Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin

AIMS/HYPOTHESIS: We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI). METHODS: This is a retrospective cohort study using the Scottish Care Information – Diabetes database for retinal screening outcomes and HbA(1c) changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan–Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA(1c), blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA(1c) and change in HbA(1c) on diabetic retinopathy progression was assessed within CSII and MDI cohorts. RESULTS: CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA(1c) and higher diastolic BP at baseline. There was a larger reduction in HbA(1c) at 1 year in those on CSII vs MDI (−6 mmol/mol [−0.6%] vs −2 mmol/mol [−0.2%], p < 0.01). Diabetic retinopathy progression occurred in a smaller proportion of adults following commencement of CSII vs continued MDI therapy over mean 2.3 year follow-up (26.5% vs 18.6%, p = 0.0097). High baseline HbA(1c) (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA(1c) at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. CONCLUSIONS/INTERPRETATION: CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA(1c). Progression of diabetic retinopathy over 3 years was not associated with a change in HbA(1c). GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-021-05456-w

Hypoglycemia Revisited in the Acute Care Setting

Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings

Development of 100^{100}Mo-containing scintillating bolometers for a high-sensitivity neutrinoless double-beta decay search

We report recent achievements in the development of scintillating bolometers to search for neutrinoless double-beta decay of $^{100}$Mo. The presented results have been obtained in the framework of the LUMINEU, LUCIFER and EDELWEISS collaborations, and are now part of the R\&D activities towards CUPID (CUORE Update with Particle IDentification), a proposed next-generation double-beta decay experiment based on the CUORE experience. We have developed a technology for the production of large mass ($\sim$1 kg), high optical quality, radiopure zinc and lithium molybdate crystal scintillators (ZnMoO$_4$ and Li$_2$MoO$_4$, respectively) from deeply purified natural and $^{100}$Mo-enriched molybdenum. The procedure is applied for a routine production of enriched crystals. Furthermore, the technology of a single detector module consisting of a large-volume ($\sim 100$~cm$^3$) Zn$^{100}$MoO$_4$ and Li$_2$$^{100}$MoO$_4$ scintillating bolometer has been established, demonstrating performance and radiopurity that are close to satisfy the demands of CUPID. In particular, the FWHM energy resolution of the detectors at 2615 keV --- near the $Q$-value of the double-beta transition of $^{100}$Mo (3034~keV) --- is $\approx$ 4--10~keV. The achieved rejection of $\alpha$-induced dominant background above 2.6~MeV is at the level of more than 99.9\%. The bulk activity of $^{232}$Th ($^{228}$Th) and $^{226}$Ra in the crystals is below 10 $\mu$Bq/kg. Both crystallization and detector technologies favor Li$_2$MoO$_4$, which was selected as a main element for the realization of a CUPID demonstrator (CUPID-0/Mo) with $\sim$7 kg of $^{100}$Mo

Comment on Lundeen et al. Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged &lt;65 Years. Diabetes Care 2023;46:687–696

e-letters - comments and responses on "Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged <65 Years. Lundeen EA, Kim M, Rein DB, Wittenborn JS, Saaddine J, Ehrlich JR, Holliday CS. Diabetes Care. 2023 Apr 1;46(4):687-696. doi: 10.2337/dc22-1834International audienc