BACKGROUND:While glucagon plays a role in hepatic lipid metabolism, alterations in circulating glucagon profiles and hepatic glucagon signaling in metabolic dysfunction-associated steatotic liver disease (MASLD) in humans remain unclear. We aimed to investigate the relationship between MASLD severity and plasma glucagon dynamics, and evaluate hepatic glucagon signaling using human liver tissue. METHODS:This retrospective cross-sectional study included 137 adults with prediabetes or type 2 diabetes who underwent a 75 g oral glucose tolerance test (OGTT) with fasting and 2-h plasma glucagon measurements. MASLD severity was assessed using noninvasive scores and transient liver elastography. To evaluate hepatic glucagon signaling across MASLD severity, human liver tissue transcriptome and single-cell RNA sequencing were analyzed. RESULTS:Participants with moderate-to-severe hepatic steatosis or high-risk metabolic dysfunction-associated steatohepatitis exhibited a lower integrated glucagon response, assessed by glucagon AUC during the 2-h OGTT, than their respective control groups (46,500 vs. 60,480 pg·min/ml, P = 0.006; and 43,680 vs. 52,620 pg·min/ml, P = 0.014, respectively). In contrast, there was no significant association between plasma glucagon levels and fibrosis severity. Transcriptomic analyses revealed downregulation of the glucagon receptor (GCGR) and downstream signaling pathways in liver tissues from individuals with MASLD, particularly within hepatocytes from those with advanced disease. CONCLUSION:Among individuals with prediabetes or type 2 diabetes, greater hepatic steatosis and inflammation are associated with lower circulating glucagon levels and attenuated hepatic glucagon signaling. These findings may provide a basis for future investigation of glucagon-based therapeutic approaches.
AIMS:Pancreatic cancer disrupts islet cell function producing pancreatogenic diabetes, which may precipitate diabetic ketoacidosis (DKA). No national study has characterized DKA prevalence or outcomes among pancreatic cancer hospitalizations. We aimed to address this gap using the National Inpatient Sample (NIS). METHODS:We analyzed using NIS 2021-2023. Adult pancreatic cancer hospitalizations (ICD-10-CM C25) were stratified by concurrent DKA (E08.1-E13.1). The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), mechanical ventilation, septic shock, cardiac arrest, ICU, venous thromboembolism, palliative care consultation, length of stay, and total charges. Multivariable logistic regression adjusted for age, sex, race/ethnicity, income quartile, primary payer, Elixhauser comorbidity category, DM type, and hospital characteristics. RESULTS:Of 218,815 pancreatic cancer hospitalizations, 0.95% (n ≈ 2075) had concurrent DKA. 86.3% had Type 2 DM, while fewer than 2% had type 3c DM. DKA patients were younger, more likely Black (21.9%vs. 14.2%), and had higher comorbidity burden. After multivariable adjustment, DKA independently predicted mortality (aOR 1.76, 95% CI 1.30-2.38), AKI (aOR 3.09, 95% CI 2.49-3.83), mechanical ventilation (aOR 2.78, 95% CI 1.92-4.03), ICU (aOR 2.49, 95% CI 1.90-3.27), septic shock (aOR 2.53, 95% CI 1.86-3.43), and cardiac arrest (aOR 2.40, 95% CI 1.33-4.34). CONCLUSION:DKA complicates approximately 1% of US pancreatic cancer hospitalizations and independently predicts doubled mortality and markedly greater critical care utilization. Black patients and lower socioeconomic groups are disproportionately affected, identifying high-risk subgroups for targeted glycemic surveillance.
