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In persons with type 1 diabetes and high glycated hemoglobin levels, the benefits of intermittently scanned continuous glucose monitoring with optional alarms for high and low blood glucose levels are uncertain.In a parallel-group, multicenter, randomized, controlled trial involving participants with type 1 diabetes and glycated hemoglobin levels between 7.5% and 11.0%, we investigated the efficacy of intermittently scanned continuous glucose monitoring as compared with participant monitoring of blood glucose levels with fingerstick testing. The primary outcome was the glycated hemoglobin level at 24 weeks, analyzed according to the intention-to-treat principle. Key secondary outcomes included sensor data, participant-reported outcome measures, and safety.A total of 156 participants were randomly assigned, in a 1:1 ratio, to undergo intermittently scanned continuous glucose monitoring (the intervention group, 78 participants) or to monitor their own blood glucose levels with fingerstick testing (the usual-care group, 78 participants). At baseline, the mean (±SD) age of the participants was 44±15 years, and the mean duration of diabetes was 21±13 years; 44% of the participants were women. The mean baseline glycated hemoglobin level was 8.7±0.9% in the intervention group and 8.5±0.8% in the usual-care group; these levels decreased to 7.9±0.8% and 8.3±0.9%, respectively, at 24 weeks (adjusted mean between-group difference, -0.5 percentage points; 95% confidence interval [CI], -0.7 to -0.3; P0.001). The time per day that the glucose level was in the target range was 9.0 percentage points (95% CI, 4.7 to 13.3) higher or 130 minutes (95% CI, 68 to 192) longer in the intervention group than in the usual-care group, and the time spent in a hypoglycemic state (blood glucose level,70 mg per deciliter [3.9 mmol per liter]) was 3.0 percentage points (95% CI, 1.4 to 4.5) lower or 43 minutes (95% CI, 20 to 65) shorter in the intervention group. Two participants in the usual-care group had an episode of severe hypoglycemia, and 1 participant in the intervention group had a skin reaction to the sensor.Among participants with type 1 diabetes and high glycated hemoglobin levels, the use of intermittently scanned continuous glucose monitoring with optional alarms for high and low blood glucose levels resulted in significantly lower glycated hemoglobin levels than levels monitored by fingerstick testing. (Funded by Diabetes UK and others; FLASH-UK ClinicalTrials.gov number, NCT03815006.).

Achieving healthy sleep supports general health and well-being1,2. Sleep disturbance in type 1 diabetes (T1DM) can be caused by factors including fear of hypoglycaemia and suboptimal glucose control3. For example, hypoglycaemia or hyperglycaemia can disturb sleep, through mechanisms including sympathetic activation and neuropathic pain, respectively4. Several observational studies have suggested that hybrid closed-loop (HCL) system initiation is associated with improved sleep,5,6 but these data could be limited by confounding and other biases. Moreover, different HCL devices could have differing effects on sleep; outcomes could be influenced by user age and the measures by which sleep is assessed. Our objectives, in older adults with T1DM, were to: a) assess the impact of an adaptive HCL system (CamAPS FX) on subjectively and objectively assessed sleep traits in a post hoc analysis of randomised controlled trial (RCT) data; and b) assess the relationship between glucose control and sleep traits in the trial cohort., This work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases under the grant number 1DP3DK112176-01 and the UK MRC Clinical Academic Research Partnership (MR/T023899/1). Additional support for the artificial pancreas work from National Institute for Health Research Cambridge Biomedical Research Centre, and JDRF. Dexcom supplied discounted continuous glucose monitoring devices

Objective: International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. Research Design and Methods: We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl. Results: Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p Conclusion: CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.

International type 1 diabetes registries have shown that HbAWe conducted a randomized crossover trial in young people with type 1 diabetes (16-24 years old) comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded continuous glucose monitoring (CGM) was worn by each participant for 10 days at the start, week 4, and week 7 of the control period. HbATime in range was significantly higher during CGM compared with control (35.7 ± 13.5% vs. 24.6 ± 9.3%; mean difference 11.1% [95% CI 7.0-15.2];CGM use in young people with type 1 diabetes improves time in target and HbA