Seohyun Kim, Soojin Park, Sang-Man Jin, Jae Hyeon Kim, Gyuri Kim
Aims
This study aimed to evaluate the association of stigma related to type 1 diabetes with CGM-derived data and psychological outcomes in adults with type 1 diabetes.
Methods
In this cross-sectional study, 104 adults with type 1 diabetes undergoing continuous glucose monitoring (CGM) completed the Type 1 Diabetes Stigma Assessment Scale (DSAS-1), Patient Health Questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), and Diabetes Distress Scale (DDS). Thirty-day standard CGM data with ≥70% sensor wear time of CGM was analysed. Linear regression was used to evaluate the potential relationship between the DSAS-1 scores and CGM-derived hypoglycaemia metrics.
Results
Higher DSAS-1 total score was independently associated with increased time below range <3.0 mmol/L (adjusted β = 0.011 per point; 95% CI: 0.0018,0.0202; p = 0.019) but not with <3.9 mmol/L. Elevated stigma associated with anxiety (adjusted OR, 1.086; 95% CI:, 1.035,1.152; p = 0.002) with no significant link to depression. Item-level analyses identified DSAS-1 items related to differential treatment (items 15 and 19) and blame/judgement (items 11, 14, and 17) as being significantly associated with clinically significant hypoglycaemia. Associations were consistent across subgroups, especially among participants with a longer diabetes duration and a higher coefficient of variation of CGM glucose levels, calculated as glucose standard deviation divided by mean glucose and expressed as a percentage.
Conclusions
In adults with type 1 diabetes using CGM, perceived stigma was significantly correlated with more time spent in hypoglycaemia and greater anxiety. Further studies are needed to identify causal relationships between stigma and clinically significant hypoglycaemia in people with type 1 diabetes.
{"title":"Association of perceived diabetes stigma with time below range <3.0 mmol/L and anxiety in adults with type 1 diabetes using continuous glucose monitoring","authors":"Seohyun Kim, Soojin Park, Sang-Man Jin, Jae Hyeon Kim, Gyuri Kim","doi":"10.1111/dme.70204","DOIUrl":"10.1111/dme.70204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to evaluate the association of stigma related to type 1 diabetes with CGM-derived data and psychological outcomes in adults with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, 104 adults with type 1 diabetes undergoing continuous glucose monitoring (CGM) completed the Type 1 Diabetes Stigma Assessment Scale (DSAS-1), Patient Health Questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), and Diabetes Distress Scale (DDS). Thirty-day standard CGM data with ≥70% sensor wear time of CGM was analysed. Linear regression was used to evaluate the potential relationship between the DSAS-1 scores and CGM-derived hypoglycaemia metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher DSAS-1 total score was independently associated with increased time below range <3.0 mmol/L (adjusted <i>β</i> = 0.011 per point; 95% CI: 0.0018,0.0202; <i>p</i> = 0.019) but not with <3.9 mmol/L. Elevated stigma associated with anxiety (adjusted OR, 1.086; 95% CI:, 1.035,1.152; <i>p</i> = 0.002) with no significant link to depression. Item-level analyses identified DSAS-1 items related to differential treatment (items 15 and 19) and blame/judgement (items 11, 14, and 17) as being significantly associated with clinically significant hypoglycaemia. Associations were consistent across subgroups, especially among participants with a longer diabetes duration and a higher coefficient of variation of CGM glucose levels, calculated as glucose standard deviation divided by mean glucose and expressed as a percentage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In adults with type 1 diabetes using CGM, perceived stigma was significantly correlated with more time spent in hypoglycaemia and greater anxiety. Further studies are needed to identify causal relationships between stigma and clinically significant hypoglycaemia in people with type 1 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roland H. Stimson, Anna R. Dover, Marcus J. Lyall, Janet I. Barclay, Scott D. Mackenzie, Shareen Forbes, Fraser W. Gibb
{"title":"Ketone test strip use is low in adults with type 1 diabetes and is not associated with HbA1c or glucose metrics on continuous glucose monitoring","authors":"Roland H. Stimson, Anna R. Dover, Marcus J. Lyall, Janet I. Barclay, Scott D. Mackenzie, Shareen Forbes, Fraser W. Gibb","doi":"10.1111/dme.70228","DOIUrl":"10.1111/dme.70228","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel R. Tilden, Erin Bergner, Kashope Anifowoshe, Sydney Garretson, Nkemjika Okonkwo, Kemberlee Bonnet, Sarah S. Jaser
Aims
Emerging adulthood is a developmental stage, which presents psychosocial, economic and academic challenges to individuals, which are further complicated for people with type 1 diabetes (T1D). While paediatric-based care systems have developed programmes to address the needs of young adults with T1D, adult-based systems have been slower to recognize this need. This qualitative study sought to understand the care experiences of emerging adults to identify barriers to engagement in adult-based care systems.
