Background Insulin patch pumps offer advantages over multiple daily injections (MDI) for pediatric diabetes, but randomized trial evidence in Chinese children remains limited. Objectives To evaluate the efficacy and safety of a tubeless insulin patch pump (Equil™) compared with MDI in children and adolescents with diabetes. Methods This multicenter, open-label, randomized, crossover, non-inferiority trial was conducted at seven pediatric endocrinology centers in China (September 2021 – October 2022). Patients aged 3–17 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were randomized 1:1 to receive continuous subcutaneous insulin infusion (CSII) via Equil™ or MDI via insulin pen for 5 days, followed by crossover. The primary outcome was mean blood glucose (MBG). Non-inferiority margin was pre-specified as 0.386 mmol/L. Secondary outcomes included glycemic variability (standard deviation of blood glucose, SDBG), glycated albumin (GA), total daily insulin dose (TDD), hypoglycemia frequency, and adverse events. Patient satisfaction was assessed using a study-specific 11-item questionnaire. Results Of 74 enrolled patients, 72 (97.3%) completed the study. CSII demonstrated non-inferiority to MDI for MBG (8.43±1.88 mmol/L, n=74, vs 9.00±2.04 mmol/L, n=72); mean difference -0.606 mmol/L; 95% CI -0.988 to -0.223; upper CI limit -0.223 < non-inferiority margin 0.386. No significant differences were observed for secondary outcomes (SDBG: 3.019 vs 3.357; GA change: 2.52±3.03% vs 2.02±3.25%, p=0.184; TDD: 132.17±78.43 vs 147.52±91.59 IU, p=0.159; hypoglycemia events: 114 vs 106). Adverse event rates were similar (75.7% vs 69.4%, p=0.399); no serious adverse events occurred. Patient satisfaction was significantly higher with CSII (total score 21.03±4.47 vs 22.00±3.99; mean difference -0.97, 95% CI -1.75 to -0.19; p=0.015), with 68.1% of patients preferring the patch pump. Conclusion The Equil™ patch pump is non-inferior to MDI in terms of glycemic control and safety for pediatric diabetes patients, with higher patient satisfaction. These findings support the patch pump as an effective alternative for children and adolescents requiring exogenous insulin therapy.
Background The changes that occur over time in the estimated glomerular filtration rate (eGFR) of transgender individuals receiving hormone therapy, and the factors that influence these changes, have not yet been fully evaluated. Methods This is a longitudinal study based on a retrospective cohort of transgender people treated at Hospital Universitario San Ignacio in Bogotá, Colombia. Changes in eGFR (calculated using the CKD-EPI 2021 formula for both sexes) were analyzed over 36 months. The impact of age, BMI, previous gender affirmation surgery and hormone therapy was analyzed using a generalized estimating equation (GEE) model. Results 166 transgender patients were included in the study (Median age 29 years, 94 women and 72 men). For transgender women, eGFR did not change over time; however, estrogen therapy was associated with a higher eGFR (+17.2 ml/min/1.73 m 2 , p<0.05). In transgender men, both CKD-EPI 2021 formulas showed a significant decrease in GFR over time. The GEE model showed a significant change in eGFR ranging from -0.63 to -0.79 per month (p < 0.05), depending on the formula used. A significant impact of age on eGFR was demonstrated in both groups. Conclusion This study suggests that transgender women did not experience significant changes in eGFR over time. Estrogen use showed a possible positive modyfing effect on eGFR. In transgender men, an overall decrease in eGFR was evident over time. Our findings emphasize the need for periodic renal assessment in transgender individuals using the same evaluation formula, and highlight the need to optimize the available diagnostic tools.
