The use of continuous glucose monitoring: A scoping review of accuracy, feasibility and nursing workload reduction in intensive care setting

The use of continuous glucose monitors (CGM) and insulin pumps has revolutionized the care of patients with type 1 diabetes (T1D). Few data are available regarding the use of diabetes technology use in the pregnant T1D population. This study was conducted to evaluate temporal trends of diabetes technology use and predictors of use among pregnant individuals with TID in the United States from 2009 to 2020.MarketScan Research Databases from 2009 to 2020 were used to identify pregnant individuals with T1D who were and were not using CGM and/or insulin pumps. Joinpoint regression analysis was used to estimate the average annual percent change (AAPC) in diabetes technology use over time. Unadjusted and adjusted log-linear Poisson regression models were developed to assess the associations between the outcomes of CGM and insulin pump use and demographic and clinical predictors. Associations were reported as adjusted risk ratios (ARR) with 95% confidence intervals (CI).Among 9,201 pregnancies with T1D, CGM use increased from 2.3% in 2009 to 13.7% in 2020 (AAPC: 13.9%; 95% CI: 11.7-17.1), while insulin pump use remained unchanged from 10.9% in 2009 to 11.8% in 2020 (AAPC: -2.4%; 95% CI: -4.4 to 0.4). Medicaid insurance and obesity were associated with a lower likelihood of CGM use and insulin pump use, while a high obstetric comorbidity index score was associated with a higher likelihood of insulin pump use (ARR: 1.26; 95% CI: 1.05-1.51).From 2009 to 2020, CGM use among pregnant individuals with T1D increased, while insulin pump use remained unchanged. Use varied by patient demographic and clinical factors, most notable for lower likelihood of CGM use and insulin pump use with Medicaid insurance. Although CGM use increased over time, overall CGM use remained lower than expected despite the known benefits of CGM use in improving neonatal outcomes in pregnancies complicated by T1D. · CGM use in pregnant individuals with T1D increased from 2.3 to 13.7%, but pump use was stable.. · Medicaid and obesity were associated with lower CGM and pump use in pregnant individuals with T1D.. · Low CGM use in pregnant T1D individuals highlights barriers and the need for equitable access..

Disclosure: K.M. St. Jean: None. P. Underwood: None. R. Longo: None. J. Keels: None. J. Upadhyay: None. Introduction: Continuous glucose monitor (CGM) use is increasing. While the relationship between CGM use and improved diabetes (DM) clinical outcomes is well known (lower hemoglobin A1c (A1c), reduced hypoglycemia events), the mechanisms underlying this association are unknown. Further, the factors that contribute to successful CGM use by patients and whether CGM use influences diabetes self-management behavior (DMB) change are still undetermined. Objective: To understand the extent to which personal CGM use influences DMB versus user-blind CGM. In addition, patient satisfaction and provider perspective were evaluated during the study. Methodology: A pilot-randomized control trial (RCT) was conducted on 30 patients (15 libre-professional CGM and 15 libre 2 CGM). Adults (18-80y) with an ICD-10 diagnosis of DM within the past 12 months, A1c >8% measured within the past 6 months, stable weight within the past 3 months (BMI ± 2 units), able to speak, read, and write English, and a negative pregnancy test for women of childbearing age seen in the Lahey Endocrine Clinic were included.Exclusion criteria included evidence of personal CGM device use prior to the trial, addition of new oral or injectable hypoglycemic agents within 3 months of trial start, current or anticipated acute use of steroids, pregnancy, medical conditions that, per investigator determination, make it unsafe to target A1c <8%, severe psychiatric illness, homeless, current substance abuse, vision or hearing impairment that may affect the use of CGM. All participants were given information on how to incorporate the CGM into daily DM management and general diabetes self-management education (DSME). DMB was measured using the Diabetes Self Care Inventory-Revised scale, which was provided at visit 1 (baseline), visit 2 (2 weeks), and visit 3 (3-6 months). Additional outcome variables, including Diabetes Distress, sleep quality, exercise habits, and nutrition, were obtained. A1c was measured at baseline and at the end of visit 3. Provider satisfaction with patient CGM use was also evaluated using a newly developed provider satisfaction survey. Results: This study remains active for enrollment. Thus far, 14 patients have been recruited (7 in Libre 2 arm and 7 in Libre Pro User blind arm). Based on initial results, personal-CGM use supports improved diabetes self-care. Further, improvements in A1c, glucose time in target range, and lower rates of hypoglycemia are evident in all CGM users. Further, 100% of the providers felt that CGM use by their patients was very effective and helped their clinical decision-making during the visit. Providers did not feel that reviewing CGM data prolonged their visit. Conclusion: This pilot suggests that personal CGM use improves diabetes self-management behavior and reaffirms that CGM use in patients with poorly controlled diabetes is associated with improved DM clinical outcomes. Presentation: 6/3/2024