Methods
A total of 20 young adults with T1D (mean age 26.5 ± 4.5) participated in five focus groups. Focus groups obtained participant reflections on care received during and after transfer to adult-based care. Data were analyzed and coded using thematic analysis and organized using the social ecological model.
Results
Key themes across each social ecological model strata emerged from focus group discussions. Provider and clinic-level factors were frequently cited as key barriers to engagement in adult-based clinical practices. In addition, system- and institutional-level gaps led young adults to express a sense that systems at all levels were poorly adapted to address their care needs. Specifically, participants noted a need for high levels of self-advocacy to obtain needed support, difficulty navigating complex health systems and gaps in care coordination between providers and clinics as key barriers to care.
Conclusions
The findings of this study highlight the importance of adapting adult care systems and providers' approaches to meet the self-identified needs of young adults to improve engagement with care and potentially avoid adverse outcomes in this high-risk people population.
{"title":"Qualitative care experiences of emerging adults with type 1 diabetes after transfer to adult care providers","authors":"Daniel R. Tilden, Erin Bergner, Kashope Anifowoshe, Sydney Garretson, Nkemjika Okonkwo, Kemberlee Bonnet, Sarah S. Jaser","doi":"10.1111/dme.70214","DOIUrl":"10.1111/dme.70214","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Emerging adulthood is a developmental stage, which presents psychosocial, economic and academic challenges to individuals, which are further complicated for people with type 1 diabetes (T1D). While paediatric-based care systems have developed programmes to address the needs of young adults with T1D, adult-based systems have been slower to recognize this need. This qualitative study sought to understand the care experiences of emerging adults to identify barriers to engagement in adult-based care systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 20 young adults with T1D (mean age 26.5 ± 4.5) participated in five focus groups. Focus groups obtained participant reflections on care received during and after transfer to adult-based care. Data were analyzed and coded using thematic analysis and organized using the social ecological model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Key themes across each social ecological model strata emerged from focus group discussions. Provider and clinic-level factors were frequently cited as key barriers to engagement in adult-based clinical practices. In addition, system- and institutional-level gaps led young adults to express a sense that systems at all levels were poorly adapted to address their care needs. Specifically, participants noted a need for high levels of self-advocacy to obtain needed support, difficulty navigating complex health systems and gaps in care coordination between providers and clinics as key barriers to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings of this study highlight the importance of adapting adult care systems and providers' approaches to meet the self-identified needs of young adults to improve engagement with care and potentially avoid adverse outcomes in this high-risk people population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amardeep S. Sidki, Patrick J. Highton, Lauren L. O'Mahoney, Thomas J. Wilkinson
Aim
Although hybrid closed-loop systems (HCLS) and sensor-augmented pump (SAP) therapy are advanced diabetes management technologies for type 1 diabetes, their relative efficacy in optimising glycaemic control is not fully established. This meta-analysis evaluated the impact of HCLS versus SAP therapy on glucose regulation across multiple randomised controlled trials (RCTs) and randomised crossover trials (RCOs). The primary aim was to determine the efficacy of HCLS in improving glycaemic control, reducing glucose variability and enhancing time in range (TIR) compared with SAP therapy.
Methods
The review was prospectively registered with the International Prospective Register of Systematic Reviews as CRD42023488722. Data from 27 studies involving over 1000 participants were analysed. The studies included both RCTs and RCOs that compared HCLS with SAP therapy. Key metrics assessed were mean glucose levels, glucose variability (coefficient of variation and standard deviation), low blood glucose index (LBGI), high blood glucose index (HBGI), glycated haemoglobin (HbA1c) and TIR (3.9–10.0 mmol/L). Hyperglycaemia and hypoglycaemia outcomes were also evaluated.
Results
HCLS significantly reduced mean glucose levels by 2.0 mg/dL compared with SAP therapy. It also decreased glucose variability, including CV and SD, and reduced LBGI, HBGI and HbA1c. HCLS increased TIR by 8.8%. Regarding hyperglycaemia, HCLS reduced the time spent above 10 mmol/L by 7.8%, above 13.9 mmol/L by 3.63% and above 16.7 mmol/L by 0.88%. Hypoglycaemia outcomes showed modest improvements, with reductions in time below 3 mmol/L by 0.10% and below 3.9 mmol/L by 0.72%.
Conclusions
Our findings support HCLS as a superior modality to SAP therapy in improving glycaemic control, particularly in paediatric populations. HCLS effectively reduces hyperglycaemia and increases TIR, with modest effects on hypoglycaemia. The clinical implications are significant, highlighting the advantages of HCLS in optimising glucose regulation and mitigating glycaemic variability. This technology offers improved glycaemic control and enhanced quality of life for people living with type 1 diabetes.
