Sean F. Dinneen

Aim: This study aims to assess the treatment burden and health‐related quality of life (HRQoL) in young adults with type 1 diabetes (T1D). Methods: Online survey on experienced treatment burden (Treatment Burden Questionnaire, TBQ, 0–150, higher scores indicate higher burden) and HRQoL (Type 1 Diabetes and Life questionnaire for ages 18–25 and 26–45, T1DAL, 0–100, higher scores indicate better HRQoL) among Dutch young adults with T1D (aged 18–30). Results: In total, 294 young adults with T1D completed the survey. Mean TBQ score was 59.5 (SD = 24.9). Regular medical care reminding participants of their health problems scored highest. Mean T1DAL scores were 55.9 (SD = 12.9) for ages 18–25, and 62.1 (SD = 13.2) for ages 26–30. Lowest scores were in the subcategory ‘Emotional experiences and daily activities’ (18–25: median = 41.7, IQR = 24.9; 26–30: median = 47.8, IQR = 22.5). TBQ was strongly negatively correlated with T1DAL ( r = −0.69, 95% CI [−0.74, −0.62], p < 0.001). Characteristics associated with higher treatment burden and lower HRQoL included female gender, lower time in range and dissatisfaction with diabetes management approach. Conclusion: Young adults with T1D report considerable treatment burden and moderate HRQoL, suggesting a high impact of diabetes care on their lives. Treatment burden is particularly affected by regular medical care activities, whereas diabetes affects the daily functioning and emotional experiences domains of HRQoL. Further research is needed to understand how young adults make care fit and to improve care for these patients, resulting in minimally disruptive care plans. While cautiously interpreted, this may be especially relevant for women and those with adverse clinical outcomes.

Aim: This study aimed to identify what young adults with type 1 diabetes (T1D) do to make diabetes care fit in their lives and the impact of diabetes and diabetes care on living. Methods: Dutch young adults with T1D (18–30 years old) submitted photographed real‐life situations of efforts to make care fit and of the impact of care on their lives. Participants organised their photos in themes, which guided the focus group discussions. We added a reflective questionnaire, semi‐structured interview and iterative validation to identify participant‐defined themes and summarise the data. Results: Participants ( N = 18) submitted 240 photographs in total, showing a broad range of situations and emotions. Participants identified 16 themes, grouped into four overarching categories describing their experiences with diabetes: (1) My diabetes: glucose levels, workload, 24/7 present; (2) My life: flow of (daily) life, special and irregular circumstances, life changes, body and health; (3) Support: devices and technology, social network, clinical (diabetes) care; (4) Mental aspects: emotional processes, perspective, being a patient. In the overlap of My diabetes and My life, they identified eating and counting carbohydrates, activity and exercise, recreational substances. Conclusion: Young adults with T1D face the complex challenge of fitting their care into their ever‐changing lives. While support systems, such as devices, healthcare professionals and social networks can help, they can also create burdens. Participants emphasised the importance of mental health in their lives with T1D. This study highlights the need for diabetes care that acknowledges the emotional, social and practical realities of young adults' lives.

Background: Young adults living with type 1 diabetes (T1D) often experience sub-optimal outcomes due to competing life demands, disruptions in care, reduced clinic attendance, and difficulties in self-management. To improve outcomes among this population, we developed and piloted the D1 Now intervention using a user-centred and theory-informed approach. This protocol describes a cluster randomised controlled trial (RCT) to test the effectiveness and cost-effectiveness of the D1 Now intervention. Methods: A cluster RCT seeking to recruit 348 young adults (aged 18–25) with T1D from 12 hospital diabetes centres in Ireland. Centres will be randomised to receive either standard care or the D1 Now intervention, which includes two components: an agenda-setting tool and a support worker. The primary outcome is the change in HbA1c from baseline to 12-month follow-up. Secondary outcomes include patient-reported psychosocial outcomes, clinical outcomes, self-management outcomes and healthcare utilisation. We will collect data through blood samples, online patient surveys, and patient records at baseline and 12 months. Additionally, we will conduct a cost-effectiveness evaluation and a mixed-methods process evaluation. Discussion: We anticipate that the D1 Now intervention will be both effective and cost-effective in improving clinical and psychosocial outcomes for young adults compared to standard care. The findings from the process evaluation will shed light on how the intervention works (or not) and how implementation into health services (if warranted) can be optimised. If effective, D1 Now will offer a sustainable model of care to support engagement and self-management for young adults living with T1D. Trial registration: ISRCTN Identifier: ISRCTN28944606 . Date applied 01 May 2025

