19 positive patients.