{"title":"Hybrid closed-loop insulin delivery improves glycaemic control compared with sensor-augmented pump therapy: A meta-analysis of ‘free-living’ randomised trials in type 1 diabetes","authors":"Amardeep S. Sidki, Patrick J. Highton, Lauren L. O'Mahoney, Thomas J. Wilkinson","doi":"10.1111/dme.70210","DOIUrl":"10.1111/dme.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Although hybrid closed-loop systems (HCLS) and sensor-augmented pump (SAP) therapy are advanced diabetes management technologies for type 1 diabetes, their relative efficacy in optimising glycaemic control is not fully established. This meta-analysis evaluated the impact of HCLS versus SAP therapy on glucose regulation across multiple randomised controlled trials (RCTs) and randomised crossover trials (RCOs). The primary aim was to determine the efficacy of HCLS in improving glycaemic control, reducing glucose variability and enhancing time in range (TIR) compared with SAP therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The review was prospectively registered with the International Prospective Register of Systematic Reviews as CRD42023488722. Data from 27 studies involving over 1000 participants were analysed. The studies included both RCTs and RCOs that compared HCLS with SAP therapy. Key metrics assessed were mean glucose levels, glucose variability (coefficient of variation and standard deviation), low blood glucose index (LBGI), high blood glucose index (HBGI), glycated haemoglobin (HbA1c) and TIR (3.9–10.0 mmol/L). Hyperglycaemia and hypoglycaemia outcomes were also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HCLS significantly reduced mean glucose levels by 2.0 mg/dL compared with SAP therapy. It also decreased glucose variability, including CV and SD, and reduced LBGI, HBGI and HbA1c. HCLS increased TIR by 8.8%. Regarding hyperglycaemia, HCLS reduced the time spent above 10 mmol/L by 7.8%, above 13.9 mmol/L by 3.63% and above 16.7 mmol/L by 0.88%. Hypoglycaemia outcomes showed modest improvements, with reductions in time below 3 mmol/L by 0.10% and below 3.9 mmol/L by 0.72%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings support HCLS as a superior modality to SAP therapy in improving glycaemic control, particularly in paediatric populations. HCLS effectively reduces hyperglycaemia and increases TIR, with modest effects on hypoglycaemia. The clinical implications are significant, highlighting the advantages of HCLS in optimising glucose regulation and mitigating glycaemic variability. This technology offers improved glycaemic control and enhanced quality of life for people living with type 1 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gestational diabetes mellitus (GDM) is a well-established independent risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease. As risks emerge within the first decade following childbirth, early intervention is required. However, competing postpartum priorities and limited time inhibit many women from prioritising their post-GDM health. Therefore, the study aimed to: (1) Measure dysglycaemia prevalence and identify predictors among Australian women with recent GDM and (2) understand women's views regarding their risk of future T2DM and approach to potential preventive strategies, including post-GDM preventive pharmacotherapy.
Methods
Cross-sectional study of women with recent (within 5 years) GDM, including an online questionnaire and oral glucose tolerance test completion by participants.
Results
Participants (n = 505) had a mean age of 37.3 ± 4.9 years, body mass index (BMI) of 27.5 ± 6.4 kg/m2 and were 2.9 ± 1.4 years postpartum. Of the 248 (49.1%) participants completing an oral glucose tolerance test, 4% had T2DM and 11% had pre-diabetes. Each 1 kg/m2 increase in BMI was associated with 10% greater odds of dysglycaemia (p = 0.03). On a 10-point scale (10 = highest), the median self-reported 5-year risk of developing T2DM was 5 [IQR: 3–7], and concern about developing T2DM was 7 [5–9]. Women strongly agreed (10 [8–10]) that preventing or delaying T2DM onset was important. Women reported being very likely to adopt lifestyle changes (4 [4–5] out of 5), and somewhat likely to take medication for T2DM prevention (3 [1–4] out of 5).
Conclusion
Women consider preventing or delaying the onset of diabetes very important. Hence, studies evaluating adjunct therapies, such as pharmacotherapy, are needed to reduce their long-term risk.
