To identify health utility decrements of injection treatment-related attributes among patients with type 2 diabetes mellitus (T2DM) in China. Health states of four attributes (hypoglycemia, dose frequency, flexibility and injection site reaction) were generated using a vignette-based method. Patients with T2DM were recruited from eight cities in China. The sample was broadly consistent with Chinese T2DM population with regard to age and sex distribution. Respondents completed seven time trade-off (TTO) tasks during face-to-face interviews. The ordinary least square (OLS), fixed effects (FE) and random effects (RE) models were used for TTO data. In subgroup analysis, groups were categorized based on whether injection treatment was currently used, number of medications, needle phobia, duration of injectable treatment and travel frequency. A total of 400 patients (52.75% male, mean [SD] age 50.30 [12.05] years) were included in this study. Severe hypoglycemia had the largest disutility value of all attributes (-0.023, P < 0.001). Three times daily, twice daily and once daily injection (needed to be carried with the patient on short trips) were associated with -0.023 (P < 0.001), -0.018 (P < 0.001) and -0.011 (P = 0.022) disutility values compared with once weekly injection (not required to be carried with the patient on short trips), respectively. The disutility value associated with injection site reaction attribute was -0.013 (P < 0.001). In subgroup analysis, the relative importance of treatment-related attributes was found to depend on patient characteristics. This study provides disutility values associated with several injection treatment-related attributes for Chinese patients with T2DM. Hypoglycemia appears to be the most important attribute, followed by dose frequency, flexibility and injection site reaction.

A phase 1b, randomized, open-label study of once-weekly insulin GZR4 in patients with type 2 diabetes mellitus.

Conditional deletion of glutaminase 1 in Tnfrsf11a-expressing cells reduces bone mass and induces postnatal growth retardation in mice.

Background: There is a limited amount of evidence concerning the association between seasonal variation and the level of physical activity in individuals with chronic disease. This longitudinal observational study aimed to explore seasonal, monthly, and holiday variations in self-monitored step counts over two years among adults with prediabetes and type 2 diabetes in Sweden. Methods: Participants were recruited at primary care centers from 2013 to 2018 to take part in a physical activity intervention. Inclusion criteria included the following: an age of 40–80 years, having prediabetes or type 2 diabetes (≥1 year), and the ability to communicate in Swedish. Individuals with recent myocardial infarction, impaired renal function, diabetic ulcers, a limited capacity for physical activity, insulin onset (&lt;6 months), recurrent or severe hypoglycemia, a high baseline for physical activity, or no internet access were excluded. In total, 120 participants wore step counters and recorded daily steps for two years. Linear mixed models adjusted for sex, age, and body mass index were applied. Results: Mean (95% CI) step counts were statistically significantly higher in summer (7825 [7762, 7889]) and spring (7805 [7757, 7853]) compared to winter (7098 [7052, 7145]) and fall (7422 [7349, 7490]). Highest step counts were registered in May (7993 [7904, 8071]), followed by June (7968 [7895, 8063]), and the lowest in January (6944 [6856, 7034]) and November (7208 [7113, 7289]). Step counts during holiday periods were statistically significantly lower than non-holiday periods across all seasons. Conclusion: Self-monitored daily steps varied over the seasons in this sample of individuals with prediabetes and type 2 diabetes. Declined physical activity levels in months with unfavorable weather conditions require attention in consultations and research.

