Background Recent studies have demonstrated that real-time CGM use reduce the incidence severe hypoglycemic events and impaired awareness of hypoglycemia (IAH) However, there are few real-world studies evaluating the effect of intermittently scanned continuous glucose monitoring (isCGM) on hypoglycemic episodes and hypoglycemia unawareness (IAH). The present study was designed to cover this research-practice gap. Methods This is a real-world, observational, prospective cohort study with 2 years of follow-up in which 60 subjects with T1D who experienced frequent hypoglycemic events were included. All the patients were invited to use isCGM type Abbott FreeStyle Libre 2 (R) on a continuous basis for 2 years. Glucometric parameters were obtained during the initial 2 weeks using isCGM and compared with data collected for the same period at 1 year and at the end of follow-up. The IAH was evaluated using the Clarke questionnaire, and to assess psychological aspects related to hypoglycemia the Hypoglycemia Fear Survey (HFS) was used. Results After 2-years of follow-up using isCGM, we observed a decrease in glucose variability (40.3 +/- 0.8 % vs. 37.1 +/- 0.9 %, p = 0.003), time in low glucose range (54-69 mg/dL) (5.2 +/- 0.4 % vs. 3.6 +/- 0.3 %, p = 0.001), time in very low glucose range (<54 mg/dL) (3.2 +/- 0.5 % vs. 0.8 +/- 0.2 %, p < 0.001), less events related to low glucose levels (10.6 +/- 1.1 vs 8.0 +/- 1.0, p = 0.042) and a short duration of hypoglycemia episodes (106.1 +/- 5.9 min vs. 85.7 +/- 5.7 min, p = 0.008). In addition, participants presented a reduction of 47 % in the frequency of IAH, assessed by the Clarke questionnaire scores (24.6 % vs. 11.6 %, p = 0.034), as well as hypoglycemia fear (77.8 +/- 2.4 vs 68.2 +/- 2.1, p < 0.001). Furthermore, a reduction in total insulin dose was also observed (0.64 +/- 0.30 UI/Kg/day vs 0.56 +/- 0.11 UI/Kg/day, p = 0.018). Conclusions In the real-world, long-term use of isCGM could reduce both hypoglycemic episodes and IAH in people with T1D.

AbstractObjectiveNumerous factors are considered to impact on the rate of complications during salvage total laryngectomy procedures. Neck dissection could be one of these factors. This study analysed the pattern of lymph node metastasis and rate of occult neck disease during salvage total laryngectomy as well as the impact of neck dissection on survival and complication rates.MethodThis was a retrospective analysis of a prospectively maintained laryngectomy database in two large tertiary teaching hospitals.ResultsThe rate of occult neck disease was 11.1 per cent. Most cases with occult neck disease had rT4 disease. Patients with complications, advanced tumour stage and positive margins had a significant decrease in overall survival. Patients receiving elective neck dissection did not have any survival benefit. Positron emission tomography-computed tomography showed a very high specificity and negative predictive value.ConclusionAccording to the low risk of occult neck disease when using contemporary imaging techniques as well as the lack of impact on survival, conservative management of the neck should be considered for crT1-T3 recurrence.