Background: People with diabetes mellitus (DM) are using mobile phone apps to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objectives: The study aimed to establish (1) whether people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps and (2) whether health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important, and their confidence with recommending apps. Methods: A survey of patients seen at a hospital diabetes clinic over 12 months (N=539) assessed current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed their confidence with app recommendations and perceived usefulness. Results: Of the 189 responders (35.0% response rate) to the patient survey, 19.6% (37/189) had used a diabetes app. App users were younger and in comparison to other forms of diabetes mellitus, users prominently had type 1 DM. The most favored feature of the app users was a glucose diary (87%, 32/37), and an insulin calculator was the most desirable function for a future app (46%, 17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.4%, 98/152). Of the 115 responders (40.2% response rate) to the HPs survey, 60.1% (68/113) had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions: The use of apps to record blood glucose was the most favored function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers).

Aim: Very low carbohydrate/ketogenic diets (VLC/KDs) are popular but their role in managing pre‐diabetes and type 2 diabetes (T2D) is uncertain. This study uses a systematic review and meta‐analysis of randomized controlled trials to estimate the effect of these diets in this population. Materials and Methods: A systematic review identified randomized controlled trials of at least 6 months duration comparing efficacy and safety of VLC/KDs (≤50 g carbohydrate or ≤10% total energy from carbohydrate per day) with a control diet (carbohydrate above the VLC/KD threshold) in adults with pre‐diabetes or T2D. The primary outcome variable was glycated haemoglobin (HbA1c) after 12 months. The meta‐analysis method was inverse variance weighting of mean values for continuous variables. Results: Key word searches identified 2290 studies; 2221 were not in scope. A full text review of 69 studies identified eight meeting inclusion criteria; in total, it involved 606 participants. Six studies reported HbA1c (%) at 12 months; four as change from baseline with a fixed effects estimate (95% confidence interval): VLC/KD minus control of 0.01% (−0.22 to 0.25), p = .91; and two as change from baseline: −0.65% (−0.99; −0.31) [−7.1 mmol/mol (−10.8; −3.4)], p < .001. Serum triglycerides were lower with VLC/KD versus control: −0.28 mmol/L (−0.44 to −0.11), p < .001. High‐density lipoprotein was higher with an estimate of 0.04 mmol/L (0.01 to 0.08), p = .03, in the five studies reporting 12‐month summary data. Conclusions: A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre‐diabetes or T2D but evidence of an advantage over other strategies is limited. More well‐designed studies are required to provide certain evidence.

Introduction: In the context of a global obesity and diabetes epidemic, gestational diabetes mellitus and other forms of hyperglycaemia in pregnancy are increasingly common. Hyperglycaemia in pregnancy is associated with short and long term complications for both the woman and her baby. These 2025 consensus recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) update the guidance for the screening, diagnosis and classification of hyperglycaemia in pregnancy based on available evidence and stakeholder consultation.Main recommendations: Overt diabetes in pregnancy (overt DIP) should be diagnosed at any time in pregnancy if one or more of the following criteria are met: (i) fasting plasma glucose (FPG) ≥ 7.0 mmol/L; (ii) two‐hour plasma glucose (2hPG) ≥ 11.1 mmol/L following a 75 g two‐hour pregnancy oral glucose tolerance test (POGTT); and/or (iii) glycated haemoglobin (HbA_1c) ≥ 6.5% (≥ 48 mmol/mol). Irrespective of gestation, gestational diabetes mellitus should be diagnosed using one or more of the following criteria during a 75 g two‐hour POGTT: (i) FPG ≥ 5.3–6.9 mmol/L; (ii) one‐hour plasma glucose (1hPG) ≥ 10.6 mmol/L; (iii) 2hPG ≥ 9.0–11.0 mmol/L. Women with risk factors for hyperglycaemia in pregnancy should be advised to have the HbA_1c measured in the first trimester. Women with HbA_1c ≥ 6.5% (≥ 48 mmol/mol) should be diagnosed and managed as having overt DIP. Before 20 weeks’ gestation, and ideally between ten and 14 weeks’ gestation, if tolerated, women with a previous history of gestational diabetes mellitus or early pregnancy HbA_1c ≥ 6.0‐6.4% (≥ 42–47 mmol/mol), but without diagnosed diabetes, should be advised to undergo a 75 g two‐hour POGTT. All women (without diabetes already detected in the current pregnancy) should be advised to undergo a 75 g two‐hour POGTT at 24–28 weeks’ gestation. Changes in management as a result from this consensus statement: These updated recommendations raise the diagnostic glucose thresholds for gestational diabetes mellitus and clarify approaches to early pregnancy screening for women with risk factors for hyperglycaemia in pregnancy.

A self-reported online survey was performed to investigate the immediate effect of COVID-19 lockdown restrictions in New Zealand on dietary intake, and lifestyle behaviours among pregnant women with diabetes. The survey was sent to 82 pregnant women who had Type 1, Type 2 Diabetes, or Gestational Diabetes and attended the Diabetes in Pregnancy Clinic in Wellington, New Zealand in May 2020, while the most restrictive COVID-19 lockdown measures were in place. All women received standard pregnancy nutrition advice provided by a dietitian, were monitoring blood glucose levels with nursing support, and seeing specialist endocrinologists and obstetricians for their pregnancy care. Fifty women (61%) responded to the survey. There was no evidence of differences in dietary intake during the restrictions, compared to before, for most food items. During the restriction's women consumed more bread (Odds Ratio (95% CI): 0.39 (0.18–0.83) p = 0.02); less battered fish: 3.11 (1.20–8.05) p = 0.02; and less hot chips/fries: 6.32 (2.67–14.93) p < 0.0001. During the restriction's women consumed more meals at home: 0.05 (0.14–0.15) p < 0.0001; less takeaways: 3.63 (1.54–7.34) p = 0.003; and less restaurant and café meals: 15.05 (6.03–37.59) p < 0.0001, when the services reopened. The nutrition of pregnant women with diabetes was not compromised during a brief COVID-19 lockdown restriction. This finding is reassuring, with countries worldwide adopting brief intermittent lockdown periods to restrict the spread of the COVID-19 virus.

The minor allele (A) of the rs373863828 variant (p.Arg457Gln) in CREBRF is restricted to indigenous peoples of the Pacific islands (including New Zealand Māori and peoples of Polynesia), with a frequency of up to 25% in these populations. This allele associates with a large increase in body mass index (BMI) but with significantly lower risk of type-2 diabetes (T2D). It remains unclear whether the increased BMI is driven by increased adiposity or by increased lean mass. We undertook body composition analysis using DXA in 189 young men of Māori and Pacific descent living in Aotearoa New Zealand. Further investigation was carried out in two orthologous Arg458Gln knockin mouse models on FVB/NJ and C57BL/6j backgrounds. The rs373863828 A allele was associated with lower fat mass when adjusted for BMI (p < 0.05) and was associated with significantly lower circulating levels of the muscle inhibitory hormone myostatin (p < 0.05). Supporting the human data, significant reductions in adipose tissue mass were observed in the knockin mice. This was more significant in older mice in both backgrounds and appeared to be the result of reduced age-associated increases in fat mass. The older male knockin mice on C57BL/6j background also had increased grip strength (p < 0.01) and lower levels of myostatin (p < 0.05). Overall, these results prove that the rs373863828 A-allele is associated with a reduction of myostatin levels which likely contribute to an age-dependent lowering of fat mass, at least in males.