Disclosure: K.M. St. Jean: None. P. Underwood: None. N. Patel: None. R. Franca: None. J.N. Keels: None. R. Rick Longo: None. J. Upadhyay: None.Introduction: Continuous glucose monitor (CGM) use improves diabetes (DM) clinical outcomes (lower hemoglobin A1c (A1c), reduced hypoglycemia) in Adults with DM prescribed insulin. The mechanisms underlying this relationship are unknown, but may relate to the influence of CGM use on diabetes self-management behavior (DMB). Methodology: A pilot-randomized control trial (RCT) was conducted on 30 patients (16 libre-professional CGM (user blind) and 14libre 2 CGM). Adults (18-80y) with an ICD-10 diagnosis of DM within the past 12 months, hemoglobin A1c (A1c >8%) measured within the past 6 months, stable weight within the past 3 months (BMI ± 2 units were included.. All participants were given information on CGM use and general diabetes self-management education (DSME). DMB was measured using the Diabetes Self Care Inventory-Revised scale at visit 1 (baseline), visit 2 (2 weeks). Additional outcome variables, including Diabetes Distress, sleep quality, exercise habits, and nutrition, were obtained. Provider satisfaction with patient CGM use was also evaluated using a newly developed provider satisfaction survey. Results: Personal-CGM use supports improved diabetes self-care and decrease rates of hypoglycemia. Individuals using the freestyle libre 2 CGM had significantly lower rates of hypoglycemia (% glucose time <80-60mg/dl mean± standard deviation (SD) User Blind CGM: 1.92±3.92 vs Libre 2 0.14±0.36 p<0.0001), % glucose <60mg/dl) User Blind CGM: 0.92±2.15 vs. Libre 2 0±0 p<0.0001). Libre 2 CGM users had significantly lower levels of anger and fear (User Blind CGM: 2.0±1.55 vs Libre 2 1.7±0.72 p=0.01) and lower levels of failing in their diabetes routine compared to User-blind CGM users as measured by the Diabetes Distress Scale (User Blind CGM: 2.81±1.74 vs Libre 2 2.42±1.94 p=0.04). Libre 2 CGM users also had significantly higher confidence in how exercise influences their glucose level compared to User-blind CGM users as measured by the DPP Diabetes Knowledge scale (User Blind CGM: 8.09±2.6 vs Libre 2 8.92±0.9 p=0.02). Further, 100% of the providers felt that CGM use by their patients was very effective and helped their clinical decision-making during the visit. Providers did not feel that reviewing CGM data prolonged their visit. Conclusion: This pilot RCT suggests that personal CGM use decreases rates of hypoglycemia, lowers diabetes distress, and improves some aspects of diabetes self-management behavior in adults with diabetes seen in an endocrine clinic. This data reaffirms that CGM use in patients with poorly controlled diabetes is associated with improved DM clinical outcomes and supports endocrine provider clinical decision making.Presentation: Monday, July 14, 2025

Diabetic retinopathy (DR) is a complication of diabetes that can lead to vision loss. Outcomes of continuous glucose monitoring (CGM) and insulin pump use in DR are not well understood. To assess the use of CGM, insulin pump, or both, and DR and proliferative diabetic retinopathy (PDR) in adults with type 1 diabetes (T1D). A retrospective cohort study of adults with T1D in a tertiary diabetes center and ophthalmology center was conducted from 2013 to 2021, with data analysis performed from June 2022 to April 2023. Use of diabetes technologies, including insulin pump, CGM, and both CGM and insulin pump. The primary outcome was development of DR or PDR. A secondary outcome was the progression of DR for patients in the longitudinal cohort. Multivariable logistic regression models assessed for development of DR and PDR and association with CGM and insulin pump use. A total of 550 adults with T1D were included (median age, 40 [IQR, 28-54] years; 54.4% female; 24.5% Black or African American; and 68.4% White), with a median duration of diabetes of 20 (IQR, 10-30) years, and median hemoglobin A1c (HbA1c) of 7.8% (IQR, 7.0%-8.9%). Overall, 62.7% patients used CGM, 58.2% used an insulin pump, and 47.5% used both; 44% (244 of 550) of the participants had DR at any point during the study. On univariate analysis, CGM use was associated with lower odds of DR and PDR, and CGM with pump was associated with lower odds of PDR (all P < .05), compared with no CGM use. Multivariable logistic regression adjusting for age, sex, race and ethnicity, diabetes duration, microvascular and macrovascular complications, insurance type, and mean HbA1c, showed that CGM was associated with lower odds of DR (odds ratio [OR], 0.52; 95% CI, 0.32-0.84; P = .008) and PDR (OR, 0.42; 95% CI, 0.23-0.75; P = .004), compared with no CGM use. In the longitudinal analysis of participants without baseline PDR, 79 of 363 patients (21.8%) had progression of DR during the study. In this cohort study of adults with T1D, CGM use was associated with lower odds of developing DR and PDR, even after adjusting for HbA1c. These findings suggest that CGM may be useful for diabetes management to mitigate risk for DR and PDR.

