RESUMEN
Aim: To evaluate the evolution of glycemic outcomes in patients living with type 1 diabetes (T1D) after 1 year of use of the MiniMed 780G advanced hybrid closed-loop (AHCL) system. Methods: We conducted an observational, retrospective, multicentric study in 20 centers in France. The primary objective was to evaluate the improvement in glycemic control after 1-year use of AHCL. The primary endpoint was the variation of time in range (TIR) between pre-AHCL and after 1-year use of AHCL. Secondary objectives were to analyze the glycemic outcomes after 3, 6, and 12 months of AHCL use, the safety, and the long-term observance of AHCL. Results: Two hundred twenty patients were included, and 200 were analyzed for the primary endpoint. 92.7% of patients continued to use AHCL. After 1 year of use of AHCL, TIR was 72.5% ± 10.6% (+9.1%; 95% confidence interval [CI] [7.6-10.5] compared to pre-AHCL initiation, P < 0.001), HbA1c 7.1% ± 0.7% (-0.5%; 95% CI [-0.6 to -0.4]; P < 0.001), time below range 2.0% [1.0; 3.0] (0.0% [-2.0; 0.0], P < 0.001), and time above range 24.8% ± 10.9% (-7.3%; 95% CI [-8.8 to -5.7]; P < 0.001). More patients achieved the glycemic treatment goals of HbA1c <7.0% (45.1% vs. 18.1%, P < 0.001) and TIR >70% (59.0% vs. 29.5% P < 0.001) when compared with pre-AHCL. Five patients experienced severe hypoglycemia events and two patients experienced ketoacidosis. Conclusion: After 1 year of use of AHCL, people living with T1D safely improved their glucose control and a higher proportion of them achieved optimal glycemic control.
Asunto(s)
Automonitorización de la Glucosa Sanguínea , Glucemia , Diabetes Mellitus Tipo 1 , Control Glucémico , Hipoglucemiantes , Sistemas de Infusión de Insulina , Insulina , Humanos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/sangre , Estudios Retrospectivos , Masculino , Femenino , Francia , Adulto , Glucemia/análisis , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/administración & dosificación , Control Glucémico/métodos , Insulina/administración & dosificación , Insulina/uso terapéutico , Persona de Mediana Edad , Hemoglobina Glucada/análisis , Resultado del Tratamiento , Hipoglucemia/prevención & control , Hipoglucemia/inducido químicamenteRESUMEN
Introduction: Obesity in patients with type 1 diabetes (T1D) may worsen their prognosis. Bariatric surgery in these patients can be associated with complications such as diabetic ketoacidosis and severe hypoglycemic episodes. Closed-loop insulin delivery could be a solution to avoid them. Case Report: A 45-year-old woman with T1D and obesity (body mass index of 38.4 kg/m2) was included in our preoperative course of bariatric surgery. Three months before surgery, a closed-loop insulin delivery was instituted due to one prior severe hypoglycemia. Patient did not have immediate or late postoperative hypoglycemia despite consuming a weak amount of carbohydrate. Three months after surgery glycemic control was on target with 86% of time in range 70-180 mg/dL and no time below 70 mg/dL. Conclusion: This case report shows that the use of a closed-loop insulin delivery made it possible to perform bariatric surgery in complete safety for our patient.
Asunto(s)
Cirugía Bariátrica , Diabetes Mellitus Tipo 1 , Hipoglucemia , Femenino , Humanos , Persona de Mediana Edad , Insulina/uso terapéutico , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/cirugía , Glucemia/metabolismo , Hipoglucemiantes/uso terapéutico , Sistemas de Infusión de Insulina , Hipoglucemia/etiología , Hipoglucemia/prevención & control , Insulina Regular Humana/uso terapéutico , Cirugía Bariátrica/efectos adversos , ObesidadAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Síndrome de Cushing/inducido químicamente , Imidazoles/uso terapéutico , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Piridinas/uso terapéutico , Hormona Adrenocorticotrópica , Síndrome de Cushing/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736.
Asunto(s)
COVID-19/diagnóstico , COVID-19/mortalidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Alta del Paciente , Anciano , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/terapia , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus/terapia , Femenino , Estudios de Seguimiento , Francia/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Pronóstico , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/fisiologíaRESUMEN
Rosai-Dorman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a rare histiocytic disorder first described in 1969. RDD involving the central nervous system is considered to be rare, with fewer than 120 cases reported in the literature. We present a 51-year-old woman with a history of panhypopituitarism, episodic memory disturbance, and a hypothalamic tumor. Stereotaxic hypothalamic lesion biopsy showed histiocytic proliferation positive for S100 protein and CD68, but negative for CD1a, typical for RDD. ¹8F-FDG PET/CT 4 months later demonstrated increased hypothalamic metabolic activity.