Background/Objectives: Insulin resistance is a key factor in the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD), but accurately measuring it in patients with type 2 diabetes (T2D) remains challenging. This study examines the relationship between a recently proposed insulin resistance index and the presence of liver steatosis and fibrosis in individuals with T2D. Methods: This cross-sectional study utilized data from the 2017–2020 National Health and Nutrition Examination Survey. Patients with T2D who did not have chronic viral hepatitis or significant alcohol intake were included. The insulin sensitivity (IS) index was calculated using a formula incorporating body mass index, urine albumin-to-creatinine ratio, triglycerides, and gamma-glutamyl transferase. Liver stiffness and steatosis were assessed through transient elastography. MASLD was defined as a controlled attenuation parameter (CAP) of ≥274 decibels/meter (dB/m), while significant liver fibrosis was defined as a liver stiffness measurement (LSM) of ≥8 kPa. Multivariable logistic regression models, adjusted for potential confounders, were used to evaluate the association between IS and these liver outcomes. Results: A total of 1084 patients with T2D were analyzed. The prevalence of MASLD and significant liver fibrosis was 74.1% (95% CI 68.7–78.9) and 25.4% (95% CI 21.2–30.2), respectively. After adjusting for age, sex, waist circumference, and race/ethnicity, lower IS scores (indicating higher insulin resistance) were independently associated with increased odds of both MASLD (quartile 1 vs. quartile 4: OR 2.66, 95% CI 1.23–5.71) and significant liver fibrosis (quartile 1 vs. quartile 4: OR 3.30, 95% CI 1.45–7.51). These findings remained consistent across subgroups stratified by age, sex, and obesity status. Conclusions: This novel IS model, derived from commonly available clinical and biochemical markers, is independently associated with liver steatosis and fibrosis. Its application may help identify patients with more advanced MASLD, facilitating early intervention and risk stratification.

Aims Monogenic diabetes is one of the few examples in metabolic diseases in which a real precision medicine approach can be implemented in daily clinical work. Unfortunately, most of what is known today comes from studies in Whites, thus leaving much uncertainty about the genetics and the clinical presentation of monogenic diabetes in non-Europeans. To fill this gap, we report here two pedigrees from Bangladesh with CEL- and RFX6- diabetes, two rare types of monogenic diabetes which have never been described so far in individuals of the Indian subcontinent. Methods Next generation, Sanger sequencing and Multiplex Ligation-dependent Probe Amplification (MLPA) were performed. Variants' interpretation was according to the American College of Medical Genetics and Genomics guidelines. Results In the pedigree with CEL-diabetes, a large and never described deletion of exon 2-11 of CEL (confirmed by MLPA) affecting the entire catalytic domain and being likely pathogenic (LP) was observed in both the proband (who had diabetes at 16) and his mother (diabetes at 31), but not in relatives with normoglycemia. In the pedigree with RFX6-diabetes, a LP protein truncation variant (PTV, p.Tyr192*) in RFX6 was found in both the proband (diabetes at 9) and his mother (diabetes at 30), thus suggesting high heterogeneity in disease onset. Normoglycemic relatives were not available for genetic testing. Conclusions We report genetic features and clinical presentation of the first two cases of CEL- and RFX6-diabetes from the Indian subcontinent, thus contributing to fill the gap of knowledge on monogenic diabetes in non-Europeans.

Context: Despite being one of the major drivers of diabetes incidence, the degree of insulin resistance in patients with type 2 diabetes (T2D) is not usually evaluated in clinical practice or in large epidemiologic studies.Objective: To identify a model of insulin sensitivity using widely available clinical and laboratory parameters in patients with T2D and evaluate its association with all-cause and cardiovascular mortality.Methods: One hundred forty patients with T2D underwent a euglycemic hyperinsulinemic clamp to measure total body glucose disposal rate (mg kg(-1) minute(-1)). We used demographic, clinical, and common laboratory parameters to estimate insulin sensitivity (IS) via stepwise linear regression on 85 patients (training cohort) and validated it in the remaining 55 (validation cohort). The identified equation was then applied to 3553 patients with T2D from the 1999-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to evaluate its association with all-cause and cardiovascular mortality up to December 2015.Results: The best model included triglycerides, gamma glutamyl transpeptidase, albumin excretion rate, and body mass index. The identified IS score correlated well with the clamp-derived glucose disposal rate in both the training (r = 0.77, P < .001) and the validation (r = 0.74, P < .001) cohorts. In the NHANES cohort, after a median follow-up of 8.3 years, 1054 patients died, 265 of cardiovascular causes. In a multivariable Cox proportional hazard model adjusted for age, sex, race-ethnicity, education, cigarette smoke, total cholesterol, chronic kidney disease, blood pressure, prevalent cardiovascular disease, and alcohol consumption, a higher estimated IS was associated with a lower risk of both all-cause and cardiovascular mortality.Conclusion: We propose a new model of IS in patients with T2D based on readily available clinical and laboratory data. Its potential applications are in both diagnosis as well as prognostication.

