The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

In the paper

“Basal insulin analogs were designed with prolonged duration of action and reduced pharmacodynamic variability compared with protamine-based (NPH) human insulin, while rapid-acting analogs were introduced with quicker onset and shorter duration than short-acting (”

What the sources say

• Partly supported

  The Rapid-acting Analog Insulins section states that these analogs have a quicker onset and shorter duration than human regular insulin. The Physiological Insulin Secretion section says regular insulin’s prolonged action can increase hypoglycemia risk after a meal and that rapid-acting analogs were designed to overcome its limitations. Our copy does not specifically establish reduced early postprandial hyperglycemia or less hypoglycemia several hours after a meal compared with regular insulin; page numbers were not provided. (LLM, conf=0.84)

  cites [3] Hirsch, 2020, The evolution of insulin and how it informs therapy and treatment choices, Endocr Rev sourceExperimental — accuracy not yet measured

In the paper

“Islet cell antibody (ICA) measurement is no longer recommended because it is an imprecise biological assay that has been superseded by the direct measurement of single antibodies (21,22).”

What the sources say

• Partly supported

  In “Autoantibodies, Assays, and Thresholds” (page not provided), the paper describes ICA immunofluorescence as technically demanding and difficult to standardize, and identifies individual antibodies that contribute to ICA staining. It does not say ICA measurement is no longer recommended or has been superseded; it also lists ICA as an alternative to ZnT8A among markers measured at disease onset. (LLM, conf=0.84)

  cites [21] Bingley, 2010, Clinical applications of diabetes antibody testing, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [22] Sabbah, 2000, Genetic, autoimmune, and clinical characteristics of childhood- and adult-onset type 1 diabetes, Diabetes Care source

In the paper

“Controversy remains as to whether latent autoimmune diabetes of adulthood (LADA) is a discrete subtype, a milder form of type 1 diabetes, or a mixture of some individuals with type 1 diabetes and others with type 2 diabetes (16,17).”

What the sources say

• Partly supported

  The Precision diagnostics section (Text box 2, ‘Diagnosing latent autoimmune diabetes in adults’) explicitly describes controversy over whether LADA is a discrete subtype or a milder form of type 1 diabetes. It also describes a mixture, but our copy says ‘some patients with type 1 diabetes and others with type 1 diabetes,’ not the claimed mixture of type 1 and type 2 diabetes. (LLM, conf=0.85)

  cites [16] Chung, 2020, Precision medicine in diabetes: a consensus report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetologia sourceExperimental — accuracy not yet measured
• Partly supported

  The Introduction describes LADA as a slowly progressive autoimmune condition within the type 1 diabetes spectrum, while Identifying Subjects With LADA calls it a clinical and metabolic hybrid of types 1 and 2. Characteristics of LADA reports that some patients have a type 1 phenotype and others resemble type 2, but the paper does not present the stated three-way classification controversy or say that LADA is a mixture of people who actually have type 1 and people who actually have type 2 diabetes. Page numbers are unavailable in our copy. (LLM, conf=0.84)

  cites [17] Buzzetti, 2020, Management of latent autoimmune diabetes in adults: a consensus statement from an international expert panel, Diabetes sourceExperimental — accuracy not yet measured

In the paper

“A diagnosis of monogenic diabetes allows specific treatment with discontinuation of insulin in many cases and has implications for family members and screening for concurrent conditions (19,20).”

What the sources say

• ?Not checked — no full text of the sourcecites [19] Pearson, 2003, Genetic cause of hyperglycaemia and response to treatment in diabetes, Lancet source
• Supported

  Section 4 says a molecular diagnosis guides treatment and has implications for genetic counseling and testing family members. Section 6.2 reports that approximately 90% of patients with KATP-channel mutations can transfer from insulin to sulfonylureas. Sections 4.1 and 8.2 link genetic diagnosis to related clinical features and describe evaluation for associated pancreatic and renal abnormalities; the treatment and screening implications depend on the subtype. (LLM, conf=0.90)

  cites [20] Hattersley, 2018, ISPAD clinical practice consensus guidelines 2018: the diagnosis and management of monogenic diabetes in children and adolescents, Pediatr Diabetes source

In the paper

“Basal insulin analogs were designed with prolonged duration of action and reduced pharmacodynamic variability compared with protamine-based (NPH) human insulin, while rapid-acting analogs were introduced with quicker onset and shorter duration than short-acting (”

What the sources say

• Supported

  The Long-acting insulin analogs section says these analogs have predictable time-action profiles and prolonged duration compared with NPH. The Intermediate-acting insulin section describes substantial day-to-day variability with NPH, while the Long-acting insulin analogs section reports greatly reduced injection-to-injection variability with detemir compared with NPH. No page numbers are supplied in our copy. (LLM, conf=0.91)

  cites [3] Hirsch, 2020, The evolution of insulin and how it informs therapy and treatment choices, Endocr Rev source

In the paper

“These benefits persisted beyond the end of the trial despite equivalent glucose levels in the two groups (HbA 1c 8% [64 mmol/mol]) in the posttrial period; furthermore, reductions in incident cardiovascular disease and mortality in the intensively treated group emerged with time (40).”

What the sources say

• Partly supported

  The introduction reports that benefits persisted after the trial despite similar glycemic control during EDIC, and the Results report a 30% lower incidence of cardiovascular disease in the former intensive-treatment group. The Results show fewer cardiovascular deaths and suggest fewer fatal events, but they do not establish the claimed reduction in overall mortality; nor do they show that a mortality reduction emerged with time. (LLM, conf=0.86)

  cites [40] The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group, 2016, Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30-year follow-up, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“rt-CGM is beneficial in reducing the burden of hypoglycemia in older adults with type 1 diabetes (78) and those with IAH (44).”

What the sources say

• Supported

  The citation to this paper is attached to the older-adults-with-type-1-diabetes portion of the sentence; the IAH portion has a separate citation. In Glycemic Control Outcomes, the trial reports significantly less time in hypoglycemia with CGM than with standard blood glucose monitoring over six months. (LLM, conf=0.93)

  cites [78] Pratley, 2020, Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical Trial, JAMA source
• ?Not checked — no full text of the sourcecites [44] van Beers, 2016, Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial, Lancet Diabetes Endocrinol source

In the paper

“Although HbA 1c is an indicator of mean glucose, it does not inform glycemic variability and hypoglycemia and, therefore, is inappropriate as the only method of glucose evaluation in type 1 diabetes (68,69).”

