Objective To assess the association between Life's Essential 8 (LE8) cardiovascular health score and prevalent microvascular complications in Chinese adults with type 2 diabetes mellitus (T2DM) and to explore whether this association differed by sex and menopausal status.Research design and methods We conducted a cross-sectional analysis of 4527 adults with T2DM in the Metabolic Management Center (MMC) registry. LE8 scores were calculated based on the American Heart Association framework and categorized into low, moderate and high tiers using the 25th and 75th percentiles as cut-offs. Prevalent composite microvascular complications were defined as diabetic kidney disease, diabetic retinopathy and/or diabetic peripheral neuropathy. Multivariable logistic regression estimated prevalence ORs and 95% CIs for the associations of LE8 scores with prevalent microvascular complications. Restricted cubic spline (RCS) analyses and interaction testing by sex and menopausal status were also conducted.Results Participants included 2894 men (63.9%), 557 premenopausal women (12.3%) and 1076 postmenopausal women (23.8%). Higher LE8 scores were associated with lower prevalence odds of microvascular complications. Compared with the low LE8 group, the adjusted prevalence OR for the high LE8 group was 0.43 (95% CI 0.36 to 0.52). The inverse association differed by sex and menopausal status (p for interaction=0.027) and appeared strongest in premenopausal women (high LE8 OR: 0.17, 95% CI 0.09 to 0.33). The RCS curves showed broadly similar inverse associations across groups.Conclusions Higher LE8 scores are inversely associated with prevalent microvascular complications in Chinese adults with T2DM. The inverse association appeared strongest in premenopausal women. These findings suggest that sex and menopausal status should be considered when interpreting the observed association.
Hyperglycemia is among the most common metabolic disturbances in critically ill patients, affecting up to 50% of adults admitted to intensive care units (ICUs), regardless of pre-existing diabetes. Both diabetes and stress-induced hyperglycemia are associated with increased risk of organ dysfunction, healthcare-associated infections, prolonged mechanical ventilation, longer ICU and hospital length of stay, and mortality. Clinical guidelines recommend initiating intravenous insulin therapy when blood glucose remains ≥180 mg/dL (10.0 mmol/L) and targeting 140–180 mg/dL (7.8–10.0 mmol/L) for most critically ill adults. Recent advances in continuous glucose monitoring, computerized insulin dosing algorithms, automated insulin delivery systems and artificial intelligence-enabled clinical decision support are transforming glucose management in the ICU and have the potential to improve safety and efficiency. This review summarizes current understanding of the pathophysiology of stress hyperglycemia, the clinical consequences of dysglycemia, contemporary glucose targets, insulin therapy and glucose monitoring strategies. We also highlight emerging technologies, special patient populations and future directions expected to shape precision glycemic management for critically ill adults.
Introduction Congenital heart disease (CHD) affects approximately 1% of live births. Advances in diagnosis and treatment have markedly improved survival, resulting in a growing adult CHD population with an increasing burden of chronic disease. Here we investigate the prevalence and impact of type 2 diabetes mellitus (T2DM) in patients with CHD.Research design and methods Cohort study from the Australian National CHD Registry, linked to national administrative health data. Control patients without T2DM were selected from the Registry and matched 3:1 by age, sex, rurality, and CHD complexity.Results Of the 58 523 individuals with CHD in the registry, 2077 (3.55%) were identified as having T2DM. Median age was 43.1 (IQR 32.0–57.9) years, and 51% were female. T2DM was associated with a hazard ratio for all-cause mortality or heart transplantation of 1.51 (95% CI 1.31 to 1.73; p<0.001). 27.6% of CHD patients with T2DM experienced any major adverse cardiovascular event (MACE) versus 10.2% of controls (p<0.001). Patients with T2DM had a higher MACE rate (rate ratio 2.87, p<0.001) and had more MACE per patient (odds ratio 4.11, p<0.001) compared with controls. Individuals with T2DM also had significantly higher rates of emergency department presentations than controls (incidence rate ratio 2.35, p<0.001) and higher rates of hospital admissions (incidence rate ratio 2.87, p<0.001).Conclusion T2DM in patients with CHD is associated with significantly lower transplant-free survival, substantially increased MACE, and greater healthcare utilization compared to matched CHD controls.
