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Aim: Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third‐party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year. Methods: The FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web‐based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow‐up data for people with type 1 diabetes who also held a driving licence was undertaken. Results: The study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow‐up data were available for a sub‐cohort of 1606/4218. At a mean follow‐up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p <.001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p <.001). Conclusion: This study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode. [ABSTRACT FROM AUTHOR]

Aims: To investigate characteristics of people hospitalized with coronavirus‐disease‐2019 (COVID‐19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission. Materials and methods: Retrospective cohort study with anonymized data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID‐19 and diabetes, from start of pandemic to November 2021. The primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age‐adjusted odds ratios were calculated using logistic regression. Results: In total, 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalized with COVID‐19. Mean (SD) age was 60 (18.2) years in DKA and 74 (11.8) years in HHS (p <.001). A higher proportion of patients with HHS than with DKA were of non‐White ethnicity (71.4% vs 39.0% p =.038). Mortality in DKA was 36.8% (n = 57) and 3.8% (n = 26) in type 2 and type 1 diabetes respectively. Among people with type 2 diabetes and DKA, mortality was lower in insulin users compared with non‐users [21.4% vs. 52.2%; age‐adjusted odds ratio 0.13 (95% CI 0.03‐0.60)]. Crude mortality was lower in DKA than HHS (25.9% vs. 65.0%, p =.001) and in statin users versus non‐users (36.4% vs. 100%; p =.035) but these were not statistically significant after age adjustment. Conclusions: Hospitalization with COVID‐19 and adjudicated DKA is four times more common than HHS but both associate with substantial mortality. There is a strong association of previous insulin therapy with survival in type 2 diabetes‐associated DKA. [ABSTRACT FROM AUTHOR]

Aims: To investigate the change in glycated haemoglobin (HbA1c), hypoglycaemia awareness and diabetes‐related distress in people with type 1 diabetes (T1D) using FreeStyle Libre (FSL) over a 2‐year follow‐up period. Methods: FSL user data from U.K wide hospitals collected during routine clinical care were analysed. People living with T1D were categorised into four groups based on the duration of follow‐up. Group I (< 1 year, n = 6940), group II (1 to 1.5 years, n = 662), group III (1.5 to 2 years, n = 385), and group IV (> 2 years, n = 642). The t‐test was used to compare the baseline and follow‐up HbA1c, GOLD score (a measure of hypoglycaemia awareness) and diabetes‐related distress scale (DDS score) (quality of life measure). Results: The study consisted of 16,834 people, with follow‐up data available for 8,629 participants. The change in HbA1c, GOLD and DDS score from baseline within the follow‐up sub‐groups (group I vs group II vs group III vs group IV) was HbA1c (−6 vs −6 vs −4 vs −4 mmol/mol; p < 0.001) (−0.55 vs −0.55 vs −0.37 vs −0.37 %), GOLD score (−0.31 vs −0.45 vs −0.26 vs −0.42; p < 0.0001 group I, II, IV and p 0.07 group III), and DDS score(−0.59 vs −0.58 vs −0.63 vs −0.50; p < 0.001), respectively. Conclusions: In people with T1D, FSL use resulted in a sustained improvement in HbA1c, hypoglycaemia awareness and diabetes‐related distress for over two years. [ABSTRACT FROM AUTHOR]

GLO:EU1/01jan23:dom14841-fig-0001.jpg PHOTO (COLOR): 1 Bar chart showing the prevalence of impaired awareness of hypoglycaemia (IAH), severe hypoglycaemia (SH) episodes and complete loss of awareness of hypoglycaemia before and after FreeStyle Libre (FSL) use. The Gold score was used to assess awareness of hypoglycaemia.[9] A score of 4 or higher indicates IAH and 7 indicates a complete loss of awareness.[9] Diabetes-related distress was measured using the two-item diabetes distress screening tool (DDS2).[10] An average of the two questions of the DDS2 scale was calculated. In this audit, people with diabetes were using FreeStyle Libre or FreeStyle Libre 2. Keywords: glycaemic control; hypoglycaemia; observational study; type 1 diabetes EN glycaemic control hypoglycaemia observational study type 1 diabetes 302 305 4 12/13/22 20230101 NES 230101 BACKGROUND FreeStyle Libre (FSL), intermittently scanned continuous glucose monitoring (isCGM), is associated with less biochemical hypoglycaemia in people with diabetes, lower HbA1c and diabetes-related distress.[1] Impaired awareness of hypoglycaemia (IAH), which affects 18%-33% of people with type 1 diabetes,[2] is the reduced ability to detect the symptoms of hypoglycaemia and is associated with a 6-fold increased risk of severe hypoglycaemia (SH).[3] Many of the studies of CGM have shown a reduction in rates of hypoglycaemia but have not shown restoration of awareness.[4], [5], [6] There are limited nationwide data investigating the prevalence of IAH, complete loss of awareness of hypoglycaemia and SH. [Extracted from the article]

Aim: To identify the baseline demographic and clinical characteristics associated with diabetes‐related distress (DRD) and factors associated with improvement in DRD after initiating use of the FreeStyle Libre (FSL) in people living with type 1 diabetes (T1D). Methods: The study was performed using baseline and follow‐up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes who initiated use of the FSL in the United Kingdom. DRD was assessed using the two‐item diabetes‐related distress scale (DDS; defined as the average of the two‐item score ≥3). People living with T1D were categorized into two groups: those with high DRD, defined as an average DDS score ≥3 and those with lower DRD, defined as a DDS score <3. We used a gradient‐boosting machine‐learning (GBM) model to identify the relative influence (RI) of baseline variables on average DDS score. Results: The study population consisted of 9159 patients, 96.6% of whom had T1D. The median (interquartile range [IQR]) age was 45.1 (32‐56) years, 50.1% were women, the median (IQR) baseline body mass index was 26.1 (23.2‐29.6) kg/m2 and the median (IQR) duration of diabetes was 20 (11‐32) years. The two components of the DDS were significantly correlated (r2 = 0.73; P < 0.0001). Higher DRD was prevalent in 53% (4879/9159) of people living with T1D at baseline. In the GBM model, the top baseline variables associated with average DDS score were baseline glycated haemoglobin (HbA1c; RI = 51.1), baseline Gold score (RI = 23.3), gender (RI = 7.05) and fear of hypoglycaemia (RI = 4.96). Follow‐up data were available for 3312 participants. The top factors associated with improvement in DDS score following use of the FSL were change in Gold score (RI = 28.2) and change in baseline HbA1c (RI = 19.3). Conclusions: In this large UK cohort of people living with T1D, diabetes distress was prevalent and associated with higher HbA1c, impaired awareness of hypoglycaemia and female gender. Improvement in glycaemic control and hypoglycaemia unawareness with the use of the FSL was associated with improvement in DRD in people living with T1D. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. Methods: A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. Results: Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55–74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. Conclusions/interpretation: In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. In people with Type 1 diabetes and COVID-19 admitted to hospital in the UK, BMI and one or more microvascular complications had a positive association and low serum creatine levels had a negative association with death/admission to intensive care unit after adjusting for age.: [ABSTRACT FROM AUTHOR]