AIM:To compare all-cause mortality in adults with T2D initiating sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP-4is) using a large multinational real-world dataset. METHODS:We conducted a retrospective, multinational, active-comparator, new-user cohort study using de-identified electronic health records from TriNetX (2015-2019). Adults aged >18 years with T2D who initiated a SGLT2i or DPP-4i after ≥12 months of continuous therapy were eligible. Propensity score matching (1:1 nearest neighbor) yielded 161,950 patients per group. All-cause mortality over 5 years was evaluated using a Cox proportional-hazards model to estimate hazard ratios and 95% confidence intervals. Kaplan-Meier curves were generated to compare cumulative mortality between groups. Sensitivity analyses and external validation in an independent Hong Kong/Singapore cohort were performed. RESULTS:Among 449,295 eligible patients, 161,950 initiated a SGLT2i and 161,950 initiated a DPP-4i after matching. Over 5 years, all-cause mortality was markedly lower in the SGLT2i group (9965 deaths; 6.2%) than in the DPP-4i group (27,330 deaths; 16.9%). Kaplan-Meier estimates showed cumulative mortality rates of 13.16% and 26.05% in the SGLT2i and DPP-4i groups, respectively. SGLT2i use was associated with a significantly reduced mortality risk (Hazard ratios 0.513; 95% confidence intervals 0.502-0.525; P < 0.001). Subgroup analyses revealed consistent reductions in mortality across sex, age categories, and baseline glycemic control levels. External validation confirmed improved survival associated with SGLT2i therapy. Collectively, these findings demonstrate a robust survival advantage of SGLT2is over DPP-4is. CONCLUSIONS:SGLT2is were consistently associated with significantly lower all-cause mortality than DPP-4is. These results underscore their clinical value and support SGLT2is as a preferred therapeutic option for patients with T2D.
OBJECTIVE:The Glycemic Risk Index (GRI) is a novel composite glycemic indicator, but its role in peripheral atherosclerotic lesions in type 2 diabetes (T2D) remains unclear. This study examined the association between GRI and the severity of peripheral atherosclerotic lesions in T2D patients and assessed its value in identifying high-risk individuals. METHODS:This retrospective study included 878 T2D patients hospitalized at the Second Hospital of Jilin University from October 2023 to October 2025. Patients were divided into no-lesion (n = 88), single-lesion (n = 287), and dual-lesion (n = 503) groups by carotid plus lower extremity arterial ultrasound examinations and stratified by GRI quartiles. The performance of GRI in identifying vascular lesion risk was compared with traditional indicators, including TIR and HbA1c. Multivariate ordinal logistic regression and subgroup analyses were conducted. RESULTS:Higher GRI quartiles were associated with poorer glycemic control, greater variability, and higher prevalence of peripheral atherosclerosis (86%-95% from Q1 to Q4), while TIR and HbA1c showed no similar trend. After full adjustment, the highest GRI quartile conferred a 76% higher risk of more severe atherosclerosis versus Q1 (OR = 1.76, 95%CI:1.15-2.70, P = 0.009; P for trend = 0.002). This association was stronger in overweight patients (BMI≥24 kg/m², P for interaction = 0.03). CONCLUSION:GRI is independently and positively associated with the severity of peripheral atherosclerotic lesions in T2D and outperforms traditional glycemic indicators, especially in overweight individuals, supporting its clinical use for atherosclerosis risk stratification.
AIM:Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated substantial metabolic benefits, but their association with pancreaticobiliary cancer risk remains unclear. We investigated the association between GLP-1RA use and pancreaticobiliary cancer incidence in patients with type 2 diabetes (T2D). METHODS:This population-based cohort study used Korean National Health Insurance Service data from 2011 to 2023. We identified 51,780 patients with T2D receiving metformin plus sulfonylurea who initiated either GLP-1RA (n=24,052) or dipeptidyl peptidase-4 inhibitor (DPP-4i, n=27,728). The primary outcomes were incident pancreatic cancer, bile duct cancer, gallbladder cancer, and composite pancreaticobiliary cancer. Hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for demographics, comorbidities, and previous diabetes medications. RESULTS:During 208,992 person-years of follow-up (mean 4.0 years), 321 pancreaticobiliary cancers occurred. GLP-1RA use was associated with a significantly lower risk of pancreatic cancer (adjusted HR 0.668, 95% CI 0.476-0.939). Similar trends were observed for bile duct cancer (adjusted HR 0.649, 95% CI 0.375-1.124), gallbladder cancer (adjusted HR 0.418, 95% CI 0.171-1.019), and composite pancreaticobiliary cancer (adjusted HR 0.681, 95% CI 0.515-0.901). These associations remained consistent in a propensity score-matched analysis and after excluding patients with baseline pancreaticobiliary disease. CONCLUSION:In this large cohort study, GLP-1RA use was associated with reduced pancreatic cancer risk compared with DPP-4i use among patients with T2D. Similar trends were observed for other pancreaticobiliary cancers. These findings suggest potential protective effects that warrant confirmation in longer-term studies.
