Ketan Dhatariya

Background: Type 1 diabetes progresses through presymptomatic early stages defined by islet autoantibody positivity and glycaemia. Early detection reduces ketoacidosis and facilitates access to disease‐modifying therapies. The extent to which autoantibody screening and follow‐up have been adopted in UK clinical practice for adults is uncertain. Methods: We conducted a web‐based survey of members of the Association of British Clinical Diabetologists (ABCD), Diabetes Technology Network UK (DTN‐UK) and Primary Care Diabetes and Obesity Society (PCDOS) between 12 December 2025 and 2 February 2026. Results: Of 164 complete responses, 116 (71%) were from doctors, 40 (24%) from nurses and 8 (5%) from other healthcare professionals. The majority were from district general hospitals ( n = 91, 56%), followed by tertiary centres ( n = 31, 19%), community‐based and private specialist diabetes services ( n = 14, 9%) and general practice ( n = 28, 17%). Thirty‐five per cent (11/31) in tertiary centres and 21% (22/105) in other care settings reported experience in managing adults with early‐stage T1D. Among these clinicians, HbA1c was the most commonly used follow‐up method (73% in tertiary centres and 86% in other settings), while approximately half offered capillary blood glucose and ketone meters and/or continuous glucose monitoring. In general practice, access to islet autoantibody testing was limited, and few had local guidelines for managing stage 1 or 2 T1D. In diabetes specialist practice, autoantibodies to GAD, IA‐2 and ZnT8, but not insulin, were the most widely requested islet autoantibody assays. Perceived readiness to implement immunotherapy was low across all settings. Conclusions: Early‐stage T1D management is evolving within UK clinical practice. Monitoring and management practices broadly align with consensus recommendations. Education, national guidance and clear commissioning frameworks will be essential for successful provision of immunotherapies.

Background: Although point-of-care testing is the standard method for inpatient glucose monitoring; it is associated with patient discomfort and late detection of dysglycaemic events. Continuous glucose monitoring (CGM) may improve glycaemic management; however, limited staff education and experience among may hinder its implementation. Aim: To investigate experience, perceptions and training needs on CGM use among inpatient nursing staff across diverse hospital wards. Methods: This is a single-centre, 38-item online survey recruited inpatient nurses in a hospital in the UK. Participants were invited via the e-newsletter and posters; the survey remained open for five months. Results: Nineteen nurses reported positive perceptions of inpatient CGM. Most considered CGM reliable (77.8%) and preferred CGM combined with POCT (66.7%). Views on its impact on workload and patient-room entries were mixed (30% agreed, 30% disagreed). Training needs included sensor placement (92.9%) and alarm management (78.6%). Conclusion: Nurses viewed CGM favourably but highlighted important training needs for inpatient use. Key points: 1. Inpatient nurses generally viewed CGM positively and considered it as a reliable tool. 2. Most nurses preferred using CGM alongside POCT, while views on its impact on patient-room entries were mixed. 3. Most nurses identified further training needs, particularly for sensor placement and CGM alarm management. 4. The small, single-site voluntary sample limits generalisability; findings should be confirmed in larger, multicentre studies.

There is an urgent and unmet need for a practical clinical guideline addressing the use of continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID) systems in hospital settings. The goal with this position statement is to facilitate effective and safe use of these devices to improve glycemic management, enhance outcomes, and contribute to standardization efforts in initiating or continuing the use of these devices in hospitals for non–critically ill hospitalized adults. The topics covered include selection criteria for management with diabetes technologies, CGM-derived glycemic metrics and goals for adults with diabetes, insulin titration and administration guidelines, perioperative care, CGM alarm settings for hypoglycemia and hyperglycemia, clinical staff training and workflows, integration of device data with the electronic health record, imaging tests considerations, and discharge planning.

There is an urgent and unmet need for a practical clinical guideline addressing the use of continuous glucose monitoring (CGM), insulin pumps and automated insulin delivery (AID) systems in hospital settings. The goal with this position statement is to facilitate effective and safe use of these devices to improve glycaemic management, enhance outcomes and contribute to standardisation efforts in initiating or continuing the use of these devices in hospitals for non-critically ill hospitalised adults. The topics covered include selection criteria for management with diabetes technologies, CGM-derived glycaemic metrics and goals for adults with diabetes, insulin titration and administration guidelines, perioperative care, CGM alarm settings for hypoglycaemia and hyperglycaemia, clinical staff training and workflows, integration of device data with the electronic health record, imaging tests considerations and discharge planning. Graphical Abstract

Background: Type 2 diabetes (T2DM) and cognitive impairment are common long-term chronic conditions affecting older people in hospital. Cognitive impairment can complicate glucose monitoring and lead to diabetes-related emergencies in T2DM. Traditionally, point of care test measurements of capillary blood glucose are conducted in-hospital for T2DM while continuous glucose monitoring (CGM) is not widely used. Aim: To understand the feasibility, acceptability and tolerability of using CGM in older inpatients with T2DM and cognitive impairment. Methods: 32 older people (mean age=78.7±6.7 years) with comorbid T2DM and cognitive impairment (Abbreviated Mini-Mental Test ≤8/10 and Mini-Addenbrooke’s Cognitive Examination ≤22/30) were recruited within a tertiary care hospital in the UK. All participants were naive to CGM and were asked to wear blinded Dexcom G7 sensors for up to 10 days. Participants were asked about feasibility, acceptability and tolerability questions at the point of sensor removal. Results: 29 participants (96%) reported no pain during CGM fitting. All participants (100%) agreed that they did not notice wearing the sensor, and it did not affect their day-to-day hospital activities. All participants (100%) found it ‘very easy’ or ‘easy’ to have the sensor fitted and wearing it for 10 days, with 27 participants (90%) finding CGM convenient. 17 participants (57%) reported favourable perceptions of the subcutaneous sensor sensation. Conclusion: CGM use in older inpatients with T2DM and cognitive impairment is highly feasible and acceptable for patients. Future studies and trials are now needed to evaluate the clinical use of CGM for glucose monitoring in hospitalised or community-dwelling older individuals with T2DM and cognitive impairment.

Aims/hypothesis: Foot ulceration is a common complication of diabetes and is associated with high mortality and costs. The quality of evidence to inform clinical practice is limited, partly because clinical studies do not consistently report baseline participant characteristics. This study aimed to develop a core descriptor set (CDS), a minimum set of descriptors to be measured in all studies evaluating interventions for people with diabetes-related foot ulceration. Methods: A longlist of descriptors was generated through a systematic review of studies assessing interventions for diabetes-related foot ulcers, pre-registered with PROSPERO (CRD42019128250). The identified descriptors were then ranked based on perceived importance by healthcare professionals from different fields and geographical locations using a nine-point Likert scale in the first round of a Delphi survey. Using standardised criteria, descriptors without consensus were re-ranked in round two. Critical descriptors and those without consensus after the Delphi process were discussed in the consensus meeting to finalise the CDS. Results: The systematic review yielded 95 candidate descriptors. The two Delphi rounds were completed by 102 and 69 healthcare professionals, respectively. The Delphi process identified 34 critically important descriptors and 13 descriptors without consensus, which were discussed in the consensus meeting. The ratified CDS included 28 descriptors across nine domains: demographic variables; individual factors; ulcer characteristics; limb characteristics; ongoing medical interventions; previous surgical interventions; medication history; biochemical measurements; and quality of life/function/symptoms. Conclusions/interpretation: This CDS reflects characteristics important to health professionals and researchers when reporting clinical studies on diabetes-related foot ulceration. Its use will aid the reporting of future studies.