What the sources say

• Supported

  The Introduction explains that patients with the same HbA1c can have different degrees of glycemic variability and markedly different glucose patterns. Its example of four patients with type 1 diabetes shows why CGM profiles add information about hypoglycemia that HbA1c alone does not provide. (LLM, conf=0.94)

  cites [68] Beck, 2017, The fallacy of average: how using hba1c alone to assess glycemic control can be misleading, Diabetes Care source
• ?Not checked — no full text of the sourcecites [69] Beck, 2019, The relationships between time in range, hyperglycemia metrics, and HbA1c, J Diabetes Sci Technol source

In the paper

“Although the evidence of HbA 1c reduction remains the most robust measure associated with chronic diabetes complications and is the only measure that is prospectively validated, more recent studies have begun to examine the relationship between time that glucose is within the target range and long-term complications and have provided the basis for glycemic targets with newer glucose monitoring”

What the sources say

• Partly supported

  The Abstract and Conclusions report that time in range is associated with retinopathy progression and microalbuminuria, and discuss its relevance to continuous glucose monitoring (CGM). The paper describes an existing consensus target range and argues that time in range should be an acceptable clinical-trial outcome; it does not establish that these studies provided the basis for glycemic targets using newer monitoring technologies. (LLM, conf=0.78)

  cites [45] Beck, 2019, Validation of time in range as an outcome measure for diabetes clinical trials, Diabetes Care sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [46] Ranjan, 2020, Improved time in range over 1 year is associated with reduced albuminuria in individuals with sensor-augmented insulin pump-treated type 1 diabetes, Diabetes Care source

In the paper

“However, switching from is-CGM without alarms to rt-CGM improved TIR and HbA 1c and reduced level 3 hypoglycemia (77).”

What the sources say

• Supported

  The Results report higher TIR and lower HbA1c after six months with rtCGM than with isCGM. They also report fewer participants experiencing severe hypoglycaemia (3 versus 13); the Procedures define severe hypoglycaemia as requiring third-party assistance. The Discussion distinguishes the study’s isCGM device from a next-generation version with alerts. Page numbers were unavailable in our copy. (LLM, conf=0.90)

  cites [77] Visser, 2021, Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial, Lancet source

In the paper

“As positive GAD antibodies may be found at a low level in adults without autoimmune diabetes and false positive results may occur, GAD should only be measured in those suspected to have type 1 diabetes (24).”

What the sources say

• Partly supported

  The Methods (Laboratory measurement; page unavailable) set the GADA positivity threshold at the 97.5th percentile of controls without diabetes and report assay specificity below 100%, supporting the possibility of positive results in people without diabetes and false positives. The Introduction also notes antibody positivity in some patients with a type 2 diabetes phenotype. The paper does not establish that such results occur specifically at low levels in adults without autoimmune diabetes, or recommend measuring GAD only when type 1 diabetes is suspected. (LLM, conf=0.83)

  cites [24] Lynam, 2019, Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults aged 18-50 years, BMJ Open sourceExperimental — accuracy not yet measured

In the paper

“GMI is calculated based on the average sensor glucose over the last 14 days and provides an approximation of a laboratory-measured HbA 1c in some individuals, but it may be higher or lower than actual HbA 1c in others (45).”

What the sources say

• Partly supported

  The Abstract (page unavailable) describes substantial individual variation between mean glucose and A1C, supporting the warning that a glucose-based estimate may differ from measured A1C. The Conclusions (page unavailable) say 10–14 days of CGM data can estimate TIR and other metrics, but our copy does not identify GMI or state that it is calculated from the last 14 days of average sensor glucose. (LLM, conf=0.84)

  cites [45] Beck, 2019, Validation of time in range as an outcome measure for diabetes clinical trials, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“These insulins reduce postprandial hyperglycemia but have otherwise not been shown to reduce HbA 1c or hypoglycemia to a greater extent than rapid-acting analogs (3).”

What the sources say

• Partly supported

  The Rapid-acting Analog Insulins section says ultrarapid insulins have a faster onset than rapid-acting analogs, allowing better control of postprandial glucose peaks. It does not address whether ultrarapid analogs have been shown to reduce HbA1c or hypoglycemia more than rapid-acting analogs; searches for those outcomes found no such comparison. (LLM, conf=0.85)

  cites [3] Hirsch, 2020, The evolution of insulin and how it informs therapy and treatment choices, Endocr Rev sourceExperimental — accuracy not yet measured

In the paper

“It appears that older adults with type 1 diabetes are more prone to mild cognitive impairment associated with hypoglycemia (110,111), while hypoglycemia occurs more frequently in those with cognitive impairment.”

What the sources say

• Partly supported

  The Discussion (page unavailable) associates severe hypoglycemia with cognitive decline in older adults with type 1 diabetes and reports an increased risk of clinically significant impairment in related studies. It does not establish that this cohort was more prone to mild cognitive impairment: its reported rate of possible mild cognitive impairment was 5.5%, versus 6.7% in general-population studies. The citation appears immediately after the first clause, so the subsequent statement about hypoglycemia occurring more frequently in people with cognitive impairment is not judged here. (LLM, conf=0.82)

  cites [110] Jacobson, 2021, Cognitive performance declines in older adults with type 1 diabetes: results from 32 years of follow-up in the DCCT and EDIC Study, Lancet Diabetes Endocrinol sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [111] Chaytor, 2019, Clinically significant cognitive impairment in older adults with type 1 diabetes, J Diabetes Complications source

In the paper

“Trials have demonstrated that the latest basal analogs may cause less hypoglycemia than first-generation basal analogs and NPH insulin, while rapid-acting analogs achieve better mealtime coverage and less post-meal hypoglycemia than short-acting (regular) human insulin (87,88).”

What the sources say

• ?Could not verify

  The Methods and Results describe a comparison of two basal insulins, glargine 300 U/mL and 100 U/mL. Although participants also used prandial insulin, the paper does not compare rapid-acting analogs with regular human insulin or report their relative mealtime coverage or post-meal hypoglycemia (searched: rapid-acting analogs, regular human insulin, prandial insulin). (LLM, conf=0.76)

  cites [87] Danne, 2020, Lower risk of severe hypoglycaemia with insulin glargine 300 U/mL versus glargine 100 U/mL in participants with type 1 diabetes: a meta-analysis of 6-month phase 3 clinical trials, Diabetes Obes Metab sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion reports less hypoglycemia with the newer basal analog insulin degludec than with insulin glargine U100, supporting the basal-analog part of the citing sentence. The paper does not compare rapid-acting analogs with regular human insulin for mealtime coverage or post-meal hypoglycemia. Its discussion of NPH concerns a separate meta-analysis of older long-acting analogs, not a direct degludec–NPH comparison. (LLM, conf=0.87)

  cites [88] Lane, 2017, Effect of insulin degludec vs insulin glargine u100 on hypoglycemia in patients with type 1 diabetes: the SWITCH 1 randomized clinical trial, JAMA sourceExperimental — accuracy not yet measured

In the paper

“The use of insulin analog regimens are associated with less hypoglycemia, while hybrid closed-loop systems result in both improvement in TIR and reduction in TBR (91).”