Background Whether cancer patients with diabetes can achieve survival outcomes comparable to those without diabetes through appropriate glycemic control over the course of cancer remains uncertain. Aim To assess mortality risk among cancer patients with diabetes compared to those without diabetes, and to evaluate whether this risk differed by level and pattern of visit-to-visit glycemic control. Materials and methods We conducted a retrospective cohort study using electronic health records from a tertiary cancer center. Adults with non-metastatic solid or hematologic malignancies and a history of diabetes, treated between 2009 and 2021, were individually matched in a 1:2 ratio to cancer patients without diabetes based on cancer type, sex, age, and treatment year, and were followed through June 2024. Mortality risks were assessed, accounting for cancer stage, aggressiveness, comorbidities, BMI, and cancer and diabetes treatments. Results Among 29,812 patients, 1948 (650 with diabetes and 1298 without) were eligible, with a total follow-up of 112,809 patient-months. Mortality risk among patients with diabetes was similar to those without (adjusted HR, 1.11 [0.89–1.39]; p = 0.35). Compared to those without diabetes, patients with good or fair glycemic control (average glucose ≤180 mg/dL) had no increased mortality risk (adjusted HR, 0.96 [0.75–1.23]; p = 0.76), while those with poor control had significantly higher risk (adjusted HR, 1.68 [1.12–2.53]; p = 0.012). Patients who experienced severe hypoglycemia had higher mortality than those without hypoglycemia (adjusted HR, 2.31 [1.01–5.28]; p = 0.048). Greater visit-to-visit glucose variability was also associated with increased mortality (adjusted HR, 1.02 [1.00–1.04]; p = 0.018). Conclusions Overall, the mortality risk among patients with cancer and diabetes was comparable to those without diabetes. However, among those with diabetes, poor glycemic control, hypoglycemia, and high glycemic variability were associated with worse survival-highlighting the need for integrated, chronic disease-informed cancer care strategies to improve patient outcomes.

Atypical antipsychotics are frequently associated with metabolic disturbances such as weight gain, insulin resistance, and hyperglycemia. In contrast, drug-induced hypoglycemia is rarely described, particularly with quetiapine. We report a case of severe, recurrent hyperinsulinemic hypoglycemia temporally associated with quetiapine use in a patient with schizophrenia, with resolution following drug withdrawal. A 72-year-old man with schizophrenia was admitted for acute psychotic decompensation while receiving long-term haloperidol and quetiapine 150 mg/day. Shortly after admission, he developed recurrent, predominantly postprandial hyperinsulinemic hypoglycemia, with plasma glucose reaching 20–40 mg/dL, repeatedly asymptomatic. During a documented episode (glucose of 48 mg/dL), insulin and C-peptide were inappropriately elevated, confirming endogenous hyperinsulinemia. Adrenal insufficiency, hypothyroidism, insulinoma, IGF-2–secreting tumors, nesidioblastosis, hepatic dysfunction, and factitious hypoglycemia were systematically investigated, with no findings supporting these alternative diagnoses. Hypoglycemia resolved promptly after quetiapine discontinuation and recurred upon rechallenge. Replacement with tiapride led to full metabolic stabilization, with no further hypoglycemic events. This case highlights a rare but potentially life-threatening adverse effect of quetiapine. Clinicians should remain vigilant for hypoglycemia in susceptible individuals, particularly older patients or those with underlying glucose dysregulation, as early recognition and drug withdrawal can prevent serious complications.

Abstract Aim To highlight the treatment challenges and to establish a management algorithm for refractory severe hypoglycaemia following gastric bypass surgery. The dietary, medical and surgical interventions performed will be discussed. Method A 33-year-old male underwent a Roux-en-Y gastric bypass in 2021 for severe obesity (BMI 57) and type 2 diabetes. Two years post operatively, signs of malnourishment developed (lost 62% body weight) alongside post prandial hypoglycaemia. An insulinoma was excluded and late dumping syndrome was diagnosed. Dietetic intervention included high protein and low carbohydrate diet. Nasojejunal feeding and total parenteral nutrition were also used. No benefit was observed; therefore, a series of medical therapies were trialled including Acarbose, Dulaglutide, Octreotide, Canagliflozin and Diazoxide with no improvement of symptoms. Robotic assisted reversal of the bypass was subsequently performed with immediate resolution of hypoglycaemic episodes. Results After ascertaining sufficient small bowel common limb length (over 4 metres), excision of the gastro-jejunostomy and old alimentary limb was performed. A partially stapled gastro-gastric anastomosis was performed to restore conventional anatomy. Post operatively, immediate cessation of hypoglycaemia was observed after introducing diet. Conclusions Post gastric bypass hypoglycaemia can be challenging to treat and often requires a multidisciplinary team approach to manage. After exhausting all non-surgical measures, robotic assisted gastric bypass reversal is a feasible intervention to treat the condition and restore quality of life. Our findings support the literature regarding a move away from performing high risk partial pancreatectomies.

