Early and sustained increase in time in range 1 year after initiation of hybrid close loop therapy via telemedicine in type 1 diabetes patients

La evidencia respalda la eficacia y seguridad del sistema Hybrid Close Loop (HCL) en pacientes con diabetes tipo 1 (DT1). Sin embargo, hay datos limitados disponibles sobre los resultados a largo plazo de los pacientes que reciben HCL con seguimiento por telemedicina. Métodos Un estudio de cohorte observacional prospectivo que incluyó pacientes con diabetes Tipo 1 que estaban actualizando al sistema HCL. La capacitación virtual y el seguimiento se realizaron a través de telemedicina. Los datos de MCG se analizaron para comparar el tiempo inicial dentro del rango (TIR), el tiempo por debajo del rango (TBR), la variabilidad glucémica y el modo automático (AM), con mediciones realizadas a los 3, 6 y 12 meses. Resultados Se incluyeron 134 pacientes con A1c basal 7,6% ± 1,1. El 40,5% tuvo algún evento de hipoglucemia grave en el último año. La TIR inicial, medida dos semanas después de comenzar AM, fue de 78,6 ± 9,94 %. No se observaron cambios evidentes a los tres (diferencia de medias − 0,15; IC-2,47; 2,17; p  = 0,96), seis (MD-1,09; IC-3,42, 1,24; p  = 0,12) y 12 meses (MD-1,30; IC-3,64). <1,04; p  = 0,08). No se encontraron cambios significativos en la TBR ni en la variabilidad glucémica a lo largo del seguimiento. El uso de AM fue de 85,6 ± 17,5% y el porcentaje de uso de sensor fue de 88,75 ± 9,5% a los 12 meses. No se informaron eventos de hipoglucemia (SH) graves. Conclusiones Los sistemas HCL permiten mejorar TIR, TBR y variabilidad glucémica de forma segura, temprana y sostenida hasta 1 año de seguimiento en pacientes con DM1 y alto riesgo de hipoglucemia seguidos a través de telemedicina.Q1Background and Aims Evidence supports the efficacy and safety of the Hybrid Close loop (HCL) system in patients with type 1 diabetes (T1D). However, limited data are available on the long-term outcomes of patients on HCL with telemedicine follow-up. Methods A prospective observational cohort study including T1D patients, who were upgrading to HCL system. Virtual training and follow-up were done through telemedicine. CGM data were analyzed to compare the baseline time in range (TIR), time below range (TBR), glycemic variability and auto mode (AM), with measurements performed at 3, 6 and 12 months. Results 134 patients were included with baseline A1c 7.6% ± 1.1. 40.5% had a severe hypoglycemia event in the last year. Baseline TIR, measured two weeks after starting AM was 78.6 ± 9.94%. No changes were evident at three (Mean difference − 0.15;CI-2.47,2.17;p = 0.96), six (MD-1.09;CI-3.42,1.24;p = 0.12) and 12 months (MD-1.30;CI-3.64,1.04;p = 0.08). No significant changes were found in TBR or glycemic variability throughout the follow-up. Use of AM was 85.6 ± 17.5% and percentage of use of sensor was 88.75 ± 9.5% at 12 months. No severe hypoglycemic (SH) events were reported. Conclusions HCL systems allow to improve TIR, TBR and glycemic variability safely, early and sustained up to 1 year of follow-up in patients with T1D and high risk of hypoglycemia followed through telemedicine.Revista Internacional - IndexadaS

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Effectiveness; Caplacizumab; Immune thrombotic thrombocytopenic purpuraEficàcia; Caplacizumab; Púrpura trombocitopènica trombòtica immunitàriaEficacia; Caplacizumab; Púrpura trombocitopénica trombótica inmunitariaImmune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P < .05) and less refractoriness (4.5% vs 14.1%; P < .05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P < .05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P < .001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Asociación entre el puntaje del cuestionario de Clarke y las métricas aportadas por el monitoreo continuo de glucosa en pacientes con diabetes y alto riesgo de hipoglucemia

Contexto: el cuestionario de Clarke (CC), determina la percepción de síntomas de hipoglucemia y un puntaje ?4 detecta pacientes con hipoglucemia inadvertida (HI). La evidencia sobre la asociación entre las métricas del Monitoreo Continuo de Glucosa (MCG) y el puntaje del CC es limitada. Objetivo: describir la asociación entre el puntaje del CC y métricas del MCG en pacientes con diagnóstico de diabetes tratados con insulina y alto riesgo de hipoglucemia. Metodología: estudio de corte transversal, en pacientes adultos con diagnóstico de diabetes tratados con insulina e historia de hipoglucemia severa o factores de riesgo para (HI).  Se registraron datos demográficos, clínicos y puntaje de Clarke basales. Se realizó MCG profesional durante 6 días. Se compararon las métricas del MCG para los grupos con o sin HI, utilizando diferentes puntos de corte (Clarke ?4 y ?3). Resultados: se incluyeron 83 pacientes (mediana de edad 63 años [RIC 53.5-70.5], 71.1% DM2, HbA1c 7.6±1.6%). La mediana de tiempo en rango (TIR70-180 mg/dL) fue 75% [RIC 63-92], tiempo debajo rango (TBR180 mg/dL 15% [3-27]. En pacientes con Clarke ?4 el %TIR fue menor (Mediana 55[RIC 41-89] vs 77[RIC 68-92], p=0.05) a expensas de mayor %TAR (Mediana 23[RIC 7-54] vs 15[RIC 3-16], p=0.15). No se encontraron diferencias significativas en %TBR<70mg/dl.  Conclusiones: HI se asoció a menor %TIR entre 70-180 mg/dL de forma clínica y estadísticamente significativa en pacientes usuarios de insulina con factores de riesgo para hipoglucemia