AIM:To report two cases of immune-mediated severe hyperinsulinemia-Type B Insulin Resistance Syndrome (TBIRS) and Exogenous Insulin Antibody Syndrome (EIAS)-and to highlight the clinical clues for differential diagnosis and the divergent therapeutic strategies. METHODS:Detailed clinical, biochemical, and immunological evaluations of two patients with extreme hyperinsulinemia (>350 µU/ml) and refractory hyperglycemia were performed, including polyethylene glycol (PEG) precipitation and insulin recovery assays. RESULTS:Patient 1, a 59-year-old woman with type 2 diabetes and pulmonary tuberculosis, had insulin levels exceeding 1000 µU/ml with positive anti-insulin receptor antibodies, confirming TBIRS. Active tuberculosis contraindicated immunosuppression and hyperglycemia persisted. Patient 2, a 61-year-old man with type 2 diabetes, had insulin levels of 767.7-833.9 µU/ml with strongly positive anti-insulin antibodies. PEG precipitation revealed an insulin recovery of 28.6% and a free-to-total insulin ratio of 6.8%, confirming EIAS. Insulin discontinuation and corticosteroids achieved glycemic control. CONCLUSION:TBIRS and EIAS, though both presenting with extreme hyperinsulinemia, require fundamentally different management strategies. Comorbidities such as active tuberculosis may preclude immunosuppressive therapy in TBIRS, creating therapeutic dilemmas. In EIAS, when initial insulin modification fails to resolve glycemic instability, timely escalation to glucocorticoid therapy can achieve sustained immunological remission and durable glycemic control.
AIM:Older adults living with type 2 diabetes represent a particularly vulnerable population. We investigated which continuous glucose monitoring (CGM)-derived targets are associated with all-cause mortality in this population. METHODS:HYPOAGE is prospective multicenter study including 141 insulin-treated older adults living with type 2 diabetes aged 75 and older, under insulin therapy for at least 6 months. All participants underwent standardized geriatric and diabetic assessments and wore an ambulatory blinded CGM (FreeStyle Libre Pro®) for 28 consecutive days. In this ancillary study, multivariable cox regressions were performed to identify factors associated with mortality after adjustment for age, sex, HbA1c, kidney function, geriatric status, and metformin use. RESULTS:At baseline, participants were 81.5 years old on average. After a median follow-up of 44 months, 58 of 141 patients had died. In adjusted model, higher percentages of level 1 time below range (TBR), level 2 TBR and glycemic variability assessed by the coefficient of variation (CV) were independently associated with an increased mortality risk (hazard ratio [95% CI] 1.51 [1.11; 2.06], 1.25 [1.02; 1.53], and 1.76 [1.21; 2.56] for an interquartile range (IQR)% increase of each parameter, respectively). When recommended CGM targets were considered, only glycemic variability (CV ≤ 36%), remained significantly associated with a lower risk of mortality (hazard ratio 0.57 [0.32; 0.99]), whereas TIR > 50% and TBR ≤ 1% were not. CONCLUSION:Among insulin-treated older adults living with type 2 diabetes, glycemic variability was independently associated with all-cause mortality, highlighting its potential relevance for clinical management in geriatric diabetes care.
