Maria Craig

• MBBS PhD FRACP MMed(ClinEpid)
• UNSW Sydney

Aim: Data on the impact of metabolic dysfunction‐associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes are lacking. However, MAFLD is well known to contribute to cardiovascular disease (CVD) in people with type 2 diabetes. We aimed to investigate markers of MAFLD in youth with type 1 diabetes and their relat...

This cohort study examines whether there is a temporal association between SARS-CoV-2 infection and the development of islet autoimmunity among Australian children with a first-degree relative with type 1 diabetes.

The gut microbiomes of traditional Indigenous and 'Western' societies differ markedly in diversity and composition. The Western diet modifies the gut microbiome, promoting cardiometabolic disorders that disproportionately affect Indigenous Australians. Studies of Indigenous gut microbiomes are underrepresented in the literature and comparative stud...

Type 1 diabetes (T1D) has two pre‐symptomatic phases (stages 1 and 2) with progressive destruction of beta cells which have been identified through longitudinal cohort studies in recent decades. The definition of T1D, with hyperglycaemia that may or may not be symptomatic, is now defined as stage 3. There is growing evidence that screening for stag...

OBJECTIVE Type1Screen offers islet autoantibody testing to Australians with a family history of type 1 diabetes (T1D) with the dual aims of preventing diabetic ketoacidosis (DKA) and enabling use of disease-modifying therapy. We describe screening and monitoring outcomes 2 years after implementing in-home capillary blood spot sampling. RESEARCH DE...

Introduction This guideline serves as an update to the 2022 International Society for Pediatric and Adolescent Diabetes (ISPAD) consensus guideline on staging for Type 1 Diabetes (T1D). Key additions include an evidence-based summary of recommendations for screening for risk of T1D and monitoring those with early-stage T1D. In addition, a review of...

Aim To explore parents’ experiences of using continuous glucose monitoring (CGM) in their young children with early-stage type 1 diabetes, being followed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study. Methods Parents of children with persistent islet autoimmunity who enrolled in the ENDIA CGM sub-study were invit...

Introduction: The COVID-19 pandemic necessitated worldwide lockdowns in 2020 and 2021, with restrictions on physical activity and changes in eating habits. Aims: To investigate temporal trends in Body Mass Index (BMI) and BMI Standard Deviation Score (SDS) inSDS) in three international T1D registries between 2018-2021. Methods: Data were extracted...

In the article cited above, incorrect affiliation information was given for author Linda A. DiMeglio. The correct affiliation for Linda A. DiMeglio is Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN. The online version of the article (https://doi.org/10.2337/dci24-0042) has been updated to correct the error.

Aims/hypothesis Dietary patterns characterised by high intakes of vegetables may lower the risk of pre-eclampsia and premature birth in the general population. The effect of dietary patterns in women with type 1 diabetes, who have an increased risk of complications in pregnancy, is not known. The aim of this study was to investigate the relationshi...

Aim One third of Australian children diagnosed with type 1 diabetes present with life‐threatening diabetic ketoacidosis (DKA) at diagnosis. Screening for early‐stage, presymptomatic type 1 diabetes, with ongoing follow‐up, can substantially reduce this risk (<5% risk). Several screening models are being trialled internationally, without consensus o...

OBJECTIVE Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measur...

Introduction The Environmental Determinants of Islet Autoimmunity (ENDIA) Study is an ongoing Australian prospective cohort study investigating how modifiable prenatal and early-life exposures drive the development of islet autoimmunity and type 1 diabetes (T1D) in children. In this profile, we describe the cohort’s parental demographics, maternal...

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant...

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programs are being increasingly emphasized. Once broadly implemented, screening initiatives will identify significant n...

Objective Microvascular complications increase the risk of cardiovascular disease and premature death in adults with type 1 diabetes. We examined the association between microvascular complications during adolescence, including cardiac autonomic nerve dysfunction and subsequent mortality. Research Design and Methods. We undertook data linkage with...

OBJECTIVE To compare demographic, clinical, and therapeutic characteristics of children with type 1 diabetes age <6 years across three international registries: Diabetes Prospective Follow-Up Registry (DPV; Europe), T1D Exchange Quality Improvement Network (T1DX-QI; U.S.), and Australasian Diabetes Data Network (ADDN; Australasia). RESEARCH DESIGN...

Background Given limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations. Methods Retrospective, cr...