Clinical trials indicate continuous glucose monitor (CGM) use in type 2 diabetes (T2D) can be beneficial across medication regimens and outpatient settings. CGM use in care for T2D is increasing rapidly, but little is known about predictors of CGM use in T2D. Adults (age 18-75) with T2D receiving primary care at an academic medical center enrolled in a RCT evaluating a self-management support intervention. The intervention did not address CGM use. At enrollment, patients completed an A1c test, self-reported demographic, clinical characteristics and individual (diabetes distress, diabetes self-efficacy, health literacy) , social (family/friend involvement, shared illness perception) , and behavioral (self-care behaviors) factors. The 15-month assessment queried CGM use in prior 12 months (current use/used and quit vs. no use) . We explored potential correlates of CGM use with unadjusted non-parametric tests of difference. Patients (N=109) completed 15-month assessments from July 2021 to March 2022. Mean age was 58±10 years; 57% female; 54% non-Hispanic white, 31% non-Hispanic black, 7% Hispanic; mean baseline A1c was 8.8%±1.8%. One-third (n=36) used CGM during the prior 15 months (including n=3 who quit) . CGM users were younger (median [IQR]: age 55 [47, 62] vs. 60 [53, 68], p=.031) , had higher baseline A1c (9.1% [8.1, 10.4] vs. 8.3% [7.5, 9.5], p=.048) and more were using insulin (69% vs. 36%, p=.002) as compared to non-users. CGM users also had higher baseline diabetes distress (45 [25, 55] vs. 30 [15, 50], p=.09) . CGM use was not related to gender, diabetes duration, race, ethnicity, health literacy, diabetes self-efficacy, family/friend involvement, perceiving diabetes as a shared illness, nor self-care behaviors. In a prospective study of adults with T2D from primary care clinics, younger age, insulin use, higher A1c and higher diabetes distress were associated with starting CGM. Two-thirds of CGM users were taking insulin. We did not find gender, race, ethnicity nor health literacy disparities in CGM use in our diverse sample. Disclosure L. S. Mayberry: Consultant; Abbott Diabetes, Cecelia Health. M. K. Roddy: None. S. S. Jaser: None. T. A. Elasy: None. Funding National Institutes of Health (R01DK119282)

T2D disproportionately affects youth of minority and lower SES backgrounds with public insurance. Continuous glucose monitor (CGM) use in youth with T1D and adults with T2D benefits glycemia and quality of life. Use of CGM in youth with T2D has not been sufficiently evaluated. We aimed to determine feasibility of CGM use, measured by % wear time per 2-week period (&amp;gt;75% wear-time as goal) prior to clinic visit, clinical outcomes including time in range (TIR) and HbA1c. Youth were provided or prescribed Libre 2 CGM and followed using established clinic workflows with data collection at each visit. We present the first 6 months (m) of data. We enrolled 30 youth with T2D, mean age 15.1 y and mean HbA1c 10.2% (6.5%-15.5%) (Table 1). At baseline, 37% had history of prior intermittent CGM use and 53% did not have glucometer data. At 3 m 47% of youth who attended visits were using CGM, at 6 m 79% were using CGM, with no participant using CGM &amp;gt;75% of the time. Mean HbA1c was lower over 6 months (1.3% decrease in 8 youth with 6m CGM data and HbA1c) and TIR was lower between 3 and 6 m among those who attended clinic visits. CGM use for 6 m was not sustained in youth with T2D, but CGM was worn by a portion of youth and associated with lower HbA1c in those who used CGM. Strategies for CGM use in youth with T2D may differ from adults with T2D or youth with T1D. Additional studies are needed to evaluate facilitators and barriers of CGM use to optimize CGM use in youth with T2D. Disclosure S.Shah: Research Support; Boehringer-Ingelheim, Takeda Pharmaceutical Co., Ltd. N.Arrizon-ruiz: None. A.Loyola: None. P.Sagan: None. B.P.Conrad: Advisory Panel; Edgepark medical supplies, Consultant; Abbott Diabetes. J.Leverenz: None. F.K.Bishop: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. Funding Stanford Diabetes Research Center (P30DK116074)