BACKGROUND/OBJECTIVES:- Despite advances in automated insulin delivery, hypoglycemia remains a major challenge in pediatric type 1 diabetes. We aimed to characterize, in real-world practice, the burden, awareness, and daily-life impact of hypoglycemia and severe hypoglycemia (SH), and to identify gaps in perception and management. METHODS:- We conducted a prospective, descriptive, multicenter study using the new GLUREDIA questionnaire, administered during routine pediatric diabetes visits across six centers in Belgium and Luxembourg. This structured, study-specific, semi-quantitative tool assessed hypoglycemia frequency, symptom severity, perceived glycemic thresholds, SH history and management, and post-SH behavioral adaptations. Hypoglycemia awareness was evaluated using items aligned with Clarke score domains. RESULTS:- Among 232 participants, 55.9% reported hypoglycemia at least weekly, with moderate-to-high symptom severity. Cognitive and daily-life symptoms (impaired focus, fatigue, hunger, tremor) were reported by >60% and interfered with activities. Hypoglycemia was identified as the dominant disease burden by 39.7% of participants. Hypoglycemia-related symptom burden remained substantial and was not fully explained by CGM-derived metrics. SH was reported by 45.7%, without clear cause in 29.1%. Recommended management, including glucagon use, was inconsistently applied, even in recurrent SH. Following SH, participants reported insulin dose reductions (27.4%), increased sugar intake (21.1%), and avoidance of physical activities (22.1%), as adaptations. The Epi-GLUREDIA questionnaire demonstrated promising discriminative ability against the Clarke score (AUC = 0.84), supporting its construct validity. CONCLUSIONS:- Despite advances in diabetes technology, hypoglycemia remains highly prevalent, impactful, and often poorly anticipated in pediatric type 1 diabetes. Gaps in SH management and hypoglycemia awareness, together with post-event adaptations, highlight the need for integrated strategies combining education, behavioral support, optimized use of technologies, and improved implementation of guidelines, including appropriate glucagon use, to improve hypoglycemia safety, recognition, and long-term outcomes in pediatric type 1 diabetes. SUMMARY:Hypoglycemia remains frequent and impactful in pediatric type 1 diabetes, with variable symptom thresholds, unexplained severe hypoglycemia, management gaps, and post-event adaptations that may impair glycemic control.
BACKGROUND AND HYPOTHESIS:While physical activity (PA) is associated in observational studies with cardiovascular and renal protection few interventional studies have assessed its long-term effect on renal outcomes. This study is the first to specifically evaluate the impact of high-intensity PA on the slowing of renal function decline in type 2 diabetes (T2D) patients at high risk for kidney disease. METHODS:ActiDiaNe is an open, randomized controlled trial involving patients with T2D (pT2D) and rapid renal function decline (eGFR slope < -5 ml/min/year over 6-24 months). Participants were randomized to high-intensity PA (HIPA) or standard PA counseling (STPA) for two years. The primary endpoint was the slope of decline in cystatin C-derived eGFR (cys-eGFR). RESULTS:Across 21 centers, 178 patients were screened, 122 randomized, and 103 (29 women/74 men) analyzed for the primary endpoint (59 HIPA vs. 44 STPA). At baseline, mean age was 66 ± 8 years, median cys-eGFR was 54 ml/min/1.73m² (37; 65), and median eGFR decline was -9 ml/min/year (-12; -7). The primary endpoint showed a decline of -2.05 ml/min/year (95% CI: -3.46 to -0.64) in HIPA vs. -2.77 ml/min/year (95% CI: -4.40 to -1.14) in STPA (P = 0.512). Cardiovascular events and deaths occurred in 10 (17%) HIPA vs. 6 (14%) STPA patients (P = 0.646), with 3 deaths in HIPA (none of them protocol-related). Hypoglycemia was reported in 32 HIPA vs. 26 STPA patients (P = 0.623). CONCLUSION:In pT2D with rapid renal function decline, HIPA did not significantly alter renal function decline compared to STPA.