Background/Objectives: Type 1 diabetes (T1D) is a common childhood condition with rising global incidence. Because early-onset T1D coincides with key periods of brain maturation, affected children may face neurocognitive risks. This review summarizes current evidence on the neurocognitive impact of pediatric T1D and related clinical implications. Methods: A structured search of PubMed, Scopus, and Web of Science (inception–October 2025) used combinations of terms related to T1D, cognitive outcomes, and brain imaging. Studies involving participants under 18 years that reported cognitive or neuroimaging findings were included. Results: Diabetic ketoacidosis (DKA) at diagnosis is consistently linked with acute and longer-term neurological injury, including reduced brain volume and potential persistent deficits in memory and executive functioning. Severe or recurrent hypoglycemia disproportionately affects the hippocampus, contributing to lasting learning and memory impairments. Chronic hyperglycemia is a major driver of progressive neurocognitive decline; higher HbA1c is associated with smaller brain volumes and poorer executive function, attention, and processing speed. Early-onset disease and longer duration further increase vulnerability. These neurocognitive effects translate into modest reductions in academic performance and quality of life, especially with poor glycemic control. Emerging evidence suggests that continuous glucose monitoring, insulin pumps, and hybrid closed-loop systems improve metabolic stability and may support healthier brain development. Conclusions: T1D children experience subtle but meaningful neurocognitive risks shaped by glycemic extremes and early disease onset. Routine neuropsychological monitoring, strengthened academic support, and wider use of advanced diabetes technologies may help preserve cognitive development. Larger, longitudinal neuroimaging studies are needed to guide targeted neuroprotective strategies.

Insulin therapy is essential for managing hyperglycaemia in type 2 diabetes mellitus when oral or non-insulin injectable agents are no longer effective. However, the comparative effectiveness and safety of different insulin regimens remain uncertain. We aimed to compare the effects of basal, basal-bolus, biphasic and prandial insulin regimens on glycaemic management, weight, severe hypoglycaemia, insulin dose and quality of life in adults with type 2 diabetes. We conducted a systematic review and network meta-analysis of RCTs. PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched through to September 2025. The inclusion criteria for studies were RCTs enrolling adults with type 2 diabetes that compared at least two of the specified insulin regimens over ≥12 weeks. Pairs of reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane RoB-2 tool. Network meta-analyses were performed using a frequentist random-effects model, with basal insulin as the reference. Fifty-eight RCTs involving 19,122 participants were included. Compared with basal insulin, HbA1c reduction was -3.4 mmol/mol (95% CI -4.9, -1.9 mmol/mol) (-0.31% [95% CI -0.45%, -0.17%]) with a basal-bolus insulin regimen, -2.7 mmol/mol (95% CI -3.7, -1.6 mmol/mol) (-0.24% [95% CI -0.34%, -0.15%]) with biphasic insulin and -4.1 mmol/mol (95% CI -6.2, -2.1 mmol/mol) (-0.38% [95% CI -0.57%, -0.19%]) with prandial insulin. These results were classified as being of moderate confidence due to incoherence. All regimens were associated with approximately 30% increased probability of achieving HbA1c target, 1 kg greater weight gain, and a borderline increase in the risk of severe hypoglycaemia. Insulin doses were slightly higher with basal-bolus and biphasic regimens. Quality-of-life data were limited. Subgroup analyses for insulin initiation and intensification yielded consistent results. Complex insulin regimens provide modest glycaemic benefits over basal insulin but are associated with greater weight gain and a suggested higher risk of hypoglycaemia. These results are based on evidence of moderate confidence. These trade-offs support the need for individualised regimen selection, informed by clinical context, patient preferences and treatment goals. PROSPERO registration no. CRD42020181473. This research was supported by the Committee for the Development of Higher Education Personnel (CAPES) and the Hospital de Clínicas de Porto Alegre - FIPE HCPA.