What the sources say

• Partly supported

  The Discussion (p. 9) reports more time in the target range and less hypoglycemia with the closed-loop system than with a sensor-augmented pump, supporting the TIR and TBR portion of the claim. The paper does not report that insulin analog regimens are associated with less hypoglycemia; that portion is unsupported. (LLM, conf=0.90)

  cites [91] Brown, 2019, Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes, N Engl J Med sourceExperimental — accuracy not yet measured

In the paper

“Risks for hypoglycemia, particularly level 3 hypoglycemia, include longer duration of diabetes, older age, history of recent level 3 hypoglycemia, alcohol ingestion, exercise, lower education levels, lower household incomes (41), chronic kidney disease, and IAH (103-105).”

What the sources say

• ?Not checked — no full text of the sourcecites [41] Weinstock, 2013, Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry, J Clin Endocrinol Metab source
• Partly supported

  The sections on diabetes duration, older adults, exercise management, and hypoglycemia unawareness support several listed risks; Patient education also identifies alcohol ingestion as a precipitating factor. The paper discusses reduced renal function in older adults but does not specifically establish chronic kidney disease as a risk factor, and its discussion of recurrent episodes does not clearly establish a recent level 3 episode as a predictor of another. The education and income items are followed by a separate citation (41), so they are not assessed against this source. (LLM, conf=0.85)

  cites [103] Seaquist, 2013, Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  The “Compromised Defenses against Hypoglycemia” section links impaired awareness, recent hypoglycemia, and prior exercise to recurrent severe hypoglycemia. It does not substantiate the listed risks of older age, alcohol ingestion, lower education, or chronic kidney disease; it discusses established or advanced diabetes but not longer duration as a measured risk factor. Household income has a separate citation in the citing sentence. (LLM, conf=0.86)

  cites [104] Cryer, 2013, Mechanisms of hypoglycemia-associated autonomic failure in diabetes, N Engl J Med sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [105] Henriksen, 2018, Hypoglycemic exposure and risk of asymptomatic hypoglycemia in type 1 diabetes assessed by continuous glucose monitoring, J Clin Endocrinol Metab source

In the paper

“People with type 1 diabetes should be encouraged to engage in a combination of aerobic and resistance exercise on most days because exercise is associated with improved fitness, increased insulin sensitivity, leading to reduced insulin requirement, improved cardiovascular health with better lipid profile and endothelial function, and decreased mortality (144-147).”

What the sources say

• ?Not checked — no full text of the sourcecites [144] Tikkanen-Dolenc, 2017, Physical activity reduces risk of premature mortality in patients with type 1 diabetes with and without kidney disease, Diabetes Care source
• ?Not checked — no full text of the sourcecites [145] Bohn, 2015, Impact of physical activity on glycemic control and prevalence of cardiovascular risk factors in adults with type 1 diabetes: a cross-sectional multicenter study of 18,028 patients, Diabetes Care source
• Partly supported

  The Results (§3.3, §3.5) and Discussion (§4, §4.4) support improved aerobic fitness, lower daily insulin dosage, and lower total cholesterol in people with type 1 diabetes; the Introduction (§1) also reports improved endothelial function and epidemiological evidence suggesting lower mortality. The paper does not establish that increased insulin sensitivity caused the lower insulin requirement or that exercise training itself reduced mortality. It found no consistent improvement in other lipid measures, and its aerobic-fitness analysis found limited effects for combined aerobic and resistance training, so it does not establish the specific recommendation to combine them on most days. Page numbers were not available in our copy. (LLM, conf=0.88)

  cites [146] Wu, 2019, Cardiovascular health benefits of exercise training in persons living with type 1 diabetes: a systematic review and meta-analysis, J Clin Med sourceExperimental — accuracy not yet measured
• Supported

  The Results section reports improved fitness in people with type 1 diabetes. The sections on insulin requirements and vascular risk factors report increased insulin sensitivity, reduced insulin requirements, improved lipids and endothelial function; the CVD and mortality discussion reports an association between physical activity and lower mortality. Page numbers were not available in our copy. (LLM, conf=0.92)

  cites [147] Chimen, 2012, What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review, Diabetologia source

In the paper

“Less carbohydrate (5-15 g) may need to be ingested to correct hypoglycemia because the automated insulin delivery system should have already reduced or stopped basal insulin delivery (130).”

What the sources say

• Partly supported

  The Introduction and Conclusions (pages unavailable) explain that predictive low-glucose suspend systems reduce or stop insulin delivery and that hypoglycemia following suspension may require less carbohydrate. The Abstract reports rescue doses of 5–16 g, not 5–15 g, and the Conclusions limit the recommendation to episodes preceded by insulin suspension rather than all hypoglycemia during automated insulin delivery. (LLM, conf=0.84)

  cites [130] Pinsker, 2021, Predictive low-glucose suspend necessitates less carbohydrate supplementation to rescue hypoglycemia: need to revisit current hypoglycemia treatment guidelines, Diabetes Technol Ther sourceExperimental — accuracy not yet measured

In the paper

“Alcohol also inhibits hepatic gluconeogenesis, leading to an increased risk of hypoglycemia for up to 24 h after the last drink (137).”

What the sources say

• Partly supported

  The Abstract identifies inhibition of gluconeogenesis as an effect of alcohol, and the Conclusions report increased hypoglycemia after breakfast the next morning in people with type 1 diabetes. But the paper says the cause of delayed hypoglycemia is unknown and does not establish risk for up to 24 hours after the last drink. Page numbers are unavailable in our copy. (LLM, conf=0.87)

  cites [137] Turner, 2001, The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes, Diabetes Care sourceExperimental — accuracy not yet measured

In the paper

“Increased alcohol consumption is associated with a higher risk of DKA and level 3 hypoglycemia (135).”

What the sources say

• Supported

  The Results report higher severe hypoglycemia and DKA rates among patients who drank alcohol than among abstainers. The Participants and variables section defines severe hypoglycemia as an event requiring another person's assistance, consistent with level 3 hypoglycemia. The findings concern young patients with type 1 diabetes. (LLM, conf=0.90)

  cites [135] Hermann, 2017, Self-reported regular alcohol consumption in adolescents and emerging adults with type 1 diabetes: a neglected risk factor for diabetic ketoacidosis? Multicenter analysis of 29 630 patients from the DPV registry, Pediatr Diabetes source

In the paper

“Inhaled human insulin, available only in the U.S., has a very rapid onset of action and short duration compared with subcutaneous rapid-acting analogs (3).”

What the sources say

• Supported

  The Rapid-acting Analog Insulins section identifies inhaled Afrezza as recombinant human regular insulin and says inhalation allows a faster onset than subcutaneous injection. It also reports a rapid onset and shorter duration than rapid-acting analog insulins. (LLM, conf=0.94)

  cites [3] Hirsch, 2020, The evolution of insulin and how it informs therapy and treatment choices, Endocr Rev source

In the paper

“Additionally, inhaled insulin can cause cough or sore throat, and therapy must be monitored with periodic spirometry because of possible effects on lung function (97).”