Background Socioeconomic (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are widespread. There is concern that unequal access to technologies, such as continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in access to CGM for children and young people (CYP) and outcomes for CGM users. Methods MEDLINE, Embase, and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-plus criteria for T1D patients under 26. Reports based in low- or middle-income countries or ≤ 500 participants were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from extracted data, though heterogeneity precluded meta-analysis. The protocol was pre-registered with PROSPERO (CRD42023438139). Results Of the 3,369 unique studies identified, 27 met inclusion criteria. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured, and minority ethnic, especially black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were generally associated with poorer outcomes, there was no significant association between domains of disadvantage and higher HbA1c for CGM users, excepting parental education. Conclusions There are significant SES, ethnic, and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This is contributing to outcome inequalities. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities. Key messages • There are significant SES, ethnic, and education inequalities in continuous glucose monitoring use for young people with T1D. Inequalities are more marked when technology is not reimbursed. • Increasing access to CGM may reduce outcome inequalities, as evidence suggests that young people benefit equally from CGM use, regardless of ethnicity or SES.

Introduction &amp; Objective: There is a growing body of evidence supporting continuous glucose monitor (CGM) use in adults with Type 2 Diabetes (T2D), and recent evidence to suggest CGM use could also be beneficial to adolescents and young adults (AYA) with T2D. CGM use is presently limited in this population and a deeper assessment is needed to understand barriers to use. The objective of this study was to determine baseline CGM use in AYA with T2D cared for by the UW Health Pediatric Diabetes Clinic. Methods: All individuals with T2D seen at least once by the UW Health Pediatric Diabetes Clinic since 2016 were included in this observational study. Electronic medical records were reviewed to collect pertinent demographic, laboratory, and diagnosis information, as well as, any documentation regarding barriers to receiving or using CGM. Parameters were compared between groups using t-test or nonparametric test, as appropriate. Results: Of the AYA with T2D seen, 156 had complete information and were included. Per chart review, 17 of the 156 AYA were using CGM. There was no statistical difference in mean hemoglobin A1C at diagnosis between groups. When considering insurance coverage, 54% of those using CGM and 66% of those not using CGM reported having Medical Advantage (MA) or other managed plan. AYA with T2D reported various barriers to starting and using CGM including not wanting to wear something that would draw attention to themselves, prohibitive costs, and difficulty obtaining insurance coverage. Notably, for some AYA with T2D who were using CGM, the aforementioned issues continued after CGM initiation. Conclusion: CGM use in AYA with T2D is limited for a variety of reasons. Understanding individual’s personal feelings around CGM will be helpful to determine how CGM use can be incorporated into their diabetes care. Insurance coverage of CGM for AYA with T2D was found to be variable. The role of CGM in the care and management of T2D in AYA continues to evolve; further exploration is needed to understand and address perceived barriers. Disclosure R. Fenske: None. E.A. Mann: None.

Continuous glucose monitor (CGM) use is known to improve glycemic outcomes for patients with Type 1 Diabetes, but uptake is not universal in the pediatric population. We hypothesized that requiring standardized documentation of CGM use and identification of barriers would increase awareness and identify potential targets for future interventions, ultimately increasing CGM use in our population. We designed standard documentation within the electronic medical record for outpatient visits to assess CGM use and barriers to use. The documentation collects data on CGM possession, %time in use, prescriptions, and barriers to use in patients with Type 1 Diabetes. Our intervention involved integrating the standard CGM documentation into diabetes note template thus automating completion by providers. Data was pulled from clinic days two weeks prior to intervention (100 patients) and another days, two months after intervention (74 patients) . Before intervention 83% of patients had a CGM compared to 87% of patients after intervention (p=0.51) . While 63% used a CGM &amp;gt;70% of the time before intervention, 73% of patients had &amp;gt;70% use post intervention (p=0.19) . Provider documentation was not universal with 12% and 4% of encounters with no documentation of time in use before and after intervention respectively. After standardization 7/patients without a CGM were prescribed one during the visit compared to 5/17 of patients prior. Barriers identified included (n) : insurance coverage (4) , skin adhesion/issues (3) , self-image (2) , lack of education /distrust (1) , technological issues (1) , resistance to wearables (1) , and other (3) . Our patient population had a high rate of CGM use. Two months after the intervention, both use of CGM and new prescriptions increased. The improvement may be related to increased awareness and addressal of CGM barriers among providers. The intervention provided insight on barriers to CGM use, such as skin/adhesion issues, that will be targeted for future improvement. Disclosure S.E.Delacey: None. N.J.Sullivan: None. N.R.Fogel: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases Ruth L. Kirschstein National Research Service Award T32 DK007169 and T1D Exchange

