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AIM To describe the different insulin therapy patterns and insulin daily doses in children and adolescents (aged 1-17 years) with type 1 diabetes. METHODS This cross-sectional study based on the longitudinal prescription (LRx) database (IQVIA) included children and adolescents who received at least two insulin prescriptions of the same drug from 1 January 2016 to 31 December 2019. The study outcomes included the proportion of patients with insulin pumps and multiple daily injection therapy, human insulin and insulin analogue use, as well as insulin daily doses. A multivariable linear regression model was used to study the association between age, sex, insulin drugs, and daily dose. RESULTS A total of 22 512 children and adolescents (mean age: 13.5 years, 47.1% female) were included. The proportion of patients using insulin pump therapy decreased with age, from 72.6% (females) and 73.0% (males) in the age group of younger than 6 years to 30.8% (females) and 26.1% (males) in adolescents. Insulin aspart was the most common short-acting insulin, with the proportion of users increasing from 56% in the age group of younger than 6 years to 69%-70% in the 13-17 years age group. The daily dose of insulin pump therapy was 10 units lower than multiple daily injection (MDI) (P

The aim of this study was to analyze the incidence of type 1 diabetes in children and adolescents (20 years of age) during the COVID-19 pandemic (3/2020 to 12/2021) in Germany.The present study was based on the IQVIA longitudinal prescription database (LRx), All persons (age ≤ 20 years) with new insulin prescriptions from 2016 to 2021 (index date) were selected and stratified by age group. Weekly (age-specific) data were used to forecast the prescription incidence for the pandemic period based on pre-pandemic data and to explore the relationship between weekly reported age-specific COVID-19 incidences and type 1 diabetes incidence and rate ratios of observed vs. predicted diabetes incidence respectively.During the pre-pandemic period, there was a stable higher insulin prescription incidence during the winter period and a lower insulin prescription incidence during summer. During the pandemic period, there was less seasonal variation in incidence related to the finding that the observed incidence during summer in 2002 and 2021 was 44 % and 65 %, higher, respectively, than the expected incidence based on pre-pandemic year. We did not find any cross-correlations between the COVID-19 incidence and the type 1 diabetes incidence for any age group. Likewise, there were no cross-correlations between the COVID-19 incidence and the incidence rate ratios of observed incidences to predicted incidences.During the COVID-19 pandemic, there was less seasonal variation in the incidence of type 1 diabetes (defined by new insulin prescriptions), with higher observed than expected incidences during summer. We found no evidence that the increase in type 1 diabetes incidence during the COVID-19 pandemic relates to direct effects of COVID-19 pandemic.

Glycemic targets are often difficult to achieve in people with type 1 diabetes, especially during exercise. Consequently, many people with type 1 diabetes avoid sports as a result of fear of hypoglycemia. Strenuous physical activity, such as a half marathon, imposes difficulties on people with type 1 diabetes. The first commercial hybrid closed‐loop (HCL) system with the potential to facilitate better diabetes management during exercise has recently been marketed. So far, no data on HCL performance during strenuous exercise have been published. A woman with well‐controlled type 1 diabetes participated in and safely finished a half marathon while undergoing HCL therapy. HCL could safely establish glycemic control without causing either hypo‐ or relevant hyperglycemia, and without the need for rescue carbohydrates while running. In the days after the half marathon, there was no change in glycemic control compared with the period before., Hybrid closed‐loop use can safely manage diabetes during a half marathon in type 1 diabetes patients.

Aim: The aim of this cross-sectional retrospective study was to estimate the prevalence of different physical and psychiatric disorders as well as multimorbidity in outpatients with type 1 diabetes (T1D) in Germany. Methods: A total of 6967 adult patients with T1D from 958 general or diabetologist practices in Germany between January 2015 and December 2019 from the Disease Analyzer database (IQVIA) were included. The main outcome of the study was the prevalence of different diabetes-related and nondiabetes-related disorders within 12 months prior to the last outpatient visit. Multivariate logistic regression models were fitted with multimorbidity differently defined as >2, >3, >4, and >5 different disorders as a dependent variable and age, sex, glycated hemoglobin (HbA1c) values, and insulin pump therapy as impact variables. Results: Mean age (standard deviation [SD]) was 45.3 (16.7) years; 42.9% were women, the mean HbA1c was 7.9% (SD: 1.4%). The most frequent disorder was arterial hypertension (31.2%), followed by dyslipidemia (26.4%), dorsalgia (20.4%), diabetic neuropathy (17.3%), and depression (14.6%). The proportion of thyroid gland disorders, retinopathy, urethritis, iron deficiency anemia, and psychiatric disorders was higher in women than in men. Hypertension and mental and behavioral disorders due to the use of tobacco were higher in men. On average, each patient was diagnosed with 3.1 different disorders. Age had the strongest association with multimorbidity, followed by HbA1c value and female sex. Conclusion: In summary, patients with T1D are often multimorbid, and the multimorbidity is associated with higher gender, female sex, and high HbA1c values. Understanding all of these factors can help practitioners create a risk profile for every patient.

Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.

Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. ispartof: PEDIATRIC DIABETES vol:21 issue:8 pages:1375-1393 ispartof: location:Denmark status: published

Aim: Insulin pump, continuous glucose monitoring (CGM), and sensor augmented pump (SAP) technology have evolved continuously leading to the development of automated insulin delivery (AID) systems. Evaluation of the use of diabetes technologies in people with T1D from January 2018 to December 2021. Methods: A patient registry (Diabetes Prospective Follow-up Database [DPV]) was analyzed for use of SAP (insulin pump + CGM ≥90 days, no automated dose adjustment) and AID (HCL or LGS/PLGS). In total 46,043 people with T1D aged 0.5 to Results: From 2018 to 2021, there was a significant increase from 28.7% to 32.9% (sensor augmented pump [SAP]) and 3.5% to 16.6% (AID) across all age groups, with the most frequent use in group A (Conclusion: In recent years, we found an increasing use of new diabetes technologies and an improvement in metabolic control (TiR) across all age groups.

This case report demonstrates that using a non‐approved long‐acting GLP‐1‐RA (dulaglutide) in adolescents with T2D is possible and feasible under special circumstances when approved therapeutic options for the pediatric population fail to achieve adequate glycemic control.

OBJECTIVE To investigate temporal trends and contemporary use of insulin pump therapy and glucose monitoring in type 1 diabetes. RESEARCH DESIGN AND METHODS In a population-based study, we analyzed the use of insulin pump therapy, continuous glucose monitoring (CGM), and self-monitoring of blood glucose (SMBG) from 1995 to 2017 in patients with type 1 diabetes identified from the Diabetes Prospective Follow-up (DPV) database in Germany and Austria. Patients were stratified by age, sex, migration background, and country. RESULTS Among 96,547 patients with type 1 diabetes (median age 17.9 years, 53% males), the percentage using insulin pump therapy increased from 1% in 1995 to 53% in 2017, with the highest rates in the youngest patients (92% in preschoolers, 74% in children, 56% in adolescents aged CONCLUSIONS Since 1995, insulin pump use has continuously increased, and insulin pump therapy is now standard in patients aged

We thank Dr Yardley and Dr Sigal for their comments on the position statement pertaining to the use of continuous glucose monitoring (CGM) systems around exercise in type 1 diabetes.

Aim Type 1 diabetes can lead to various long-term complications including macro- and microvascular disorders and osteoporosis. However, published data on the association between type 1 diabetes (T1D) and urinary system and genital tract disorders is limited. The aim of this work was to estimate the prevalence and incidence of urinary system- and genital tract disorders among women with T1D treated in gynecological practices in Germany. Methods This retrospective cohort study included women aged 16 years or older with T1D diagnosis between January 2015 and December 2018 from 268 gynecological practices in Germany (IMS Disease Analyzer database). T1D patients were matched 1:5 by age and physician with non-diabetic patients. The main outcome of the study was the prevalence of different urinary system, pelvic organ and genital tract disorders documented between the first documentation of T1D diagnosis and the last outpatient visit. All study disorders were included as dependent variables in multivariate logistic regression models, while T1D was applied as an impact variable. In each model, the effect of T1D on the defined disorder was adjusted for all other study disorders. Results The present study included 1357 women with and 6785 women without T1D (mean age 45.6 years). T1D was significantly associated with acute vulvitis (OR: 2.12 (95% CI: 1.56–2.90), other specified urinary incontinence (OR: 1.64 (95% CI: 1.19–2.26), acute cystitis (OR: 1.46 (95% CI: 1.10–1.95), and absent, scanty and rare menstruation (OR: 1.37 (95% CI: 1.13–1.67). Conclusion These findings may have implications for the future care of women with T1D. Firstly, the focus should not be on diabetes management alone, but also on identifying and handling additional associated comorbidities including urinary system and genital tract disorders. Secondly, the data suggest that patients with T1D should be asked specifically about symptoms they may be experiencing that are related to the associated disorders identified.

