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This article discusses a study on the use of the Freestyle Libre system in adults with type 2 diabetes on basal-bolus insulin regimens. The study found that there was a small reduction in glycated hemoglobin (HbA1c) levels over a three-year period, with a larger reduction observed in those with higher baseline HbA1c levels. The study suggests that the use of Freestyle Libre may be beneficial for individuals with type 2 diabetes using basal-bolus insulin regimens. However, further research is needed to determine its effectiveness in other treatment regimens and non-insulin-treated type 2 diabetes. [Extracted from the article]

The article focuses on the real-world outcomes after one year of using Omnipod 5, a tubeless automated insulin delivery (AID) system for adults with type 1 diabetes in the UK. It reports significant improvements in time in range (TIR), HbA1c, and glucose variability, with no increase in time below range (TBR). It highlights that individuals with higher baseline HbA1c and lower bolus insulin use experienced the greatest improvements.

Aims: Intensive glycaemic control is associated with substantial health benefits in people with type 1 diabetes. We sought to examine clinical and demographic factors associated with meeting glycaemic targets in type 1 diabetes. Methods: We conducted a cross‐sectional analysis of 4594 individuals with type 1 diabetes. The primary outcome of the study was assessing factors associated with meeting HbA1c targets. Secondary endpoints included factors associated with continuous subcutaneous insulin infusion (CSII) use and persistent C‐peptide secretion. Results: Socioeconomic deprivation was strongly associated with a lower likelihood of achieving an HbA1c <58 mmol/mol (7.5%) (20% in the most deprived quintile vs. 40% in the least deprived, p < 0.001). In multivariate analysis, absence of smoking history (OR 3.06, p < 0.001), flash monitoring (OR 1.49, p < 0.001), CSII (1.43, p = 0.022) and longer diabetes duration (OR 1.02 per year, p = 0.004) were independently associated with achieving HbA1c <58 mmol/mol (7.5%), whereas increasing age (OR 0.99 per year, p = 0.004) and C‐peptide <50 pM (OR 0.58, p < 0.001) were associated with a lower likelihood of meeting this target. Low C‐peptide (<50 pM) was less likely in men (OR 0.55, p < 0.001) and never smokers (0.44, p < 0.001) in multivariate analysis. Conclusions: Lower levels of deprivation, non‐smoking, higher C‐peptide, technology use, lower BMI and male gender were all associated with a higher likelihood of meeting HbA1c targets. Access to proven diabetes treatments is lower in the most deprived individuals. Urgent efforts are required to provide treatments which are effective across the socioeconomic gradient. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Anaemia is a key cause of morbidity in chronic kidney disease (CKD). Androgen deficiency (AD) in males can contribute to anaemia of all causes, including in CKD. We sought to examine the prevalence of AD in men with CKD, the extent to which it contributed to anaemia and whether it was independently associated with long‐term survival.This cross‐sectional observational study was conducted among males aged 18 years and over with CKD stages 4 and 5. The study analysed morning blood samples with regard to their full blood count, urea and electrolytes, albumin, lipids, testosterone (T) and sex hormone binding globulin, with calculation of free testosterone by mass action equation. Mortality data were obtained 15 years later for survival analysis.Among 322 patients with a mean age of 63 years, the overall prevalence of AD was 68.9%. There was a statistically significant negative correlation between erythropoiesis stimulating agent (ESA) dose and testosterone concentrations (Pearson correlation −0.193, p = 0.05). There was a positive correlation between haemoglobin (Hb) and free testosterone level among patients not on ESA therapy (Pearson correlation 0.331, p < 0.001). Kaplan‐Meier plots showed p < 0.001 on log‐rank analysis, indicating that AD was significantly associated with worse survival. However, in Cox regression analysis, free testosterone was not associated with survival (95% CI for free testosterone 0.997–1.000).AD is highly prevalent among this population, and increases further with older age and more severe CKD warranting haemodialysis. Association of lower Hb and higher ESA dose with lower T concentration might be causative, which has important pharmaco‐economic as well as clinical implications. Lower survival in men with low T, more likely reflects overall poor health rather than causation. A properly constituted randomised controlled study evaluating the effect of native T replacement is warranted in men with CKD and AD. [ABSTRACT FROM AUTHOR]

