Conducting and interpreting nutrition research involves consideration of the research question, study design, wide variability of nutrients in foods and dietary patterns, food environment, approaches used to collect and analyze dietary data, and manner in which results are reported. This article reviews all of these considerations with regard to diabetes-related nutrition research.

Diabetes remission-the occurrence of durable normoglycemia without antidiabetic medications-has been demonstrated in some patients with type 2 diabetes who have achieved and sustained weight loss through lifestyle intervention or metabolic and bariatric surgery. Although this pursuit would represent a paradigm shift in our diabetes chronic care model, could diabetes remission become a routine treatment strategy in patients with type 2 diabetes? This article reviews the mechanisms by which weight loss can drive improvements in insulin sensitivity and β-cell function sufficient to normalize glycemia, treatment approaches that provide evidence for diabetes remission, and avenues for developing the research and discovery that will be required to make diabetes remission possible as part of the routine medical management of type 2 diabetes.

Daily self-monitoring of blood glucose (SMBG) is essential for type 1 diabetes management yet is challenging during adolescence. Ecological momentary assessment (EMA) is the repeated sampling of behaviors and experiences in real time in the natural environment. The purpose of this study was to evaluate 1) the validity of self-reported SMBG values via text message-delivered EMA surveys compared with objective SMBG values via glucose meters and 2) in-the-moment motivators and barriers to performing SMBG in a pediatric type 1 diabetes population. Youth (n = 62, aged 11-21 years) with type 1 diabetes received three text messages daily for 10 days containing surveys inquiring about SMBG engagement. Objective SMBG values were downloaded from glucose meters. On average, participants reported performing SMBG 4 times/day. Of the self-reported SMBG values, 39.6% were accurate. Inaccurate values included additions (i.e., self-reported value with no objective value), omissions (i.e., objective value with no self-reported value), and alterations (difference between self-report and objective SMBG values ≥10 mg/dL). Of the matched pairs of self-reported and objective SMBG values, 41.3% were altered. Bland-Altman plots determined that the mean difference between self-reported and objective glucose data were -5.43 mg/dL. Participants reported being motivated to check their blood glucose because it was important for their health, and reported barriers included wanting to ignore the task, forgetting, and not having devices. Youth's self-reported SMBG values may not align with objective readings. The results of this study can facilitate future research to determine individual factors related to SMBG and accuracy of self-reporting.

BACKGROUND | Young adulthood is a vulnerable developmental period associated with increased risk for suboptimal health outcomes in youth with type 1 diabetes. Psychosocial factors have been associated with self-management and glycemic control in younger populations, but the extent to which these associations exist among young adults is poorly understood. This study aimed to examine the psychosocial functioning of young adults with type 1 diabetes and associated clinical outcomes. METHODS | Participants included young adults (n = 44) between the ages of 18 and 23 years in a pediatric setting who were preparing to transition to adult care. All participants completed self-report measures of psychosocial functioning at baseline as part of this longitudinal observational study. Outcome data included glycemic control, frequency of blood glucose monitoring, and self-management ratings at baseline and 1-year follow-up. RESULTS | Young adults with type 1 diabetes reported higher levels of depressive symptoms, lower self-efficacy, and more risk behaviors compared with previously published scores for adolescents. Young adults also reported greater resilience and transition readiness than their younger counterparts. Psychosocial variables were differentially related to glycemic control and frequency of blood glucose monitoring both cross-sectionally and longitudinally. CONCLUSION | This study provides key information about the psychosocial functioning of young adults with type 1 diabetes. It identifies relevant psychosocial factors that are associated with meaningful health outcomes during the transition preparation period. These findings may inform the development of clinical programs aimed at promoting transition preparation and health outcomes in young adults with type 1 diabetes.

The number of children with type 1 diabetes is rising, and these children must manage their diabetes during the day while in kindergarten or school. A total of 678 German kindergarten and school teachers (89% female) attended a structured training program for supporting children with type 1 diabetes in their diabetes management. The teachers completed questionnaires on their overall self-perception of their ability to handle diabetes and institutional factors supporting children with type 1 diabetes. Of these teachers, 251 who were currently working with a child with type 1 diabetes provided further insight into the experiences of children with diabetes in school and kindergarten. Teachers reported deficits in three areas: knowledge about diabetes and diabetes management, institutional support, and communication with parents and health professionals. On average, they gave themselves only fair ratings on both their knowledge about diabetes (3.60 ± 1.10 on a 5-point scale) and their ability to assist children with their diabetes management (3.67 ± 1.09). Whereas general information about supporting children with type 1 diabetes seemed to have been provided by almost half of the institutions (43%), specific school policies for sports (30%), extracurricular activities such as field trips (20%), or activities including sleepovers (16%) were rare. Poor communication between teachers, parents, and health professionals was reported. These deficits indicated by kindergarten and school teachers underline the importance of structured trainings and written policies on type 1 diabetes to improve the status of children with type 1 diabetes in school and kindergarten.

Many people with diabetes do not achieve individualized treatment targets. Therapeutic inertia, the underuse of effective therapies in preventing serious clinical end points, is a frequent, important contributor to this failure. Clinicians, patients, health systems, payors, and producers of medications, devices, and other products for those with diabetes all play a role in the development of therapeutic inertia and can all help to reduce it.

From a behavioral perspective, therapeutic inertia can happen when obstacles to changing a diabetes treatment plan outweigh perceived benefits. There is a complex interaction of important treatment-related obstacles for people with diabetes (PWD), their treating health care professional (HCP), and the clinical setting in which they interact. Tipping the scales toward more effective action involve strategies that increase perceptions of the benefits of treatment intensification while addressing important obstacles so that treatment changes are seen by both PWD and HCPs as worthwhile and achievable.

IN BRIEF Insulin pump therapy is advancing rapidly. This article summarizes the variety of insulin pump technologies available to date and discusses important clinical considerations for each type of technology.

IN BRIEF With the introduction of intermittently scanned continuous glucose monitoring (CGM) systems to the marketplace, providers and patients now have several options to continuously monitor glucose levels. This article addresses appropriate patient selection criteria for using patient- or practice-based CGM systems and the barriers to achieving optimal benefits from this technology. The authors have developed a flowchart to guide clinicians and patients in decision-making regarding the most appropriate type of CGM to use in various circumstances.

Full realization of the benefits of continuous glucose monitoring (CGM) depends on addressing barriers such as cost, accuracy, burdens of daily use, and uncertainty about applying the data. Lack of systematic education has also hampered widespread adoption among patients and health care professionals. This article describes the practical application of an affordable and intuitive category of CGM called "flash" that requires users to scan the sensor with a handheld reader for on-demand access to continuous data. The data may be used for in-the-moment therapy adjustment, retrospective review of glucose patterns, and observation of glucose trending in response to behavior. Higher rates of flash CGM scanning have been associated with increased time in the glycemic target range and reduced time in hyper- and hypoglycemia. Growing interest in this technology suggests new opportunities for helping more patients incorporate CGM into their daily self-care.