Jesus Moreno-Fernandez

Background: The primary barrier to maximizing the benefits of intermittently scanned continuous glucose monitoring (isCGM) is low scan frequency. Higher daily scan frequency correlates with better glycemic control. Aim: To evaluate the effect of a nurse‐led educational intervention on scan frequency and behavioral change in adults with type 1 diabetes (T1D) showing low scanning frequency. Methods: In this 12‐week quasi‐experimental study, adults with T1D using isCGM and low scan frequency participated in a single, individualized, direct education session led by a diabetes nurse educator. The intervention focused on increasing daily scan frequency and supporting patient engagement in self‐management. Results: Thirty‐four patients using isCGM participated. Mean daily scan frequency increased from 3.1 to 6.1 scans/day following the intervention. This rise was associated with an 8.0% improvement in TIR. A positive correlation was observed between scan frequency and TIR, with each additional daily scan associated with a 0.51% increase in TIR. Linking Evidence to Action: A single, targeted educational session can significantly improve isCGM adherence and glycemic control in adults with T1D and low adherence, supporting its value as a practical strategy in routine clinical care. Trial Registration: The protocol was publicly registered at ClinicalTrials.gov (NCT05570162)

To evaluate the effect of the August´s 2023 heatwaves over glycemic control in adults with type 1 diabetes (T1D) treated with advance hybrid closed-loop systems (AHCL). Cross-sectional retrospective analysis of adult patients with T1D in Castilla-La Mancha (south-central Spanish region) using AHCL during the August´s 2023 heatwaves period. Primary outcome was change in time in range (TIR) 3.0–10 mmol/L (70–180 mg/dL) of interstitial glucose after the end of the heatwaves period. A total of 193 T1D patients were analyzed. TIR remained constant after the end of the heatwaves period (0.5% [95% CI -0.3, 1.3; P = 0.236]). No differences were observed among the rest of glycometric index. The percentage of patients meeting all the recommendations of the International Consensus of Time in Range was similar during the heatwaves period than after it ended (44.6% vs. 45.6%, P = 1.000). Finally, the percentage of time in automatization and daily insulin dose also stayed stable (0.5% [95% CI -1.4, 2.4; P = 0.601] and 0.0 UI/day [95% CI -1.0, 1.0; P = 0.981], respectively). Adults with T1D treated with AHCL maintained glycemic control during August´s 2023 heatwaves. These data raise the possibility that AHCL systems could help protect T1D patients from the effects of heatwaves on glycemic control.

We would like to express our gratitude to Lebbar et al. (1) for their interest in our work (2) and for their valuable comments. We value this opportunity t We would like to express our gratitude to Lebbar et al. (1) for their interest in our work (2) and for their valuable comments. We value this opportunity t

OBJECTIVE: Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS: A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70–180 mg/dL difference from beginning to end of follow-up. RESULTS: One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16–72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS: The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.