The article compares the outcomes of adults with type 1 diabetes using the Omnipod 5 system with either Dexcom G6 or Freestyle Libre 2 Plus sensors. The study found no significant differences in time spent in automode or in CGM metrics between the two sensor types. While there were some differences in glucose levels, the study suggests that sensor choice with Omnipod 5 does not result in clinically meaningful differences in performance or outcomes. The study highlights the need for further research to determine if one sensor system is superior in reducing time below range and glucose variability. [Extracted from the article]

Various methods can be used to evaluate awareness of hypoglycemia in people with type 1 diabetes, but their comparative accuracy in identifying this clinical syndrome has not been examined. Participants completed a questionnaire to assessing their hypoglycemia awareness status using each of the three methods available for this purpose (designated as the Gold, Clarke and Pedersen-Bjergaard methods). Blood glucose measurements were then recorded four times daily, prospectively over a four-week period. Data were obtained from 80 patients (55 male; HbA1c 8.1% {1.4}; age, median (IQR) 47.5 (35.5-56.3), years old; duration of diabetes, median (IQR) 20 years {9-31}). Utilising the three methods, the prevalence of impaired awareness of hypoglycemia (IAH) were 24% (Gold), 26% (Clarke) and 62.5% (Pedersen-Bjergaard) respectively. Patients who were identified as having IAH with the Gold method were significantly older (p = 0.01), had a longer duration of diabetes (p = 0.04), recorded more biochemical hypoglycemia over the 4-week monitoring period (p = 0.003), experienced lower autonomic symptom scores during hypoglycemia (p = 0.005) and reported a higher incidence of severe hypoglycemia (SH) during the preceding year (p = 0.001), compared to those with normal awareness. Very similar findings were obtained with the Clarker method. By contrast, the Pedersen-Bjergaard method identified only a long duration of diabetes and a history of SH as factors associated with IAH. In evaluating awareness of hypoglycemia it is suggested that the methods of Clarke or Gold should be utilised preferentially to identify people with this acquired syndrome. [ABSTRACT FROM AUTHOR]

Background: Early worsening of diabetic retinopathy (EWDR) was observed in the intensively treated arm of the Diabetes Control and Complications Trial (DCCT) before long-term benefits accrued. We sought to assess whether there may be an increased risk of EWDR in high-risk individuals following intermittent-scanning continuous glucose monitoring (iscCGM) commencement., Methods: An observational study of 139 individuals with type 1 diabetes ≥5 years duration and with baseline HbA1c >75 mmol/mol (9.0%). This cohort was stratified by subsequent HbA1c response to iscCGM (best responders and non-responders). Pan-retinal photocoagulation (PRP), worsening retinopathy status and new development of retinopathy were compared between groups., Results: HbA1c change was -23 mmol/mol (IQR -32 to -19) (-2.1% [-2.9 to -1.8]) in responders and +6 mmol/mol (2-12) (+0.6 [0.2-1.1]) in non-responders ( P  < .001). There was no difference in subsequent PRP between responders (14.1%) and non-responders (10.3%, P  = .340). Baseline HbA1c (HR 1.052 per mmol/mol, P  = .002) but not response category (HR 1.244, P  = .664) was independently associated with the risk of requiring PRP. Worsening of retinopathy was not different between responders (16.9%) and non-responders (20.6%, P  = .577), and the same was true with respect to new development of retinopathy (33.3% vs 31.8%, P  = .919)., Conclusions: In a cohort enriched for risk of diabetic retinopathy, reduction in HbA1c did not result in an increased risk of PRP, worsening retinopathy, or new development of retinopathy. These findings offer reassurance that substantial reduction in HbA1c is not independently associated with early worsening of diabetic eye disease in iscCGM users.