{"title":"Type 2 diabetes after gestational diabetes, a cross-sectional study—DIVINE-NSW","authors":"Vivian Yejee Lee, Katherine Donges, Amanda Beech, Angela Makris, Clare Arnott, Anushka Patel, Amanda Henry","doi":"10.1111/dme.70155","DOIUrl":"10.1111/dme.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Gestational diabetes mellitus (GDM) is a well-established independent risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease. As risks emerge within the first decade following childbirth, early intervention is required. However, competing postpartum priorities and limited time inhibit many women from prioritising their post-GDM health. Therefore, the study aimed to: (1) Measure dysglycaemia prevalence and identify predictors among Australian women with recent GDM and (2) understand women's views regarding their risk of future T2DM and approach to potential preventive strategies, including post-GDM preventive pharmacotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional study of women with recent (within 5 years) GDM, including an online questionnaire and oral glucose tolerance test completion by participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants (<i>n</i> = 505) had a mean age of 37.3 ± 4.9 years, body mass index (BMI) of 27.5 ± 6.4 kg/m<sup>2</sup> and were 2.9 ± 1.4 years postpartum. Of the 248 (49.1%) participants completing an oral glucose tolerance test, 4% had T2DM and 11% had pre-diabetes. Each 1 kg/m<sup>2</sup> increase in BMI was associated with 10% greater odds of dysglycaemia (<i>p</i> = 0.03). On a 10-point scale (10 = highest), the median self-reported 5-year risk of developing T2DM was 5 [IQR: 3–7], and concern about developing T2DM was 7 [5–9]. Women strongly agreed (10 [8–10]) that preventing or delaying T2DM onset was important. Women reported being very likely to adopt lifestyle changes (4 [4–5] out of 5), and somewhat likely to take medication for T2DM prevention (3 [1–4] out of 5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Women consider preventing or delaying the onset of diabetes very important. Hence, studies evaluating adjunct therapies, such as pharmacotherapy, are needed to reduce their long-term risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uffe Søholm, Sharmala Thuraisingam, Elizabeth Holmes-Truscott, Nicole de Zoysa, Debbie Cooke, Simon Heller, Jane Speight, the DAFNEplus Study Group
Aims
To identify meaningful clusters of participants with shared baseline characteristics (demographic, clinical, and psychological) from a sample of adults with type 1 diabetes (T1D) completing dose adjustment for normal eating (DAFNE) structured T1D education, or the updated DAFNEplus programme. Further, to determine whether those clusters respond differently, at 6- and 12 months, to DAFNE and DAFNEplus on core outcomes: HbA1c and diabetes-specific quality of life (QoL).
Methods
Latent profile analysis was conducted on the DAFNEplus randomised control trial dataset using relevant indicator variables (age; HbA1c; hypoglycaemia awareness; diabetes-specific QoL, distress, and positive well-being; fear of hypoglycaemia; satisfaction with diabetes management). Model fit indices were used to select the optimal number of clusters and multilevel linear regression models to estimate the effect of DAFNEplus (compared with DAFNE) on HbA1c and diabetes-specific QoL in each cluster.
Results
A total of n = 363 participants were included in the analysis (n = 147, 40% randomised to DAFNEplus). The final model included two clusters: the first was consistently worse off on clinical and psychological indicator variables. The multilevel analysis showed a significant adjusted mean difference, at 12 months (first cluster only), between DAFNE and DAFNEplus in diabetes-specific QoL (0.81; 95% CI: 0.19–1.43; p = 0.01), but not at other time points or in HbA1c.
Conclusions
This study suggests that DAFNEplus has significant added benefits in reducing the negative impact of diabetes on QoL for a subgroup of adults with T1D, but not for their HbA1c. This provides important insights for the future real-world implementation of the DAFNEplus programme.
{"title":"Changes in HbA1c and diabetes-specific quality of life following structured type 1 diabetes education: Exploratory latent profile analysis of outcomes in the DAFNEplus trial","authors":"Uffe Søholm, Sharmala Thuraisingam, Elizabeth Holmes-Truscott, Nicole de Zoysa, Debbie Cooke, Simon Heller, Jane Speight, the DAFNEplus Study Group","doi":"10.1111/dme.70203","DOIUrl":"10.1111/dme.70203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To identify meaningful clusters of participants with shared baseline characteristics (demographic, clinical, and psychological) from a sample of adults with type 1 diabetes (T1D) completing dose adjustment for normal eating (DAFNE) structured T1D education, or the updated DAFNE<i>plus</i> programme. Further, to determine whether those clusters respond differently, at 6- and 12 months, to DAFNE and DAFNE<i>plus</i> on core outcomes: HbA1c and diabetes-specific quality of life (QoL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Latent profile analysis was conducted on the DAFNE<i>plus</i> randomised control trial dataset using relevant indicator variables (age; HbA1c; hypoglycaemia awareness; diabetes-specific QoL, distress, and positive well-being; fear of hypoglycaemia; satisfaction with diabetes management). Model fit indices were used to select the optimal number of clusters and multilevel linear regression models to estimate the effect of DAFNE<i>plus</i> (compared with DAFNE) on HbA1c and diabetes-specific QoL in each cluster.