Context: Beyond HbA1c, continuous glucose monitoring (CGM) is now widely used in clinical practice, providing more detailed information about glycemic control. However, its ability to predict long-term microvascular outcomes in type 1 diabetes remains unclear. Objective: To evaluate the association between CGM-derived glucometrics and the 5-year incidence of microvascular complications, providing longitudinal real-world evidence in adults with type 1 diabetes. Design: Longitudinal real-world cohort study with 5-year follow-up. Setting: Tertiary referral center. Participants: Two hundred forty-six adults with type 1 diabetes (median age 40 [28-53] years, diabetes duration 24 [13-33] years). Intervention: No interventional treatment. Main Outcome Measure: Composite microvascular endpoint including nephropathy (persistent albuminuria ≥20 µg/min, estimated glomerular filtration rate <60 mL/min/1.73 m2, and/or renin–angiotensin–aldosterone system inhibitor use for albuminuria), severe retinopathy (proliferative retinopathy, maculopathy, and/or blindness), and peripheral neuropathy (monofilament score <6/6 and/or abnormal nerve conduction). Results: HbA1c decreased from 7.6% (59 mmol/mol) to 7.2% (55 mmol/mol), and time in range (TIR, 70-180 mg/dL) increased from 50 ± 14% to 61 ± 15%. All CGM-derived metrics (TIR, mean glucose, glucose management indicator) were associated with the composite endpoint. In this longitudinal real-world cohort, a ≥10% decrease in TIR was associated with higher complication rates (33.3%) compared with a stable TIR (7.9%) or ≥10% increase (15.0%) (P = .011). In multivariable analyses adjusted for age and baseline TIR, change in TIR (ΔTIR) remained independently associated with outcomes. Body mass index and systolic blood pressure were not significant. Models incorporating glucometrics and age showed acceptable discriminative performance (area under the curves 0.757-0.787). Conclusion: Continuous glucose monitoring–derived glucometrics were associated with the 5-year incidence of microvascular complications in this real-world cohort, with ΔTIR potentially providing additional prognostic information beyond glycated hemoglobin (HbA1c). Further validation is needed before routine clinical implementation.

Aims: To examine the association between depressive symptoms and metabolic profile in women with prior gestational diabetes mellitus (GDM) and early postpartum prediabetes, and to explore whether a mobile-based lifestyle intervention affected mental health outcomes. Methods: Secondary, exploratory analysis of a multi-centric randomized controlled trial (MELINDA), evaluating a mobile-based lifestyle intervention versus standard follow-up (control group) in women with prediabetes after GDM. The analysis included 166 participants who completed the Center for Epidemiologic Studies–Depression (CES-D) questionnaire [score of ≥16 being suggestive for (sub)clinical depression] at baseline (6–16 weeks postpartum) and one year post-randomization. Results: At one year, 26.5% of women (n = 44) reported depressive symptoms, with no significant difference between the intervention and control groups (30.5% vs. 22.6%, p = 0.293). Women with depressive symptoms (symptomatic women) were younger (30.9 ± 4.9 vs. 32.5 ± 3.8 years, p = 0.033) and were less often highly educated (61.4% vs. 80.3%, p = 0.028). At baseline, symptomatic women had a higher rate of metabolic syndrome (38.6% vs. 21.9%, p = 0.044), higher LDL-cholesterol [3.2 ± 0.8 vs. 2.8 ± 0.8 mmol/L, p = 0.009], lower quality of life (lower SF-36 scores, p < 0.050) and a higher level of anxiety based on the STAI-6 questionnaire (14.5 ± 3.6 vs. 11.2 ± 2.6, p < 0.001). These differences persisted at one year postpartum with worse metabolic profile, more anxiety and lower quality of life in symptomatic women. Conclusions: Depressive symptoms are common in women with prediabetes in early postpartum after GDM and are associated with a persistent worse metabolic profile, increased anxiety and lower quality of life postpartum. The mobile-based lifestyle intervention did not improve mental health.

Background: Metabolic bariatric surgery is a highly effective and long-lasting treatment for obesity and related chronic conditions. Women of reproductive age represent the largest group undergoing these procedures. Observational studies suggest an increased risk of preterm birth and impaired foetal growth in this population, though the underlying mechanisms remain unclear. A key hypothesis is that altered glucose metabolism, characterised by frequent hypoglycaemia and glycaemic fluctuations, may contribute to these adverse outcomes. While glycaemic variability following metabolic bariatric surgery has been documented, its pattern during pregnancy and impact on pregnancy outcomes are still underexplored. Methods: In this Belgian multicentre prospective cohort study, we will investigate glycaemic patterns during pregnancy in women who have undergone metabolic bariatric surgery. Women aged 18–45 years with a confirmed singleton pregnancy up to 11 weeks and 6 days and a history of Roux-en-Y gastric bypass or sleeve gastrectomy will be eligible for inclusion. Women with pregestational diabetes or those taking medication known to interfere with glucose metabolism will be excluded. All participants will receive blinded continuous glucose monitoring (Dexcom^® G6) for a 10-day period at four time points throughout the pregnancy. Foetal body composition and growth will be measured during routine ultrasound; skinfolds will be measured in the neonate. The primary outcome is the association between mean glycemia and glycaemic variability on continuous glucose monitoring and birth weight. The planned sample size is ninety-five women. Linear mixed models for repeated measurements will be used for analysis. Confounders such as smoking, micronutrient deficiency, and surgery-to-conception interval will be added to the model as covariates. In a second exploratory phase, each participant in the surgical group will be matched with a control participant—without a history of metabolic bariatric surgery—based on pre-pregnancy BMI and age. Control participants will undergo the same study procedures, allowing for exploratory comparison of glycaemic patterns and other study outcomes. Discussion: This prospective longitudinal study will be the largest study using continuous glucose monitoring to investigate glucose metabolism during pregnancy after metabolic bariatric surgery and its impact on foetal growth and newborn body composition. Trial registration: ClinicalTrials.gov: NCT05084339. Registration date: 15 October 2021.