BACKGROUND:Despite recent progress in insulin delivery, carbohydrate counting is essential for determining prandial insulin doses and is, therefore, a key component of education for patients living with type 1 diabetes (PwT1D). This study aimed to evaluate the relationship between carbohydrate knowledge and glycemic control. METHODS:Carbohydrate knowledge was assessed using GluciQuizz, a validated, self-administered questionnaire totaling 36 points submitted to participants in the SFDT1 cohort. Glycemic control was determined using a 14-day time in range (TIR, 70-180 mg/dl) RESULTS: The median age of the 635 participants was 43 [interquartile range 32-54] years, T1D duration of 25 [14-36] years. The median overall GluciQuizz score was 25 [23-28]: 24 [21-27] among the 158 participants treated with multiple daily injections (MDI), 25 [22-27] among the 255 users of continuous subcutaneous insulin infusion (CSII), and 26 [24-29] among the 222 users of automated insulin delivery (AID) systems. Median TIR (%) was: overall 68 [55-77]; MDI 60 [50-72]; CSII 62 [49-73]; AID 75 [69-82]. The total GluciQuizz score was positively associated with TIR in the overall population (β ± SE = 0.04 ± 0.01; P < 0.001). This association remained significant in CSII users (β ± SE = 0.06 ± 0.02; P < 0.001) but not in those treated with MDI (P = 0.19) or AID (P = 0.55). CONCLUSIONS:Better carbohydrate knowledge is independently associated with improved glycemic control in PwT1D using CSII but not among those using MDI or AID systems. These findings highlight the continued relevance of structured nutritional education, particularly for individuals using CSII.
Aim Patients with type 2 diabetes (T2D) and obesity are at increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD) with advanced fibrosis (AF), requiring systematic non-invasive assessment using liver stiffness measurement (LSM) or the ELF test. However, access to these biomarkers remains limited in diabetology. We therefore evaluated the diagnostic performance of a new point-of-care ultrasound device, Hepatoscope, for the risk stratification of AF. Methods Participants with T2D and/or obesity and MASLD age 40-80 years, BMI <40 kg/m2 prospectively included in a multi-centre study (NCT04435054) underwent LSM using vibration controlled transient elastography (LSM-VCTE, FibroScan) and 2D-transient elastography (LSM-2DTE) using Hepatoscope version 1 and ELF. Post-acquisition reprocessing of the LSM-2DTE data using the CE approved version 2 (LSM-2DTE-2) was performed in a subgroup of n=120 participants. The area under the ROC curve (AUROC) and 95% confidence interval (CI) were assessed for the detection of intermediate to high-risk of AF, defined by LSM-VCTE ≥ 8 kPa. Results Among 294 participants (83.3% T2D, 42.5% female, 71.4% obesity), 24.8% had LSM-VCTE ≥ 8kPa. Significant correlation was observed between LSM-VCTE and LSM-2DTE-1 r: 0.37 [0.26-0.47], P < 0.001 and was higher between LSM-VCTE and LSM-2DTE-2: r: 0.61 [0.47-0.71], P < 0.001. In the subgroup of 120 participants, the AUROC (95%CI) of LSM-2DTE-2 for the detection of LSM-VCTE ≥ 8kPa was 0.81 (0.72-0.89) compared to 0.64 (0.52-0.75) for ELF. Conclusion This proof-of-concept study provides evidence supporting the role of LSM-2DTE using the Hepatoscope in the risk stratification of AF in diabetology settings. Larger studies are needed to validate its performance.
Background The impact of insulin-resistance on bone mineral density (BMD) remains unclear. Sclerostin inhibits bone formation, and increases with ageing, metabolic syndrome, and renal failure. Genetically-determined low sclerostin levels are associated with high BMD. Our aim was to determine the bone phenotype and the influence of insulin-resistance without obesity on sclerostin levels in Familial Partial Lipodystrophy type 2 (FPLD2). Methods Demographic, metabolic, anthropometric, and bone parameters were compared after adjustment on age and menopausal status across four groups of women (19 FPLD2, 12 obese with diabetes, 14 obese without diabetes, 11 lean controls). Results The FPLD2 group had significantly higher Intra-Abdominal/Total-Abdominal Fat (IAF/TAF) ratio and lower fat mass percentage compared to the other groups. Glucose parameters (Fasting blood glucose, C-peptide, HbA1c, HOMA2-IRCP), and triglycerides were significantly higher in the FPLD2 group than in controls, with a higher sclerostin level. Sclerostin levels were positively associated with age, glucose parameters, Z-score, T-score, and negatively with osteocalcin. FPLD2 was the only subgroup in which the association between sclerostin and HOMA2-IRCP was maintained. In contrast, osteocalcin levels were negatively associated with age, glucose parameters, triglycerides, IAF/TAF, and bone parameters. Neither sclerostin or osteocalcin were associated with BMI, whole-body fat, or leptin. Conclusion The association of sclerostin (positive) and osteocalcin (negative) with HOMA2-IRCP, but not with fat mass parameters, suggests a predominant role of insulin-resistance over fat mass in the regulation of osteokines. Insulin-resistance may uncouple the usual relationship between sclerostin and BMD. The sclerostin contribution in early atherosclerosis in FPLD2 remains to be studied.
