Efficacy of the hybrid closed-loop insulin delivery system in children and adolescents with type 1 diabetes: a meta-analysis with trial sequential analysis

ABSTRACT The aim of this study was to assess the efficacy and safety of hybrid closed-loop (HCL) systems for insulin delivery in children and adolescents with type 1 diabetes (T1D). We searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCTs) published until March 2023 comparing the HCL therapy with control therapies for children and adolescents with T1D. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) with 95% confidence intervals (CIs) for binary endpoints. Four RCTs and 501 patients were included, of whom 323 were randomized to HCL therapy. Compared with control therapies, HCL significantly improved the period during which glucose level was 70-180 mg/dL (WMD 10.89%, 95% CI 8.22-13.56%) and the number of participants with glycated hemoglobin (HbA1c) level < 7% (RR 2.61, 95% CI 1.29-5.28). Also, HCL significantly reduced the time during which glucose level was > 180 mg/dL (WMD -10.46%, 95% CI -13.99 to -6.93%) and the mean levels of glucose (WMD -16.67 mg/dL, 95% CI -22.25 to -11.09 mg/dL) and HbA1c (WMD -0.50%, 95% CI -0.68 to -0.31). There were no significant differences between therapies regarding time during which glucose level was < 70 mg/dL or <54 mg/dL or number of episodes of ketoacidosis, hyperglycemia, and hypoglycemia. In this meta-analysis, HCL compared with control therapies was associated with improved time in range and HbA1c control in children and adolescents with T1D and a similar profile of side effects. These findings support the efficacy of HCL in the treatment of T1D in this population.

"Anti-obesity medications" or "medications to treat obesity" instead of "weight loss drugs" - why language matters - an official statement of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM)

ABSTRACT Obesity is largely undertreated, in part because of the stigma surrounding the disease and its treatment. The use of the term "weight loss drugs" to refer to medications for the treatment of obesity may contribute to this stigma, leading to the idea that anyone who wants to lose weight could use them and that short-term use, only in the active weight loss phase would be enough. On the contrary, the use of terms such as "medications to treat obesity" or "anti-obesity medications" conveys the idea that the treatment is directed at the disease rather than the symptom. This joint statement by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM) intends to alert the press, healthcare professionals and scientific community about the importance of the appropriate use of language, with the aim of improving obesity care.

Flash glucose monitoring system in special situations

ABSTRACT The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

Prevalência de sintomas de ansiedade e depressão em pacientes com diferentes graus de obesidade / Prevalence of anxiety and depression symptoms in patients with different degrees of obesity

Introdução: A obesidade apresenta elevada prevalência e está associada ao aumento da morbidade e mortalidade. Vários estudos já identificaram impacto negativo da adiposidade em sintomas psicológicos, porém ainda se investiga a relação de causalidade entre estas afecções. Objetivo: Determinar a prevalência de sintomas ansiosos e depressivos em pacientes com diferentes graus de obesidade. Métodos: Estudo observacional transversal realizado entre 2016 e 2019 por meio da aplicação do questionário Escala Hospitalar de Ansiedade e Depressão (HADS) em pacientes com obesidade. Resultados: Foram incluídos 47 pacientes no estudo. 14 pacientes com obesidade grau 1 (G1) , 14 pacientes com obesidade grau 2 (G2) e 19 pacientes com obesidade grau 3 (G3). Do total, 37 eram mulheres (78,7%), com média de idade 43±10 anos, 110,6±27,7 kg e índice de massa corporal de 41,8±9,3 kg/m². Entre os participantes, 17 (36,2%) tinham sintomas de ansiedade, sendo 6 (42,9%) do G1, 6 (42,9%) do G2 e 5 (26,3%) do G3, (p=0,511). 16 pacientes (34%) tiveram sintomas depressivos, correspondendo a 5 (35,7%) pacientes no G1, 4 (28,6%) no G2 e 7 (36,8%) no G3, (p=0,874). Uma moderada correlação entre HADS-A e HADS-D foi constatada (r=0,654) (p<0,001). Conclusão: Foram identificadas elevadas taxas de sintomas ansiosos e depressivos entre os pacientes avaliados, dados estes, superiores aos dados da população geral descrito na literatura. Entretanto, não foram identificadas diferenças entre os diferentes graus de obesidade quanto a prevalência de sintomas ansiosos ou depressivos.

