Abbreviations: DCCT, Diabetes Control and Complications Trial; GOLD, glycaemic control and optimisation of life quality in type 1 diabetes; DIAMOND, multiple daily injections and continuous glucose monitoring in diabetes; SWITCH, sensing with insulin pump therapy to control HbA 1c ; JDRF, Juvenile Diabetes Research Foundation; CITY, CGM intervention in teens and young adults with type 1 diabetes; WISDM, wireless innovation for seniors with diabetes mellitus; HypoDE, real-time continuous glucose monitoring in patients with type 1 diabetes at high risk for low glucose values using multiple daily injections in Germany; IN CONTROL, continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia; IMPACT, novel glucose-sending technology and hypoglycaemia in type 1 diabetes; SELFY, FreeStyle libre glucose monitoring system paediatric study; REPLACE, an evaluation of a novel glucose sensing technology in type 2 diabetes; GP-OSMOTIC, general practice optimising structured monitoring to improve clinical outcomes in type 2 diabetes.

Aims:To explore the lived experience of neuropsychiatric symptoms (NPS) among females with mild cognitive impairment (MCI).Design: A phenomenological study using individual, semi-structured, telephonebased interviews was conducted to explore how the NPS are aroused, evolve, and affect the overall well-being, illness perception and the corresponding coping responses adopted by females with MCI.Methods: Twenty-nine participants with MCI were recruited from the community setting in Hong Kong between March and October 2020. Interviews were audiorecorded, transcribed verbatim, and analysed using an interpretative phenomenological analysis approach and constant comparison strategy.Results: Three themes were identified: (1) living vigilant lives with threats and uncertainty, (2) snowballing into further negative emotions and (3) seeking outlets for negative emotions. Our findings suggested that the participants' cognitive, functional and social challenges aroused intense emotional responses such as depression, agitation and anxiety. These noting negative emotions were further perpetuated by maladaptive coping responses, unrealistic expectations from coping strategies and overwhelming disease burden. Various internal and external strategies were adopted to enhance emotional adaptation, of which adopting a positive attitude appeared to be the most promising strategy. Conclusion:This study shed light on the challenging experience of MCI. The cognitive afflictions and the resultant impacts on various life domains evoked a cluster of NPS. Support services need to enhance emotional adjustment through alleviating the various life stressors and strengthening the coping resources.Impact: Elucidating the lived experience of NPS provides important insights into the development of a more effective, comprehensive and person-centred care planning for the population with MCI. Holistic care planning should extend beyond cognitive health optimization into enhancing disease knowledge, improve emotional coping, rebuild self-identity and bolstering social supports among this preclinical cohort.

Objectives To conduct a systematic review and network meta‐analysis examining the effects of non‐pharmacological interventions on neuropsychiatric symptoms (NPS) in a community‐dwelling population with preclinical and mild dementia to identify the design characteristics of more effective interventions. Methods A comprehensive search was conducted in 10 electronic databases. Two reviewers independently appraised the methodological quality of studies using the Risk of Bias 2.0 tool. A pairwise meta‐analysis was performed to estimate the standardized mean differences (SMD) with 95% confidence intervals. Network meta‐analysis was then used to estimate the relative effects and rankings of different interventions. Results Twenty‐one studies involving 1773 participants were included. Seven studies focused on preclinical dementia, and 14 studies focused on mild dementia. The majority of studies reported a single domain of NPS (depression, anxiety, apathy or agitation) rather than overall NPS. Data on depression were pooled. Pairwise analysis and network meta‐analysis indicated that multimodal interventions (SMD = −0.47, p = 0.01) were superior to psycho‐behavioral educative interventions (SMD = −0.04; p = 0.65), cognitive training (SMD = −0.27, p = 0.10), and art‐based interventions for improving depression. The more crucial design characteristics included those that emphasized skill transferal into daily life, psycho‐behavioral content to encourage a positive outlook and self‐identity, and disease‐specific educational content to improve symptom management. Conclusions This review indicated that multimodal interventions with cognitive, psycho‐behavioral and educative components were the most effective approaches for improving depression in patients with preclinical and mild dementia. More comprehensive evaluations using standardized and robust measures of NPS in patients with preclinical dementia are warranted.

Introduction The prevalence of dementia in Tanzania, as in other developing countries is progressively increasing. Yet international screening instruments for mild cognitive impairment are lacking. The aim of this study was to determine the psychometrics and the diagnostic ability of the Montreal Cognitive Assessment 5 minutes protocol (MoCA-5-min) among older adult in the rural Tanzania. Methods The MoCA-5-min and the IDEA cognitive screening were concurrently administered through face to face to 202 community-dwelling older adults in Chamwino district. Exploratory factor analysis (EFA) using principal component method and oblique rotation was performed to determine the underlying factor structure of the scale. The concurrent, construct as well as predictive validities of the MoCA-5min were examined by comparing its score with IDEA cognitive screening and psychiatrist's diagnosis using DSM-V criteria respectively. Results The EFA found that all the MoCA-5-min items highly loaded into one component, with factor loading ranging from 0.550 to 0.879. The intraclass correlation coefficient for 6 weeks test-retest reliability was 0.85. Its strong significant correlation with the IDEA screening (Pearson's r = 0.614, p < 0.001) demonstrated a good concurrent validity. Using the psychiatrist's rating as the gold standard, MoCA-5-min demonstrated the optimal cutoff score for MCI at 22, which yielded the sensitivity of 80% and specificity of 74%; and dementia at score of 16 giving a sensitivity of 90% and specificity of 80%. Upon stratifying the sample into different age groups, the optimal cutoff scores tended to decrease with the increase in age. Conclusion The MoCA-5-min is reliable and provides a valid and accurate measure of cognitive decline among older population in the rural settings of Tanzania. The use of varying cutoff scores across age groups may ensure more precise discriminatory power of the MoCA-5-min.