IN BRIEF This study quantitatively measures diabetes stigma and its associated psychosocial impact in a large population of U.S. patients with type 1 or type 2 diabetes using an online survey sent to 12,000 people with diabetes. A majority of respondents with type 1 (76%) or type 2 (52%) diabetes reported that diabetes comes with stigma. Perceptions of stigma were significantly higher among respondents with type 1 diabetes than among those with type 2 diabetes, with the highest rate in parents of children with type 1 diabetes (83%) and the lowest rate in people with type 2 diabetes who did not use insulin (49%). Our results suggest that a disturbingly high percentage of people with diabetes experience stigma, particularly those with type 1 or type 2 diabetes who are on intensive insulin therapy. The experience of stigma disproportionately affects those with a higher BMI, higher A1C, and poorer self-reported blood glucose control, suggesting that those who need the most help are also the most affected by stigma.

After assessing patient perspectives on the success of current diabetes therapies and the factors that have the greatest impact on daily life, we show that time-in-range is a crucial outcome for people with diabetes and that current therapies are falling short on this metric. We also show that patients feel significant stress and worry, and they believe they are falling short in diet, exercise, and weight maintenance. In addition, they believe diet and exercise and in-range blood glucose are the biggest drivers of improved diabetes management and mindset. Together, these findings support the need for therapies that improve outcomes including and beyond A1C.

Hemoglobin A1c (A1C) is currently the "gold standard" in measuring diabetes outcomes. Substantial evidence, however, demonstrates the limitations of A1C in characterizing daily glycemic fluctuations and quality of life (1) or in accurately reflecting mean blood glucose levels (2). Data derived from continuous glucose monitoring (CGM) systems present a more comprehensive glycemic picture than A1C alone and are decidedly valuable as clinicians and patients seek to individualize therapy and make treatment changes accordingly. Concern about inconsistent reporting of CGM-measured outcomes has hampered progress in the field, as thresholds for these metrics often differ among trials. As a result, the diabetes community has developed consensus on key glycemic metrics to measure outcomes beyond A1C, which can be used in research, therapy development, and regulatory review (3,4). This report seeks to contribute broader engagement of the diabetes community and a specific focus on regulatory implications of achieving consensus on glycemic outcomes beyond A1C. CONVENING BROAD REPRESENTATION OF THE DIABETES COMMUNITY

The optimal zero delay coding of a finite state Markov source is considered. The existence and structure of optimal codes are studied using a stochastic control formulation. Prior results in the literature established the optimality of deterministic Markov (Walrand-Varaiya type) coding policies for the finite time horizon problem, and the optimality of both deterministic nonstationary and randomized stationary policies for the infinite time horizon problem. Our main result here shows that for any irreducible and aperiodic Markov source with a finite alphabet, deterministic and stationary Markov coding policies are optimal for the infinite horizon problem. In addition, the finite blocklength (time horizon) performance on an optimal (stationary and Markov) coding policy is shown to approach the infinite time horizon optimum at a rate O(1/T ). The results are extended to systems where zero delay communication takes place across a noisy channel with noiseless feedback.

Given the progressive nature of type 2 diabetes, treatment intensification is usually necessary to maintain glycemic control. However, for a variety of reasons, treatment is often not intensified in a timely manner. The combined use of basal insulin and a glucagon-like peptide-1 receptor agonist is recognized to provide a complementary approach to the treatment of type 2 diabetes. This review evaluates the efficacy and safety of two co-formulation products, insulin degludec/liraglutide and insulin glargine/lixisenatide, for the treatment of type 2 diabetes inadequately controlled on either component agent alone. We consider the benefits and limitations of these medications based on data from randomized clinical trials and discuss how they may address barriers to treatment intensification.