What the sources say

• Partly supported

  The Results (Respiratory Treatment-Emerent Adverse Events; page unavailable) identify cough as the most common respiratory adverse event with Technosphere insulin. The Discussion mentions throat irritation as an adverse effect of other inhaled medications, but does not establish sore throat as an effect of this insulin. The Methods (Pulmonary Safety; page unavailable) describe spirometry used in the studies, and the Results (Pulmonary Function; page unavailable) report small lung-function declines; neither passage says patients must undergo periodic spirometry during therapy. (LLM, conf=0.88)

  cites [97] McGill, 2020, Comprehensive pulmonary safety review of inhaled Technosphere® insulin in patients with diabetes mellitus, Clin Drug Investig sourceExperimental — accuracy not yet measured

In the paper

“Alcohol promotes ketosis, which in the context of consumption of sugary alcoholic beverages, may increase the risk of DKA (136).”

What the sources say

• Partly supported

  The Conclusions (page not available) report elevated post-meal β-hydroxybutyrate after alcohol consumption, and the Introduction raises the possibility of ketoacidosis when excessive drinking is combined with lax diabetic control. The paper does not address sugary alcoholic beverages or establish that their sugar content increases DKA risk. (LLM, conf=0.88)

  cites [136] Kerr, 2009, The influence of liberal alcohol consumption on glucose metabolism in patients with type 1 diabetes: a pilot study, QJM sourceExperimental — accuracy not yet measured

In the paper

“Sleep disturbance, psychological stress, and alcohol can also induce IAH (112).”

What the sources say

• Partly supported

  The section “Impaired Awareness of Hypoglycemia as a Barrier for Glucose Control” says there is evidence that sleep, psychological stress, and alcohol can induce IAH. It says sleep, however, not sleep disturbance; the copy does not establish that the disturbance itself induces IAH. (LLM, conf=0.86)

  cites [112] Lin, 2020, Hypoglycemia unawareness and autonomic dysfunction in diabetes: Lessons learned and roles of diabetes technologies, J Diabetes Investig sourceExperimental — accuracy not yet measured

In the paper

“Injection prior to meals acts to suppress glucagon secretion, delay gastric emptying, and promote satiety (247-250).”

What the sources say

• Partly supported

  The Discussion reports that pramlintide delayed gastric emptying in men with insulin-dependent diabetes. The study administered pramlintide by intravenous infusion, not a pre-meal injection; our copy does not report suppression of glucagon secretion or promotion of satiety. (LLM, conf=0.90)

  cites [247] Kong, 1997, Infusion of pramlintide, a human amylin analogue, delays gastric emptying in men with IDDM, Diabetologia sourceExperimental — accuracy not yet measured
• Partly supported

  The Results report that pramlintide was injected before the meal, and the gastric-emptying findings report delayed emptying of the first meal in men with IDDM. The paper does not report suppression of glucagon secretion or promotion of satiety; searches for those effects returned no supporting passage. Page numbers were unavailable in our copy. (LLM, conf=0.88)

  cites [248] Kong, 1998, The effect of single doses of pramlintide on gastric emptying of two meals in men with IDDM, Diabetologia sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [249] Fineman, 2002, The human amylin analog, pramlintide, corrects postprandial hyperglucagonemia in patients with type 1 diabetes, Metabolism source
• Supported

  The Introduction (page not provided) reports that pramlintide suppresses glucagon secretion and slows gastric emptying. The Discussion (page not provided) reports that an injection given before a meal reduced food intake and likely enhanced the satiating effect of food. (LLM, conf=0.92)

  cites [250] Chapman, 2005, Effect of pramlintide on satiety and food intake in obese subjects and subjects with type 2 diabetes, Diabetologia source

In the paper

“Diabetes-specific emotional distress affects 20-40% of people with type 1 diabetes and can be experienced at any point in time from early adulthood to older age.”

What the sources say

• Partly supported

  The Discussion reports that 41.6% of adults with type 1 diabetes in the community sample had at least moderate diabetes distress, not the stated 20–40% range. Results §3.3 compares distress in participants younger and older than 41, supporting its occurrence across adult age groups, but the study does not establish that it can arise at any point from early adulthood through older age. (LLM, conf=0.84)

  cites [168] Fisher, 2015, Understanding the sources of diabetes distress in adults with type 1 diabetes, J Diabetes Complications sourceExperimental — accuracy not yet measured

In the paper

“Prolonged significant diabetes distress is associated with depressed mood and elevated HbA 1c levels (169).”

What the sources say

• Partly supported

  The Results report that greater diabetes distress was associated with higher HbA1c at baseline, and that changes in the two covaried over nine months in adults with type 1 diabetes (Abstract, Results; Results, Time-varying analyses; no page given). The paper does not report that prolonged distress was associated with depressed mood; it examines depressive symptoms separately and emphasizes distinguishing them from diabetes distress (Conclusion; no page given). (LLM, conf=0.86)

  cites [169] Hessler, 2017, Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes, Diabet Med sourceExperimental — accuracy not yet measured

In the paper

“However, an increased rate of DKA led to rejection of market authorization for type 1 diabetes by the FDA, whereas the European Medicines Agency has approved low-dose dapagliflozin (5 mg) and sotagliflozin (200 mg) for those with a BMI $27 kg/m 2 (261).”

What the sources say

• Partly supported

  The Introduction reports a positive EMA committee opinion for dapagliflozin in patients with type 1 diabetes and BMI ≥27 kg/m², and the Clinical Outcomes section documents increased ketoacidosis risk. But the paper does not report an FDA rejection caused by that risk or EMA approval of both drugs at the stated doses; it says sotagliflozin was still under FDA review and describes the doses as approved or proposed. (LLM, conf=0.90)

  cites [261] Taylor, 2019, SGLT2 inhibitors as adjunctive therapy for type 1 diabetes: balancing benefits and risks, Lancet Diabetes Endocrinol sourceExperimental — accuracy not yet measured

In the paper

“In the U.S., national surveillance of emergency department visits and hospital admissions suggests a rate of 28 cases per 1,000 adults with diabetes per year, with a worrisome increase in emergency department visits and admissions for DKA seen since 2009 (209).”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [209] Benoit, 2020, Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes in the U.S., 2006-2015, Diabetes Care source

In the paper

“Both therapeutic options can effectively prevent hypoglycemia, restore normoglycemia, and possibly stabilize the progression of complications of type 1 diabetes (223-227).”

