To investigate whether intermittently scanned continuous glucose monitoring (isCGM) significantly improves glycemic control compared with capillary selfmonitored blood glucose (SMBG) in youth with type 1 diabetes and high-risk glycemic control. RESEARCH DESIGN AND METHODSThis multicenter 6-month randomized, controlled, parallel-arm trial included 64 participants aged 13-20 years with established type 1 diabetes and glycated hemoglobin (HbA 1c ) ‡9% ( ‡75 mmol/mol). Participants were allocated to 6-month intervention (isCGM; FreeStyle Libre; Abbott Diabetes Care, Witney, U.K.) (n 5 33) or control (SMBG; n 5 31) using minimization. The primary outcome was the difference in change in HbA 1c from baseline to 6 months. RESULTSThere was no evidence of a difference between groups for changes in HbA 1c at 6 months (adjusted mean 0.2% greater improvement for isCGM [95% CI 20.9 to 0.5] [22.1 mmol/mol (95% CI 29.6 to 5.4)]; P 5 0.576). However, glucose-monitoring frequency was 2.83 (95% CI 1.72-4.65; P < 0.001) times higher in the isCGM group compared with that in the SMBG group at 6 months. The change in the Diabetes Treatment Satisfaction Questionnaire mean item score also favored isCGM at 6 months (P 5 0.048), with no significant differences between groups for fear of hypoglycemia and quality of life (both general and diabetes specific) (all P > 0.1). CONCLUSIONSFor youth with high-risk glycemic control, isCGM led to improvements in glucose testing frequency and diabetes treatment satisfaction. However, these did not translate to greater improvement in glycemic control over usual care with SMBG at 6 months.Glucose monitoring is a fundamental component of type 1 diabetes care (1). Frequency of self-monitoring of blood glucose (SMBG) via intermittent finger-prick capillary glucose measurements is related to glycemic control, with improvements in glycated hemoglobin (HbA 1c ) of up to 0.5% (5 mmol/mol) for each additional glucose check, up to five per day (2). However, this degree of monitoring represents a considerable management burden and can lead to reduced adherence (3).

NaHCO₃ supplementation increased blood HCO₃⁻ concentration and attenuated the decline in blood pH compared with placebo during high-intensity exercise in well-trained rugby players but did not significantly improve exercise performance. The higher incidence and greater severity of GI symptoms after ingestion of NaHCO₃ may negatively affect physical performance, and the authors strongly recommend testing this supplement during training before use in competitive situations.

Background Providing timely follow-up care for patients with inflammatory bowel disease in remission is important but often difficult because of resource limitations. Using smartphones to communicate symptoms and biomarkers is a potential alternative. We aimed to compare outpatient management using 2 smartphone apps (IBDsmart for symptoms and IBDoc for fecal calprotectin monitoring) vs standard face-to-face care. We hypothesized noninferiority of quality of life and symptoms at 12 months plus a reduction in face-to-face appointments in the smartphone app group. Methods Inflammatory bowel disease outpatients (previously seen more often than annually) were randomized to smartphone app or standard face-to-face care over 12 months. Quality of life and symptoms were measured quarterly for 12 months. Acceptability was measured for gastroenterologists and patients at 12 months. Results One hundred people (73 Crohn’s disease, 49 male, average age 35 years) consented and completed baseline questionnaires (50 in each group). Intention-to-treat and per-protocol analyses revealed noninferiority of quality of life and symptom scores at 12 months. Outpatient appointment numbers were reduced in smartphone app care (P &lt; 0.001). There was no difference in number of surgical outpatient appointments or number of disease-related hospitalizations between groups. Adherence to IBDsmart (50% perfect adherence) was slightly better than adherence to IBDoc (30% perfect adherence). Good acceptability was reported among most gastroenterologists and patients. Conclusions Remote symptom and fecal calprotectin monitoring is effective and acceptable. It also reduces the need for face-to-face outpatient appointments. Patients with mild-to-moderate disease who are not new diagnoses are ideal for this system. Clinical Trial Registration Number ACTRN12615000342516.

Both individual and workplace factors influence outdoor workers' sun protection.

The beneficial effects on morbidity and visual recall over a short period, in addition to some biochemical improvements, highlight the potential of this micronutrient-fortified seasoning powder supplied in a school lunch. This trial was registered at clinical trials.gov as ACTRN12605000341628.

Occupational Sun Protection: Workplace Culture, Equipment Provision and Outdoor Workers' Characteristics: Anthony I. REEDER, et al. Cancer Society of New Zealand Social and Behavioral Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand— Objectives The aim of this study was to describe outdoor workers' sun‐protective practices, workplace sun‐safety culture and sun‐protective equipment provision; investigate the association of demographic, personal and occupational factors with sun‐protective practices; and identify potential strategies for improving workers' sun protection. Methods The present study used a clustered survey design with randomly identified employers in nine occupations. Employees provided questionnaire measures of demographics, personal characteristics (skin type, skin cancer risk perceptions, tanning attitudes, sun‐exposure knowledge), personal occupational sun protection practices (exposure reduction, use of sun‐protective clothing, sunscreen and shade), workplace sun‐protective equipment provision and perceived workplace sun‐safety culture. Summative scores were calculated for attitudes, knowledge, work place provision and culture. Amultivariable model was built with worker and workplace variables as plausible predictors of personal sun protection. Results In this study, 1,061 workers (69% participation) from 112 workplaces provided sufficient information for analysis. Sex, age, prioritized ethnicity, education and risk perception differed significantly between occupational groups (p<0.001), as did workers' sun‐protective practices and workplace sun‐protection equipment provision and supportive culture. After adjustment, each one‐point increase in Workplace Sun‐safety Culture Score (range 12 points) was associated with a 0.16 higher Personal Sun‐Protection Score (p<0.001), and each one‐point increase in Workplace Provision Score (range 4 points) was associated with a 0.14 higher score (p<0.001). Sun Protection Score was significantly associated with skin response to sun exposure (p<0.001), female sex (p=0.021), tanning attitudes (p=0.022) and occupation (p=0.049), but not ethnicity, age education, knowledge or skin cancer risk perception. Conclusions Protective equipment provision and sun‐protective workplace culture are promising components for the development of comprehensive programmes to improve outdoor workers' sun‐protective practices.

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