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

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 glucoselevel 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.

Continuous Glucose Monitoring Systems in Noninsulin-Treated People with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Introduction: Continuous glucose monitoring (CGM) has shown favorable outcomes in patients with type 2 diabetes (T2D) who are on insulin therapy. However, the efficacy of CGM in managing glucose levels in noninsulin-treated people with T2D remains controversial. Methods: PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing CGM to self-monitoring of blood glucose (SMBG) in people with T2D not using insulin. We computed weighted mean differences (WMDs) and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Statistical analyses were performed using R version 4.2.3. Results: We included six RCTs comprising 407 noninsulin-treated people with T2D of whom 228 were randomized to CGM. Diabetes duration ranged from 5.4 to 13.9 years. The mean age was 57.9 years and the mean body mass index was 30.8 kg/m2. Four trials used real-time CGM (rt-CGM) and two intermittent scanning CGM (is-CGM). Compared with SMBG, CGM significantly reduced the glycated hemoglobin level (WMD -0.31%; 95% CI -0.42 to -0.21; I2 = 0%), glucose level (WMD -11.16 mg/dL; 95% CI -19.94 to -2.39; I2 = 0%), time in hypoglycemia level 2 (WMD -0.28%; 95% CI -0.52 to -0.03; I2 = 91%), glucose time >180 mg/dL (WMD -7.75%; 95% CI -12.04 to -3.45; I2 = 0%), and the standard deviation of glucose variation (WMD -4.00 mg/dL; 95% CI -6.86 to -1.14; I2 = 0%). CGM also increased time in range (WMD 8.63%; 95% CI 4.54-12.71; I2 = 0%) and treatment satisfaction (SMD 0.79; 95% CI 0.54-1.05; I2 = 0%). Conclusion: In this meta-analysis, rt-CGM and is-CGM were associated with improvement in glycemic control in people with T2D not using insulin when compared to SMBG.

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.

Hiperparatireoidismo primário: apresentação atípica. Relato de caso / Primary hyperparathyroidism: an atypical presentation. Case report

O objetivo deste estudo foi relatar um caso de hiperparatireoidismo primário com características clínicas, laboratoriais e de imagem atípicas, levando a suspeita diagnóstica de carcinoma de para tireoide que é uma causa rara de hiperparatireoidismo primário. Paciente do gênero masculino, 55 anos, apresentava quadro de perda ponderal significativa, astenia e mal estar generalizado. Ao exame físico, foi encontrada uma massa cervical palpável à esquerda. Procedeu-se assim à investigação laboratorial que evidenciou aumento das concentrações de cálcio e de paratormônio. Foi realizada ultrassonografia cervical que confirmou a presença de nódulo cervical e cintilografia por SESTAMIBI-99mTc que mostrou nódulo hipercaptante, de 2,5cm de diâmetro, próximo à tireoide. Outros exames evidenciaram litíase renal e lesões ósseas líticas disseminadas. Tais achados levaram à hipótese de hiperparatireoidismo primário causado por carcinoma de paratireoide. O paciente foi então submetido a procedimento cirúrgico e à biópsia de congelamento da lesão. Esta revelou características benignas, afastando a hipótese de carcinoma e a necessidade de uma ressecção inbloc associada à linfadenectomia, procedimento indicado em caso positivo para malignidade. A análise anatomopatológica do nódulo evidenciou um adenoma. Um ano após o tratamento,o paciente permanece livre de doença. O carcinoma de paratireoide deve ser considerado quando da presença de níveis extremamente elevados de cálcio sérico e paratormônio. Apesar do diagnóstico de carcinoma não ter se confirmado na análise histopatológica, a manutenção desta patologia entre os diagnósticos diferenciais foi essencial para a abordagem adequada do caso e para sua exclusão diagnóstica com maior segurança...

The aim of this article is to report a case of primary hyperparathyroidism with atypical clinical, laboratory and imaging features. These findings raised a diagnostic suspicion for parathyroid carcinoma, a rare cause of primary hyperparathyroidism. A 55 year-old male patient presented complaints of significant weight loss, weakness and general malaise. He also had a palpable cervical mass. Imagingm studies evidenced nephrolithiasis and diffuse lytic bone lesions. Laboratory tests showed very high levels of serum calcium and parathormone. These findings prompted a neck ultrasonography and SESTAMIBI-99mTc scintigraphy, which revealed a 2.5cm nodule with increased captation near the thyroid gland. The patient was submitted to surgical exploration and a frozen section biopsy of the lesion. The lesion showed benign patterns, and there was, therefore, no need for an in bloc resection and lymphadenectomy, which is the appropriate procedure in malignancy cases. The histopathologic analysis of the nodule revealed an adenoma. At the one year follow-up, the patient remained disease-free. Parathyroid carcinoma must be considered in cases with very high levels of serum calcium and parathormone. Although the diagnosis of carcinoma was not confirmed histologically, keeping this pathology in mind among the differential diagnosis was essential for the appropriate management of the case and the safe diagnostic exclusion of that malignancy...