The Effectiveness of Superbolus on Postprandial Blood Glucose Management of Pregnant Women With Type 1 Diabetes.

AIM: Pregnancies of women with pregestational diabetes are at risk of after-meal glucose peaks and late after-meal hypoglycemia, particularly at breakfast. We aimed to explore the effectiveness of a specific feature of insulin pump therapy called superbolus in preventing these glucose swings. METHODS: In this retrospective observational study, we analyzed continuous glucose monitoring data of patients with type 1 diabetes in pregnancy who were advised to use superbolus to manage their breakfast. Some of the postprandial basal insulin delivery was partially reduced and delivered instead as additional insulin bolus on top of a normal bolus. Outcomes of interest were one hour after breakfast glucose levels, the time in glucose range for after breakfast period, the number of late hypoglycemic episodes. RESULTS: Overall, 21 consecutive pregnant women with type 1 diabetes (mean age 34.3 ± 5.5 years, mean pregestational body mass index 23.7 ± 4.7 kg/m2, HbA1c levels during pregnancy 6.1 ± 0.6%) were studied. Superbolus reduced after breakfast glucose peaks (one hour after breakfast glucose levels 130 ± 17 mg/dL vs 123 ± 10 mg/dL before and after superbolus use, respectively, P = .01), improved the time in glucose range for after breakfast period (70.4% vs 50.8%, P = .001), and reduced the number of late hypoglycemic episodes (3 [1-5] vs 1 [0-2], P< .0001). CONCLUSION: Superbolus was effective in avoiding after-meal glucose peaks, increased postprandial glucose time in target, without late hypoglycemia occurrence. It represents a valid option for the treatment of pregnant women with type 1 diabetes using insulin pump.

The effectiveness of a televisit service for people with type 1 diabetes: An observational, retrospective, single center, one year follow-up study.

The use of a televisit service complying with efficiency and safety regulatory parameters was effective in significantly improving HbA1c levels of people with T1D after a one-year follow-up period. No acute diabetes-related complications occurred. Patients were highly satisfied with the service. Televisit is a valid option for diabetes management.

Minimed Medtronic 780G optimizes glucose control in patients with type 1 diabetes mellitus.

BACKGROUND AND AIMS: The new advanced hybrid closed loop insulin infusion systems have the potential to significantly improve glycaemic control. The aim of this study was to evaluate the effectiveness of the Minimed 780G system in 59 patients with type 1 diabetes. METHODS AND RESULTS: Glucose control obtained by using the system in automatic mode at 1-2 months of activation, at 2-4 months, at 4-6 months, and beyond 6 month was compared with those obtained with the system in manual mode. A significant improvement in time-in-range and in time-above-range throughout the follow-up was observed, as well as a significant reduction in time-below-range (<54 mg/dl) after 6 months, a significant reduction of the glucose variability and of HbA1c. After switching the mode, all target percentages lied on the average within the recommended ranges by literature consensus and no severe hypoglycemia nor ketoacidosis episodes were recorded. CONCLUSION: The Minimed 780G allowed a rapid and progressive improvement of the overall glucose control.

Advanced technology for type 1 diabetes care in a deaf-mute patient.

A 48-year-old deaf-mute man attending our outpatient clinic for long-term severely decompensated type 1 diabetes (mean glycated haemoglobin over 100 mmol/mol) has proved to be the best candidate for the beneficial implant of a next-generation closed loop insulin pump featuring a new refined auto-correction algorithm. The patient had already worn a stand-alone real-time continuous glucose monitoring (rt-CGM) device for 2 years, but his haemoglobin A1c (HbA1c) remained out of target with ample glucose variability. Then, we decided to use a novel advanced hybrid closed-loop insulin pump (the MiniMed 780G) coupled with his CGM device. After only 4 months this system led to a significant improvement in mean daily glucose levels (201±100 mg/dL vs 141±57 mg/dL), time in glucose range (43% vs 78%), percentage of time spent in hyperglycaemia (52% vs 20%), glucose variability (Coefficient of Variation 46% vs 38%), and HbA1c levels (121 mmol/mol vs 56 mmol/mol). The patient was highly satisfied.