Background and Aims Type 2 diabetes mellitus (T2DM) is the leading global cause of end-stage kidney disease (ESRD). Patients receiving hemodialysis often have a high cardiometabolic risk profile, including insulin resistance, glycemic variability, chronic inflammation, sarcopenia, and altered mineral metabolism. In this setting, standard glycemic markers are often unreliable, supporting the use of additional non-pharmacological strategies, particularly structured physical activity, alongside standard treatment. This narrative review synthesizes current evidence on metabolic dysregulation in hemodialysis patients with T2DM and evaluates the potential role of intradialytic exercise as a multi-target intervention. Methods A focused narrative search was conducted in PubMed, Scopus and Web of Science (2014–2025). Randomized trials, observational studies, clinical guidelines and narrative reviews addressing key metabolic and musculoskeletal complications, CKD-MBD, and intradialytic exercise in advanced kidney disease were considered. Conclusions Intradialytic exercise represents a feasible adjunct strategy targeting interconnected metabolic pathways in patients with T2DM and ESRD. Further large-scale prospective studies are warranted to define the optimal intensity, modality and timing of intradialytic exercise and to clarify its long-term cardiometabolic and clinical benefits.
Objective Evidence on advanced hybrid closed-loop (AHCL) systems in older adults with type 1 diabetes (T1D) remains limited. This study compared the effectiveness and safety of the MiniMed 780G system between adults aged ≥60 years and younger adults. Methods We conducted a cross-sectional study in patients with T1D using the MiniMed 780G system. Eligible participants were aged ≥40 years and had used the device for at least four weeks before study entry. Clinical variables, body composition, grip strength, and glycemic outcomes were compared according to age group (<60 vs. ≥60 years). Results A total of 118 patients were included, 45% of whom were aged ≥60 years. In this group, 79% were independent for basic activities of daily living and 60% used SmartGuard at optimal settings. Glycemic management was similar in both age groups, including time in range (76.58±8.59 vs. 76.73±9.58; p=0.535), time in tight range (52.0±10.02 vs. 52.75±10.73; p=0.694), and time below range <70 mg/dL (1.39±1.33 vs. 1.81±1.39; p=0.100). In adjusted ANCOVA models, age group was not significantly associated with either TIR or TITR. Optimal SmartGuard settings, grip strength, fat mass, and phase angle were more strongly associated with glycemic profile than age. Conclusions MiniMed 780G use was safe and effective in older adults with T1D, achieving glycemic outcomes comparable to younger adults. Optimal SmartGuard settings are associated with a better metabolic profile and should be considered regardless of age. Additionally, grip strength and body composition should be included in the clinical assessment of patients with T1D using AHCL systems.
Background:A knowledge gap persists regarding whether virtual training differs from in-person training in terms of metabolic control and clinical safety among adults with type 1 diabetes mellitus (T1D) initiating the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system. Methods:Observational study comparing two retrospective cohorts of adult patients with type 1 diabetes mellitus (T1DM) treated with the Medtronic MiniMed™780G hybrid closed-loop insulin automation system: one cohort trained in-person and a second cohort trained virtually at the Hospital Universitario San Ignacio, Bogotá (Colombia). Metabolic control and safety parameters were evaluated 12 weeks after training initiation. A logistic regression model was developed to identify factors associated with meeting glycemic target (Time in range 70-180 mg/dL ≥ 70%) at 12 weeks. Results:191 patients were analyzed; (49.7% virtual 50.3% in-person training). After 12 weeks, no statistically significant differences were observed in TIR between the cohorts (75% vs. 77.5%, p = 0.51). Severe hypoglycemia (<54 mg/dL) decreased significantly in both groups (p<0.02), without differences between cohorts. The type of training was not significantly associated with achieving the goals of TIR (adjusted OR 0.78; 95% CI:0.16-3.82; p=0.76). Younger age (<45 years) was independently associated with improved metabolic control (adjusted OR 0.08; 95% CI:0.01-0.75; p=0.02). Higher socioeconomic status showed a trend toward better outcomes (adjusted OR 35.04; 95% CI:0.94-1260.6; p=0.05). Conclusions:Both virtual and in-person training are effective and safe strategies for initiating the MiniMed™ 780G AHCL system in adults with T1D, with no significant differences between training modalities.