The European Association for the Study of Diabetes (EASD) has developed a Standard Operating Procedure (SOP) for the development of clinical practice guidelines, ensuring adherence to rigorous methodological standards based on the principles of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Key components include a transparent process for managing conflicts of interest, the incorporation of multidisciplinary panels including individuals with lived experience of diabetes, an evidence synthesis based on comprehensive systematic reviews, and an explicit peer review process. This SOP delineates the roles and responsibilities of the main structures involved, including the Guidelines Oversight Committee, Guideline Development Panels, and Evidence Synthesis Teams. Additionally, the SOP describes the main stages in guideline development, namely scoping of the guideline topic, evidence synthesis, development of Evidence-to-Decision frameworks for the formulation of clear, patient-centred recommendations, writing of the guideline document and the review process. Graphical Abstract

Apperloo EM, Neuen BL, Fletcher RA, et al. Efficacy and safety of SGLT2 inhibitors with and without glucagon-like peptide 1 receptor agonists: a SMART-C collaborative meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2024;12:545-557. 38991584.

Background To date, evaluations of the structured diabetes education programme, Dose Adjustment for Normal Eating (DAFNE), have focused on improvements in clinical and psychosocial outcomes, however, little is known about implementation and participant attendance across centres. We compared participant profile, course delivery and retention across Irish and UK centres and patterns of course delivery pre and during Covid-19. Methods Data collected annually by DAFNE centres (01.01.2019 to 01.01.2022) were analysed. Multivariable logistic regression assessed the association between demographic (age, gender) and clinical variables (years since diagnosis; DKA requiring admission in past 12 months; severe hypoglycaemic event (hypo) in the last year), course format and country, with non-completion (attended <5 sessions). Results Overall, 6749 people attended DAFNE courses across 91 centres in 3 years. Compared to Ireland, UK-based course attendees were slightly older on average and had diabetes for longer. In 2019 (pre-Covid), 86 centres delivered an average of 10 courses per centre (range: 1 to 30). During Covid (2020) when remote format courses were first offered, 79 centres delivered an average of 5 courses per centre (1 to 15). Overall, 10% of participants did not complete. Younger age, having a severe hypo in the last year, and attending a remote course (vs. standard 5-day face-to-face) were associated with non-completion. Conclusions Course delivery varies widely across centres. This may reflect centre size and resource availability. Although participant non-completion was low, our data do not capture those who withdraw pre-course. Future work should explore barriers and facilitators of course acceptance and retention.

Aims/Introduction: Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence.Materials and Methods: Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta‐analysis – Scoping Review protocol. Peer‐reviewed, English‐language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field.Results: A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review.Conclusions: Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real‐world settings, and with improved technology.

The term value‐based healthcare (VBHC) describes an approach to the organization and delivery of care that emphasizes reducing the cost of care while improving outcomes. This involves increased investment earlier in the care pathway e.g., in the prevention, timely diagnosis, and screening for complications in order to maximize the overall impact of care. Key elements of VBHC include the collection and interpretation of relevant data to drive quality improvement and appropriateness of care, a focus on a continuum of care from prevention through to complications, an awareness of the financial drivers of the cost of care and a recognition that meaningful outcomes of care are those that are important to patients. Although VBHC has its origins in North America and has mostly been applied to private health systems, the principles can also be applied to national health services. In publicly funded health systems, where resources are finite, VBHC initiatives aim to eliminate ineffective care that has no beneficial impact or added value for patients and to optimize patient outcomes by delivering care that meets the changing healthcare needs of a population over time. The National Health Service in Wales has established a VBHC Office and has begun to realize the benefits of adopting VBHC approaches. The Irish Health Service Executive (HSE) can learn from the approaches used in Wales. In this paper we explore some of the principles of VBHC through case studies from Ireland and Wales highlighting how national health services are using VBHC to achieve improvement in outcomes for people living with diabetes.