Aim: To evaluate the long-term efficacy, up to 2 years, of an advanced hybrid closed-loop (AHCL) system and to assess predictors of best results of the therapy. Methods: We retrospectively evaluated 296 adults with type 1 diabetes mellitus [mean age 42.8 ± 16.5 years, men 42.9%, duration of diabetes 22.5 ± 12.8 years, body mass index 24.9 ± 4.7 kg/m2, baseline glycated hemoglobin (HbA1c) 63.4 ± 12.2 mmol/mol (8.0 ± 1.1%) ] who used the MiniMed™ 780G system. Demographic and clinical data were recorded. Continuous glucose monitoring (CGM)-derived metrics and insulin requirement were analyzed from the 4 weeks before and from every quarter after the switch to the AHCL system. Results: In the first quarter of AHCL treatment, all CGM metrics improved. Time in range (TIR) increased from 58.1 ± 17.5% to 70.3 ± 9.5% (P < 0.0001). The improvement lasted for up to 2 years of observation regardless of previous insulin therapies. Throughout the period of observation, 53.4% of participants achieved mean TIR >70%, 92.6% mean time below range <4%, and 46% mean glucose management indicator <53 mmol/mol (7.0%). At univariable logistic regression older age, lower baseline HbA1c and insulin requirement were associated with mean TIR >70%. At multivariable analysis, lower HbA1c remained independently associated with a better glycemic control. However, mean TIR increased more in participants with a higher baseline HbA1c. Conclusions: Switching to an AHCL leads to a rapid improvement in glycemic control lasting for up to 24 months along with a low risk for hypoglycemia, confirming the safety of the system. Lower baseline HbA1c was the main predictor of better efficacy of therapy, although higher baseline HbA1c was associated with the greatest improvement in mean TIR.

Diabetes Technology & TherapeuticsVol. 25, No. 7 Letter to the EditorReal-World Insulin Treatment in Pregnant Women with Type 1 Diabetes Using an Advanced Hybrid Closed-Loop SystemAlessandro Roberto Dodesini, Nicolò Diego Borella, Giuseppe Lepore, Silvia Bonfadini, Anna Corsi, Cristiana Scaranna, Rosalia Bellante, and Roberto TrevisanAlessandro Roberto DodesiniAddress correspondence to: Alessandro Roberto Dodesini, MD, Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo 24127, Italy E-mail Address: [email protected]Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, Nicolò Diego Borellahttps://orcid.org/0000-0003-3082-1873Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, Giuseppe LeporeEndocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, Silvia BonfadiniEndocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, Anna CorsiEndocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, Cristiana ScarannaEndocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, Rosalia BellanteEndocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Search for more papers by this author, and Roberto TrevisanEndocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.Search for more papers by this authorPublished Online:28 Jun 2023https://doi.org/10.1089/dia.2023.0031AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 25Issue 7Jul 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Alessandro Roberto Dodesini, Nicolò Diego Borella, Giuseppe Lepore, Silvia Bonfadini, Anna Corsi, Cristiana Scaranna, Rosalia Bellante, and Roberto Trevisan.Real-World Insulin Treatment in Pregnant Women with Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System.Diabetes Technology & Therapeutics.Jul 2023.516-518.http://doi.org/10.1089/dia.2023.0031Published in Volume: 25 Issue 7: June 28, 2023Online Ahead of Print:April 25, 2023Online Ahead of Editing: March 17, 2023 TopicsClosed-loop systemType 1 diabetes PDF download