Introduction: Obesity has high prevalence and is associated with increased morbidity and mortality. Several studies have already identified negative impact of adiposity on psychological symptoms, but the causal relationship between these conditions is still investigated. Objective: To determine the prevalence of anxious and depressive symptoms in patients with different degrees of obesity. Methods: Cross-sectional observational study conducted between 2016 and 2019 by applying the questionnaire Hospital Anxiety and Depression Scale (HADS) in obese patients. Results: 47 patients were included in the study. 14 patients with grade 1 obesity (G1), 14 patients with grade 2 obesity (G2) and 19 patients with grade 3 obesity (G3). Of the total, 37 were women (78.7%), with a mean age of 43 ± 10 years, 110.6 ± 27.7 kg and body mass index of 41.8 ± 9.3 kg / m². Among the participants, 17 (36.2%) had anxiety symptoms, being 6 (42.9%) from G1, 6 (42.9%) from G2 and 5 (26.3%) from G3, (p = 0.511). 16 patients (34%) had depressive symptoms, corresponding to 5 (35.7%) patients in G1, 4 (28.6%) in G2 and 7 (36.8%) in G3, (p = 0.874). A moderate correlation between HADS-A and HADS-D was found (r = 0.654) (p <0.001). Conclusion: High rates of anxious and depressive symptoms were identified among the patients evaluated, which is higher than the general population data described in the literature. However, no differences were identified between the different degrees of obesity regarding the prevalence of anxious or depressive symptoms.

Effects of a structured education program on glycemic control in type 1 diabetes

ABSTRACT Objective Diabetes mellitus is associated with significant morbidity and mortality, and education is known to play a key role in managing this disease. This study addresses the effects of a structured education program (SEP) on self-care in subjects with type 1 diabetes mellitus (T1DM). The aim was to evaluate the effect of a SEP on glycemic control, knowledge, and skills associated with diabetes care in subjects with T1DM. Subjects and methods A total of 47 adults with T1DM were followed up for 20 months (32 participated in the SEP and 15 served as a control group). The SEP consisted of workshops, individualized care, 24-hour distant support, and a questionnaire assessing knowledge of diabetes care. Glycosylated hemoglobin (HbA1c) levels were measured before and after the SEP implementation. Results Compared with pre-SEP levels, the mean HbA1c levels decreased by approximately 20% (21 mmol/mol) at 1 year, with a further 11% reduction (10 mmol/mol) observed 8 months later (p < 0.001). Knowledge about diabetes care increased by 37% between the pre-SEP and post-SEP questionnaires (p < 0.005). Conclusion Relevant improvements occurred after SEP activities. The sustained decrease in HbA1c levels and the overall increase in knowledge and confidence regarding diabetes care reinforce the importance, necessity, and positive outcomes of a SEP intervention in T1DM.

Hypercalcemia and acute renal insufficiency following use of a veterinary supplement / Hipercalcemia e insuficiência renal aguda após uso de suplemento veterinário

Abstract A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.

Resumo Um paciente de 24 anos do sexo masculino, previamente hígido, apresentou-se com uma história de dois meses de dor epigástrica, náuseas, vômitos, fadiga e mal-estar. Ele relatava abuso de diferentes substâncias, incluindo um composto vitamínico veterinário injetável contendo altas doses de vitamina A, D e E, e um veículo oleoso que induz edema local com aumento de volume muscular. A creatinina sérica estava 3,1 mg/dL, alanina transaminase 160 mg/dL, aspartato transaminase 11 mg/dL, testosterona total 23 ng/dL, 25-OH-vitamina D > 150 ng/mL (toxicidade > 100), 1,25-OH-vitamina D 80 pg/mL, vitamina A 0,7 mg/dL, paratormônio < 3 pg/mL, cálcio total 13,6 mg/dL, cálcio urinário de 24h 635 mg/24h (VR 42-353). Uma ultrassonografia do trato urinário demonstrou sinais de nefropatia parenquimatosa. O diagnóstico foi hipercalcemia e insuficiência renal aguda secundária a intoxicação por vitamina D. Ele foi tratado inicialmente com hidratação intravenosa, furosemida e prednisona. No quinto dia de hospitalização uma dose de pamidronato dissódico foi adicionada. O paciente evoluiu com normalização do cálcio sérico e da função renal. Trinta dias depois ele apresentou testes clínicos e laboratoriais normais, exceto a 25-OH-vitamina D que estava persistentemente elevada (107 ng/mL), já que ela pode demorar vários meses para normalizar. Este relato de caso é um alerta aos riscos relacionados ao uso de substâncias veterinárias para fins estéticos.