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of <i>n</i> = 363 participants were included in the analysis (<i>n</i> = 147, 40% randomised to DAFNE<i>plus</i>). The final model included two clusters: the first was consistently worse off on clinical and psychological indicator variables. The multilevel analysis showed a significant adjusted mean difference, at 12 months (first cluster only), between DAFNE and DAFNE<i>plus</i> in diabetes-specific QoL (0.81; 95% CI: 0.19–1.43; <i>p</i> = 0.01), but not at other time points or in HbA1c.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study suggests that DAFNE<i>plus</i> has significant added benefits in reducing the negative impact of diabetes on QoL for a subgroup of adults with T1D, but not for their HbA1c. This provides important insights for the future real-world implementation of the DAFNE<i>plus</i> programme.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreas Matheou, Orestis Zavlis, Steve White, Thomas McDonnell, Alexander Warner-Levy, John Warner-Levy, Loren Wilkins, Hellena Habte-Asres, Abigail Lay, Liliana Shalamanova, Martin Whyte, Martin Gibson, Philip A. Kalra, Adrian Heald
<div> <section> <h3> Introduction</h3> <p>The pathophysiology of chronic kidney disease (CKD) and type 2 diabetes (T2D) is multifactorial and associated with a plethora of underlying conditions and complications. Their link is reciprocal and understanding its nature, particularly over time, could improve the health of many.</p> </section> <section> <h3> Methods</h3> <p>A prospective study was conducted to examine the development of the two main components of CKD (urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR)) over 24 years (2001–2024) in a sample of 718 individuals with a diagnosis of T2D. Longitudinal modelling was conducted to examine the rate of change of ACR and eGFR over the 24 years, as well as whether sex, smoking status, glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) influenced that rate of change in both our total sample and three sub-groups (no CKD, CKD with increased ACR and preserved eGFR, and CKD with increased ACR and reduced eGFR).</p> </section> <section> <h3> Results</h3> <p>At baseline, 428 (59.6%) patients were male while 290 (40.4%) were female. Mean age at baseline was 56.6 ± 12.4 years. Mean follow-up period was 16.4 ± 2.1 years. 451 (62.8%) patients had a normal ACR and eGFR ≥60 mL/min/1.73 m<sup>2</sup>, no CKD. At 24-year follow-up, 196 (43%) of these patients had progressed to an ACR >3 mg/mmol and/or eGFR<60 mL/min/1.73 m<sup>2</sup>, developing CKD. At final follow-up, 282 patients were still alive. In the whole cohort, 10 (1.4%) patients progressed to end-stage kidney disease eGFR<15 mL/min/1.73 m<sup>2</sup>.</p> <p>For the whole cohort ACR increased exponentially, while eGFR decreased linearly by 1.02 mL/min/1.73 m<sup>2</sup> per year.</p> <p>For ACR: SBP (<i>β</i> = 0.36, 95% CI [0.24, 0.48]) and DBP (<i>β</i> = 0.40, 95% CI [0.16, 0.64]) were the only significant independent predictors of ACR progression particularly in the sub-group with increased ACR and preserved eGFR.</p> <p>For eGFR: Female sex (<i>β</i> = −3.79, 95% CI [1.96, 5.63]), SBP (<i>β</i> = −0.12, 95% CI [−0.17, −0.06]), DBP (<i>β</i> = −0.19, 95% CI [−0.08, −0.31]), HbA1c (<i>β</i> = −1.17, 95% CI [−0.63, −1.71]), baseline cholesterol (<i>β</i> = 0.86, 95% CI [0.29, 1.43]) and smoking (<i>β</i> = −2.05, 95% CI [−3.80, −1.30]) were significant independent predictors of eGFR progression, but only in the non-CKD at baseline sub-group.</p> <p>At the end of follow-up 436 (60%) of people had died including 219 (48.6%) o
{"title":"Progression of albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) over 24 years in people with type 2 diabetes. Drivers, potential protectors and associated mortality","authors":"Andreas Matheou, Orestis Zavlis, Steve White, Thomas McDonnell, Alexander Warner-Levy, John Warner-Levy, Loren Wilkins, Hellena Habte-Asres, Abigail Lay, Liliana Shalamanova, Martin Whyte, Martin Gibson, Philip A. Kalra, Adrian Heald","doi":"10.1111/dme.70193","DOIUrl":"10.1111/dme.70193","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The pathophysiology of chronic kidney disease (CKD) and type 2 diabetes (T2D) is multifactorial and associated with a plethora of underlying conditions and complications. Their link is reciprocal and understanding its nature, particularly over time, could improve the health of many.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective study was conducted to examine the development of the two main components of CKD (urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR)) over 24 years (2001–2024) in a sample of 718 individuals with a diagnosis of T2D. Longitudinal modelling was conducted to examine the rate of change of ACR and eGFR over the 24 years, as well as whether sex, smoking status, glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) influenced that rate of change in both our total sample and three sub-groups (no CKD, CKD with increased ACR and preserved eGFR, and CKD with increased ACR and reduced eGFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 428 (59.6%) patients were male while 290 (40.4%) were female. Mean age at baseline was 56.6 ± 12.4 years. Mean follow-up period was 16.4 ± 2.1 years. 