Real-world glycaemic outcomes in patients with type 1 diabetes using glucose sensors-Experience from a single centre in Dublin.

AIMS: To evaluate changes in glycated haemoglobin (HbA1 c) and sensor-based glycaemic metrics after glucose sensor commencement in adults with T1D. METHODS: We performed a retrospective observational single-centre study on HbA1 c, and sensor-based glycaemic data following the initiation of continuous glucose monitoring (CGM) in adults with T1D (n = 209). RESULTS: We observed an overall improvement in HbA1 c from 66 (59-78) mmol/mol [8.2 (7.5-9.3)%] pre-sensor to 60 (53-71) mmol/mol [7.6 (7.0-8.6)%] on-sensor (p < .001). The pre-sensor HbA1 c improved from 66 (57-74) mmol/mol [8.2 (7.4-8.9)%] to 62 (54-71) mmol/mol [7.8 (7.1-8.7)%] within the first year of usage to 60 (53-69) mmol/mol [7.6 (7.0-8.4)%] in the following year (n = 121, p < .001). RT-CGM-user had a significant improvement in HbA1 c (Dexcom G6; p < .001, r = 0.33 and Guardian 3; p < .001, r = 0.59) while a non-significant reduction was seen in FGM-user (Libre 1; p = .279). Both MDI (p < .001, r = 0.33) and CSII group (p < .001, r = 0.41) also demonstrated significant HbA1 c improvement. Patients with pre-sensor HbA1 c of ≥64 mmol/mol [8.0%] (n = 125), had attenuation of pre-sensor HbA1 c from 75 (68-83) mmol/mol [9.0 (8.4-9.7)%] to 67 (59-75) mmol/mol [8.2 (7.6-9.0)%] (p < .001, r = 0.44). Altogether, 25.8% of patients achieved the recommended HbA1 c goal of ≤53 mmol/mol and 16.7% attained the recommended ≥70% time in range (3.9-10.0 mmol/L). CONCLUSIONS: Our study demonstrated that minimally invasive glucose sensor technology in adults with T1D is associated with improvement in glycaemic outcomes. However, despite significant improvements in HbA1 c, achieving the recommended goals for all glycaemic metrics remained challenging.

A review of the evidence on cardiovascular outcomes from obesity treatment.

Background: Obesity is a chronic disease with a myriad of complications including cardiovascular disease. There is a growing interest to examine if obesity treatment is associated with cardiovascular outcomes. Methods: In this narrative review, we focused on randomized controlled trials (RCT) with cardiovascular outcomes (CVO) from lifestyle intervention, bariatric surgery, glucagon-like peptide-1 analogues (GLP-1a) and other pharmacotherapy. Additionally, we provide a comprehensive look into the RCT of sodium glucose cotransporter 2 inhibitors (SGLT2i) and CVO in obesity, while also summarizing several ongoing randomized cardiovascular outcome controlled trials for the pharmacological treatment of obesity. Results: To date, the results from the randomized controlled trials supported the association between obesity treatment and cardiovascular outcomes. Studies have large sample sizes, conducted over long duration, with the majority demonstrating superiority in primary cardiovascular outcome end points compared to placebo. Conclusion: Future data from several ongoing anti-obesity medications cardiovascular outcome trials such as SELECT, SURPASS, SUMMIT and SURMOUNT-MMO hold promises. Further studies are warranted to investigate the long term cardiovascular outcomes following lifestyle intervention and bariatric surgery.

Recent advances in the treatment of patients with obesity and chronic kidney disease.

Obesity is a chronic disease characterised by excess adiposity, which impairs health. The high prevalence of obesity raises the risk of long-term medical complications including type 2 diabetes and chronic kidney disease. Several studies have focused on patients with obesity, type 2 diabetes and chronic kidney disease due to the increased prevalence of diabetic kidney disease. Several randomized controlled trials on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 analogues, and bariatric surgery in diabetic kidney disease showed renoprotective effects. However, further research is critical to address the treatment of patients with obesity and chronic kidney disease to lessen morbidity.Key messageObesity is a driver of chronic kidney disease, and type 2 diabetes, along with obesity, accelerates chronic kidney disease.Several randomized controlled trials on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 analogues, and bariatric surgery in diabetic kidney disease demonstrate the improvement of renal outcomes.There is a need to address the treatment of patients with obesity and CKD to lessen morbidity.