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Aims Advanced hybrid closed-loop (AHCL) systems represent the latest introduction in the treatment of type 1 diabetes (T1DM). Randomized controlled trials and real-world evidence studies showed that AHCL systems are a safe and effective insulin management strategy. Aim of this retrospective, single-center, real-life study was to evaluate the effect on metabolic control, evaluated by continuous glucose monitoring (CGM) metrics, of the switch from four available insulin strategies to an AHCL system in adult patients with type 1 diabetes. Methods A total of 102 patients with T1DM (mean age 42.1 ± 16.3 years, males/females 47/55, duration of diabetes 21.4 ± 13.3 years, BMI 24.4 ± 4.5 kg/m 2 , HbA 1c 59.9 ± 9.6 mmol/mol or 7.6 ± 0.9%), treated with four different insulin therapies [multiple daily insulin (MDI) therapy, continuous subcutaneous insulin infusion (CSII), sensor-augmented pump (SAP) with predictive low-glucose suspend (PLGS), and hybrid closed loop (HCL) system] were evaluated before hand, two months and six months after switching to an AHCL (Minimed™ 780G system, Medtronic, Northridge, CA) system. Results Two months after the switch, mean GCM metrics improved in all four treatment groups. Six months after the switch, the participants of all four groups achieved a mean GMI < 53 mmol/mol, TIR > 70%, TBR < 4%, and CV < 36%, which is recommended by the ADA Standard of Medical Care in Diabetes 2022, including the MDI group with worse baseline glycemic control. Conclusions Switching to an AHCL leads to a rapid improvement in glycemic control lasting for up to six months independently of previous insulin treatment and baseline conditions.

INTRODUCTION:Despite the development of several recommendations, glycemic control in a large proportion of patients with type 2 diabetes, including those treated with insulin, remains suboptimal. This study is aimed to identify a set of actions to promote the reduction of inappropriate clinical practices in type 2 diabetes failing basal insulin supported oral therapy (BOT).METHODS:A panel of diabetes specialists was assembled to identify a list of ten corrective actions, "things not to do," for the management of type 2 diabetes: five concerning treatments, procedures and diagnostic tests and five about relationship, communication and information. The Choosing Wisely methodology and approach were the inspiration.RESULTS:A total of 73/73 (100%) panelists responded to the survey. Twenty-four actions were proposed. The final list of inappropriate actions deemed most important to improve the management of patients with type 2 diabetes failing BOT were: (1) do not use secretagogues-do not neglect the use of innovative glucose-lowering agents; (2) do not underestimate the risk of lack of hypoglycemia awareness; (3) do not underestimate the benefit of personalization of therapy; (4) do not delay insulin intensification; (5) do not delay modification of the therapeutic regimen. In the area of patient communication, the following actions were identified: (1) do not fail to train in the management of hypoglycemia; (2) do not underestimate whether the patient has understood the modification of therapy; (3) do not prescribe injection therapy without adequately instructing the patient to titrate it; (4) do not ignore the patient's adherence; (5) do not stop listening to the patient and verify learning.CONCLUSION:A set of corrective experience-based actions to enact in a timely manner, which can assist physicians in improving clinical outcomes and patients' needs in terms of communications and interaction, is proposed. The list is intended to promote discussions among diabetes specialists to provide high-value diabetes care.

Effective enforcement of lockdown measures, use of technology, and implementation of telemedicine may have significantly reduced the number of diabetic pregnant women who tested positive for COVID‐19 in Bergamo, Italy.

"No abstract is available for this article." This article is protected by copyright. All rights reserved.

