Craig E. Taplin

Background: Advances in the understanding of type 1 diabetes (T1D) natural history have enabled screening for islet autoantibodies and the detection of presymptomatic (early-stage) T1D prior to clinical presentation and the need for insulin replacement therapy. As screening programs expand, increasing numbers of children are being identified with early-stage T1D, creating a pressing need for relevant, accessible, evidence-based educational resources. Due to the rapidly changing paradigm of T1D care in such settings, many health care professionals currently lack awareness or guidance on which educational resources to recommend to families. To date, no review has systematically identified and evaluated educational resources for families navigating early-stage T1D or for health care professionals supporting them. Objective: This scoping review aims to (1) systematically identify and evaluate educational resources for early-stage T1D; (2) assess resource readability, understandability, quality, and credibility; (3) create an inventory of resources consistent with current care and health literacy guidelines; and (4) identify resource gaps and priorities for future development. Methods: A comprehensive search of peer-reviewed (MEDLINE, CINAHL, PsycInfo, and Scopus) and gray literature databases (Google advanced searches and targeted searches of professional organizations, advocacy groups, research consortiums, and screening programs) will be conducted to identify English-language resources (eg, fact sheets, websites, videos, and infographics). Resources must target, or be suitable for adaptation for, audiences including youth (aged <25 years), families, parents, carers, and/or health care professionals. Resources must provide information about early-stage T1D, monitoring of early-stage T1D, trajectories, psychosocial aspects, or care navigation. Eligible resources will undergo standardized assessment using validated tools for readability (Flesch-Kincaid Grade Level [FKGL] and Simple Measure of Gobbledygook [SMOG]), understandability (Patient Education Materials Assessment Tool [PEMAT]), information quality (Quality Evaluation Scoring Tool [QUEST]), and credibility (adherence to current early-stage T1D guidelines). Two reviewers will abstract data using a charting tool prepared for the study. Results: Resources will be grouped by type, audience, and origin. Readability, understandability, quality, and credibility assessments will be presented in tables. Resource gaps will be identified to make recommendations for future resource development. The review will begin in March 2026, and data extraction and analysis will be completed by August 2026, with manuscript submission by October 2026. Conclusions: This paper presents the protocol for the first scoping review to systematically compile and appraise educational resources for early-stage T1D. The findings will offer a clear overview of the current resource landscape, identify gaps, highlight resources that adhere to current early-stage T1D and health literacy guidelines, and provide a foundation for future development and co-design of fit-for-purpose materials.

Aim: School time represents a significant component of overall glycaemia for children with type 1 diabetes (T1D), and glucose levels during instructional time may be important for optimising academic progress. There is, however, limited literature regarding glycaemia during school hours. This study aimed to evaluate glucose levels during school in primary school‐aged children with T1D in Western Australia (WA) and to compare these with non‐school days. Methods: A 12‐week cross‐sectional cohort study was performed comprising a WA school term and subsequent school holidays, utilising demographic, clinical and continuous glucose monitor data from the WA Children's Diabetes Database for primary school children with > 1 year of diagnosis of T1D. Results: A total of 235 children, mean age 9.54 ± 1.67 years and duration of T1D of 4.08 ± 2.31 years met inclusion criteria. Children had higher mean ± standard deviation time in range (3.9–10.0 mmol/L) during school (58.0% ± 15.8%) than equivalent hours during school holidays (53.5% ± 18.8%, p < 0.001) and weekends (56.6% ± 17.3%, p = 0.006). Children had lower mean sensor glucose, SD sensor glucose and time above range (> 10.0 and > 13.9 mmol/L) during school compared to school holidays and weekends. Time below 3.9 mmol/L was higher during school time compared with weekdays during school holidays ( p = 0.024), but lower than on school term weekends ( p = 0.009), and < 4% in all periods. There was no significant difference in time below 3.0 mmol/L. Conclusions: Primary school‐aged children in WA had modestly improved glycaemia during school compared with weekends, with more pronounced improvements compared with school holidays.