Introduction Mendelian susceptibility to mycobacterial disease (MSMD) is a group of immune disorders causing increased risk of mycobacterial and other intracellular infections, with mutations in the interferon-γ receptor 1 (IFN-γR1) among the first described causes. Case Report A 6-month-old girl, second child of consanguineous parents from rural Mexico, had a sibling who died at 4 months from ganglionar tuberculosis and disseminated mycobacteriosis linked to a confirmed IFNGR1 mutation. She received BCG (vaccine stands for Bacillus Calmette–Guérin) at birth. At 4 months, she developed right axillary lymphadenopathy that partially improved; at 5 months, it recurred with inflammation, respiratory symptoms, pancytopenia, and an erythematous, scaly rash. A biopsy drained pus and cultured positive for mycobacteria; she was treated with a cephalosporin, metronidazole, and anti-tuberculous therapy. Referred to tertiary care for respiratory instability, she presented mild malnutrition, microcephaly, holosystolic murmur, ascites, hepatomegaly (4 cm), splenomegaly (7 cm), severe diaper dermatitis, and an axillary mass. Disseminated BCG disease was diagnosed; treatment continued with anti-tuberculous drugs, steroids, human immunoglobulin therapy, and prophylaxis with trimethoprim/sulfamethoxazole and fluconazole. Labs showed normocytic anemia, anisocytosis, thrombocytopenia, hypoalbuminemia, direct hyperbilirubinemia, and severe hypoglycemia. Ultrasound showed hepatosplenomegaly, portal hypertension, and bilateral cervical lymphadenopathy; bone marrow was normal. Gastric bacilloscopy, HIV, and viral PCR were negative except for Acinetobacter baumannii in a respiratory panel. She developed sepsis-related cholestasis, coagulopathy, factor XII deficiency, colitis, catheter-related infection, suspected fungal infection, and ventilator-associated pneumonia due to A. baumannii, treated with broad-spectrum antibiotics. Given the family history, IFNGR1 sequencing confirmed a pathogenic homozygous nonsense mutation c.672G&amp;gt;A (p.Trp224*); both parents were heterozygous carriers. Discussion In countries with routine BCG vaccination, recognizing possible inborn errors of immunity and assessing family history support early diagnosis and appropriate treatment.

Introduction and Objective: Fasting presents unique metabolic challenges for individuals with T1D. The 25-h Yom Kippur complete fast provides an opportunity to evaluate whether automated insulin delivery (AID) systems can maintain metabolic stability, prevent hypoglycemia and ketosis, and determine basal insulin requirements during prolonged fasting. Methods: This real-world, noninterventional study included 54 adolescents and young adults with T1D (mean age 17.3 ± 3.3 years, HbA1c 6.8 ± 1.0%). Participants used MiniMed 780 G (n = 34), Control-IQ (n = 10), or open-source AID systems (n = 10). Common system-specific adjustments included setting a 150 mg/dL exercise target, activating sleep mode, and modifying basal or glucose targets, while 11 participants made no changes. Ketone levels were measured after the 25-h fast and a routine overnight fast. Analyses compared glucose and insulin across fasting periods and different 780 G settings and assessed predictors of hypoglycemia and ketone levels. Results: All participants successfully completed the fast. Mean TIR increased from 71.6 ± 13.9% during routine days to 82 ± 13.2% during fasting (P < 0.01), while time <70 mg/dL decreased from 2.6% to 2.2% (P = 0.017). Ten mild hypoglycemic events occurred after the pre-fast meal and one during fasting. A higher baseline percentage of time <70 mg/dL was the only predictor of hypoglycemia. No significant difference was found between 780 G users with exercise mode and those with no or minor changes. Participants received 43.4 ± 16.8% (range 9.3%-90%) of their usual insulin dose. Median (IQR) end-of-fast ketone levels were 0.4 (0.3, 0.7) mmol/L vs 0.1 (0, 0.1) mmol/L on a regular morning (n = 31); insulin doses <30% of usual dose were associated with higher ketone levels. No severe hypoglycemia or serious adverse events occurred. Conclusion: AID systems enable safe 25-h fasting by maintaining glucose control and reducing the risk of hypoglycemia and ketonuria. Fasting adjustments should be individualized and can often be minor.

