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There is limited evidence supporting the recommendation that drivers with insulin-treated diabetes need to start journeys with glucose >90 mg/dL. Glucose levels of drivers with type 1 diabetes were monitored for 3 weeks using masked continuous glucose monitoring (CGM). Eighteen drivers (median [IQR] age 40 [35, 51] years; 11 men) undertook 475 trips (duration 15 [13, 21] min). Hypoglycemia did not occur in any trip starting with glucose >90 mg/dL (92%; n  = 436). Thirteen drivers recorded at least one trip (total n  = 39) starting with glucose <90 mg/dL. Among these, driving glucose was <70 mg/dL in five drivers (38%) during 10 trips (26%). Among five drivers (28%), a ≥ 36 mg/dL drop was observed within 20 min of starting their journey. Journey duration was positively associated with maximum glucose change. These findings support current guidelines to start driving with glucose >90 mg/dL, and to be aware that glucose levels may change significantly within 20 min. A CGM-based, in-vehicle display could provide glucose information and alerts that are compatible with safe driving. Clinical Trial Registration number: ACTRN12617000520336.

Background: This prerandomization analysis from the Australian HCL-Adult trial (registration number: ACTRN12617000520336) compared masked continuous glucose monitoring (CGM) metrics among adults using insulin pumps versus multiple daily injections (MDIs), who were all self-monitoring blood glucose (SMBG). Methods: Adults with type 1 diabetes, using an insulin pump or MDIs without real-time CGM (and entering a trial of closed-loop technology), were eligible. MDI users were given an insulin dosage calculator. All participants received diabetes and carbohydrate-counting education, then wore masked CGM sensors for 3 weeks. Ethics Approval: HREC-D 088/16 Results: Adults using MDIs ( n  = 61) versus pump ( n  = 59) did not differ by age, sex, diabetes duration, insulin total daily dose, or HbA 1c at baseline. After education, median (interquartile range) CGM time in range (TIR) 70-180 mg/dL (3.9-10.0 mmol/L) was 54% (47, 62) for those using MDIs and 56% (48, 66) for those using pump ( P  = 0.40). All CGM metrics were equivalent for 24 h/day for MDI and pump users. Overnight, those using MDIs (vs. pump) spent more time with glucose <54 mg/dL (<3.0 mmol/L): 1.4% (0.1, 5.1) versus 0.5% (0.0, 2.0), respectively ( P  = 0.012). They also had more CGM hypoglycemia episodes (121 vs. 54, respectively; incidence rate ratio [95% confidence interval] 2.48 [1.51, 4.06]; P  < 0.001). Conclusions: Adults with type 1 diabetes using pumps versus MDIs in conjunction with SMBG experienced less nocturnal hypoglycemia, measured by masked CGM, after equivalent diabetes and dietary education in conjunction with insulin dosage calculator provision to all. However, both groups had equivalent TIR. This observation may reflect advantages afforded by flexibility in basal insulin delivery provided by pumps.

OBJECTIVE--We recently reported that after 26 weeks, exenatide once weekly (EQW) resulted in superior A1C reduction, reduced hypoglycemia, and progressive weight loss compared with daily insulin glargine (IG) in patients with type 2 diabetes who were taking metformin alone or with sulfonylurea. This 84-week extension study assessed the long-term safety and efficacy of EQW versus IG. RESEARCH DESIGN AND METHODS--This multicenter, open-label, randomized, two-arm, parallel trial assessed change in A1C, proportions of patients achieving A1C <7.0 and ≤ 6.5%, body weight, incidence of hypoglycemia, and overall safety. RESULTS--Of 415 patients who completed 26 weeks, 390 (194 EQW and 196 IG patients) entered the extension study. At 84 weeks, A1C decreased from baseline (8.3%) by 21.2% for EQW vs. 21.0% for IG (P = 0.029). The proportions of patients who achieved end point A1C targets,7.0 and ≤6.5%were 44.6%for EQWpatients vs. 36.8%for IG patients (P = 0.084) and 31.3%for EQWpatients vs. 20.2%for IG patients (P = 0.009), respectively. Patients taking EQW lost 2.1 kg of body weight, whereas those taking IG gained 2.4 kg (P < 0.001). Among patients taking metformin plus sulfonylurea, the incidence of minor hypoglycemia was 24% for EQW patients vs. 54% for IG patients (P < 0.001); among patients taking metformin alone, it was 8% for EQWpatients vs. 32% for IG patients (P < 0.001). Among adverse events occurring in ≥5% of patients, diarrhea and nausea occurred more frequently (P < 0.05) in the EQWgroup than in the IG group (12 vs. 6% and 15 vs. 1%, respectively). CONCLUSIONS--After 84 weeks, patients treated with EQWcontinued to experience better glycemic control with sustained overall weight loss and a lower risk of hypoglycemia than patients treated with IG. [ABSTRACT FROM AUTHOR]

AIM To assess relationships between continuous glucose monitoring (CGM) time in 70-180mg/dL range (TIR), time below range (TBR), <70mg/dL, time above range (TAR), >180mg/dL and glucose coefficient of variation (CV) in relation to currently recommended clinical CGM targets for older people, which recommend reduced TIR and TBR targets relative to the general type 1 diabetes population. METHODS We conducted a post-hoc analysis using the JDRF Australia Adult Hybrid Closed Loop trial database examining correlations in 120 adults with type 1 diabetes of 3-weeks masked CGM (Guardian Sensor 3; Medtronic) metrics (n=61 on multiple daily injections, 59 on non-CGM augmented pumps) using manual insulin dosing at baseline and at 26-weeks, with 50% randomized to automated insulin dosing (AID). RESULTS Correlations between baseline TIR and TAR were strong (r= -0.966; p<0.0001), weak for TBR (r=0.363; p<0.0001) and glucose CV (r=0.037; p=0.687) while moderate between CV and TBR (r=0.726; p<0.0001). Associations were similar for participants aged >60 years (n=15) vs. younger subjects. Correlations of changes in (∆) TIR with ∆TAR over 26-weeks were strong (r=-0.945; p<0.001) and for ∆TBR were weak (r=0.025; p=0.802). ∆CV did not significantly correlate with ∆TAR (r=-0.064; p=0.526) but did with ∆TBR (r=0.770; p=<0.001) CONCLUSIONS Changes in TIR are not associated with changes in TBR. We therefore suggest that, particularly with AID, while TBR targets in older adults may be prioritized to ensure safety that they should not be linked to TIR but addressed independently. [ABSTRACT FROM AUTHOR]

The article offers information on an open-label randomized study which compared the efficacy of exenatide with insulin glargine titrated to glucose targets in lowering hemoglobin A1c. The study subjects, which involved adults with type 2 diabetes who had suboptimum glycaemic control, were randomly assigned to add exenatide or insulin glargine to their blood-glucose lowering regimens. Presented in details are the findings of the study. It concludes that exenatide is ideal for patients whose risk for hypoglycemia, weight loss and convenience are particular concerns.