La hiperglucemia intrahospitalaria es más importante que el antecedente de diabetes para predecir la aparición de desenlaces clínicos adversos en pacientes hospitalizados con COVID-19

Contexto: en pacientes con COVID-19, la diabetes mellitus y la hiperglucemia son condiciones prevalentes. La literatura es escasa en cuanto a la asociación de estas dos variables con desenlaces desfavorables en pacientes hospitalizados por COVID-19. Objetivo: evaluar la asociación entre hiperglucemia y la aparición de desenlaces adversos en pacientes con COVID-19. Metodología: estudio de cohorte retrospectiva en el que se evaluó la asociación entre presentar hiperglucemia con la aparición de síndrome de dificultad respiratoria aguda (SDRA), lesión renal aguda (LRA) y muerte intrahospitalaria en pacientes hospitalizados por COVID-19. Resultados: se incluyeron 408 pacientes (edad media 60.48, 58.8 % hombres, 34.1 % con diabetes, 40.4 % con hiperglucemia intrahospitalaria). La hiperglucemia se asoció de forma independiente a un mayor riesgo de SDRA (OR: 1.84, IC 95 %: 1.15 – 2.94; p=0.001), LRA (OR: 2.73; IC: 1.24–5.96; p=0.012) y muerte intrahospitalaria (OR: 2.61; IC: 1.20–5.68; p=0.015) después de controlar por variables de confusión. El antecedente de diabetes no se asoció de forma independiente con un mayor riesgo en ninguno de los tres desenlaces adversos. Conclusiones: la hiperglucemia se asocia de forma independiente con peores desenlaces en pacientes hospitalizados por COVID-19 a diferencia de la diabetes mellitus

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P <.05) and less refractoriness (4.5% vs 14.1%; P <.05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P <.05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P <.001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P < .05) and less refractoriness (4.5% vs 14.1%; P < .05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P < .05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P < .001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Early and sustained increase in time in range 1 year after initiation of hybrid close loop therapy via telemedicine in type 1 diabetes patients

Q2Q1Pacientes con Diabetes tipo 1Background and Aims: Evidence supports the efficacy and safety of the Hybrid Close loop (HCL) system in patients with type 1 diabetes (T1D). However, limited data are available on the long-term outcomes of patients on HCL with telemedicine follow-up. Methods: A prospective observational cohort study including T1D patients, who were upgrading to HCL system. Virtual training and follow-up were done through telemedicine. CGM data were analyzed to compare the baseline time in range (TIR), time below range (TBR), glycemic variability and auto mode (AM), with measurements performed at 3, 6 and 12 months. Results: 134 patients were included with baseline A1c 7.6% ± 1.1. 40.5% had a severe hypoglycemia event in the last year. Baseline TIR, measured two weeks after starting AM was 78.6 ± 9.94%. No changes were evident at three (Mean difference − 0.15;CI-2.47,2.17;p = 0.96), six (MD-1.09;CI-3.42,1.24;p = 0.12) and 12 months (MD-1.30;CI-3.64,1.04;p = 0.08). No significant changes were found in TBR or glycemic variability throughout the follow-up. Use of AM was 85.6 ± 17.5% and percentage of use of sensor was 88.75 ± 9.5% at 12 months. No severe hypoglycemic (SH) events were reported. Conclusions: HCL systems allow to improve TIR, TBR and glycemic variability safely, early and sustained up to 1 year of follow-up in patients with T1D and high risk of hypoglycemia followed through telemedicine.https://orcid.org/0000-0002-8907-3470https://orcid.org/0000-0002-1353-148Xhttps://orcid.org/0000-0001-6838-3253https://orcid.org/0000-0002-8393-9974https://orcid.org/0000-0003-4498-5342https://orcid.org/0000-0001-5401-0018https://orcid.org/0000-0002-3885-5448Revista Internacional - IndexadaA1N

Characteristics Associated With Elevated Time Below Range in Elderly Patients With Type 1 Diabetes Using an Automated Insulin Delivery System