OBJECTIVE:Dysregulation of bile acid (BA) profiles is closely associated with obesity and its related metabolic abnormalities. This study aims to investigate the BA alterations between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) and identify specific BA species associated with MUO. METHODS:We measured serum bile acid profiles in two cross-sectional studies. The discovery cohort included 261 normal-weight, 80 MHO, and 120 MUO individuals. The validation cohort, consisting of 104 MHO and 104 MUO participants (matched for age, sex, and BMI), was used for confirmation. RESULTS:Individual primary bile acids (PBAs), including cholic acid, glycocholic acid, chenodeoxycholic acid, and total PBA concentration, were markedly increased in MUO compared with both normal-weight and MHO subjects. Total secondary bile acids were decreased in both obesity phenotypes compared with normal-weight subjects, but did not differ between MUO and MHO. Among individuals with obesity, either individual PBA or total PBA levels were positively correlated with metabolic deterioration parameters such as WHR, HOMA-IR, HbA1c, and TG. Moreover, a higher total PBA level was associated with an increased proportion of MUO. These findings were further replicated in the validation cohort. CONCLUSIONS:Serum individual PBAs and total PBAs were significantly elevated in MUO compared with MHO. Higher PBA levels were associated with adverse metabolic parameters and an increased proportion of MUO. This study characterizes the distinct BA profiles across obesity phenotypes and highlights the associations between PBAs and MUO.
AIM:Patients with type 2 diabetes (T2D) receiving dialysis have a very high risk of cardiovascular events. Evidence for the cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in this population remains limited. Here, we assessed this issue using a target trial emulation framework. METHODS:We conducted a cohort study using a Japanese administrative claims database. We included adults aged 20 years or older with T2D receiving maintenance dialysis who initiated a GLP-1RA or a DPP-4i between April 2015 and March 2023. The primary outcome was the 3-year risk of major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, stroke, and cardiovascular death. The observational analogue of the per-protocol effect was estimated using pooled logistic regression with inverse probability weighting to adjust for baseline and time-varying confounders. RESULTS:Among 4793 patients (557 GLP-1RA initiators and 4236 DPP-4i initiators), the estimated 3-year risk of MACE was 29.7% (95% CI, 22.3% to 38.3%) for GLP-1RA users and 37.6% (95% CI, 35.2% to 40.8%) for DPP-4i users, giving a risk difference of -8.0% (95% CI, -15.5% to 0.9%) and risk ratio of 0.79 (95% CI, 0.59 to 1.03). CONCLUSION:Compared with DPP-4is, sustained use of GLP-1RAs may reduce the risk of MACE among patients with T2D receiving maintenance dialysis. These findings suggest a potential cardiovascular benefit but require confirmation in randomized controlled trials before introduction into clinical practice.
AIMS:This study addressed the challenge of glucose management in inpatients receiving nutritional support, even with automated insulin delivery (AID). We evaluated whether advanced AID would improve glycaemic control compared with standard subcutaneous insulin therapy in inpatients receiving nutrition support. METHODS:We did a single-centre, open-label, randomised controlled trial in adult inpatients receiving nutrition support who required subcutaneous insulin therapy. Patients recruited from non-critical care surgical and medical wards were randomly assigned (1:1) to receive advanced AID or conventional subcutaneous insulin therapy (control group) given in accordance with local clinical practice. Patients were followed up for up to 20 days or until hospital discharge. The primary endpoint was the TIR, the proportion of time that sensor glucose concentrations were within the target range, 3.9-10.0 mmol/l. This trial is registered with ClinicalTrials.gov, number ChiCTR2300078746. RESULTS:Between February 2023 and September 2024, 32 patients were assessed for eligibility; of these, 26 were enrolled and randomly assigned to the closed-loop group (n = 13) or the control group (n = 13). TIR was 63.1 % [SD 12.8] in the closed-loop group and 31.5 % [20.1]in the control group (difference 31.7 percentage points [95 % CI 18.0-45.2; P < 0.001]). The time spent below the target range (< 3.9 mmol/l) did not differ between groups. No serious adverse event occurred in each group. No episodes of severe hypoglycaemia or hyperglycaemia with ketonaemia occurred in either study group. CONCLUSIONS:The advanced AID system improves glycaemic control without increasing the risk of hypoglycaemia in inpatients receiving nutrition support, particularly in patients with acute severe pancreatitis.