Comprehensive knowledge, specific skills, and data-analysis competences are prerequisites of successful use of continuous glucose monitoring systems (CGM). SPECTRUM is a structured and manufacturer-independent training-program for real time CGM (rtCGM) comprising one web-based introduction and six modules (each 90 minutes) of face-to-face group sessions. SPECTRUM was evaluated longitudinally among adults with type 1 diabetes from 10 diabetes centers. Outcome parameters were rtCGM-knowledge and -skills (rtCGM-Profi-Check), satisfaction with the course, technology acceptance and metabolic control. Initially 120 participants with type 1 diabetes were included (mean age 42.4±13.4 years, diabetes duration 21.6±11.6 years, 56% female, mean HbA1c 7.70±1.34%). Data were collected at study entry, after the final group session, and at 6 months follow-up. The study was completed by 108 patients (10% dropped out, mainly due to scheduling problems). After training rtCGM knowledge (scale 0-40) improved by 43% (from 21.2±7.6 to 30.4±4.5; p SPECTRUM was shown to be effective in increasing the knowledge and skills about rtCGM in adults with type 1 diabetes. The effect was sustainable and independent from diabetes center and rtCGM-system used. Training participants showed an improvement in glycemic control and improved satisfaction and acceptance of rtCGM. Disclosure G. Freckmann: Advisory Panel; Self; Abbott, Sensile Medical AG. Consultant; Self; Beurer, iSens, Metronom Health, Pharmasens, Profusa, Inc., Roche Diabetes Care. Speaker’s Bureau; Self; Novo Nordisk A/S. S. Schlueter: Advisory Panel; Self; A. Menarini Diagnostics, Abbott. Consultant; Self; Roche Diabetes Care. Speaker’s Bureau; Self; Ascensia Diabetes Care, AstraZeneca, Berlin-Chemie AG, Dexcom, Inc., Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Ypsomed AG. Other Relationship; Self; Springer Publishing Company, Verlag Kirchheim & Co. GmbH. P. Wintergerst: None. L. Heinemann: Consultant; Self; Becton, Dickinson and Company, LifeCare, Inc., Roche Diabetes Care. Stock/Shareholder; Self; Profil Institute for Clinical Research. T. Rückert: None. A. Hinz: Research Support; Self; Institut for Diabetestechnologie Ulm, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Berlin-Chemie AG, Eli Lilly and Company. M. Wernsing: Advisory Panel; Self; Abbott. Research Support; Self; Roche Diabetes Care. F. Thienel: Research Support; Self; Roche Diabetes Care. Speaker’s Bureau; Self; Abbott. T. Biester: Advisory Panel; Self; AstraZeneca. Speaker’s Bureau; Self; Dexcom, Inc., Medtronic, Roche Diabetes Care, Sanofi, Ypsomed AG. P. von Blanckenburg: None. W. Keuthage: Advisory Panel; Self; Deutschland GmbH, Novo Nordisk A/S, Roche Diabetes Care. Board Member; Self; Abbott, Berlin-Chemie AG. R. Ziegler: Advisory Panel; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. Consultant; Self; Novo Nordisk A/S, Roche Diabetes Care. Speaker’s Bureau; Self; Abbott, Dexcom, Inc., Novo Nordisk A/S, Roche Diabetes Care. E. Martin: None. M. Holder: None. D. Deiss: Advisory Panel; Self; Abbott, Roche Diabetes Care. Consultant; Self; Senseonics. G. Buchal: None. L. van den Boom: Advisory Panel; Self; Medtronic. K. Lange: Consultant; Self; Abbott, Dexcom, Inc., Medtronic. Funding Dexcom, Inc.; Roche Diabetes Care; Sanofi; Menarini Group; Kirchheim Verlag; Medtronic

AIM To compare the daily consumption of blood glucose test strips (BGTSs) prior to and after the initiation of intermittent-scanning continuous glucose monitoring (iscCGM). METHODS This study included 1343 adults (≥18 years) with type 1 (T1D) or type 2 diabetes (T2D; mean age 51.4 years; 39.1% women) from the IMS Disease Analyzer database with an initial prescription of iscCGM in Germany between January 2015 and July 2018 (index date). We compared the average daily BGTS consumption after the index date versus prior to the index date. A multivariate logistic regression model was used to investigate the association between predefined variables and the probability of no longer using BGTSs after the index date. RESULTS The mean (SD) daily BGTS consumption per patient decreased from 2.7 (3.0) prior to the index date to 1.4 (2.4) after the index date, and was similar in patients with T1D and those with T2D, in women and men, and across different age groups, as well in patients treated in diabetologist practices and those treated in general practices. In total, 40% of patients continued to use BGTSs, and 30% used them at least once daily. Male sex and glycated haemoglobin concentration (