Introduction: Type 1 diabetes (T1D) continues to impose substantial global health burdens, including recurrent severe hypoglycemia and risks of long-term complications. Allogeneic islet transplantation offers a minimally invasive alternative to whole-organ pancreas transplantation for restoring endogenous insulin secretion; however, long-term durability remains uncertain. Methods: This systematic review and meta-analysis included studies (2000–2025) reporting outcomes of islet transplant alone (ITA), islet-after-kidney (IAK), or simultaneous islet–kidney transplantation in adults with T1D. Random-effects models were used to pool insulin independence, graft failure, and five-year mortality. Study quality was assessed through the Newcastle–Ottawa Scale. Results: Eighteen studies comprising 1,941 recipients (1,418 ITA, 523 IAK) were included. One-year insulin independence rates were 56% (95% CI 33–80%) for ITA and 58% (95% CI 30–86%) for IAK, declining to 30% at five years for both ITA (95% CI 20–39%) and IAK (95% CI 20–41%). Graft failure rose progressively, reaching 38% (95% CI 22–53%) for ITA and 25% (95% CI 0–52%) for IAK at five years. The pooled five-year mortality rate was 6% (95% CI 3–9%), with no deaths directly attributed to the procedure in studies reporting cause-specific outcomes. Conclusions: Islet transplantation provides meaningful short-term metabolic benefits and a favorable safety profile for selected individuals with T1D, but long-term graft durability remains limited compared to pancreas transplantation. Slightly better preservation of graft function in IAK suggests potential metabolic advantages for kidney transplant recipients.

IntroductionThis study evaluated 6-month effectiveness and safety of automated insulin delivery (AID) in comparison with multiple daily injections (MDI) in pediatric and adult type 1 diabetes (T1D).Materials and methodsIndividuals with T1D, aged 2–80 years, were enrolled across 32 international centers (in the United States, Europe, Canada, and New Zealand) and randomized 1:1 to AID intervention (MiniMed™ 670G or 770G system) or MDI with or without continuous glucose monitoring. Primary endpoints were change in mean HbA1c for participants with a baseline HbA1c >8.0% (Group 1) and percentage of time spent below 70 mg/dL (%TBR <70 mg/dL [<3.9 mmol/L]) for participants with baseline HbA1c ≤8.0% (Group 2), to show superiority of AID intervention versus MDI. Safety endpoints including rates of severe hypoglycemia and diabetic ketoacidosis (DKA), and difference in diabetes treatment satisfaction score were assessed.ResultsFor Group 1, N = 56 participants (aged 29.4 ± 17.0 years) were randomized to AID intervention and N = 54 participants (aged 36.8 ± 19.6 years) were randomized to MDI. For Group 2, N = 73 (aged 37.4 ± 21.0 years) and N = 69 (aged 39.2 ± 19.3 years), respectively, were randomized to AID and MDI. Change in HbA1c (mean [95% CI] difference of −0.7% [−1.1, −0.3], P = 0.0002) and difference in %TBR <70 mg/dL (4.8% [−6.4, −3.1], P<0.001) favored AID intervention versus MDI. Rates of severe hypoglycemia (AID: 1.82/100 patient-years) and DKA (MDI: 3.52/100 patient-years) were low and met preestablished success criteria for safety.DiscussionThis large, international, multicenter randomized controlled trial demonstrates safety of the MiniMed™ 670G/770G systems. AID significantly improved HbA1c and time spent in hypoglycemia when compared with MDI, in both youth and adults living with T1D.Clinical trial registrationhttps://clinicaltrials.gov/, identifier NCT02748018.