What the sources say

• ?Not checked — no full text of the sourcecites [223] Gruessner, 2013, The current state of pancreas transplantation, Nat Rev Endo crinol source
• Partly supported

  The Results (page not provided) report that more than 90% of islet recipients with available data remained free of severe hypoglycemic events, and that HbA1c and fasting blood glucose improved. The Conclusions (page not provided) describe whole-pancreas transplantation as a β-cell replacement option and report insulin-independence rates for both procedures. The paper does not establish that both procedures restore normoglycemia or stabilize the progression of type 1 diabetes complications. (LLM, conf=0.88)

  cites [224] Barton, 2012, Improvement in outcomes of clinical islet transplantation: 1999-2010, Diabetes Care sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [225] Niclauss, 2014, Has the gap between pancreas and islet transplantation closed?, Transplantation source
• ?Not checked — no full text of the sourcecites [226] Bassi, 2011, Impact of islet transplantation on diabetes complications and quality of life, Curr Diab Rep source
• ?Not checked — no full text of the sourcecites [227] Thompson, 2011, Reduced progression of diabetic microvascular complications with islet cell transplantation compared with intensive medical therapy, Transplantation source

In the paper

“Clinical trials have shown a reduction in HbA 1c (0.3-0.4% [3-4 mmol/ mol]) and modest (1 kg) weight loss (251-254).”

What the sources say

• ?Not checked — no full text of the sourcecites [251] Whitehouse, 2002, A randomized study and open-label extension evaluating the long-term efficacy of pramlintide as an adjunct to insulin therapy in type 1 diabetes, Diabetes Care source
• ?Not checked — no full text of the sourcecites [252] Ratner, 2002, Adjunctive therapy with the amylin analogue pramlintide leads to a combined improvement in glycemic and weight control in insulin-treated subjects with type 2 diabetes, Diabetes Technol Ther source
• Partly supported

  The HbA1c results section reports a 0.35-percentage-point reduction at week 52 with one pramlintide dose, but it was not significantly different from placebo; the dose with a significant effect reduced HbA1c by 0.62 points. The paper also reports modest weight loss, though its stated mean is 1.4 kg rather than 1 kg (Abstract; page not available). Thus the direction of both effects is supported, but the quoted magnitudes do not accurately characterize the significant treatment result. (LLM, conf=0.86)

  cites [253] Hollander, 2003, Pramlintide as an adjunct to insulin therapy improves long-term glycemic and weight control in patients with type 2 diabetes: a 1-year randomized controlled trial, Diabetes Care sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [254] Ratner, 2004, Amylin replacement with pramlintide as an adjunct to insulin therapy improves long-term glycaemic and weight control in Type 1 diabetes mellitus: a 1-year, randomized controlled trial, Diabet Med source

In the paper

“Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating, are overrepresented in type 1 diabetes populations, particularly in young women (193,194) but may also occur in men.”

What the sources say

• Partly supported

  The Frequency of DSM-IV and subthreshold eating disorders section reports that eating disorders were more common in adolescent females with type 1 diabetes than in controls, and the Self reported data section reports more binge eating. But there were no cases of anorexia nervosa in either group, so this study does not establish that anorexia nervosa was overrepresented. The statement about men follows the citations and is not attributed to this source. (LLM, conf=0.86)

  cites [193] Jones, 2000, Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study, BMJ sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [194] Colton, 2015, Eating disorders in girls and women with type 1 diabetes: a longitudinal study of prevalence, onset, remission, and recurrence, Diabetes Care source

In the paper

“The study ultimately found no difference in the primary end point, minimal and nonsustained effects on HbA 1c , minimal effects on weight (1 kg reduction), and no change in total daily insulin dose (246).”

What the sources say

• Partly supported

  The Discussion reports no significant difference in the primary cIMT outcome. The Results report a small HbA1c reduction that was not sustained and a 1.17 kg reduction in bodyweight. However, the claim that total daily insulin dose did not change is too absolute: the Results found no average reduction in weight-adjusted insulin dose over three years, but did find a small, sustained reduction after six months. (LLM, conf=0.87)

  cites [246] Petrie, 2017, Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial, Lancet Diabetes Endocrinol sourceExperimental — accuracy not yet measured

In the paper

“Three general strategies are being investigated: 1) use of immunosuppressive or immunomodulatory drugs; 2) use of a physical barrier (e.g., encapsulation) (288); and 3) gene editing for immune evasion and/or immune protection (289).”

What the sources say

• Supported

  Citation (288) is attached to the physical-barrier strategy, not to the drugs or gene-editing strategies. The paper’s Abstract (page not specified in our copy) explicitly describes encapsulation as a physical barrier between transplanted β-cells and recipients that protects the cells from the immune system. (LLM, conf=0.95)

  cites [288] Desai, 2017, Advances in islet encapsulation technologies, Nat Rev Drug Discov source
• ?Could not verify

  Citation 289 is attached to gene editing for immune evasion or protection, not to the drug or encapsulation strategies. The Introduction describes genome editing in human pluripotent stem cells for disease modeling, but the passages found for immune evasion, immune protection, transplantation rejection, and HLA do not address editing cells to avoid immune responses. Our copy therefore does not verify the cited point. (LLM, conf=0.72)

  cites [289] Hendriks, 2016, Genome editing in human pluripotent stem cells: approaches, pitfalls, and solutions, Cell Stem Cell sourceExperimental — accuracy not yet measured

In the paper

“Postpartum breastfeeding, erratic sleep and eating schedules may increase the risk of hypoglycemia and insulin dosing may require adjustment (269,270).”

What the sources say

• ?Not checked — no full text of the sourcecites [269] Roeder, 2016, Changes in postpartum insulin requirements for patients with well-controlled type 1 diabetes, Am J Perinatol source
• Partly supported

  In Patients, methods, and results (pp. 1357–58), five breastfeeding women had hypoglycaemic reactions, after which insulin doses were reduced and adjusted according to blood glucose. The Comment recommends reducing insulin for women who intend to breastfeed. The paper does not address erratic sleep or eating schedules as hypoglycemia risks. (LLM, conf=0.88)

  cites [270] Davies, 1989, Insulin requirements of diabetic women who breast feed, BMJ sourceExperimental — accuracy not yet measured

In the paper

“Diabetes management may be particularly challenging in individuals with chronic kidney disease who may be at an increased risk of hypoglycemia and in whom HbA 1c can be falsely low (276)”

What the sources say

• Partly supported

  The Glycemic control to minimize DKD section states that severe hypoglycemia risk increases as CKD advances. It suggests that glycated albumin may reflect glycemic control more accurately in this population, but the passages do not say that HbA1c can be falsely low. (LLM, conf=0.85)

  cites [276] Molitch, 2015, Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes, Kidney Int sourceExperimental — accuracy not yet measured

In the paper

“Both xenotransplantation with porcine islets and human stem cells are under investigation to solve the problem of limited availability of donors for pancreas or islet transplantation (287).”

