There were no differences in the efficacy or safety of the isophane and glargine-based insulin regimens. We recommend an initial daily insulin dose of 0.5 units/kg bodyweight if not on insulin, a greater than 30% increase in pre-prednisolone insulin dose and larger insulin dose adjustments in patients with prednisolone-induced hyperglycaemia.

The current study confirms the marked superiority of the weight-based heparin regimen for treatment of patients with ACS. The nomogram dramatically facilitated the attainment of therapeutic APTT, and may represent the optimal method for titration of heparin dosage to individual heparin requirements in patients with ACS.

Issue addressed:We sought to examine barriers to access to, use of, and benefits from digital health services in an area of socioeconomic disadvantage of Adelaide, Australia. Methods:We conducted waiting room surveys in two hospital diabetes clinics and one hospital antenatal clinic in South Australia, and follow-up telephone interviews with 20 patients. We examined the extent of access to, use of and benefits from digital health services, and what barriers people encountered. We undertook mixed methods, with quantitative descriptive analysis and qualitative analysis.Results: Thirty-seven diabetes clinic patients (54% response rate) and 99 antenatal clinic patients (33% response rate) participated. Sixty-two percent of the patients with diabetes and 27% of antenatal clinic patients had never used digital health services. Seventeen percent of patients with diabetes and 30% of antenatal clinic patients were hesitant users, and 22% of patients with diabetes and 44% of antenatal clinic patients were confident users. Barriers included struggling to afford the technology or to stay connected and a lack of trust in online health information. Potential benefits included feeling more empowered and complementing face-to-face care.Conclusions: There are socioeconomic barriers to access, use of, and ability to benefit from digital health strategies that mean not everyone will be able to benefit from digital health services.So What?: As COVID-19 accelerates the shift towards digital health services, people experiencing socioeconomic disadvantage may be excluded. If barriers to access and use are not addressed, they will exacerbate already increasing health inequities.

Context Cardiovascular disease occurs prematurely in type 1 diabetes. The additional risk of overweight is not well characterised. Objective Primary aim was to measure the impact of BMI in youth with type 1 diabetes on cardiovascular risk factors. Secondary aim was to identify other determinants of cardiovascular risk. Design Observational longitudinal study of 7061 youth with type 1 diabetes followed for median 7.3 (IQR 4-11) years over 41 (IQR 29-56) visits until March 2019. Setting 15 tertiary care diabetes centres in the Australasian Diabetes Data Network. Participants aged 2 – 25 years at baseline, with at least two measures of BMI and blood pressure. Main outcome measure Standardised systolic and diastolic blood pressure scores and non-HDL cholesterol were co-primary outcomes. Urinary albumin/creatinine ratio was the secondary outcome. Results BMI z-score related independently to standardised blood pressure z- scores and non-HDL cholesterol. An increase in 1 BMI z-score related to an average increase in systolic/diastolic blood pressure of 3.8/1.4mmHg and an increase in non –HDL cholesterol (coefficient + 0.16mmol/L, 95%CI 0.13-0.18; p<0.001) and in LDL cholesterol. Females had higher blood pressure z–scores, higher non-HDL and LDL cholesterol, and higher urinary albumin/creatinine than males. Indigenous youth had markedly higher urinary albumin/creatinine (coefficient +2.15 mg/mmol, 95% CI 1.27-3.03; p<0.001) and higher non-HDL cholesterol than non-indigenous youth. Continuous subcutaneous insulin infusion was associated independently with lower non-HDL cholesterol and lower urinary albumin/creatinine. Conclusions BMI had a modest independent effect on cardiovascular risk. Females and indigenous Australians in particular had a more adverse risk profile.