There is room for improvement in the outcome of automated insulin delivery. Our aim was to explore the impact on glucose metrics of algorithmic modifications of a DBLG1 hybrid closed-loop system, targeting the management of meal periods, hypoglycemia and hyperglycemia. We performed a two-step analysis of CGM data of all consenting adult patients with type 1 diabetes who were equipped in Europe with DBLG1 between November 1, 2023 and January 31, 2025, comparing three successive versions of the algorithm: v1.12 vs. v1.16 (first step, retrospective comparison), then v1.16 vs. v1.17 (second step, ambispective before/after analysis). Time in range of 70 to 180 mg/dL was the primary endpoint. The first step (duration 319 days, 937 patients) compared 269 users of 1.12 version and 668 users of 1.16 version. Median TIR improved from 65.3% [IQR 58.4%-72.1%] to 71.3 [63.3%-78.0%]. Time in Tight Range 70 to 140 mg/dL increased from 37.5% [30.6%-43.1%] to 40.4% [31.7%-48.5%]. Time in Hypoglycemia was stable. Time >250 mg/dL decreased from 8.9% to 5.4%, GMI from 7.3% to 7.1%, CV from 30.4% to 27.4%, and GRI from 38.0 to 30.0. The second step (1212 patients, 120 days) showed a further improvement of TIR from 68.8% [59.6%-76.8%] to 70.8% [63.0%-77.6%] when upgrading from v1.16 to v1.17, with marginal changes in other glucose metrics. The incidence rates of severe hypoglycemia or hyperglycemia remained very low. This large post-market report illustrates the margin of improvement in AID performances through algorithmic refinements that improve the efficacy without deteriorating the safety of closed-loop insulin delivery.

BackgroundMalaria is a common and potentially deadly infection in Sub‐Saharan Africa, causing nearly 600,000 deaths. Despite improvements in treatment and prevention, it continues to wreak havoc, particularly in this region, which accounts for more than 95% of cases. Individuals living in malaria‐endemic areas traditionally have a lower risk of developing severe malaria.Case PresentationWe report a case of a 67‐year‐old woman with hypertension and bilateral knee osteoarthritis. She was referred from a health center due to confusion and abnormal movements in a febrile context. Findings upon admission revealed a patient with a poor general state, an inflammatory syndrome, a confusional syndrome, a cortical irritation syndrome, a hemolytic anemia, and a severe hypoglycemia. Both the rapid diagnostic test and the thick blood smear for malaria were positive. The clinical course was marked by persistent signs of hemolysis and hypoglycemia, status epilepticus, deep coma, the development of diffuse ecchymoses, digital ischemia and Stage 2 pressure ulcers, worsening of respiratory failure, hepatocellular failure, acute kidney injury, and hyperkalemia reaching 6.24 mmol/L. Therapeutic interventions led to significant improvements in the patient’s level of consciousness, resolution of status epilepticus, correction of hypoglycemia, and attenuation of hemolysis, although acute kidney injury persisted, requiring extrarenal epuration. Despite improvements in consciousness and correction of respiratory, liver, and kidney function, the patient ultimately succumbed to sepsis before digital amputation could be performed.ConclusionThis case serves as a reminder of the severe complications and potential fatality associated with malaria. Emphasis must be placed on prevention.