Background: Socioeconomic status (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are well-established. There is concern that unequal access to technologies, including continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in the prevalence of CGM use for children and young people (CYP) and outcomes for CGM users.Methods: Medline, Embase and Web of Science were searched for observational studies published between January 2000 and July 2023 which report CGM use stratified by any PROGRESS-Plus criteria for T1D patients under 26. Reports based in low- or middle-income countries, ≤500 participants or only reporting hybrid closed-loop systems were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle–Ottawa Scale. Unadjusted odds ratios were calculated from the extracted summary data, though heterogeneity precluded meta-analysis. The protocol was preregistered with PROSPERO (CRD42023438139).Results: Of the 3369 unique studies identified, 27 met the inclusion criteria. Thirty-three percent were of ‘good' or ‘very good' quality. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured and minority ethnic, especially Black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were associated with poorer outcomes in general, for CGM users there was no significant association between domains of disadvantage and higher HbA1c, excepting parental education.Conclusions: There are significant SES, ethnic and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This inequity is contributing to inequalities in T1D outcomes. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities.

Frequency of Continuous Glucose Monitoring use and Change in Hemoglobin A1C for Adults With Type 1 Diabetes in a Clinical Practice Setting

Use of CGM can optimize glycemic control; however, consistency of CGM use in youth and teens/young adults with T1D has been low in prior studies. We assessed 1-year use of Dexcom CGM in young children (ages 2 to &amp;lt;8y) in the Strategies to Enhance New CGM in Early Childhood (SENCE) study and in teens/young adults (ages 14 to &amp;lt;25y) in the CGM Intervention in Teens and Young Adults (CITY) study. Analyses included average # of days/week and percent of CGM wear time over 4 weeks prior to 6 and 12-month study visits. CGM use data from month 6 and 12 months are shown in the Table. For 84 youth in SENCE, median # days/week of CGM use was 7.0 with CGM being used 92% of time at 12 months; 79% were using CGM 7 days/week and only 2% discontinued CGM altogether. In 70 teens/young adults in CITY, median # of days/week of CGM use was 6.8, with CGM being used 86% of time at 12 months; 46% were using CGM 7 days/week and 9% discontinued CGM. At 12 months 88% of SENCE participants and 97% of CITY participants using CGM reported dosing insulin with CGM without using confirmatory fingerstick blood glucose value; 54% and 55%, respectively used remote monitoring features. CGM use in cohorts of very young children, teens and young adults was higher than previously reported. Improved CGM features, including mobile app data display, remote monitoring and non-adjunctive approval for dosing insulin, likely contributed to increased use. Disclosure D. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. L. Kanapka: None. C. Bauza: None. C. Xie: None. L. DiMeglio: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. K. Miller: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust; Dexcom, Inc.

Background: Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use. Methods: This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (Current Users, Past Users, and Never Users). Results: Current Users demonstrated significantly lower HbA1c than Never Users and significantly lower diabetes distress than Past Users. CGM use was not associated with family conflict or quality of life. Conclusions: CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.

Data on the cost implications of continuous glucose monitoring (CGM) use in type 1 diabetes (T1D) pregnancies in the United States are sparse. Drawing on associations identified in real-world evidence from a retrospective chart review at the Barbara Davis Center for Diabetes, we conducted a cost-consequences analysis of CGM use versus self-monitoring of blood glucose (SMBG), inclusive of neonatal intensive care unit (NICU) spending. In the base-case analysis assuming per-label CGM use and per-guideline finger-stick frequency, the per-person cost was $16,254 for CGM versus $15,182 for SMBG. In a real-world scenario analysis, the per-person cost was $13,708 for CGM versus $14,524 for SMBG. In both analyses, there was a cost savings for NICU admissions of $2,903 with CGM use. In the probabilistic sensitivity analysis, CGM was cost saving in 25% of base-case model iterations and 46% of real-world model iterations. This study adds to the growing evidence base that the increased costs of CGM use versus SMBG to manage T1D pregnancies are likely offset by better neonatal health outcomes.

The Official Journal of ATTD Advanced Technologies &amp; Treatments for Diabetes Conference 22‐25 February 2023 I Berlin &amp; Online