Impact of continuous glucose monitoring on hospitalizations and glucose control in people with type 2 diabetes: real-world analysis.

AIM: The real-world benefits of continuous glucose monitoring (CGM) in the broad type 2 diabetes (T2D) population are not well studied. Our study evaluated the impact of CGM use on health care resource utilization over 12 months in adults with T2D. MATERIALS AND METHODS: This retrospective cohort analysis used Optum's de-identified Market Clarity data of >79 million people to evaluate CGM use in people with T2D who were treated with non-insulin (NIT), basal insulin (BIT) and prandial insulin therapy (PIT). The primary outcomes were changes in all-cause hospitalizations, acute diabetes-related hospitalizations and acute diabetes-related emergency room visits during the 6- and 12-month post-index period following transition from blood glucose monitoring to CGM. A pre-specified subgroup analysis assessed glucose control and medication changes among people with T2D over 1 year. RESULTS: The analysis included 74 679 adults with T2D (NIT; n = 25 269), (BIT; n = 16 264) and (PIT; n = 33 146). Significant reductions in all-cause hospitalizations, acute diabetes-related hospitalizations and acute diabetes-related emergency room visits were observed in the 6-month post-index period that were sustained during the 6-12 month post-index period (NIT, -10.1%, -31.0%, -30.7%; BIT, -13.9%, -47.6%, -28.2%; and PIT, -22.6%, -52.7%, -36.6%, respectively). A subgroup analysis of 6030 people showed mean glycated haemoglobin reductions at approximately 3 months, which were also sustained throughout the post-index period: NIT, -1.1 (0.05)%; BIT, -1.1 (0.06)%; and PIT, -0.9 (0.04)%, p < 0.0001. CONCLUSIONS: CGM use in real-life across different therapeutic regimens in adults with T2D was associated with reductions in health care resource utilization with improved glucose control over 1 year.

Rosette-forming multicentric B-cell lymphoma in a giant panda.

Literature covering diseases of the giant panda (Ailuropoda melanoleuca) is either in Chinese or focuses on infectious agents. Here we describe the clinical signs, gross and microscopic findings, and immunohistochemistry results of a B-cell lymphoma in multiple organs of a 35-y-old captive male giant panda. The animal was euthanized because of prolonged anorexia and vomiting. Postmortem examination revealed ascites, generalized lymphadenopathy, splenomegaly, hepatomegaly, and thickened gall bladder mucosa. Histologically, the architecture of these organs was effaced by a densely cellular neoplasm composed of large, CD79a-positive neoplastic B lymphocytes supported by a fine fibrovascular stroma. Neoplastic cells occasionally palisaded around an eosinophilic fibrillary center, sometimes resembling Homer Wright rosettes. To our knowledge, rosette-forming lymphoma has not been reported previously in animals.

Spatiotemporal changes in largemouth bass mercury concentrations from Connecticut waterbodies, 1995-2021.

We evaluated spatiotemporal changes in the mean and variation in largemouth bass (Micropterus salmoides) mercury concentrations over three discrete time periods (1995, 2005-2006, and 2019-2021) across 56 Connecticut waterbodies. We detected largemouth bass raw mercury concentrations that exceeded the US Environmental Protection Agency (USEPA) Fish Tissue Residue Criterion (≥ 0.30 µg g-1 ww) in 75.1%, 63.3%, and 47.7% of all fish sampled during 1995, 2005-2006, and 2019-2021, respectively. Total length (TL)-adjusted largemouth bass mercury concentrations declined across all ecoregions in Connecticut between subsequent sampling periods but increased between 2005-2006 and 2019-2021 in the Northwest Hills/Uplands ecoregion. The coefficient of variation (CV) of largemouth bass TL-adjusted mercury concentrations increased through time, increasing from 25.78% during 1995 to 36.47% during 2019-2021. The probability of a largemouth bass having a raw mercury concentration > 0.30 µg g-1 ww increased with total length (TL), but the TL with a 50% probability varied across ecoregions and periods. The variation in largemouth bass mercury concentrations highlights the roles that changes to individual behaviors, food web structure, lake properties, and legacy mercury may play in shaping broad patterns and trends in mercury consumption risks.

Detection of numerous phycotoxins in young bull sharks (Carcharhinus leucas) collected from an estuary of national significance.