BACKGROUND Advances in understanding of type 1 diabetes (T1D) natural history have enabled screening for islet autoantibodies and the detection of pre-symptomatic (early-stage T1D) prior to clinical presentation and the need for insulin replacement therapy. As screening programs expand, increasing numbers of children are being identified with early-stage T1D creating a pressing need for relevant, accessible, evidence-based educational resources. Due to the rapidly changing paradigm of T1D care in such settings, many healthcare professionals currently lack awareness or guidance on which educational resources to recommend to families. To date, no review has systematically identified and evaluated educational resources for families navigating early-stage T1D or healthcare professionals supporting them. OBJECTIVE This scoping review aims to: (1) systematically identify and evaluate educational resources for early-stage T1D, (2) assess their readability, understandability, quality, and credibility, (3) create an inventory of resources consistent with current care and health literacy guidelines, and (4) identify resource gaps and priorities for future development. METHODS A comprehensive search of peer-reviewed and grey literature databases (MEDLINE, Google, professional organizations, advocacy groups, research consortiums, and screening programs) will be conducted to identify English-language resources (factsheets, websites, videos, infographics). Eligible resources will undergo standardised assessment using validated tools for readability, understandability, information quality, and credibility. RESULTS Expected outputs include descriptive summaries and structured appraisal findings across readability, understandability, information quality, and credibility. The review will begin in March 2026, with completion expected by August 2026. CONCLUSIONS This paper presents the protocol for the first scoping review to systematically compile and appraise educational resources for early-stage T1D. The findings will offer a clear overview of the current resource landscape, identify gaps, and provide a foundation for future development and co design of fit for purpose materials.

Aims/hypothesis: Children with early-stage (pre-symptomatic) type 1 diabetes are currently identified primarily via research-based screening programmes in Australia. Once identified, families live with the knowledge that their child has an increased chance of developing symptomatic, lifelong, insulin-requiring type 1 diabetes but have no specific clinical pathway available to them in Western Australia (WA) for accessing tailored support or education. This project aimed to co-design a new clinical pathway to address this unmet need. Methods: Experience-based co-design (EBCD) methodology was applied, comprising three phases undertaken consecutively over 12 months. Recruitment for each phase was via open invitation with voluntary participation. Phases 1 and 2 involved facilitated community conversations and focus groups conducted separately for type 1 diabetes community members and healthcare professionals (HCPs). Data from these phases were analysed using deductive and inductive content analysis to identify key categories of information and a prototype clinical pathway was developed incorporating these. For phase 3, a combined workshop was held with all stakeholders to obtain feedback on the prototype, and refine it accordingly. Results: In phase 1, 16 community members (people living with type 1 diabetes, families whose child or children had been screened for type 1 diabetes) and 36 HCPs (doctors, nurse educators, social workers, dietitians, a mental health nurse and administrative staff from Perth Children’s Hospital) participated in separate community conversations. The following three key categories were identified: (1) the need for education; (2) the need for support and strategies for managing uncertainty; and (3) the need for information on disease-modifying therapies and access to clinical trials. In phase 2, seven community members and 11 HCPs participated in separate focus groups. The following key priorities were identified: (1) the need for access to HCPs skilled in supporting patients to manage uncertainty; (2) the need for flexibility in delivery modes (telehealth/in-person); (3) the need for early referral to relevant clinical trials; and (4) the need for reliable and up-to-date resources. In phase 3, three community members and three HCPs attended a combined workshop to provide feedback on a prototype clinical pathway and their feedback was incorporated into a final version. Conclusions/interpretation: Application of EBCD methodology enabled the development of a new clinical pathway tailored to the needs of WA families with a child living with early-stage type 1 diabetes. Graphical

Despite the various traumatic events that a young person living with type 1 diabetes (T1D) may experience, little is known about the burden and manifestation of traumatic stress in this population. Though mental health outcomes have been explored generally, medical trauma-sensitive approaches to understanding these experiences remain limited. We utilised a qualitative descriptive approach to explore the impact of T1D on young people’s mental health through the paediatric medical traumatic stress model (PMTS). Young people aged 13–30 living with T1D were interviewed. These interviews were recorded, transcribed, and analysed using Reflexive Thematic Analysis. Three main themes were generated: (1) perceived sources of trauma throughout the T1D journey, (2) responses to and consequences of trauma, and (3) role of resilience throughout the T1D journey. The first and second themes elucidate the sources of traumatic stress ranging from physiological, clinical, and social experiences. Furthermore, the consequences of unaddressed trauma are observed throughout adolescence, but is most evident in the transition between adolescence and young adulthood. The final theme refers to sources of resilience for young people living with T1D and its role in mitigating the consequences of adverse trauma immediately post-diagnosis and in the long term. Application of the PMTS model to these experiences offers a novel perspective on young people’s experiences of living with T1D and enhances our understanding of trauma and traumatic stress in this population. Findings suggest that interventions focused on bolstering resilience might contribute to the prevention of long-term adverse mental health outcomes for young people living with T1D.