What the sources say

• Partly supported

  The Abstract (page not provided) identifies scarce donor tissue as a barrier to islet transplantation and describes efforts to generate β-cells from human pluripotent stem cells. The section “Directed differentiation from hPSCs” also discusses these cells as a potential therapeutic source. Our copy does not support the other attributed approach: xenotransplantation with porcine islets (searched: porcine, xenotransplantation). (LLM, conf=0.88)

  cites [287] Nair, 2020, Emerging routes to the generation of functional β-cells for diabetes mellitus cell therapy, Nat Rev Endocrinol sourceExperimental — accuracy not yet measured

In the paper

“The use of advanced technologies in older individuals is useful and should not be discontinued or a priori excluded because of the older age (78,274).”

What the sources say

• Partly supported

  The Discussion (page not available in our copy) reports that continuous glucose monitoring modestly reduced hypoglycemia in adults aged 60 or older with type 1 diabetes. That supports the usefulness of this technology in the studied group, but not a claim about advanced technologies generally or a recommendation against discontinuing them or excluding people from them solely because of age. (LLM, conf=0.84)

  cites [78] Pratley, 2020, Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical Trial, JAMA sourceExperimental — accuracy not yet measured
• ?Could not verify

  The ‘Presence of Age-Related Conditions’ section recommends medication-reminder alarms and assistive devices, but does not address whether advanced diabetes technologies are useful for older adults. Searches for advanced technologies, insulin pumps, and continuous glucose monitoring found no passage in our copy that establishes the attributed point. (LLM, conf=0.72)

  cites [274] Leung, 2018, Diabetes management in the elderly, Diabetes Spectr sourceExperimental — accuracy not yet measured

In the paper

“Furthermore, accurate diagnosis allows an assessment of the risk of diabetes in first-degree relatives and appropriate counseling.”

In the paper

“Accurate classification of the type of diabetes has implications beyond the use of insulin treatment; education, insulin regimen, use of adjuvant therapies, access to newer technologies, need for psychosocial support to address the profound psychological impact of the diagnosis of diabetes, and concurrent disease screening may all depend on the diagnosis an individual receives.”

In the paper

“Most of the available data discussed below are derived from White European populations and may not be representative of other ethnic groups.”

In the paper

“Although profound insulin deficiency is the hallmark of type 1 diabetes, some adults with type 1 diabetes maintain some insulin secretion for years after diagnosis and may not require insulin treatment at diagnosis (5), leading to diagnostic uncertainty about the type of diabetes and its management.”

What the sources say

• ?Not checked — no full text of the sourcecites [5] Davis, 2015, Prevalence of detectable C-peptide according to age at diagnosis and duration of type 1 diabetes, Diabetes Care source

In the paper

“The most discriminative feature is younger age at diagnosis (<35 years), with lower BMI (<25 kg/m 2 ), unintentional weight loss, ketoacidosis, and glucose >20 mmol/L (>360 mg/dL) at presentation also being informative.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (8)(9)(10)

In the paper

“Four critical times where DSMES is particularly needed can be distinguished: 1) at diagnosis; 2) when not meeting targets; 3) when transitions occur; and 4) when complications develop (Fig. 5) (63).”

What the sources say

• ?Not checked — no full text of the sourcecites [63] Powers, 2020, Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association, Diabetes Care source

In the paper

“Pre-COVID-19, results from a limited number of studies using telemedicine in different subgroups of people with type 1 diabetes suggested that remote monitoring, education, and provider visits have the potential to: improve outcomes, quality of life, and selfmanagement; increase access to care and reduce costs; and are well-accepted with improved treatment satisfaction (54)(55)(56)(57).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (54)(55)(56)(57)

In the paper

“The cornerstone of type 1 diabetes therapy is insulin replacement.”

In the paper

“The risk of primary development of retinopathy was reduced by 75%, and progression of retinopathy slowed by 54%.”

What the sources say

• ?Not checked — no full text of the sourcecites [39] Nathan, 1993, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus, N Engl J Med source

In the paper

“The cost of intensive management was, however, a 2-3-fold increase in the rates of severe hypoglycemia, as well as weight gain.”

What the sources say

• ?Not checked — no full text of the sourcecites [39] Nathan, 1993, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus, N Engl J Med source

In the paper

“Although low C-peptide concentrations may occur in some types of secondary diabetes and very long-standing type 2 diabetes, these situations are unlikely to be confused for type 1 diabetes; however, in some cases, investigation of other types of diabetes may be appropriate.”

In the paper

“Seeing high or low glucose values can evoke feelings of frustration, anxiety, and guilt, leading many people with type 1 diabetes to measure less often than needed (73).”

What the sources say

• ?Not checked — no full text of the sourcecites [73] Moreland, 2006, Use of a blood glucose monitoring manual to enhance monitoring adherence in adults with diabetes: a randomized controlled trial, Arch Intern Med source

In the paper

“The development of microalbuminuria was reduced by 39% and clinical neuropathy by 60% in those assigned to intensive therapy.”

What the sources say

• ?Not checked — no full text of the sourcecites [39] Nathan, 1993, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus, N Engl J Med source

In the paper

“Blood ketone measurement is the method of choice and so adults with type 1 diabetes should be offered blood ketone testing strips and a meter (86).”

What the sources say

• Not checked yetcites [86] National Institute for Health and Care Excellence . Type 1 diabetes in adults: diagnosis and management. Accessed 10 June 2021. Available from www.nice.org.uk/guidance/ng17

In the paper

“Pre-COVID-19, results from a limited number of studies using telemedicine in different subgroups of people with type 1 diabetes suggested that remote monitoring, education, and provider visits have the potential to: improve outcomes, quality of life, and selfmanagement; increase access to care and reduce costs; and are well-accepted with improved treatment satisfaction (54)(55)(56)(57).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (54)(55)(56)(57)

In the paper

“Most meters meet the accuracy standards established by the International Organization for Standardization”

What the sources say

• ?Not checked — no full text of the sourcecites [75] Klonoff, 2018, Investigation of the accuracy of 18 marketed blood glucose monitors, Diabetes Care source

In the paper

“Although the evidence of HbA 1c reduction remains the most robust measure associated with chronic diabetes complications and is the only measure that is prospectively validated, more recent studies have begun to examine the relationship between time that glucose is within the target range and long-term complications and have provided the basis for glycemic targets with newer glucose monitoring”

In the paper

“Plasma C-peptide is the recommended test where available, with modestly higher performance than urine measurement.”

In the paper

“This is challenging because insulin demands vary widely according to meals, exercise, and many other factors.”

In the paper

“rt-CGM is effective for adults with type 1 diabetes in improving HbA 1c (particularly when high) and reducing hypoglycemia for both those using insulin pumps or multiple daily injections (MDI) (42)(43)(44)76).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites (42)(43)(44)76

In the paper

“GMI and TIR may be more useful than HbA 1c for clinical management because they reflect more recent blood glucose levels and provide more detailed clinical information.”

In the paper

“Postprandial glucose measurements should be made 1-2 h after the beginning of the meal, which generally corresponds to peak levels in people with diabetes.”