451 (62.8%) patients had a normal ACR and eGFR ≥60 mL/min/1.73 m<sup>2</sup>, no CKD. At 24-year follow-up, 196 (43%) of these patients had progressed to an ACR >3 mg/mmol and/or eGFR<60 mL/min/1.73 m<sup>2</sup>, developing CKD. At final follow-up, 282 patients were still alive. In the whole cohort, 10 (1.4%) patients progressed to end-stage kidney disease eGFR<15 mL/min/1.73 m<sup>2</sup>.</p>\u0000 \u0000 <p>For the whole cohort ACR increased exponentially, while eGFR decreased linearly by 1.02 mL/min/1.73 m<sup>2</sup> per year.</p>\u0000 \u0000 <p>For ACR: SBP (<i>β</i> = 0.36, 95% CI [0.24, 0.48]) and DBP (<i>β</i> = 0.40, 95% CI [0.16, 0.64]) were the only significant independent predictors of ACR progression particularly in the sub-group with increased ACR and preserved eGFR.</p>\u0000 \u0000 <p>For eGFR: Female sex (<i>β</i> = −3.79, 95% CI [1.96, 5.63]), SBP (<i>β</i> = −0.12, 95% CI [−0.17, −0.06]), DBP (<i>β</i> = −0.19, 95% CI [−0.08, −0.31]), HbA1c (<i>β</i> = −1.17, 95% CI [−0.63, −1.71]), baseline cholesterol (<i>β</i> = 0.86, 95% CI [0.29, 1.43]) and smoking (<i>β</i> = −2.05, 95% CI [−3.80, −1.30]) were significant independent predictors of eGFR progression, but only in the non-CKD at baseline sub-group.</p>\u0000 \u0000 <p>At the end of follow-up 436 (60%) of people had died including 219 (48.6%) o","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetic vascular complications (DVCs) are among the most serious issues faced by individuals with diabetes. The pathogenesis of DVC involves various pathological processes, including lipid metabolism disorders, inflammatory responses, apoptosis and neovascularisation. While exosomes, the phosphatidylinositol 3-Kinase/Protein Kinase B (PI3K/Akt) pathway and autophagy have been extensively studied individually in DVC, a gap exists in understanding their integrative crosstalk and feedback mechanisms as a cohesive regulatory network.
Methods
Based on a review of the literature, we analyse the individual and interactive roles of exosomes, the PI3K/Akt pathway and autophagy in DVC pathogenesis, with a focus on their integrative regulatory network.
Results
Exosomes carrying specific miRNAs, proteins, and other bioactive molecules regulate intracellular autophagy via the PI3K/Akt pathway. At the same time, autophagy is bidirectionally regulated by the PI3K/Akt pathway. Through this mutual regulation, they collectively influence exosome biogenesis and secretion, which in turn modulates cell survival, proliferation, and inflammatory responses to maintain intracellular homeostasis. Both processes co-regulate cellular metabolic homeostasis and inflammatory responses through the PI3K/Akt pathway, affecting vascular endothelial function.
Conclusions
In this review, we propose the novel conceptual framework of the “exosome–PI3K/Akt–autophagy axis” and investigate the role and mechanism in DVC, aiming to provide novel therapeutic targets and strategies for its treatment.
{"title":"The exosome-PI3K/Akt-autophagy axis in diabetic vascular complications: Mechanisms and implications","authors":"Wei Liu, Weiting Xiao, Qiongli Zeng, Yi Zhou, Jinwei Yang, Wen Ouyang","doi":"10.1111/dme.70196","DOIUrl":"10.1111/dme.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic vascular complications (DVCs) are among the most serious issues faced by individuals with diabetes. The pathogenesis of DVC involves various pathological processes, including lipid metabolism disorders, inflammatory responses, apoptosis and neovascularisation. While exosomes, the phosphatidylinositol 3-Kinase/Protein Kinase B (PI3K/Akt) pathway and autophagy have been extensively studied individually in DVC, a gap exists in understanding their integrative crosstalk and feedback mechanisms as a cohesive regulatory network.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Based on a review of the literature, we analyse the individual and interactive roles of exosomes, the PI3K/Akt pathway and autophagy in DVC pathogenesis, with a focus on their integrative regulatory network.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Exosomes carrying specific miRNAs, proteins, and other bioactive molecules regulate intracellular autophagy via the PI3K/Akt pathway. At the same time, autophagy is bidirectionally regulated by the PI3K/Akt pathway. Through this mutual regulation, they collectively influence exosome biogenesis and secretion, which in turn modulates cell survival, proliferation, and inflammatory responses to maintain intracellular homeostasis. Both processes co-regulate cellular metabolic homeostasis and inflammatory responses through the PI3K/Akt pathway, affecting vascular endothelial function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this review, we propose the novel conceptual framework of the “exosome–PI3K/Akt–autophagy axis” and investigate the role and mechanism in DVC, aiming to provide novel therapeutic targets and strategies for its treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoli Zhu, Eng Sing Lee, Frederick H. F. Chan, Ruoyu Yin, Phoebe X. H. Lim, Rachel W. S. Koh, Carpenter Judith, Voon Hooi Lim, Richard S. Y. Low, Jie Su, Faridah Binte Mohamad Yusoff, Yee Chui Chen, Konstadina Griva
Aims
To evaluate the feasibility, acceptability, and implementation of HEALing (Healing through Empowerment and Active Listening)—a clinic-integrated self-care intervention delivered by trained wound care nurses in three 30-min face-to-face sessions over 6 weeks to support diabetic foot ulcer healing.