Desfechos metabólicos de pacientes submetidos a bypass gástrico em Y de Roux em um hospital universitário / Metabolic outcomes of patients undergoing Roux-en-Y gastric bypass in a university hospital

Introdução: A obesidade é uma das doenças mais prevalentes da atualidade, carregando consigo comorbidades e complicações importantes. O bypass gástrico em Y de Roux (GYR) é o tratamento cirúrgico para obesidade mais realizado em nível mundial. O presente estudo visa avaliar o peso e o perfil metabólico pré e pós-operatório de pacientes que realizaram GYR no Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC). Métodos: Trata-se de um estudo de coorte retrospectiva, com pacientes submetidos a GYR no ano de 2012 no HU-UFSC. Foram avaliados os dados antropométricos e o perfil metabólico no pré-operatório e em três momentos distintos no primeiro ano de pós-operatório. Resultados: Foram incluídos 58 pacientes, a maioria mulheres (87%), com média de peso de 122,15 ± 17,26 kg e IMC de 47,14 ± 5,90 kg/m2 . Quinze pacientes (25,8%) apresentavam diabetes. O peso e IMC ao final do acompanhamento foram de 78,05 ± 13,53 kg e 30,39 ± 4,58 kg/m2 , respectivamente, sendo o percentual de perda de peso de 35,96 ± 7,20%. Houve diminuição significativa da glicemia de jejum (111,29 ± 32,92 vs. 88,12 ± 11,92 mg/dL) e melhora do perfil lipídico. Entre os pacientes diabéticos, observou-se queda na HbA1c (7,60 ± 1,42 vs. 5,81 ± 0,67%), e o percentual de pacientes que apresentavam HbA1c menor que 6,5% passou de 57,1 para 91,3%. Conclusão: Os resultados do estudo demonstram que o GYR em nosso meio resultou em significativa perda de peso e melhora do perfil metabólico, tanto em pacientes diabéticos quanto em não diabéticos.

Introduction: Obesity is currently one of the most prevalent diseases, being associated with significant comorbidities and complications. Roux-en-Y gastric bypass (RYG) is the most frequently performed surgical procedure for the treatment of obesity worldwide. This study aimed to evaluate the weight and metabolic profile of patients before and after RYG at the University Hospital of Universidade Federal de Santa Catarina (HU-UFSC). Methods: This is a retrospective cohort study, with patients who underwent RYG in 2012 at HU-UFSC. Anthropometric data and metabolic profile were evaluated preoperatively and at three different time points in the first year postoperatively. Results: Fifty-eight patients were included, mostly women (87%), with an average weight of 122.15 ± 17.26 kg and BMI of 47.14 ± 5.90 kg/m2 . Fifteen patients (25.8%) had diabetes. The weight and BMI at the end of follow-up were 78.05 ± 13.53 kg and 30.39 ± 4.58 kg/m2 , respectively, and the percentage of weight loss was 35.96 ± 7.20%There was a significant decrease in fasting blood glucose (111.29 ± 32.92 vs. 88.12 ± 11.92 mg/dL) and an improvement of lipid profile. Among diabetic patients, we observed a decrease in HbA1c (7.60 ± 1.42 vs. 5.81 ± 0.67%), and the percentage of patients who had an HbA1c of less than 6.5% increased from 57.1 to 91.3%. Conclusions: The results of the study show that in our environment the GYR led to a significant weight loss and improved the metabolic profile of both diabetic and non-diabetic patients.