Introduction: Childhood-onset type 1 diabetes (T1D) is associated with an increased risk of premature cardiovascular mortality. Objectives: This study aimed to assess the evolution of subclinical vascular damage in young people with T1D as they transitioned through adolescence. Methods: Repeated vascular phenotyping was performed in early adolescen...

OBJECTIVE Innate immune responses may be involved in the earliest phases of type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS To test whether blocking innate immaune cells modulated progression of the disease, we randomly assigned 273 individuals with stage 1 T1D to treatment with hydroxychloroquine (n = 183; 5 mg/kg per day to a maximum of 400 m...

The microbiome has emerged as a key determinant of human health and reproduction, with recent evidence suggesting a dysbiotic microbiome is implicated in adverse perinatal health outcomes. The existing research has been limited by the sample collection and timing, cohort design, sample design, and lack of data on the preconception microbiome. This...

Background: Intrauterine exposure to hypertensive disorders of pregnancy, including gestational hypertension (GH) and preeclampsia (PE), may influence infant growth and have long-term health implications. This study aimed to compare growth outcomes of infants exposed to a normotensive pregnancy (NTP), GH, or PE from birth to 2 years. Methods: In...

Aims To determine the incidence of hospitalisation for all diagnoses among Australian youth with type 1 diabetes. Methods We linked Australians aged under 20 years with type 1 diabetes on the National Diabetes Services Scheme ( n = 45,685) to hospital admission data from 2010 to 2019. We determined relative risks (RR) of hospitalisation among thos...

Background In-utero hyperglycemia exposure influences later cardiometabolic risk, although few studies include women with pre-existing type 2 diabetes (T2D) or assess maternal body mass index (BMI) as a potential confounder. Objective To explore the association of maternal T2D and gestational diabetes mellitus (GDM) with childhood anthropometry, a...

Aim: To determine low-density lipoprotein cholesterol (LDL-C) screening frequency and levels, and factors associated with elevated LDL-C, in Australasian youth with type 1 diabetes (T1D). Methods: Data were extracted from the Australasian Diabetes Data Network (ADDN), a prospective clinical quality registry, on all T1D healthcare visits attended...

Aim: To compare HbA1c and clinical outcomes in adolescents and young adults with type 1 diabetes (T1D), with or without celiac disease (CD). Methods: Longitudinal data were extracted from ADDN, a prospective clinical diabetes registry. Inclusion criteria were T1D (with or without CD), ≥ 1 HbA1c measurement, age 16-25 years and diabetes duration...

We aimed to identify differences in care and outcomes of very young children with T1D onset from 3 multicenter registries from three continents: T1DX-QI (US), DPV (Germany/Austria/Switzerland/Luxembourg), and ADDN (Australia/New Zealand). These results are an update of 2,011 children of this age-group treated in 2011/2012 in European/US centers (Di...

Background: Enteroviruses are routinely detected with molecular methods within large cohorts that are at risk of type 1 diabetes. We aimed to examine the association between enteroviruses and either islet autoimmunity or type 1 diabetes. Methods: For this systematic review and meta-analysis, we searched PubMed and Embase for controlled observati...

Background: The Environmental Determinants of Islet Autoimmunity (ENDIA) pregnancy-birth cohort investigates the developmental origins of type 1 diabetes (T1D), with recruitment between 2013 and 2019. ENDIA is the first study in the world with comprehensive data and biospecimen collection during pregnancy, at birth and through childhood from at-ris...

Background: We sought research experiences of caregivers and their children were enrolled in the Environmental Determinants of Islet Autoimmunity (ENDIA) study. Methods: ENDIA is a pregnancy–birth cohort investigating early-life causes of type 1 diabetes (T1D). Surveys were sent to 1090 families between June 2021 and March 2022 with a median partic...

Aim: Hypertension increases complication risk in type 1 diabetes (T1D). We examined blood pressure (BP) in adolescents and young adults with T1D from the Australasian Diabetes Data Network, a prospective clinical diabetes registry in Australia and New Zealand. Methods: This was a longitudinal study of prospectively collected registry data. Incl...

Among the environmental factors associated with type 1 diabetes (T1D), viral infections of the gut and pancreas has been investigated most intensely, identifying enterovirus infections as the prime candidate trigger of islet autoimmunity (IA) and T1D development. However, the association between respiratory tract infections (RTI) and IA/T1D is comp...