This post hoc analysis assessed efficacy and hypoglycaemia outcomes of once-weekly insulin icodec (icodec) versus once-daily (OD) basal insulin comparators across different baseline glycated haemoglobin (HbA1c), body mass index (BMI) and type 2 diabetes (T2D) duration subgroups using data from five phase 3a trials of icodec in adults with T2D. Treatment outcomes were assessed, by trial, in insulin-naive (ONWARDS 1, 3 and 5) and insulin-experienced (ONWARDS 2 and 4) adults across baseline HbA1c (≤8%, >8% to ≤9% and >9%), baseline BMI (<25 kg/m2, ≥25 to <30 kg/m2, ≥30 to <35 kg/m2 and ≥ 35 kg/m2) and baseline T2D duration (<5 years, ≥5 to <10 years, ≥10 to <15 years, ≥15 years) subgroups. The primary outcome was change in HbA1c from baseline to planned end of treatment. The achievement of HbA1c <7% (<53 mmol/mol) without clinically significant or severe hypoglycaemia and the rate of hypoglycaemic episodes were also assessed. Across trials, the estimated treatment differences for change in HbA1c and odds ratios for achievement of HbA1c <7% without clinically significant or severe hypoglycaemia between icodec and OD basal insulin comparators were overall consistent across baseline HbA1c, BMI and T2D duration subgroups; no statistically significant treatment by subgroup interactions were seen. Hypoglycaemia rates were numerically low for both treatment arms and consistent across subgroups in ONWARDS 1-3 and 5. The efficacy and hypoglycaemia profile of icodec versus OD basal insulin comparators was overall consistent across trial populations irrespective of baseline HbA1c, BMI or T2D duration.

Background. The objective of this study was to determine the efficacy of liraglutide in reducing cardiovascular complications. Methodology. Literature searches of electronic databases (PubMed and ScienceDirect) were performed to identify relevant studies. Relevant journals included were electronically searched for randomized controlled trials (RCTs) regarding the use of liraglutide versus placebo in reducing the rate of cardiovascular complications. Data extraction and quality assess-ment were done by independent reviewers. Statistical analysis of the study was accomplished using Cochrane Systematic Review Software Review Manager. Mean difference was used to analyze a data set which used mean and standard deviation from the studies. A p-value of less than 0.05 for the observed effect size was considered statistically significant. Results. A total of two RCTs with 16,977 patients were included in this meta-analysis. The results showed that in the lirag-lutide group, there is a statistically lower rate of the major adverse cardiovascular events (risk ratio [RR] 0.86 [0.78, 0.95]), cardiovascular events (RR 0.75 [0.63, 0.89]), and all-cause mortality (RR 0.81 [0.70, 0.93), but it is not statistically significant when compared to the placebo group in terms of non-fatal myocardial infarction and non-fatal stroke. There is no significant difference in rates of severe adverse events in general (p&gt;0.05). However, liraglutide caused significant reduction in rates of severe hypoglycemia as an independent secondary outcome (p&lt;0.05). Conclusion. Compared with placebo, liraglutide provided a significant reduction in MACE, cardiovascular events, all-cause mortality and severe hypoglycemia as an adverse event. Keywords. Liraglutide, GLP-1 agonist, Major adverse cardiovascular events, Type 2 diabetes, Cardiovascular complications

To evaluate the efficacy and safety of advancing to higher levels of diabetes technology in older adults with type 1 diabetes (T1D). Web of Science, PubMed, Cochrane Library, and SCOPUS were searched. Inclusion criteria were randomised controlled trials (RCTs); aged ≥60 years with T1D. Interventions were pre-specified into two domain comparisons: (1) Higher-level insulin delivery (defined as automated insulin delivery, AID) versus lower-level insulin delivery (comprising sensor-augmented pumps and predictive low-glucose suspend); and (2) Higher-level glucose monitoring (defined as continuous glucose monitoring, CGM) versus lower-level glucose monitoring (self-monitoring of blood glucose). Co-primary efficacy outcomes were time-below-range of <3.9 mmol/L(TBR3.9) and time-in-range of 3.9-10.0 mmol/L (TIR). Safety outcomes were episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia (SH). Five RCTs (comprising six comparisons) with 482 participants were included. Three trials enrolled participants aged ≥60 years, and two trials enrolled those aged ≥65 years. Three crossover trials contributed to the AID comparison, and two parallel to the CGM comparison. The mean age was 69.2 years, with a mean T1D duration of 36.1 years. In the pooled analysis, higher-level technologies significantly increased TIR (MD = +7.90%, 95% CI: 7.09 to 8.72, p <0.001) and reduced TBR3.9 (MD = -0.62%, 95% CI: -1.02 to -0.22, p = 0.002). Benefits were also observed for TBR <3.0 mmol/L, time-above-range >10.0 and >13.9 mmol/L, HbA1c, and glycemic variability (all p <0.05). Critically, SH risk was markedly lower with higher-level technologies (Peto OR = 0.16, 95% CI: 0.06 to 0.41, p <0.001; number-needed-to-treat = 20), without a significant increase in DKA risk (Peto OR = 3.72, 95% CI: 0.75 to 18.49, p = 0.11). Advancing to higher-level technologies for glucose monitoring and insulin delivery significantly and safely improve glycemic control in older adults with T1D. Physiological age alone should not be a primary barrier to prescribing these technologies, particularly for carefully selected older adults.