Methods
A mixed-methods, single-arm hybrid effectiveness–implementation pilot and qualitative study was conducted. Feasibility was evaluated through enrolment, retention, attendance and data completeness; acceptability via qualitative interviews; and implementation by tracking intervention delivery time. Potential effectiveness was assessed through changes in psychological (illness beliefs, foot care confidence, diabetes distress, quality of life, autonomy support), behavioural (foot care practices), knowledge (of wound deterioation), and clinical (HbA1c) outcomes from baseline to 4 weeks post intervention. Data were analysed using descriptive statistics, paired-sample t-tests and thematic analysis.
Results
A total of 29 individuals living with DFU participated in the study (response rate: 78%), with enrolment occurring between August and September 2024. Retention was 90% (N = 26). The average HEALing session lasted 32 min (range: 15–50 min). Statistically significant improvements were observed across psychological, behavioural, knowledge and clinical outcomes from baseline to post-intervention (all p < 0.005; Cohen's d = 0.8–1.1). Qualitative findings reinforced the intervention's acceptability, highlighting how HEALing enhanced knowledge, emotional healing and empowerment through autonomy,fostering greater motivation and engagement in self-care.
Conclusions
This pilot suggests the feasibility and acceptability of HEALing in nurse-led DFU care, with preliminary indications of psychological and clinical benefits. The findings support the potential for scalable integration of psychological support, warranting further evaluation in larger, controlled trials with extended follow-up.
目的：评估HEALing （HEALing through Empowerment and Active Listening）的可行性、可接受性和实施情况。HEALing是一种临床整合的自我护理干预，由训练有素的伤口护理护士在6周内进行3次30分钟的面对面会议，以支持糖尿病足溃疡的愈合。方法：采用混合方法、单臂混合效果实施试点和定性研究。通过入学、留校、出勤和数据完整性评估可行性；通过定性访谈的可接受性；通过跟踪干预措施的交付时间来实施。通过心理（疾病信念、足部护理信心、糖尿病困扰、生活质量、自主支持）、行为（足部护理实践）、知识（伤口恶化）和临床（HbA1c）结果的变化来评估潜在的有效性，从基线到干预后4周。数据分析采用描述性统计、配对样本t检验和专题分析。结果：共有29名DFU患者参与了这项研究（应答率：78%），入组时间为2024年8月至9月。保留率90% （N = 26）。平均治疗持续32分钟（范围：15-50分钟）。从基线到干预后，在心理、行为、知识和临床结果方面观察到统计学上显著的改善（所有p）。结论：该试点表明，在护士主导的DFU护理中，治疗的可行性和可接受性，具有心理和临床益处的初步迹象。研究结果支持了可扩展的心理支持整合的潜力，需要在更大的、长期随访的对照试验中进一步评估。
{"title":"Healing through empowerment and active listening (HEALing): A mixed-methods evaluation of the feasibility and acceptability of a nurse-led self-care support intervention for people with diabetic foot ulcers","authors":"Xiaoli Zhu, Eng Sing Lee, Frederick H. F. Chan, Ruoyu Yin, Phoebe X. H. Lim, Rachel W. S. Koh, Carpenter Judith, Voon Hooi Lim, Richard S. Y. Low, Jie Su, Faridah Binte Mohamad Yusoff, Yee Chui Chen, Konstadina Griva","doi":"10.1111/dme.70187","DOIUrl":"10.1111/dme.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the feasibility, acceptability, and implementation of HEALing (Healing through Empowerment and Active Listening)—a clinic-integrated self-care intervention delivered by trained wound care nurses in three 30-min face-to-face sessions over 6 weeks to support diabetic foot ulcer healing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed-methods, single-arm hybrid effectiveness–implementation pilot and qualitative study was conducted. Feasibility was evaluated through enrolment, retention, attendance and data completeness; acceptability via qualitative interviews; and implementation by tracking intervention delivery time. Potential effectiveness was assessed through changes in psychological (illness beliefs, foot care confidence, diabetes distress, quality of life, autonomy support), behavioural (foot care practices), knowledge (of wound deterioation), and clinical (HbA1c) outcomes from baseline to 4 weeks post intervention. Data were analysed using descriptive statistics, paired-sample <i>t</i>-tests and thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 29 individuals living with DFU participated in the study (response rate: 78%), with enrolment occurring between August and September 2024. Retention was 90% (<i>N</i> = 26). The average HEALing session lasted 32 min (range: 15–50 min). Statistically significant improvements were observed across psychological, behavioural, knowledge and clinical outcomes from baseline to post-intervention (all <i>p</i> < 0.005; Cohen's <i>d</i> = 0.8–1.1). Qualitative findings reinforced the intervention's acceptability, highlighting how HEALing enhanced knowledge, emotional healing and empowerment through autonomy,fostering greater motivation and engagement in self-care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This pilot suggests the