In the paper

“Compared with subcutaneous insulin regimens, intraperitoneal insulin infusion reduces HbA 1c , glycemic variability, and hypoglycemia (98,99).”

What the sources say

• ?Not checked — no full text of the sourcecites [98] Spaan, 2014, Systematic review: continuous intraperitoneal insulin infusion with implantable insulin pumps for diabetes mellitus, Acta Diabetol source
• ?Not checked — no full text of the sourcecites [99] Renard, 2007, Implantable insulin pumps. A position statement about their clinical use, Diabetes Metab source

In the paper

“Insulin analogs are, therefore, considered the insulins of choice.”

In the paper

“The mechanism for this is complex, including cardiac arrhythmias, activation of both the coagulation system and inflammation, and endothelial dysfunction (108).”

What the sources say

• ?Not checked — no full text of the sourcecites [108] International Hypoglycaemia Study Group, 2019, Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management, Lancet Diabetes Endocrinol source

In the paper

“Its prevalence is estimated to be close to 25% in people with type 1 diabetes but is likely to be underestimated according to CGM data (113).”

What the sources say

• ?Not checked — no full text of the sourcecites [113] Geddes, 2008, Prevalence of impaired awareness of hypoglycaemia in adults with type 1 diabetes, Diabet Med source

In the paper

“Several studies have shown that rates of hypoglycemia have not declined, even with more widespread use of insulin analogs and CGM, while other studies have shown benefit with these therapeutic advances (41).”

What the sources say

• ?Not checked — no full text of the sourcecites [41] Weinstock, 2013, Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry, J Clin Endocrinol Metab source

In the paper

“In addition, regular physical activity is associated with reduced risk of microvascular complications, osteoporosis, and cancer in people with type 1 diabetes (148).”

What the sources say

• ?Not checked — no full text of the sourcecites [148] Wadén, 2008, Physical activity and diabetes complications in patients with type 1 diabetes: the Finnish Diabetic Nephropathy (FinnDiane) Study, Diabetes Care source

In the paper

“Lipohypertrophy is common and typically occurs when the same sites are repeatedly used for injections or pump sites; it leads to use of higher insulin doses and is a cause of glycemic variability, leading to both hyper-and hypoglycemia (95,96).”

What the sources say

• ?Not checked — no full text of the sourcecites [95] Famulla, 2016, Insulin injection into lipohypertrophic tissue: blunted and more variable insulin absorption and action and impaired postprandial glucose control, Diabetes Care source
• ?Not checked — no full text of the sourcecites [96] Blanco, 2013, Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes, Diabetes Metab source

In the paper

“However, in the Type 1 Diabetes Exchange Clinic Registry, the risk of level 3 hypoglycemia was increased not only in those whose HbA 1c was below 7.0% (53 mmol/mol), but also in people with an HbA 1c above 7.5% (58 mmol/mol) (41).”

What the sources say

• ?Not checked — no full text of the sourcecites [41] Weinstock, 2013, Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry, J Clin Endocrinol Metab source

In the paper

“Hypoglycemia is not inevitable, and several strategies can be used to reduce the risk (121).”

What the sources say

• ?Not checked — no full text of the sourcecites [121] Little, 2014, Severe hypoglycaemia in type 1 diabetes mellitus: underlying drivers and potential strategies for successful prevention, Diabetes Metab Res Rev source

In the paper

“What may not be as well recognized is that level 3 hypoglycemia is also associated with major microvascular events, noncardiovascular disease, and death from any cause, although much of this evidence is obtained from people with type 2 diabetes (108).”

What the sources say

• ?Not checked — no full text of the sourcecites [108] International Hypoglycaemia Study Group, 2019, Hypoglycaemia, cardiovascular disease, and mortality in diabetes: epidemiology, pathogenesis, and management, Lancet Diabetes Endocrinol source

In the paper

“Structured diabetes education in flexible insulin therapy, which may incorporate psychotherapeutic and behavioral therapies, progressing to diabetes technology, incorporating sensors and insulin pumps, are effective treatments in those with persisting need (125).”

What the sources say

• ?Not checked — no full text of the sourcecites [125] Yeoh, 2015, Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis, Diabetes Care source

In the paper

“The reference method to assess IAH is the hyperinsulinemic-hypoglycemic clamp (115), although this is not used out of a research frame due to its invasiveness, cost, and time commitment from people with diabetes.”

What the sources say

• ?Not checked — no full text of the sourcecites [115] Mitrakou, 1991, Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction, Am J Physiol source

In the paper

“Anxiety and depression often coexist and may partly overlap with symptoms of diabetes distress (174).”

What the sources say

• ?Not checked — no full text of the sourcecites [174] Snoek, 2015, Constructs of depression and distress in diabetes: time for an appraisal, Lancet Diabetes Endocrinol source

In the paper

“Subgroup analysis in people with residual C-peptide production suggests greater HbA 1c reduction and improved safety, with lower risk of ketosis.”

In the paper

“These outcomes can translate into improved patientreported outcomes, but research in this area is limited (241).”

What the sources say

• ?Not checked — no full text of the sourcecites [241] Speight, 2010, Patient-reported outcomes following islet cell or pancreas transplantation (alone or after kidney) in type 1 diabetes: a systematic review, Diabet Med source

In the paper

“However, increasingly, data on SGLT2 inhibitors have shown renal and heart failure benefits in people without diabetes, suggesting that people with type 1 diabetes and these comorbidities may also benefit.”

In the paper

“Telemedicine offers the potential to reach populations with decreased access to care, and 24 h access to advice about managing hyperglycemia and ketosis/ketonemia at home can reduce the risk of hospital admission (211).”

What the sources say

• ?Not checked — no full text of the sourcecites [211] Ehrmann, 2020, Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes, Lancet Diabetes Endocrinol source

In the paper

“Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have been explored in people with type 1 diabetes for two indications; the first aimed to ameliorate b-cell decline at the time of diagnosis and there are ongoing trials of this approach.”

In the paper

“These selection criteria minimize operative mortality (<1%) and reduce early technical pancreas graft loss (<10%) (229,232).”

What the sources say

• ?Not checked — no full text of the sourcecites [229] Gruessner, 2012, Long-term outcome after pancreas trans plantation, Curr Opin Organ Transplant source
• ?Not checked — no full text of the sourcecites [232] Kandaswamy, 2006, Pancreas versus islet transplantation in diabetes mellitus: How to allocate deceased donor pancreata?, Transplant Proc source

In the paper

“In several phase III programs in people with type 1 diabetes, the use of SGLT-1 or SGLT-1/2 inhibitors reduced HbA 1c , improved TIR, reduced body weight, and improved blood pressure (244).”

