All HARPdoc RCT participants were attending specialist diabetes services, offering structured education (a requirement for participation) and access to technologies, particularly insulin pump therapy and/or CGM, with a mandate in the UK to be offered to those with hypoglycaemia.33,34 About 80% of participants had been offered pump and/or CGM, and although many had tried it, only 50% were using technology at baseline.35 This supports the hypothesis that unaddressed cognitive barriers may prevent successful engagement with conventionally offered support in an otherwise motivated group. The gene discussed is INS; the disease is diabetes mellitus.