Introduction Extended-wear continuous glucose monitoring (CGM) may reduce device burden in pediatric type 1 diabetes (T1D), but accuracy must be maintained throughout the labeled sensor lifetime. This study was designed to evaluate device performance under routine clinical conditions rather than under controlled laboratory conditions. We evaluated the real-world accuracy, 21-day wear-period performance, glycemic profile, and user satisfaction of the Instara-1 21-day CGM system.Research design and methods CGM readings were paired with the temporally nearest capillary reference glucose value within the predefined matching window. Sensor accuracy was assessed by calculating the mean absolute relative difference (MARD) using paired capillary fingerstick blood glucose measurements as the reference. The primary accuracy analysis used the ±10-minute matching window after exclusion of values flagged as >50% outliers. Accuracy was assessed using MARD, ±20/20 agreement, Bland-Altman analysis in both absolute and relative percentage terms, daily MARD across 21 days, and glucose-range stratification. CGM-derived glycemic metrics were summarized in 52 participants, and user satisfaction was evaluated with a Turkish questionnaire validated for children and adolescents.Results The primary ±10-minute analysis included 2386 paired values. Overall, MARD was 8.4%, median ARD was 5.4%, and CGM-reference correlation was strong (r=0.965). Overall, 90.7% of paired values were within the ±20/20 agreement band. Bland-Altman analysis showed a small negative absolute bias (−6.2 mg/dL; 95% limits of agreement −50.6 to +38.2 mg/dL) and a relative percentage bias of −3.1% (95% limits of agreement −28.4% to +22.1%). Daily MARD remained stable across 21 days, and all sensors except one completed the full 21-day wear period. In the 52-patient cohort, mean glucose was 176.98±42.37 mg/dL, time in range was 52.74±20.34%, and coefficient of variation was 39.36±8.24%. In the analytical satisfaction dataset, the total satisfaction score was 4.35±0.61, and 78.4% had a total score ≥4.Conclusions The Instara-1 21-day CGM system demonstrated clinically acceptable real-world accuracy in pediatric T1D, with stable performance across the full labeled wear period and high user satisfaction.
Introduction Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes when tight glycemic control is not achieved. Insulin therapy is frequently required to manage fasting hyperglycemia; however, optimal initiation and titration remain challenging within the short treatment window. Weight-based approaches are commonly used to guide insulin prescribing in clinical practice. This study aimed to evaluate whether baseline clinical characteristics, including pre-pregnancy weight and body mass index (BMI), predict insulin requirements in women with GDM.Research design and methods We conducted a retrospective cohort study of women with GDM managed using a rapid insulin titration protocol at our center between 2022 and 2023. Baseline demographic and clinical characteristics, including pre-pregnancy body weight, BMI, and oral glucose tolerance test (OGTT) results, were used to predict the initial insulin dose required to achieve glycemic targets and the maximum insulin dose required during pregnancy.Results Insulin therapy was initiated in 58 women. Marked interindividual variability was observed in both the insulin dose required to achieve glycemic targets and the maximum insulin dose administered. Regression analyses demonstrated poor predictive performance of pre-pregnancy weight and BMI to reliably predict insulin requirements, as reflected by low R² values: initial insulin dose required to achieve glycemic target using weight (R²=0.61) or BMI (R²=0.58) and maximum insulin dose required using weight (R²=0.30) or BMI (R²=0.36).Conclusions Pre-pregnancy weight and baseline BMI have limited utility in predicting insulin requirements in women with GDM. A fixed starting dose with rapid glucose-based titration may represent a more robust way to achieve individualized insulin dose requirements in GDM.