What the sources say

• ?Not checked — no full text of the sourcecites [244] Snaith, 2020, Reducing type 1 diabetes mortality: role for adjunctive therapies?, Trends Endocrinol Metab source

In the paper

“These include having had one previous episode of DKA, high HbA 1c , low self-management skills (including omission of insulin therapy), psychiatric disorders, infections, somatic comorbidity, alcohol and drug abuse and less interaction with the health care team (211-213).”

What the sources say

• ?Not checked — no full text of the sourcecites [211] Ehrmann, 2020, Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes, Lancet Diabetes Endocrinol source
• ?Not checked — no full text of the sourcecites [212] Kinney, 2020, Cannabis use is associated with increased risk for diabetic ketoacidosis in adults with type 1 diabetes: findings from the T1D Exchange clinic registry, Diabetes Care source
• ?Not checked — no full text of the sourcecites [213] Hare, 2021, Clinical, psychological and demographic factors in a contemporary adult cohort with diabetic ketoacidosis and type 1 diabetes, Intern Med J source

In the paper

“whether these benefits would also be seen in people with type 1 diabetes is unknown.”

In the paper

“The main indications are a history of frequent, acute, and severe metabolic complications (hypoglycemia, hyperglycemia, ketoacidosis), clinical and emotional problems with exogenous insulin therapy that are incapacitating, or consistent failure of insulin-based management, including technological aids (233).”

What the sources say

• ?Not checked — no full text of the sourcecites [233] Robertson, 2004, Pancreas transplantation in type 1 diabetes, Diabetes Care source

In the paper

“In people with type 2 diabetes, improved cardiovascular outcomes, mainly due to a reduction in congestive heart failure, and improved renal outcomes have been established, but there are only limited data on the applicability of these findings to people with type 1 diabetes (262,263).”

What the sources say

• ?Not checked — no full text of the sourcecites [262] Zelniker, 2019, SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials, Lancet source
• ?Not checked — no full text of the sourcecites [263] Groop, 2020, Effect of dapagliflozin as an adjunct to insulin over 52 weeks in individuals with type 1 diabetes: post-hoc renal analysis of the DEPICT randomised controlled trials, Lancet Diabetes Endocrinol source

In the paper

“In a European (predominantly Germany and Austria) registry, adults with type 1 diabetes had DKA at a rate of 2.5 per 100 patient-years (210).”

What the sources say

• ?Not checked — no full text of the sourcecites [210] Kalscheuer, 2019, Event rates and risk factors for the development of diabetic ketoacidosis in adult patients with type 1 diabetes: analysis from the DPV Registry based on 46,966 patients, Diabetes Care source

In the paper

“Although CGM is not approved in the U.S. for use in pregnancy and no studies in pregnancy have used CGM alone, the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) showed that when CGM was used in conjunction with BGM, CGM was associated with better pregnancy outcomes (266) and is widely recommended in Europe.”

In the paper

“The U.S. Type 1 Diabetes Exchange Clinic Network reported that 4.8% of participants (age 26 to 93 years) had been hospitalized for DKA in the prior year (41).”

What the sources say

• ?Not checked — no full text of the sourcecites [41] Weinstock, 2013, Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry, J Clin Endocrinol Metab source

In the paper

“The largest clinical trials in people with type 1 diabetes were conducted with liraglutide and showed decreases in HbA 1c at daily doses of 1.8 mg (0.2-0.4% [2-4 mmol/mol]), decreases in weight (5 kg), and reductions in insulin doses (257,258).”

What the sources say

• ?Not checked — no full text of the sourcecites [257] Mathieu, 2016, Efficacy and safety of liraglutide added to insulin treatment in type 1 diabetes: the ADJUNCT ONE treat-to-target randomized trial, Diabetes Care source
• ?Not checked — no full text of the sourcecites [258] Ahrén, 2016, Efficacy and safety of liraglutide added to capped insulin treatment in subjects with type 1 diabetes: the ADJUNCT TWO randomized trial, Diabetes Care source

In the paper

“SPK transplants show a 5-year pancreas graft survival of 83% and are superior to pancreas transplants alone (PTA) or pancreas after a kidney transplant (55% and 70%, respectively) (229).”

What the sources say

• ?Not checked — no full text of the sourcecites [229] Gruessner, 2012, Long-term outcome after pancreas trans plantation, Curr Opin Organ Transplant source

In the paper

“Depression and anxiety symptoms are twice as prevalent among people with type 1 diabetes relative to people without diabetes, negatively impacting quality of life (171-173).”

What the sources say

• ?Not checked — no full text of the sourcecites [171] Barnard, 2006, The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review, Diabet Med source
• ?Not checked — no full text of the sourcecites [172] Hermanns, 2005, Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors, Diabet Med source
• ?Not checked — no full text of the sourcecites [173] Smith, 2013, Association of diabetes with anxiety: a systematic review and meta-analysis, J Psychosom Res source

In the paper

“Immunotherapy approaches are being evaluated for their potential use in stage 1 ($2 islet autoantibodies but normoglycemia) or stage 2 (autoantibodies and dysglycemia) type 1 diabetes to prevent stage 3 clinical type 1 diabetes, and for the preservation of b-cell function before and shortly after onset of stage 3 clinical type 1 diabetes (290).”

What the sources say

• ?Not checked — no full text of the sourcecites [290] Dayan, 2019, Changing the landscape for type 1 diabetes: the first step to prevention, Lancet source

In the paper

“The major limiting step to achieving normoglycemia is hypoglycemia, which occurs more frequently in the first half of pregnancy, in part because of diminished awareness of hypoglycemia and pregnancy-associated nausea and vomiting (267).”

What the sources say

• ?Not checked — no full text of the sourcecites [267] Nielsen, 2008, Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control, Diabetes Care source

In the paper

“This report has covered many areas of the management of type 1 diabetes; however, the writing group recognizes that huge gaps exist in our knowledge in the prevention, diagnosis, and treatment of the disease.”

In the paper

“The most discriminative feature is younger age at diagnosis (<35 years), with lower BMI (<25 kg/m 2 ), unintentional weight loss, ketoacidosis, and glucose >20 mmol/L (>360 mg/dL) at presentation also being informative.”

In the paper

“The rate of optimizing blood glucose levels in this group of people should also be individualized as rapid improvement may be associated with transient early worsening of retinopathy or the development of acute painful neuropathy (278,279).”

What the sources say

• ?Not checked — no full text of the sourcecites [278] The Diabetes Control and Complications Trial Research Group, 1998, Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial, Arch Ophthalmol source
• ?Not checked — no full text of the sourcecites [279] Llewelyn, 1986, Acute painful diabetic neuropathy precipitated by strict glycaemic control, Acta Neuropathol source

In the paper

“Monogenic diabetes is suggested by the presence of one or more of the following features: HbA 1c <58 mmol/mol (7.5%) at diagnosis, one parent with diabetes, features of specific monogenic cause (e.g., renal cysts, partial lipodystrophy, maternally inherited deafness, severe insulin resistance in the absence of obesity), and monogenic diabetes prediction model”