Recent evidence suggests the immediate effects of the COVID‐19 lockdowns and restrictions have resulted in increased weight in children and adolescents. However, the longer‐term effects have not been assessed. The aim of this study was to examine the impact and longer‐term effects of the COVID‐19 pandemic on BMI and weight status of children and ad...

Background and objectives Preeclampsia is a serious multisystem blood pressure disorder during pregnancy that is associated with increased long-term risk of cardiovascular disease to the mother and offspring. We investigated the vascular health of children exposed to intrauterine preeclampsia. Materials and methods This was a cross-sectional study...

WHAT IS NEW OR DIFFERENT? For some people with cystic fibrosis (CF), a new and life-changing era has begun; however, for others, existing disparities have only increased. The lives of persons with CF (PwCF) have been profoundly changed by the advent of highly effective CF transmembrane conductance regulator (CFTR) modulator therapy (HEMT) (elexacaf...

Background The gastrointestinal ecosystem is a highly complex environment with a profound influence on human health. Inflammation in the gut, linked to an altered gut microbiome, has been associated with the development of multiple human conditions including type 1 diabetes (T1D). Viruses infecting the gastrointestinal tract, especially enterovirus...

OBJECTIVE The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term Hb...

Objective: To examine the prevalence, time trends, and risk factors of diabetic retinopathy (DR) among youth with type 1 diabetes (T1D) from 11 countries (Australia, Austria, Denmark, England, Germany, Italy, Luxemburg, Netherlands, Slovenia, United States, and Wales). Subjects and methods: Data on individuals aged 10-21 years with T1D for >1 ye...

Background Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and...

Since the 2018 ISPAD guidelines on this topic, follow‐up of large cohorts from around the globe have continued informing the current incidence and prevalence of co‐morbidities and complications in young adults with youth‐onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth‐onset T2D, the initial...

Aims: Islet autoantibody screening of infants and young children in the Northern Hemisphere, together with semi-annual metabolic monitoring, is associated with a lower risk of ketoacidosis (DKA) and improved glucose control after diagnosis of clinical (stage 3) type 1 diabetes (T1D). We aimed to determine if similar benefits applied to older Austr...

OBJECTIVE Cardiac autonomic neuropathy (CAN) may contribute to vascular complications in diabetes. We hypothesized that adolescents with CAN are at greater risk of diabetic retinopathy and early kidney dysfunction. RESEARCH DESIGN AND METHODS In this prospective longitudinal study of 725 adolescents with type 1 diabetes without retinopathy and alb...

OBJECTIVE Current guidelines recommend biennial diabetic retinopathy (DR) screening commencing at the age of 11 years and after 2–5 years’ duration of type 1 diabetes. Growing evidence suggests less frequent screening may be feasible. RESEARCH DESIGN AND METHODS Prospective data were collected from 2,063 youth with type 1 diabetes who were screene...

Objective To investigate the association between early life exposures during the first 1,000 days (conception to age 24 months) and aortic intima-media thickness (aIMT), an early indicator of cardiovascular disease (CVD) risk, in youth. Study design Databases MEDLINE, EMBASE, Scopus, CINAHL and AMED were searched from inception to July 2021. Eligi...

Background: Cardiovascular autonomic neuropathy (CAN) is an overlooked but common and serious diabetes complication. We examined CAN in youth with diabetes and associations with cardiovascular risk factors. Methods: This was a prospective cohort of youth aged <20 years with type 2 or type 1 diabetes (n=66/1153, median age 15.4/16.5 years, durati...

Hypertension increases complication risk in type 1 diabetes (T1D) . We examined blood pressure (BP) in young people with T1D from ADDN, a prospective clinical diabetes registry in Australia and New Zealand. Inclusion criteria: T1D (duration ≥1 year) and age 16-25 years at last visit (2011-2020) . Hypertension was defined as (on ≥3 occasions) systol...

The COVID-pandemic necessitated worldwide lockdowns in 2020, with restrictions on physical activity and changes in eating habits. We investigated temporal trends in BMI in three international T1D registries between 2018-2020. Data were extracted from DPV (Germany/Austria/Luxembourg/Switzerland) , T1D Exchange (T1DX, US) , and Australasian Diabetes...