Nutrition knowledge is associated with greater weight loss in obese patients following a multidisciplinary rehabilitation program.

BACKGROUND: A major objective of the metabolic-nutritional-psychological multidisciplinary rehabilitation of obese subjects is providing a nutritional education aimed at achieving a weight loss and the improvement of obesity-related cardio-metabolic diseases. The impact of nutrition knowledge in healthy eating patterns and weight loss is still debated. The aim of this study was to identify whether the increase in nutrition knowledge is associated with weight loss. METHODS: Two hundred fifty-six obese patients (80% women, mean age 57.5±12.4 years) were consecutively recruited among those referred for a three-month metabolic-nutritional-psychologic rehabilitation program. Education level and time of the onset of obesity were collected. Before and at the end of the intervention, anthropometric measures and body composition were assessed and the Moynihan Questionnaire (MQ) and the International Physical Activity Questionnaire administered. The weight loss maintenance was evaluated in patients who attended the 6-month follow-up visit. RESULTS: Nutrition knowledge was poor/sufficient in 97 out of 256 obese patients. The MQ Score was associated with the education level but not with age, gender and Body Mass Index. After rehabilitation, there was an increase in nutrition knowledge (mean score change -12±10.5%, P<0.0001) in the whole group of patients as well as in those with poor knowledge, 77% of whom reached a good/high level of knowledge on healthy diet. The improvement in knowledge was greater in patients with a weight loss ≥5% (P<0.05 vs. patients with a lower weight loss). Weight maintenance at follow-up, was associated with a better improvement in the nutritional knowledge during the previous rehabilitation. CONCLUSIONS: Weight-management programs should include a strong component of nutrition education to alleviate knowledge inequalities and promote more effective weight loss and control. The MQ may be a useful tool to verify the nutritional education carried out during the rehabilitation of obese subjects.

From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management.

AIMS: Despite the very clear association between polycystic ovary syndrome (PCOS) and dysglycemia, few studies have explored the continuum of glycemic alterations leading from minor glucose abnormalities to overt diabetes. The purpose of this review is to trace the natural history of glycemic alteration in women with PCOS. METHODS: We performed a literature review without time limit until August 2019. Inclusion criteria were studies addressing the association between impaired glucose tolerance or impaired fasting glucose or type 2 diabetes (T2D) and PCOS with at least an English abstract. The exclusion criteria were no PCOS or impaired glucose tolerance or impaired fasting glucose or T2D as outcome. The outcomes of interest were the onset of impaired glucose tolerance, impaired fasting glucose, T2D, and the progression from impaired glucose tolerance or impaired fasting glucose to T2D. RESULTS: Healthy diet and physical activity are the first-line therapy for PCOS. Treatment with metformin was associated with significant lower 2-hour postload glucose levels and with reduction in fasting glucose when compared to placebo. Thiazolidinediones were more effective in reducing fasting glucose levels compared to placebo. Metformin and pioglitazone treatments showed similar effects on fasting glucose levels. The sodium-glucose cotransporter-2 inhibitor empagliflozin did not show differences in metabolic parameters when compared to metformin. The combination therapy with metformin plus the glucagon-like peptide-1 receptor agonist liraglutide was associated with significant improvements in basal and postload glucose levels compared with only liraglutide. Likewise, a combination therapy with the dipeptidyl peptidase-4 inhibitor saxagliptin and metformin demonstrated superiority versus metformin in fasting glucose and oral glucose tolerance test normalization. Myo-inositol supplementation was associated with lower insulin levels, glucose levels, and insulin resistance when compared with placebo, metformin, or estrogen treatments. CONCLUSIONS: The use of insulin-sensitizing agents, such as metformin and inositols, along with lifestyle interventions may improve the metabolic profile in PCOS women.