• HbA_1c determination from dried blood spots has been reported but results have been affected by stability issues, requiring methodologies which have included extended drying periods, and storage at low temperatures or for a limited period of time.
• HbA_1c levels determined from HemaSpot blood collection devices show a strong correlation with venous HbA_1c results, with the potential for calibration against the venous method used.
• Patient acceptance of the blood collection method was high, with 61.7% of participants indicating that they would be more likely to have their testing carried out if this method of blood collection was available.
• By providing patients with an opportunity to increase compliance with regular HbA_1c testing, the use of venous calibrated HbA_1c determination from HemaSpot blood collection devices provides the potential for improved glycaemic control.

• Only one in five of those with type 2 diabetes in primary care in Norway met all three targets for HbA_1c, blood pressure and LDL cholesterol.
• There was substantial heterogeneity in the achievement of HbA_1c, blood pressure and LDL cholesterol targets among general practitioners and practices.
• The heterogeneity in risk factor control remained after adjustment for case mix.
• Detailed analysis with 12 population-related, 10 general practitioner-related and four practice-related factors explained <15% of the total variation in target achievement.
• Most of the variation was at the population level.
• Young people, obese people and those with macrovascular complications achieved targets less frequently.
• The use of a structured diabetes form is recommended.

• Gestational diabetes is associated with significant complications if untreated, yet a proportion of at-risk women invited for antenatal screening do not complete testing. There is a lack of evidence to guide improvements in antenatal screening completion.
• Younger women and those from minority ethnic groups were less likely to complete testing. Key barriers to completion cited by women related to the demands of the testing protocol, ability to attend appointments, and mental health or social issues.
• Modification of testing protocols, increased support for vulnerable groups, and fuller explanation regarding test indications and risk could improve screening rates.

• Poor glucose control in the third trimester is known to be associated with adverse outcomes in pregnancies with pre-existing diabetes, but the contribution of early pregnancy glycaemia remains controversial.
• Higher first trimester HbA_1c is associated with increasing rates of large for gestational age neonates, preterm delivery and transfer to neonatal intensive care units.
• First trimester HbA_1c ≥ 48 mmol/mol (6.5%) does not result in significant increased rates of adverse outcomes if HbA_1c is ≤ 42 mmol/mol (6.0%) in the third trimester.
• Even if severe hypoglycaemia in the first trimester prompts less tight glycaemic control, good neonatal outcomes can still be achieved with satisfactory glucose control in the third trimester.

• It is unclear to what extent the findings of the sodium–glucose co-transporter-2 (SGLT-2) inhibitor cardiovascular outcomes trials (CVOTs) are generalizable to the real-world type 2 diabetes populations.
• Using a national primary care database, we found that the inclusion criteria of four SGLT-2 inhibitor CVOTs applied to between 7% and 27% of people with type 2 diabetes.
• Generalizability of the findings from CVOTs to a wider type 2 diabetes population may be restricted to groups defined by the inclusion criteria for each trial.
• Uniform inclusion criteria for trials would allow direct comparison to be made between trials.

• The burden of diabetes and its treatment may cause psychosocial stress.
• Good metabolic control improves psychosocial well-being.
• Identifying people early in the disease course through screening and introducing long-term intensive treatment does not cause psychosocial harm.
• Clinicians and public health systems implementing early detection and intensive treatment protocols for type 2 diabetes do not need to worry that these may have a long-term adverse impact on peoples’ psychosocial well-being.

• Intermediate hyperglycaemia is an important risk factor for diabetes, but the proportion of people with this condition varies according to the definition used.
• The extent to which impaired fasting glucose, impaired glucose tolerance and/or HbA_1c criteria are associated with mortality remains unclear.
• Intermediate hyperglycaemia assessed using the HbA_1c-based American Diabetes Association definition was associated with increased mortality rate in a 10-year cohort from a Latin American country.
• HbA_1c appeared to be a measurement associated with mortality in this Peruvian population.

• The prevalence of diabetes (for type 1 and type 2) in Poland in 2014 is 8.4% and is similar to that in other European countries.
• More than every fourth person with diabetes is unaware of their disease.
• The prevalence of diabetes has increased significantly over the last decade (2004–2014), from 6.6% to 8.4%.

• Sociodemographic differences exist in the transitions from non-diabetic hyperglycaemia to type 2 diabetes and to ‘low-risk’ status in older adults.
• Participants with non-diabetic hyperglycaemia who had a disability, who were economically inactive, and those living in socio-economic disadvantage were more likely to develop type 2 diabetes in the future.
• Participants with non-diabetic hyperglycaemia who were living in socio-economic disadvantage were less likely to transition to low-risk status in the future.
• Findings from this study could inform researchers in diabetes prevention programmes about the selection of participants into these programmes and the effectiveness of these programmes for disadvantaged social groups.

• Type 2 diabetes is associated with an increased fracture risk but, paradoxically, bone density is not reduced. Trabecular bone score, which provides an indirect measure of bone microarchitecture, is reduced in diabetes and adds to fracture risk prediction.
• Trabecular bone score and advanced glycation end-product accumulation, as assessed by skin autofluorescence, are inversely related in post-menopausal women with type 2 diabetes, however, HbA_1c and waist rather than skin autofluorescence were significant predictors of trabecular bone score.
• This study suggests a pathophysiological role for hyperglycaemia and visceral adiposity in the microarchitecture changes of bone seen in people with diabetes.

• Acute measures of glucose control have been associated with retinopathy and microalbuminuria, but their relationship with neuropathy requires exploration.
• Greater glucose variability and percentage time above range was associated with worsening nerve function.
• Higher percentage time in range was correlated with better nerve function.
• Increasing glucose variability and time above range was associated with greater corneal nerve length in the inferior whorl and higher counts of microneuromas.
• Monitoring of acute measures of glucose control may have more utility than HbA_1c in the prevention of diabetic neuropathy.

• Cardiovascular autonomic dysfunction is a risk factor for mortality in type 1 diabetes.
• Hyperoxaemia can acutely improve autonomic function in individuals with short-duration type 1 diabetes.
• We explored the potential for improving autonomic function in long-duration type 1 diabetes with macroalbuminuria, and found that autonomic function could be improved.
• Autonomic dysfunction in type 1 diabetes might be a dynamic and reversible condition. Hypoxia might represent a target of intervention for attenuating progression of autonomic dysfunction in type 1 diabetes.

• Long-term survivors of type 1 diabetes are burdened by several complications, conditions and medications that may cause pain. However, a description of the level of bodily pain is lacking.
• This study is the first to describe high levels of bodily pain, which are associated with quality of life, in long-term survivors of type 1 diabetes.
• A broader focus on pain is warranted and screening tools should facilitate this.

What is already known?

• Young adults with type 1 diabetes often disengage from clinic attendance and may end up with sub-optimal glycaemic levels and an increased risk of complications

What this study has found

• We have developed a novel complex intervention, called D1 Now, which focuses on promoting engagement of young people with clinical services. We describe the protocol for a pilot cluster randomised controlled trial (RCT) evaluating the D1 Now intervention in 5 Diabetes Centres on the island of Ireland

What are the clinical implications of the study?

• If the intervention proves feasible to deliver we plan to proceed to a definitive RCT with the aim of achieving improved long-term outcomes for young adults