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a severe and increasingly common form of pancreatitis requiring prompt triglyceride-lowering therapy. This study aimed to evaluate the safety and effectiveness of a standardized fixed-dose insulin drip protocol option implemented across a healthcare system. Multicenter retrospective cohort study. A total of 466 adult patients admitted with HTG-AP between 15 July 2017, and 10 October 2024. Patients were divided into pre-protocol (n = 242) and post-protocol (n = 224) groups based on implementation of the fixed-dose insulin protocol on 10 June 2021. The primary outcome was intensive care unit (ICU) length of stay. Secondary outcomes included hospital length of stay and time to achieve triglyceride levels < 1000 mg/dL (11.3 mmol/L). Safety outcomes included incidence of hypoglycemia and hypokalemia. Baseline demographics were generally similar between groups, with higher rates of a history of diabetes and hyperlipidemia in the post-protocol group. No statistically significant differences were observed in ICU length of stay, hospital length of stay, or time to triglyceride reduction. Mild hypoglycemia was more common post-protocol (36.6% vs. 25.2%, p = 0.008), while rates of severe hypoglycemia and hypokalemia were low and comparable between groups. The fixed-dose insulin protocol demonstrated similar clinical outcomes to historical care with an acceptable safety profile. This protocol offers a reproducible and standardized approach to managing HTG-AP in diverse inpatient settings.

IntroductionCardiovascular disease (CVD) is a common complication and major cause of mortality in people with type 1 diabetes (T1D). This study quantifies the prevalence of CVD among commercially insured adults with T1D in the USA from 2017 to 2021, overall and among age-defined and sex-defined subgroups.Research design and methodsWe used Merative MarketScan nationwide commercial insurance claims database (2017–2021) to identify adults ≥20 years with T1D (International Classification of Diseases, 10th Revision (ICD-10) codes). CVD ascertainment was based on ICD-10 codes for myocardial infarction, atrial fibrillation, ischemic heart disease, heart failure, peripheral artery disease, and stroke. Comorbidities included hypertension, obesity, hyperlipidemia, retinopathy, neuropathy, nephropathy, severe hypoglycemia, and diabetic ketoacidosis. Annual prevalence and age-specific and sex-specific prevalence of CVD were calculated overall and by comorbidities. Logistic regression was used to examine associations between sex, prevalent comorbidities, and odds of CVD.ResultsThe sample size ranged from n=21 748 in 2017 to n=13 294 in 2021. Among adults with T1D (mean (SD) age (48.51 (13.95) years in 2017 and 46.80 (13.04) years in 2021; 47% female), the prevalence of CVD ranged from 18.18% (95% CI 17.77 to 18.66%) in 2017 to 20.58% (95% CI 19.91 to 21.24%) in 2021. In 2021, among those aged 20–39 years, 40–64 years, and 65+years, the prevalence of CVD was 4.97%, 20.41%, and 52.94%, respectively. The age-adjusted prevalence of CVD was higher in males than females (21.93% vs 19.07%). Age, sex, and all comorbidities were independently associated with CVD. Odds of CVD were highest among those with hypertension (adjusted OR 3.15, 95% CI: 2.77 to 3.57).ConclusionIn this sample of US commercially insured adults with T1D, CVD prevalence remained stable at ~20% from 2017 to 2021. Early detection via improved screening and targeted management of comorbidities are key preventive strategies.