There were huge impacts in terms of their quality of life, both on the adolescents themselves but also on their parents and their families. And actually, many of these children described not having that much difference in their day-to-day activities after they were diagnosed with type 1 diabetes compared to beforehand. And they had no idea what living with type 1 diabetes was without a hybrid closed loop system. So, almost by its own success, these children didn’t notice a difference in their lives, which I think is a really compelling finding. My name is Charlotte Boughton. I’m a clinical researcher at the University of Cambridge in the UK, working in closed-loop research. I was one of the clinical investigators at the coordinating site of the CLOuD study, which is the longest closed-loop study in children and adolescents with type 1 diabetes from diagnosis, and we followed these children up for four years, and the results were recently published. The study was designed to see whether a period of intensive insulin management could protect the beta cell function and preserve endogenous insulin secretion in children and adolescents recently diagnosed with type 1 diabetes. We used the Cambridge hybrid-closed loop system, and 97 children were randomised to receive either the hybrid closed-loop technology for a period of four years or standard therapy. And during the standard therapy, many of the children were using other diabetes technologies, glucose sensors, insulin pumps, and eventually 15 % by the end of the study were also using hybrid closed-loop systems. There’s some early data from the 1980s which showed that a period of intensive insulin management in-hospital shortly after diagnosis led to improved beta cell function at 12 months. Since then, there’ve been a couple of other studies which have gone against that finding. And I think there’ll always be a question as whether earlier improved glycaemic control or more intensive insulin management could address that, and what the study showed was that despite improving glucose outcomes, so HbA1c and time in target glucose range, there was no difference between the two groups in the amount of endogenous insulin secretion at 12 months, 24 months, three years and four years. And this was actually repeated by a similar study in the US that followed children up for one year. So we're quite confident in the findings that with existing tools and allowing these children to undertake free-living with their type 1 diabetes, there is no way that we can affect the decline in C-peptide secretion that occurs after diagnosis. Using technology where it is at the moment is not going to be able to address that problem. It hasn’t completely closed the door for it, so we need to look at other mechanisms to delay beta cell decline. There were lots of other things that we learned whilst were doing this study. We have four years of hybrid closed-loop data, so lots for us to look into. Not only were we able to maintain improved glycaemic outcomes over the period of four years during adolescence, which is a really challenging period for young people to manage their diabetes, but this was significantly better than in the control group when people use closed-loop. There were huge impacts in terms of their quality of life, both on the adolescents themselves, but also on their parents and their families. And actually, many of these children described not having that much difference in their day-to-day activities after they were diagnosed with type 1 diabetes compared to beforehand. And they had no idea what living with type 1 diabetes was without a hybrid closed-loop system. So almost by its own success, these children didn’t notice a difference in their lives, which I think is a really compelling finding. We showed that the variability of day-to-day incident requirements in this cohort is really high. So it’s really challenging to manage that with standard non-automated insulin therapies. It’s as variable as it is in very young children where we think there’s a really strong indication for using automated insulin delivery. We also showed that it was safe in this cohort. The algorithm was adaptive enough to be able to manage with that variability. And one of the other findings that we showed was also that in those children who were diagnosed in DKA, which historically has been associated with worse glycaemic outcomes, more hypoglycaemia, and greater risk of complications, actually at two years, the glycaemic control was the same in the closed-loop group in those who had DKA diagnosis and in those who didn’t. They also had really minimal burden of diabetes management. These children were spending ten minutes a day managing their diabetes, which was reflected in the interview studies where actually people didn’t notice a big disruption in their lives after their diagnosis of type 1 diabetes. As a consortium, we very strongly advocate for use of automated insulin delivery systems right after diagnosis of type 1 diabetes. One of the sub-studies we did was to interview healthcare professionals working with participants in the study, and they suggested that, actually, the preconceptions and the biases of healthcare professionals were not reflected in how those participants manage with the system. So, to avoid inequities and increasing disparities in access to technology, this needs to be offered to everybody with type 1 diabetes. If they decline because of their personal preference, absolutely fine, but we shouldn’t be selecting people based on any psychological or educational factors, because those that need it the most are often deprived of this technology. So, really easy question. Everyone should be offered it, and then it’s their personal choice.