Introduction: Prospective data quantifying physical activity (PA) levels in Australian youth with type 1 diabetes (T1D) are lacking. Structured questionnaire instruments may provide useful information, but have not been evaluated in youth with T1D. The objective of this study was to evaluate the validity of three paediatric PA questionnaires in young people with T1D and their ability to differentiate those not meeting PA guidelines of 60 min of moderate-to-vigorous PA (MVPA) per day from those who do. Methods: Eighty youth with T1D (42 boys, 38 girls; age: 13.1 ± 2.6 years; body mass index: 20.2 ± 3.9 kg·m−2; glycosylated haemoglobin: 58.5 ± 10.1 mmol/mol; T1D duration: 5.4 ± 3.1 years) wore an Actigraph GT3x accelerometer for 7 days and on day 8 completed three self-report PA instruments: (i) the Physical Activity Questionnaire (PAQ), (ii) Previous Day Physical Activity Recall (PDPAR), and (iii) a Single-Item Physical Activity Scale (SIPAS). Validity coefficients for each instrument using accelerometry-derived MVPA minutes were determined using Spearman’s correlation coefficient. Receiver operator characteristic (ROC) curves were generated and optimal cut-points determined. Results: Mean daily MVPA minutes were 46.6 ± 25.5 min; 21/80 participants (26%) achieved an average of ≥60 MVPA minutes per day. The PAQ had the highest validity coefficient (r = 0.53; p < 0.001), followed by the single-item tool (r = 0.39; p < 0.001) and PDPAR (r = 0.09; p = 0.4). Area under the ROC curve was 0.7, 0.5, and 0.7 for the PAQ, PDPAR, and single-item tools, respectively. Optimal cut-points for sensitivity and specificity were (i) a PAQ composite score of 2.8 (66.1% and 66.7%), (ii) 75 MVPA minutes on the PDPAR (59.3% and 47.6%), and (iii) 4.5 days on the SIPAS (71.2% and 38.1%). Conclusion: The PAQ has moderate-to-high criterion validity and showed moderate ability to discriminate between T1D youth meeting PA guidelines from those who do not. The single-item question had low-to-moderate construct validity, while the PDPAR did not correlate with objectively measured PA levels. The feasibility of incorporating the PAQ into clinical care for youth with T1D warrants further evaluation.

Background: Children and young people with type 1 diabetes (T1D) experience high rates of mental ill health and stress due to the emotional and cognitive energy required to manage their condition. Our team has codesigned Wellbeing T1D, a brief trauma‐informed online intervention for adolescents living with T1D. This 5‐week intervention will teach skills to promote problem solving, improve emotional regulation and promote helpful thinking and coping. Objectives: The aim of this project is to pilot the Wellbeing project with Australian adolescents, aged 13–17 years. The feasibility and potential effectiveness of the intervention will be evaluated. We hypothesise that the Wellbeing project will show efficacy in improving the well‐being, resilience and coping skills of adolescents with T1D. Methods: A double arm, pre–post longitudinal study design will be employed, with an intervention group and a non‐intervention group receiving treatment as usual, to determine the potential effectiveness of the intervention content and delivery. We aim to recruit approximately 40 adolescents, at least 6 months post‐T1D diagnosis, to take part in the intervention. We will measure changes in participants' level of optimism, self‐compassion and diabetes‐specific distress and resilience at three timepoints. Conclusion: This protocol outlines the first trauma‐informed intervention aimed at addressing symptoms of traumatic stress in this population. Wellbeing T1D has the potential to be used in a variety of settings (both clinical and non‐clinical) to reduce the disease burden on adolescents living with T1D and their families, improve long‐term mental health outcomes and ultimately reduce morbidity from diabetes and its other physical complications.