A review on the beneficial effects of bariatric surgery in the management of obesity.

INTRODUCTION: Obesity is a chronic disease with a complex interplay of multiple factors such as genetic, metabolic, behavioral, and environmental factors. The management of obesity includes; lifestyle modification, psychological therapy, pharmacological therapy, and bariatric surgery. To date, bariatric surgery is the most effective treatment for obesity by offering a long-term reduction in weight, remission of obesity-related complications, and improving quality of life. However, bariatric surgery is not equally effective in all patients. Thus, if we can predict who would benefit most, it will improve the risk versus benefit ratio of having surgery. AREAS COVERED: In this narrative review, we explore the question on who will benefit the most from bariatric surgery by examining the recent evidence in the literature. In addition, we investigate the predisposing predictors of bariatric surgery response. Finally, we offer the best strategies in the clinic to explain the potential benefits of bariatric surgery to patients. EXPERT OPINION: Bariatric surgery is an effective obesity management approach. Despite its efficacy, considerable variation of individual response exists. Thus, it is important to recognize patients that will benefit most, but at present very few predictors are available which can be clinically useful.

The Relationship Between Percentage Weight Loss and World Health Organization-Five Wellbeing Index (WHO-5) in Patients Having Bariatric Surgery.

PURPOSE: The association between bariatric surgery outcome and depression remains controversial. Many patients with depression are not offered bariatric surgery due to concerns that they may have suboptimal outcomes. The aim of this study was to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery. MATERIALS AND METHODS: All patients were routinely reviewed by the psychologist and screened with WHO-5. The consultation occurred 3.5 ± 1.6 months before bariatric surgery. Body weight was recorded before and 1 year after surgery. A total of 45 out of 71 (63.3%) patients with complete WHO-5 data were included in the study. Data analysis was carried out with IBM SPSS Statistics (version 27) to determine the correlation between baseline WHO-5 and %TWL in patients having bariatric surgery. RESULTS: Overall, 11 males and 34 females were involved with mean age of 47.5 ± 11.5 and BMI of 46.2 ± 5.5 kg/m2. The %TWL between pre- and 1-year post-surgery was 30.0 ± 8.3% and the WHO-5 Wellbeing Index mean score was 56.5 ± 16.8. We found no correlation between %TWL and the WHO-5 Wellbeing Index (r = 0.032, p = 0.83). CONCLUSION: There was no correlation between the baseline WHO-5 Wellbeing Index and %TWL 1-year post-bariatric surgery. Patients with low mood or depression need to be assessed and offered appropriate treatment but should not be excluded from bariatric surgery only based on their mood.

A Metabolomics Approach to the Identification of Urinary Biomarkers of Pea Intake.

A significant body of evidence demonstrates that isoflavone metabolites are good markers of soy intake, while research is lacking on specific markers of other leguminous sources such as peas. In this context, the objective of our current study was to identify biomarkers of pea intake using an untargeted metabolomics approach. A randomized cross-over acute intervention study was conducted on eleven participants who consumed peas and couscous (control food) in random order. The urine samples were collected in fasting state and postprandially at regular intervals and were further analysed by ultra-performance liquid chromatography coupled to quadrupole time of flight mass spectrometry (UPLC-QTOF-MS). Multivariate statistical analysis resulted in robust Partial least squares Discriminant Analysis (PLS-DA) models obtained for comparison of fasting against the postprandial time points (0 h vs. 4 h, (R²X = 0.41, Q² = 0.4); 0 h vs. 6 h, ((R²X = 0.517, Q² = 0.495)). Variables with variable importance of projection (VIP) scores ≥1.5 obtained from the PLS-DA plot were considered discriminant between the two time points. Repeated measures analysis of variance (ANOVA) was performed to identify features with a significant time effect. Assessment of the time course profile revealed that ten features displayed a differential time course following peas consumption compared to the control food. The interesting features were tentatively identified using accurate mass data and confirmed by tandem mass spectrometry (MS using commercial spectral databases and authentic standards. 2-Isopropylmalic acid, asparaginyl valine and N-carbamoyl-2-amino-2-(4-hydroxyphenyl) acetic acid were identified as markers reflecting pea intake. The three markers also increased in a dose-dependent manner in a randomized intervention study and were further confirmed in an independent intervention study. Overall, key validation criteria were met for the successfully identified pea biomarkers. Future work will examine their use in nutritional epidemiology studies.