Florida's Indian River Lagoon (IRL) has experienced large-scale, frequent blooms of toxic harmful algae in recent decades. Sentinel, or indicator, species can provide an integrated picture of contaminants in the environment and may be useful to understanding phycotoxin prevalence in the IRL. This study evaluated the presence of phycotoxins in the IRL ecosystem by using the bull shark (Carcharhinus leucas) as a sentinel species. Concentrations of phycotoxins were measured in samples collected from 50 immature bull sharks captured in the IRL between 2018 and 2020. Ultra-performance liquid chromatography/tandem mass spectrometry was used to measure toxins in shark gut contents, plasma, and liver. Analysis of samples (n = 123) demonstrated the presence of multiple phycotoxins (microcystin, nodularin, teleocidin, cylindrospermopsin, domoic acid, okadaic acid, and brevetoxin) in 82 % of sampled bull sharks. However, most detected toxins were in low prevalence (≤25 % of samples, per sample type). This study provides valuable baseline information on presence of multiple phycotoxins in a species occupying a high trophic position in this estuary of national significance.

Cost analysis of self-monitoring blood glucose in nonintensively managed type 2 diabetes.

OBJECTIVES: To compare health care resource utilization (HCRU) and costs between self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) users in adults with nonintensively managed type 2 diabetes (T2D). STUDY DESIGN: Retrospective analysis of the MarketScan Databases. METHODS: Adults with T2D using SMBG or initiating CGM between January 2018 and March 2019 were eligible for inclusion. Inclusion criteria were (1) 2 consecutive claims for T2D or 1 claim for T2D and a claim for glucose-lowering therapy, (2) at least 1 pharmacy claim for SMBG strips or CGM sensors, and (3) continuous enrollment for 1 year before and after the index date. Individuals with evidence of CGM in the preindex period, pregnancy, use of rapid-acting insulin or glucagon, type 1 diabetes, gestational diabetes, or secondary diabetes at any time during the study period were excluded. SMBG and CGM patients were matched using propensity score, and all-cause HCRU and costs during a 1-year period were compared. RESULTS: A total of 3498 patients were included in each matched cohort. The per-patient per-year (PPPY) all-cause cost was $20,542 in CGM users vs $19,349 in SMBG users (P < .001). The PPPY cost of glucose-lowering medication was $6312 in CGM users vs $5606 in SMBG users (P < .001). No significant differences in the number of emergency department visits or hospitalizations were observed, but CGM users had more all-cause outpatient visits and office visits with an endocrinologist. CONCLUSIONS: In adults with nonintensively managed T2D, SMBG appears to be less costly than CGM and is associated with lower pharmacy costs.

Urinary excretion of estrogenic chemicals following consumption of capsule coffee and French press coffee: A crossover study.

Background: Coffee brewed from capsules contain estrogenic chemicals (ECs) that may harm the reproductive system. However, there are no studies investigating whether consuming capsule coffee causes these ECs to present in urine. Objective: Compare the effects of consuming capsule coffee vs. a plastic-free (French press) method on the appearance of ECs in urine. Methods: Participants (n = 30) were randomized to consume 540 mL of capsule or French press coffee once, then switched and consumed the other coffee after washout. Urine samples were collected prior to consumption, at 6 h and 24 h. Coffee and urine samples were analyzed for nine ECs using ultra-performance liquid chromatography with tandem mass spectrometry: bisphenol A (BPA), bisphenol F (BPF), bisphenol S, di(2-ethylhexyl) phthalate (DEHP), benzophenone, 4-nonylphenol (4-NP), dibutyl phthalate, caprolactam and dimethyl terephthalate. Results: In coffee samples, BPF (French press: 13.9 ng/mL, capsule: 16.1 ng/mL) and DEHP (capsule: 1.12 ng/mL) were present. In 6 h urine samples, the detection frequency for DEHP was 6.7% in capsule and 13.3% in French press coffee. BPF was detected in only one urine sample post-consumption. Conclusion: Consuming capsule coffee did not increase urinary EC exposure compared to consuming French press coffee.

A case of pseudohyperchloraemia caused by sodium nitrate ingestion.