Introduction Advanced hybrid closed-loop systems (AHCL) systems are the preferred insulin delivery method for people with type 1 diabetes (PwT1D). Time in tight range (TITR) is becoming a new target for glycemic control. The ability of different AHCL systems to achieve an improvement in TITR remains unclear. Method Multicenter observational cross-sectional study to analyze the effect on TITR of the three different AHCL systems marketed in Spain: MM780G with SmartGuard (MM780G), Tandem t:slim X2 with Control-IQ (Control-IQ) and Ypsopump with CamAPS FX (CamAPS). PwT1D ≥ 18 yrs and treated with the same AHCL device for at least 3 months were recruited consecutively. The main objective was to analyze the differences in TITR between the three types of AHCL. Results A total of 189 patients (female 66.8%) were recruited. Mean age was 42.8 ± 12.8 yrs. (18-72 yrs.) and T1D duration 23.5 ± 11.8 yrs. Time on AHCL automatization was 94.6 ± 7.6%. Overall TITR was 51.7 ± 11.6 % with no between-group differences (P = 0.154). Notably, nocturnal TITR was higher with CamAPS (53.6 ± 15.4%, P = 0.029), compared to MM780G (45.9 ± 17.8%, P = 0.029) and Control-IQ (50.6 ± 15.4%, P = 0.029). However, time below range level 1 and 2 was higher among CamAPS group (3.9 ± 2.8% and 0.7 ± 1.0%, respectively; P < 0.001), compared to MM780G (1.6 ± 1.6% and 0.2 ± 0.3%, respectively; P < 0.001) and Control-IQ (2.5 ± 2.0% and 0.5 ± 0.5%, respectively; P < 0.001). HbA1c was higher in MM780G treated patients, compared to both Control-IQ and CamAPS (6.9 ± 0.7% vs. 6.5 ± 0.6%, P = 0.003). Conclusion AHCL systems are useful for achieving TITR >50%, with no differences between treatment groups. However, this study has detected differences in some aspects of glycemic control between the devices used which could have clinical implications.
Aim. - To synthesize existing evidence on environmental factors influencing T1D development and progression, describe methods for exposome assessment, and identify current research gaps. Methods. - This review follows the JBI methodology and PRISMA-ScR guidelines. A comprehensive literature search was performed in PubMed, Embase, CINAHL, Web of Science and Google Scholar in November 2024, with alerts screening up to August 2025. We systematically reviewed studies examining environmental exposures across the lifespan in relation to T1D incidence, outcomes, and complications. Results. - Out of 982 records screened, 109 studies were included. Most studies focused on T1D development, while few addressed exposome determinants of disease progression. Eighteen exposure types were identified: 5 from the general external exposome (e.g., meteorological conditions, urban/rural environment, psychosocial factors); 12 from the specific external exposome (e.g., diet including breastfeeding and cow’s milk, infectious agents primarily enteroviruses, atmospheric pollutants like NOx, O₃, SO₄, PM₁₀); and one from the internal exposome (e.g., gut microbiota dysbiosis, metabolic imbalance). Conclusion. - Infectious agents, air pollutants, and early-life diet are well studied and consistently associated with T1D onset. However, little is known about the role of cumulative and combined exposures, or the exposome’s influence on disease progression and complications. Comprehensive research integrating exposome assessment across the life course is essential to improve T1D prevention and clinical management.