The incidence of enterovirus D68 (EV-D68) in New South Wales, Australia, is unknown. As part of a state-wide surveillance program, enterovirus positive diagnostic specimens were assessed from patients presenting to hospitals with respiratory and meningitis syndromes from August 2018 to November 2019. Diagnostic enterovirus positive samples were col...

Background Few studies have assessed whether children exposed to in utero hyperglycaemia experience different growth trajectories compared to unexposed children. Objectives To assess association of type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) with early childhood weight, length/height and body mass index (BMI) trajectories, and wi...

Objective: To examine trends in diabetic retinopathy (DR) and diabetic macular edema (DME) in adolescents with type 1 diabetes between 1990 and 2019. Research design and methods: We analyzed 5,487 complication assessments for 2,404 adolescents (52.7% female, aged 12-20 years, diabetes duration >5 years), stratified by three decades (1990-1999, 2...

Here we report prolonged viral shedding for over 29 days of SARS‐CoV‐2 Delta variant (B.1.617.2) in six patients with severe coronavirus disease (COVID‐19) admitted to the intensive care unit (ICU). One patient remained culture positive 33 days after onset of disease. These features, including the persistence of high viral load (Ct < 30) in these p...

Objective: To describe bone mineral density (BMD), bone structure and fracture prevalence in adolescents with type 1 diabetes (T1D) and explore their associations with glycemic control and microvascular complications. Study design: Cross sectional study of 64 adolescents (38 males) with T1D duration >10 years who underwent dual-energy X-ray abso...

Background Neonatal diabetes mellitus (NDM) is a rare (1:90,000 newborns) but potentially devastating metabolic disorder characterized by hyperglycemia combined with low levels of insulin. Dominantly-acting insulin (INS) gene mutations cause permanent NDM through single amino acid changes in the protein sequence leading to protein misfolding, which...

Introduction: Type 2 diabetes in young adults (nominally, 18-30 years of age) is a more aggressive condition than that seen in older age, with a greater risk of major morbidity and early mortality. This first Australian consensus statement on the management of type 2 diabetes in young adults considers areas where existing type 2 diabetes guidance,...

This study aimed to explore the association between hyperglycemia in pregnancy (type 2 diabetes (T2D) and gestational diabetes mellitus (GDM)) and child developmental risk in Europid and Aboriginal women. PANDORA is a longitudinal birth cohort recruited from a hyperglycemia in pregnancy register, and from normoglycemic women in antenatal clinics. T...

Monogenic diseases can often manifest diverse clinical phenotypes and cause diagnostic dilemmas. While monoallelic loss-of-function variants in TNFAIP3 (Haploinsufficiency of A20; HA20) cause a highly penetrant autoinflammatory disease, the variable expressivity suggest a role for additional genetic and environmental disease modifiers. Here, we ide...

Background: The Environmental Determinants of Islet Autoimmunity (ENDIA) study is an Australia-wide pregnancy-birth cohort study following children who have a first-degree relative with type 1 diabetes (ACTRN1261300794707). A dedicated ENDIA Facebook page was established in 2013 with the aim of enhancing recruitment and supporting participant rete...

Aims/hypothesis We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control. Methods This was a prospective observational study in 710 normoalbuminuric...

OBJECTIVE Pregnancy and type 1 diabetes are each associated with increased anxiety and depression, but the combined impact on well-being is unresolved. We compared the mental health of women with and without type 1 diabetes during pregnancy and postpartum and examined the relationship between mental health and glycemic control. RESEARCH DESIGN AND...

Aims: Greater aortic intima media thickness (aIMT), a marker of subclinical atherosclerosis, can identify individuals at risk of CVD. This systematic review with meta-analysis compared aIMT in youth with type 1 diabetes and healthy controls. Methods: A systematic search of published literature (to July 2021) was undertaken using electronic datab...

Context Although HbA1c is currently the best parameter used clinically to assess risk for the development of diabetes complications, it does not provide insight into short-term fluctuations in glucose levels. This review summarises the relationship between continuous glucose monitoring (CGM)-derived metrics of glycaemic variability and diabetes-rel...

Aims Studies of the gut microbiome have focused on its bacterial composition. We aimed to characterize the gut fungal microbiome (mycobiome) across pregnancy in women with and without type 1 diabetes. Methods Faecal samples (n=162) were collected from 70 pregnant women (45 with and 25 without type 1 diabetes) across all trimesters. Fungi were anal...