Background. Poor outcomes have been reported in patients withtype 2 diabetes and coronavirus disease 2019 (COVID-19), thus it is mandatoryto explore novel therapeutic approaches for this population. Methods. In a multicenter case-control retrospective observational study, sitagliptin, an oral and highly selective DPP-4 inhibitor, wasadded to standard-of-care (e.g.; insulin administration) at the time ofhospitalization in patients with type 2 diabetes who were hospitalized with COVID-19.Every center also recruited at 1:1 ratio untreated controls matched for age andgender. All patients had pneumonia and exhibited oxygen saturation lower than 95%when breathing ambient air, or were receiving oxygen support. The primaryendpoints were discharge from the hospital/death and improvement of clinicaloutcomes, defined as an increase in at least two points on a seven-categorymodified ordinal scale. Data werecollected retrospectively from patients receiving sitagliptin from March 1 throughApril 30, 2020. Results. Of the 338 consecutive patients with type 2 diabetes and COVID-19 admittedin Northern Italy hospitals included in this study, 169 were on sitagliptin,while 169 were on standard-of-care. Treatment with sitagliptin at the time ofhospitalization was associated with reduced mortality (18% vs. 37% of deceasedpatients; HR=0.44, 95% CI: 0.29-0.66, p=0.0001), with an improvement inclinical outcomes (60% vs. 38% of improved patients, p=0.0001) and with a greaternumber of hospital discharges (120 vs. 89 of discharged patients, p=0.0008),compared to patients receiving standard-of-care respectively. Conclusions. In this multicenter case-control retrospective observational study ofpatients with type 2 diabetes admitted to the hospital for COVID-19,sitagliptin treatment at the time of hospitalization was associated withreduced mortality and improved clinical outcomes as compared tostandard-of-care treatment. The effects of sitagliptin in patients with type 2 diabetesand COVID-19 should be confirmed in an ongoing randomized, placebo-controlledtrial.

There are no data whether hybrid closed-loop (HCL) systems are superior to sensor-augmented pump (SAP) therapy with predictive low glucose suspend (PLGS) feature in improving glucose control. Aim of our study was to evaluate the effect on metabolic control and glucose variability of the switch from SAP therapy with PLGS to a HCL system in type 1 diabetic individuals. Forty adults with type 1 diabetes, who had been using SAP therapy with PLGS feature (Minimed 640G; Medtronic, Northridge, CA) for at least 12 months were evaluated in a 6-month case-control observational retrospective study. Twenty subjects who consecutively switched from Minimed 640G to a HCL system (Minimed 670G; Medtronic) (670G group) were compared with a control group consisting of 20 subjects who continued with the MiniMed 640G pump (640G group) matched for age, gender, and HbA(1c). At the end of the study there was a significant reduction in average HbA(1c) levels (-4.9 +/- 6.4 mmol/mol [-0.4% +/- 0.6%], P < 0.01), sensor glucose concentrations (-15.4 +/- 17.7 mg/dL, P < 0.005), coefficient of variation of sensor glucose concentrations (-3.8% +/- 3.6%, P < 0.01), percentage time spent in both hyperglycemic range 181-250 mg/dL (-5.1% +/- 4.5%, P < 0.05), and >250 mg/dL (-6.1% +/- 6.9%, P < 0.05) in the 670G group, whereas they remained unchanged in the 640G group. Percentage of time spent in euglycemic range significantly increased (11.6% +/- 8.3%, P < 0.005) only in the 670G group. There was no change in time spent in hypoglycemic range in both groups. In adults with type 1 diabetes, switching from a 640G to a 670G system significantly improved glucose control and reduced glucose variability, thus reaching in most cases the recommended targets for time spent in euglycemic and hyperglycemic ranges without increasing the risk of hypoglycemia.

Mobile health (mHealth) applications (apps) have been recently introduced as an easily accessible tool for providing information to pregnant women with diabetes. Despite the growing number of apps on the topic “diabetes & pregnancy”, a smartphone app offering comprehensive and individualized information to both women (before and during gestation) and their healthcare professionals was still missing. To overcome this lack, the Italian Diabetes and Pregnancy Study Group conceived and realized in 2016 a novel mobile app called “MySweetGestation”. It is designed to be an interactive educational tool for both patients and physicians not expert in the field. Through an interactive way of learning, it provides validated information to the user, focusing on different area of interest: from prevention and risk factors for developing diabetes during pregnancy to treatment and follow-up strategies after gestation. Three years since its publication, MySweetGestation has been downloaded in different western and eastern countries worldwide, suggesting a widespread social impact. Easily accessible personalized information made available via mHealth technology may be of great importance to spread controlled information among the pregnant population. MySweetGestation, being an interactive educational device for both patients and healthcare professionals, may contribute to improve the management of pregnant women with diabetes.

"Effects of a low glycemic index high in fiber diet on blood glucose in women with gestational diabetes." The Journal of Maternal-Fetal & Neonatal Medicine, 34(6), pp. 1010–1011