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Objective: Using a multistep machine-learning procedure, add virtual continuous glucose monitoring (CGM) traces to the original sparse data of the landmark Diabetes Control and Complications Trial (DCCT). Assess the association of CGM metrics with the microvascular complications of type 1 diabetes observed during the DCCT and establish time-in-range (TIR) as a viable marker of glycemic control. Research Design and Methods: Utilizing the DCCT glycated hemoglobin data obtained every 1 or 3 months plus quarterly 7-point blood glucose (BG) profiles in a multistep procedure: (i) utilized archival BG traces to model interday BG variability and estimate glycated hemoglobin; (ii) trained across the DCCT BG profiles and associated each profile with an archival BG trace; and (iii) used previously identified CGM "motifs" to associate a CGM trace to a BG trace, for each DCCT participant. Results: TIR (70-180 mg/dL) computed from virtual CGM data over 14 days prior to each glycated hemoglobin measurement reproduced the observed glycemic control differences between the intensive and conventional DCCT groups, with TIR generally >60% and <40% in these groups, respectively. Similar to glycated hemoglobin, TIR was associated with the risk of development or progression of retinopathy, nephropathy, and neuropathy (all P -values <0.0001). Poisson regressions indicated that TIR predicted retinopathy and microalbuminuria similarly to the original glycated hemoglobin data. Conclusions: The landmark DCCT was revisited using contemporary data science methods, which allowed adding individual CGM traces to the original data. Fourteen-day CGM metrics predicted microvascular diabetes complications similarly to glycated hemoglobin. Clinical Trials Registration: Not a clinical trial.

With increasing prevalence of obesity and cardiovascular diseases, there is a growing interest in the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an adjunct therapy in type 1 diabetes (T1D). The GLP-1RAs are currently not approved by the US Food and Drug Administration for the treatment of T1D in the absence of randomized controlled trials documenting efficacy and safety of these agents in this population. The Diabetes Technology Society convened a series of three consensus meetings of clinicians and researchers with expertise in diabetes technology, GLP-1RA therapy, and T1D management. The project was aimed at synthesizing current literature and providing conclusions on the use of GLP-1RA therapy as an adjunct to automated insulin delivery (AID) systems in adults with T1D. The expert panel members met virtually three times on January 17, 2024, and April 24, 2024, and August 14, 2024, to discuss topics ranging from physiology and outcomes of GLP-1RAs in T1D to limitations of current sensors, algorithms, and insulin for AID systems. The panelists also identified research gaps and future directions for research. The panelists voted to in favor of 31 recommendations. This report presents the consensus opinions of the participants that, in adults with T1D using AID systems, GLP-1RAs have the potential to (1) provide effective adjunct therapy and (2) improve glycemic and metabolic outcomes without increasing the risk of severe hypoglycemia or diabetic ketoacidosis., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: VNS received research support from Novo Nordisk, Insulet, and Tandem Diabetes Care and received honoraria from LifeScan for advisory board attendance and from Dexcom, Embecta, and Insulet for speaking arrangements. ALP is on the advisory board of Medscape, Vertex, and Lilly; has received research support from Insulin and Abbott; and reports stock options from Omada Health. GEU has received research support (to Emory University) from Abbott, Bayer, Dexcom, and Sanofi. HKA received research support through University of Colorado from Dexcom, Tandem Diabetes, Senseonics, Medtronic, Eli Lilly, REMD Biotherapeutics, IM Therapeutics, and IAFMS and received honoraria through University of Colorado from Senseonics and Mannkind for advisory board attendance. GA has received research support to her institution Northwestern University from Fractyl Health, MannKind, Insulet, Tandem Diabetes, and Welldoc. GA has received consulting fees from Dexcom and Insulet. LB reports having participated in advisory boards of Eli Lilly, Novo Nordisk, Oviva, Roche Diabetes Care, Sanofi, and Ypsomed and received speaker fees from Dexcom, Ypsomed and Oviva. EC is an advisory board member and consultant for Novo Nordisk, Eli Lilly, Adocia, MannKind, Lexicon, Arecor, PortalInsulin, and Proventionbio. EC was also a speaker for Novo Nordisk. KD discloses research support from Dexcom, Sanofi, Viacyte, Abbott, and Insulet; consulting with Eli Lilly, Insulet, Oppenheimer, Dexcom; and honorarium from UptoDate, Medscape, Med Learning Group, Impact Education, and Elsevier. CF receives royalties from Dexcom and Novo Nordisk managed through her institution. PGJ reports receiving grants from the National Institutes of Health, The Leona M. and Harry B. Charitable Trust, the Juvenile Diabetes Research Foundation, Dexcom, and the Oregon Health & Science University Foundation; consultancy fees from CDISC; US patents 62/352,939, 63/269,094, 62/944,287, 8810388, 9,480,418, 8,317,700, 61/570382, 8,810,388, 7,976,466, and 6,558,321; and reports stock options from Pacific Diabetes Technologies, outside submitted work. RAL reports consulting fees from Abbott Diabetes Care, Biolinq, Capillary Biomedical, Deep Valley Labs, Gluroo, PhysioLogic Devices, ProventionBio, and Tidepool. JKM is a member of the advisory board of Abbott Diabetes Care, Becton-Dickinson, Boehringer Ingelheim, Eli Lilly, Embecta, Medtronic, Novo Nordisk A/S, Prediktor A/S, Roche Diabetes Care, Sanofi-Aventis, and Viatris and received speaker honoraria from Abbott Diabetes Care, AstraZeneca, Boehringer Ingelheim, Dexcom, Eli Lilly, Menarini, MSD, Novo Nordisk A/S, Roche Diabetes Care, Sanofi, Servier, and Ypsomed. JLS has conducted clinical trials for Eli Lilly, Insulet, and Medtronic and has received in-kind support for research studies from Dexcom and Medtronic. She has consulted for Eli Lilly, Lexicon, Medtronic, and Sanofi. She has been a member of advisory boards for Bigfoot Biomedical, Cecelia Health, Eli Lilly, Insulet, the T1D Fund, and Vertex. DCK is a consultant for Afon, Better Therapeutics, Integrity, Lifecare, Nevro, Novo, Samsung, and Thirdwayv. AC, UM, PP, SS, EZ, CNH, ATA, TT, and REA have nothing to disclose.