Objective: To describe bone mineral density (BMD), bone structure, and fracture prevalence in adolescents with type 1 diabetes (T1D) and explore their associations with glycemic control and microvascular complications. Research design and methods: Cross sectional study of 64 adolescents (38 males) with T1D duration >10 years who underwent dual-ener...

Aim To determine advantages conferred by a youth-specific transition clinic model for young adults with type 1 diabetes (T1D) at Westmead Hospital (WH) as compared with Australian registry data. Methods Prospectively collected data included age, diabetes duration, visit frequency, post code, BMI, mode of insulin delivery, continuous glucose monito...

Background Neonatal diabetes mellitus (NDM) is defined as insulin-requiring persistent hyperglycemia occurring within the first 6 months of life, which can result from mutations in at least 25 different genes. Activating heterozygous mutations in genes encoding either of the subunits of the ATP-sensitive K⁺ channel (KATP channel; KCNJ11 or ABCC8) o...

In adults, there has been a decline in the incidence of diabetic retinopathy associated with improvements in diabetes management. Data on incident severe diabetic retinopathy in adolescents are sparse. In our established diabetes complications assessment service, we recorded nine cases of sight-threatening retinopathy in youth aged 15-17.9 years fr...

Aims/hypothesis The β-cell stress hypothesis suggests that increased insulin demand contributes to the development of type 1 diabetes. In the TRIGR trial we set out to assess the profile of plasma glucose and HbA1c before the diagnosis of clinical diabetes compared to nondiabetic children. A cohort of children (N = 2159) with an affected first-degr...

Background The gut microbiome changes in response to a range of environmental conditions, life events and disease states. Pregnancy is a natural life event that involves major physiological adaptation yet studies of the microbiome in pregnancy are limited and their findings inconsistent. Pregnancy with type 1 diabetes (T1D) is associated with incre...

Objectives: Distinct hemoglobin A1c (HbA1c) trajectories during puberty are identified in youth with established type 1 diabetes (T1D). We used data from 3 international registries to evaluate whether distinct HbA1c trajectories occur from T1D onset. Methods: Participants were <18 years old at diagnosis with at least 1 HbA1c measured within 12 m...

Background: There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD); however, findings in youth are inconsistent. Purpose: To perform a systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: DXA, peripheral quantitative computed tomography (pQCT), and/or...

For over a century, viruses have left a long trail of evidence implicating them as frequent suspects in the development of type 1 diabetes. Through vigorous interrogation of viral infections in individuals with islet autoimmunity and type 1 diabetes using serological and molecular virus detection methods, as well as mechanistic studies of virus-inf...

The Environmental Determinants of Islet Autoimmunity (ENDIA) Study is an Australia‐wide observational pregnancy‐birth cohort of children at genetic risk on account of a first‐degree relative with type 1 diabetes (1). 1511 participants were recruited from all Australian States and Territories from 2013‐2019 with 1473 live‐born infants in follow‐up....

Objective: The relationship between retinal vascular calibers (RVCs) and diabetic neuropathy is unclear. We investigated associations between RVCs and sensory nerve abnormality in adolescents with type 1 diabetes. Research design and methods: In a prospective longitudinal study of 889 adolescents with type 1 diabetes with baseline mean (±SD) age...

For over a century, viruses have left a long trail of evidence implicating them as frequent suspects in the development of type 1 diabetes. Through vigorous interrogation of viral infections in individuals with islet autoimmunity and type 1 diabetes using serological and molecular virus detection methods, and mechanistic studies of virus infected h...

The aim of this cross-sectional study was to compare plasma C-peptide presence and levels in people without diabetes (CON) and with Type 1 diabetes and relate C-peptide status to clinical factors. In a subset we evaluated 50 microRNAs (miRs) previously implicated in beta-cell death and associations with clinical status and C-peptide levels. Diabete...

Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating i...

Background The gut microbiome changes in response to a range of environmental conditions, life events and disease states. Pregnancy is a natural life event that involves major physiological adaptation yet studies of the microbiome in pregnancy are limited and their findings inconsistent. Pregnancy with type 1 diabetes (T1D) is associated with incre...

Accumulating evidence supports the high prevalence of co-infections among Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients, and their potential to worsen the clinical outcome of COVID-19. However, there are few data on Southern Hemisphere populations, and most studies to date have investigated a narrow spectrum of viruses using...