Emergency department presentations of sodium nitrate poisoning are increasing in frequency. Point-of-care blood gas analysis is useful for identifying methaemoglobinaemia and other abnormalities in such patients. Topically applied nitrate is known to positively interfere with chloride measurement in both point-of-care instruments and automated analysers of the clinical chemistry laboratory. In this article, the authors describe a case of pseudohyperchloraemia caused by sodium nitrate, which was consumed orally for the purpose of suicide. Consistent with the established pattern of interference, the ABL800 (Radiometer Medical, Brønshøj Copenhagen) blood gas analyser produced spuriously high chloride results, whilst the Alinity (Abbott Diagnostics, Abbot Park, Illinois) automated analyser resulted in chloride measurements comparable to those of inductively coupled mass spectrometry (ICP-MS). Both instruments, measure chloride with ion-selective electrodes (ISEs). The ABL800 (Radiometer) uses a membrane electrode, which is vulnerable to permeation by lipophilic nitrate ions, whereas the Alinity (Abbott) employs a silver chloride redox electrode system that is resistant to precipitation of silver nitrate due to its relatively high solubility. These mechanistic differences likely explain why nitrate interferes with some point-of-care devices but does not appear to affect the results of automated analysers.

Effectiveness of Gravity and Manual Stress Radiographs and the Use of Lateral Talar Displacement in Determining Ankle Stability of Supination-External Rotation Type Ankle Fractures.

OBJECTIVES: (1) To evaluate adequacy and reproducibility of the gravity and manual stress imaging in the diagnosis of unstable ankle fractures and (2) to evaluate the diagnostic utility of lateral talar displacement ratio (LTDR) derived in relation to the talar body width on ankle stress imaging. DESIGN: Retrospective cohort study. SETTING: Level 1 Trauma Center. PATIENTS: One hundred seventy consecutive patients who presented with supination-external rotation 2 ankle fractures (OTA/AO 44-B2.1) requiring dynamic stress testing. INTERVENTION: Dynamic stress imaging to determine ankle stability. MAIN OUTCOME MEASURE: Ankle instability and subsequent need for surgical fixation as determined by dynamic stress imaging. RESULTS: No statistical significant difference was found between the adequacy of gravity stress radiographs and manual stress images in regards to surgical decision-making (P = 0.595). Using manual and gravity stress images, receiver operating characteristic curves were generated for medial clear space (MCS) (area under the curve = 0.793, 0.901) and LTDR (0.849, 0.850), corresponding to thresholds of 10.5% and 10.2% for manual and gravity, respectively. Seventy-three of 105 patients (69.5%) with MCS > 5 mm and 62 of 75 patients (82.7%) with LTDR > 10% were offered surgical intervention. Sixty-two of the 77 patients (80.5%) offered surgery had both MCS > 5 mm and LTDR > 10%. CONCLUSION: This study shows that manual stress radiographs are just as effective as gravity stress radiographs in making an assessment of ankle fracture stability as there was no difference in diagnostic value between gravity and manual stress imaging in regards to surgical decision-making. Use of additional radiographic measurements such as the LTDR can provide additional information in determining stability when MCS is within a clinical gray area. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Estrogenic activity of capsule coffee using the VM7Luc4E2 assay.

Coffee brewed from capsule machines may contain estrogenic chemicals migrated from plastic, but the estrogenic activity of capsule coffee has not been evaluated. This study evaluated the estrogenic activity of capsule coffee using the VM7Luc4E2 estrogen receptor transcriptional activation assay. Estrogenic potentials of six capsule coffee samples were calculated using relative maximum amplitude response of E2 (>15%RME2 indicative of estrogenic activity) and estradiol equivalent factor (EEF). Estrogenic chemical content was determined using ultra-performance liquid chromatography with tandem mass spectrometry. All capsule coffee samples possessed estrogenic activity (48-56%RME2). EEFs were 6-7 orders of magnitude lower than that of E2, (1.2 × 10-7-1.7 × 10-6), indicating substantially weaker estrogenic potencies. Bisphenol A, bisphenol F, benzophenone, 4-nonylphenol, dibutyl phthalate, and dimethyl terephthalate were detected in capsule coffee. Capsule coffee exhibited estrogenic activity in vitro, and its estrogenic chemical content is likely driving its estrogenicity, warranting further investigations to fully understand the degree to which they are related and to predict the estrogenic potential based on the concentration of estrogenic chemicals.