feasibility and acceptability of HEALing in nurse-led DFU care, with preliminary indications of psychological and clinical benefits. The findings support the potential for scalable integration of psychological support, warranting further evaluation in larger, controlled trials with extended follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monika Cigler, Uffe Søholm, Melanie Broadley, François Pouwer, Evertine J. Abbink, Namam Ali, Bastiaan E. de Galan, Eric Renard, Mark Evans, Julie Maria Bøggild Brøsen, Ulrik Pedersen-Bjergaard, Rory J. Mc Crimmon, Simon Heller, Sharon Caunt, Stephanie A. Amiel, Patrick Divilly, Natalie Zaremba, Pratik Choudhary, Julia K. Mader, the Hypo-RESOLVE consortium
Aims
Hypoglycaemia remains a barrier to optimal diabetes management, with few tools for capturing real-time person-reported hypoglycaemia (PRH). This study evaluated the Hypo-METRICS app, originally developed for a multinational 10-week prospective study of hypoglycaemia. It enables real-time reporting of hypoglycaemic episodes and their impact on daily functioning using Ecological Momentary Assessment (EMA), thereby overcoming limitations of retrospective self reports.
Methods
After completing the Hypo-METRICS study, 120 participants with type 1 diabetes mellitus (T1D) or type 2 diabetes mellitus (T2D) from Austria, Denmark, the Netherlands, and the United Kingdom were invited to complete a web-based questionnaire assessing app content, functionality, intervention effects, user engagement and the influence of the Covid-19 pandemic.
Results
Ninety-six participants (80%; 29 T1D, 67 T2D) completed the questionnaire (40% women; mean age 57.2 ± 16.1 years; 26% impaired hypoglycaemia awareness; HbA1c 60 ± 13 mmol/mol (7.6 ± 1.1%); diabetes duration 20.4 ± 11.3 years). App content and functionality were rated highly (>8/10 and >7/10, respectively). Some reported declining engagement, likely due to study length. COVID-19 had a minimal impact on app use.
Conclusions
The Hypo-METRICS app was well accepted, with strong ratings for usability and functionality. Given its unique strengths, the app has the potential to become an essential instrument for researchers aiming to capture the real-world burden and impact of hypoglycaemia.
{"title":"User evaluation of the Hypo-METRICS app: A tool for real-time symptom reporting of hypoglycaemia","authors":"Monika Cigler, Uffe Søholm, Melanie Broadley, François Pouwer, Evertine J. Abbink, Namam Ali, Bastiaan E. de Galan, Eric Renard, Mark Evans, Julie Maria Bøggild Brøsen, Ulrik Pedersen-Bjergaard, Rory J. Mc Crimmon, Simon Heller, Sharon Caunt, Stephanie A. Amiel, Patrick Divilly, Natalie Zaremba, Pratik Choudhary, Julia K. Mader, the Hypo-RESOLVE consortium","doi":"10.1111/dme.70185","DOIUrl":"10.1111/dme.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Hypoglycaemia remains a barrier to optimal diabetes management, with few tools for capturing real-time person-reported hypoglycaemia (PRH). This study evaluated the Hypo-METRICS app, originally developed for a multinational 10-week prospective study of hypoglycaemia. It enables real-time reporting of hypoglycaemic episodes and their impact on daily functioning using Ecological Momentary Assessment (EMA), thereby overcoming limitations of retrospective self reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>After completing the Hypo-METRICS study, 120 participants with type 1 diabetes mellitus (T1D) or type 2 diabetes mellitus (T2D) from Austria, Denmark, the Netherlands, and the United Kingdom were invited to complete a web-based questionnaire assessing app content, functionality, intervention effects, user engagement and the influence of the Covid-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-six participants (80%; 29 T1D, 67 T2D) completed the questionnaire (40% women; mean age 57.2 ± 16.1 years; 26% impaired hypoglycaemia awareness; HbA1c 60 ± 13 mmol/mol (7.6 ± 1.1%); diabetes duration 20.4 ± 11.3 years). App content and functionality were rated highly (>8/10 and >7/10, respectively). Some reported declining engagement, likely due to study length. COVID-19 had a minimal impact on app use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Hypo-METRICS app was well accepted, with strong ratings for usability and functionality. Given its unique strengths, the app has the potential to become an essential instrument for researchers aiming to capture the real-world burden and impact of hypoglycaemia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"43 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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