Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms.

AIMS: To evaluate the efficacy of an advance closed-loop (AHCL) system in restoring awareness of hypoglycemia in patients with type 1 diabetes (T1D). METHODS: We conducted a prospective study including 46 subjects with T1D flash glucose monitoring (FGM) or continuous glucose monitoring (CGM) switching to a Minimed 780G® system. Patients were classified in three groups according to the therapy used before switching to Minimed® 780G: multiple dose insulin (MDI) therapy + FGM (n = 6), continuous subcutaneous insulin infusion + FGM (n = 21), and sensor-augmented pump with predictive low-glucose suspend (n = 19). FGM/CGM data were analyzed at baseline, after 2 and 6 months on AHCL. Clarke's score of hypoglycemia awareness was compared at baseline and 6 months recordings. We also compared the efficacy of the AHCL system in improving A1c among patients with appropriate perception of symptoms of hypoglycemia compared to those presenting with impaired awareness of hypoglycemia (IAH). RESULTS: Participants had a mean age of 37 ± 15 and a diabetes duration of 20 ± 10 years. At baseline, 12 patients (27%) showed IAH as defined by a Clarke's score ≥ 3. Patients with IAH were older and had lower estimated glomerular filtration rate (eGFR) compared with those who did not have IAH; with no differences in baseline CGM metrics or A1c. An overall decrease in A1c was observed after 6 months on AHCL system (from 6.9 ± 0.5% to 6.7 ± 0.6%, P < 0.001), regardless of prior insulin therapy. The improvement in metabolic control was greater in patients with IAH, showing a reduction in A1c from 6.9 ± 0.5 to 6.4 ± 0.4% vs 6.9 ± 0.5 to 6.8 ± 0.6% (P = 0.003), showing a parallel increase in total daily boluses of insulin and automatic bolus correction administered by the AHCL system. In patients with IAH Clarke's score decreased from 3.6 ± 0.8 at baseline to 1.9 ± 1.6 after 6 months (P < 0.001). After 6 months on AHCL system, only 3 patients (7%) presented with a Clarke's score ≥ 3, resulting in an absolute risk reduction of 20% (95% confidence interval: 7-32) of having IAH. CONCLUSIONS: Switching from any type of insulin administration to AHCL system improves restoration of hypoglycemia awareness and metabolic control in patients with T1D, particularly in adults with impaired perception of hypoglycemia symptoms. TRIAL REGISTRATION: ClinicalTrial.gov ID NCT04900636.

Academic Performance of Native and Immigrant Students: A Study Focused on the Perception of Family Support and Control, School Satisfaction, and Learning Environment.

The international assessment studies of key competences, such as the PISA report of the OECD, have revealed that the academic performance of Spanish students is significantly below the OECD average. In addition, it has also been confirmed that the results of immigrant students are consistently lower than those of their native counterparts. Given the context, the first objective of this work is to observe the variables (support, control, school satisfaction, and learning environment) which distinguish between retained and non-retained native and immigrant students. The second objective is to check, by comparing the retained and non-retained native and immigrant students and separating the two levels, in order to find out which of the selected variables clearly differentiate the two groups. A sample of 1359 students was used (79.8% native students and 20.2% immigrant students of Latin American origin), who were enrolled in the 5th and 6th year of Primary Education (aged 10-11 years) and in the 1st and 2nd year of Secondary Education (aged 12-13 years). The measurement scales, which undergo a psychometric analysis in the current work, have been developed in a previous research study (Lorenzo et al., 2009). The construct validity and reliability are reported (obtaining alpha indices between 0.705 and 0.787). Subsequently, and depending on the results of this analysis, inferential analyses are performed, using as independent variables the ethno-cultural origin and being retained or not, whereas, as dependent variables, the indices referring to students' perception of family support and control, as well as the assessment of the school and learning environment. Among other results, the Group × Being retained/Not being retained [F(1, 1315) = 4.67, p < 0.01] interaction should be pointed out, indicating that native non-retained subjects perceive more control than immigrants, as well as the Group × Being retained/Not being retained [F(1, 1200) = 5.49, p < 0.01] interaction, showing that native non-retained students perceive more family support. Given the results obtained, our intention is to provide solid evidence that would facilitate the design of family involvement programs, helping to improve students' educational performance.