Antecedentes: Este estudio investigó las características asociadas con un mayor riesgo de hipoglucemia en pacientes de edad avanzada. con diabetes mellitus tipo 1 (DT1) que utilizan sistemas automatizados de administración de insulina (AID). Métodos: estudio observacional transversal que incluyó pacientes >60 años, utilizando terapia con bomba de insulina aumentada por sensor. con gestión predictiva de niveles bajos de glucosa (SAPT-PLGM), circuito cerrado híbrido (HCL) y circuito cerrado híbrido avanzado (AHCL), durante más de tres meses. Se realizó una evaluación geriátrica y se determinó la composición corporal para investigar su asociación con el logro de objetivos de tiempo por debajo del rango (TBR) <70 mg/dL. Resultados: Se incluyeron 59 pacientes (47,5% de hombres, edad media de 67,6 años, hemoglobina glucosilada [HbA1c] de 7,5 ± 0,6%, tiempo en rango (TIR) ​​77,8 ± 9,9%). El tiempo por debajo del rango <70 y <54 mg/dL fue de 2,2 ± 2,3 % y 0,4 ± 0,81 %, respectivamente. Los pacientes con TBR elevado 1%) tenían niveles más altos de HbA1c, TIR más bajo, tiempo por encima del rango (TAR) elevado y Alta variabilidad glucémica. En cuanto a la composición corporal, se asociaron mayor masa muscular, fuerza de agarre y grasa visceral. con una TBR menor <70 mg/dL. Estos factores fueron independientes del tipo de tecnología utilizada, pero el TIR fue mayor cuando utilizando sistemas AHCL en comparación con los sistemas SAPT-PLGM y HCL. Conclusiones: En pacientes ancianos tratados con sistemas AID con buen estado funcional, menor masa magra, menor fuerza de prensión, y un menor porcentaje de grasa visceral se asoció con una TBR superior al 1%, independientemente del dispositivo utilizado. Un similar Este hallazgo se encontró con indicadores de MCG como niveles más altos de HbA1c, TIR más bajo, TAR más alto y CV más alto. geriátrico La evaluación es crucial para personalizar el manejo del paciente. Palabras clave administración automatizada de insulina, diabetes tipo 1, ancianos, hiperglucemia, hipoglucemia, tiempo dentro del rangoQ1Q1Background: This study investigated the characteristics associated with an increased risk of hypoglycemia, in elderly patients with type 1 diabetes mellitus (T1D) using automated insulin delivery (AID) systems. Methods: Cross-sectional observational study including patients >60 years, using sensor-augmented insulin pump therapy with predictive low-glucose management (SAPT-PLGM), hybrid closed-loop (HCL), and advanced hybrid closed-loop (AHCL), for more than three months. A geriatric assessment was performed, and body composition was determined to investigate its association with achieving time below range (TBR) <70 mg/dL goals. Results: The study included 59 patients (47.5% of men, mean age of 67.6 years, glycated hemoglobin [HbA1c] of 7.5 ± 0.6%, time in range (TIR) 77.8 ± 9.9%). Time below range <70 and <54 mg/dL were 2.2 ± 2.3% and 0.4 ± 0.81%, respectively. Patients with elevated TBR 1%) had higher HbA1c levels, lower TIR, elevated time above range (TAR), and high glycemic variability. Regarding body composition, greater muscle mass, grip strength, and visceral fat were associated with a lower TBR <70 mg/dL. These factors were independent of the type of technology used, but TIR was higher when using AHCL systems compared with SAPT-PLGM and HCL systems. Conclusions: In elderly patients treated with AID systems with good functional status, lower lean mass, lower grip strength, and lower visceral fat percentage were associated with TBR greater than 1%, regardless of the device used. A similar finding along was found with CGM indicators such as higher HbA1c levels, lower TIR, higher TAR, and higher CV. Geriatric assessment is crucial for personalizing patient management. Keywords automated insulin delivery, type 1 diabetes, elderly, hyperglycemia, hypoglycemia, time in rangehttps://orcid.org/0000-0001-9781-5668https://scholar.google.com/citations?hl=es&user=0_4w_UoSIO8Chttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000115525N/AS

Leucine-Rich Alpha-2 Glycoprotein 1 Accumulates in Complicated Atherosclerosis and Promotes Calcification

Atherosclerosis is the primary cause of cardiovascular disease. The development of plaque complications, such as calcification and neo-angiogenesis, strongly impacts plaque stability and is a good predictor of mortality in patients with atherosclerosis. Despite well-known risk factors of plaque complications, such as diabetes mellitus and chronic kidney disease, the mechanisms involved are not fully understood. We and others have identified that the concentration of circulating leucine-rich α-2 glycoprotein 1 (LRG1) was increased in diabetic and chronic kidney disease patients. Using apolipoprotein E knockout mice (ApoE−/−) (fed with Western diet) that developed advanced atherosclerosis and using human carotid endarterectomy, we showed that LRG1 accumulated into an atherosclerotic plaque, preferentially in calcified areas. We then investigated the possible origin of LRG1 and its functions on vascular cells and found that LRG1 expression was specifically enhanced in endothelial cells via inflammatory mediators and not in vascular smooth muscle cells (VSMC). Moreover, we identified that LRG1 was able to induce calcification and SMAD1/5-signaling pathways in VSMC. In conclusion, our results identified for the first time that LRG1 is a direct contributor to vascular calcification and suggest a role of this molecule in the development of plaque complications in patients with atherosclerosis