Use of insulin degludec in pregnancy: two case reports and a literature review

Abstract As of now, insulin Degludec has no indication for use in pregnancy, because of the lack of studies that prove its safety for foetus. However it isn't infrequent that some women conceive while treating with insulin Degludec. So, before deciding to change the type of insulin therapy during pregnancy, an evaluation of the risk associated to a possible temporary worsening of glycaemic control, due to that insulin replacement, is needed. Referring to case series reported in the scientific literature could provide a support when a clinical decision need to be taken. We report two cases of women affected by type 1 diabetes who had unplanned pregnancies during treatment with insulin Degludec. In order to avoid the risk of a possible worsening of glycaemic control due to insulin switch, we decided to continue the treatment with Degludec during their pregnancies, after obtaining the patients' written informed consent. Daily insulin requirement gradually increased for both women pregnancy progressed, and glycated haemoglobin (HbA1c) values improved from the first observation to delivery: 55 mmol/mol (7.2%) at 9 weeks to 47 mmol/mol (6.5%) at 36 weeks, in Patient 1 (P1); 44 mmol/mol (6.2%) at 8 weeks to 33 mmol/mol (5.2%) at 36 weeks, in Patient 2 (P2). P1 delivered at week 37 with a caesarean section due to failed induction. The newborn, a girl of 3398 g at birth, developed neonatal hypoglycaemia and respiratory distress (Apgar 6-6). Six days after birth she underwent colectomy because of necrotizing enterocolitis and was finally diagnosed with atypical cystic fibrosis. P2 gave birth to a healthy girl (weight 2745g at birth, Apgar 7-9) at 37 weeks, undergoing a caesarean section for maternal cervical dystocia, without neonatal complications. Our experience provides additional evidence on the safety of insulin Degludec in pregnancy without any maternal or neonatal outcome suggesting its toxicity

ACTH-dependent Cushing's Syndrome: Diagnostic Pitfalls in Concomitant Non-secreting Pituitary Adenomas

Objectives: To describe the possible pitfalls in correctly interpreting clinical, radiological and biochemical findings in ACTH-dependent Cushing's syndrome. Methods: We describe a case of a pituitary adenoma visualized at MRI not correlated with an ACTH-dependent Cushing’s syndrome. Results: Radiological imaging and hormonal testing can be misleading in suspected pituitary ACTH-related Cushing’s syndrome. Conclusion: Correct interpretation of the initial clinical presentation can help in the proper diagnosis and treatment of ACTH-dependent Cushing’s syndrome

Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk. an expert-based multidisciplinary delphi consensus

Background: Continuous glucose monitoring (CGM) shows in more detail the glycaemic pattern of diabetic subjects and provides several new parameters (“glucometrics”) to assess patients’ glycaemia and consensually guide treatment. A better control of glucose levels might result in improvement of clinical outcome and reduce disease complications. This study aimed to gather an expert consensus on the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk or with heart disease. Methods: A list of 22 statements concerning type of patients who can benefit from CGM, prognostic impact of CGM in diabetic patients with heart disease, CGM use during acute cardiovascular events and educational issues of CGM were developed. Using a two-round Delphi methodology, the survey was distributed online to 42 Italian experts (21 diabetologists and 21 cardiologists) who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. Results: Forty experts (95%) answered the survey. Every statement achieved a positive consensus. In particular, the panel expressed the feeling that CGM can be prognostically relevant for every diabetic patient (70%) and that is clinically useful also in the management of those with type 2 diabetes not treated with insulin (87.5%). The assessment of time in range (TIR), glycaemic variability (GV) and hypoglycaemic/hyperglycaemic episodes were considered relevant in the management of diabetic patients with heart disease (92.5% for TIR, 95% for GV, 97.5% for time spent in hypoglycaemia) and can improve the prognosis of those with ischaemic heart disease (100% for hypoglycaemia, 90% for hyperglycaemia) or with heart failure (87.5% for hypoglycaemia, 85% for TIR, 87.5% for GV). The experts retained that CGM can be used and can impact the short- and long-term prognosis during an acute cardiovascular event. Lastly, CGM has a recognized educational role for diabetic subjects. Conclusions: According to this Delphi consensus, the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk is promising and deserves dedicated studies to confirm the experts’ feeling

Crecer en familia hoy: El desafío de la pluralidad.

¿Qué es lo que entendemos por familia hoy en día y qué contribuye a formarla? En otras palabras, ¿qué es lo que hace familia en la actualidad? En diciembre del 2018, una veintena de profesionales de la educación provenientes de cuatro países (España, Francia, Italia y Rumanía) se reunieron en Barcelona durante una semana para compartir con los investigadores una serie de actividades y aprendizajes en torno a esta cuestión. Fue el comienzo de una prolongada y compleja investigación llevada a cabo por un grupo multilingüe, multiprofesional e interdisciplinario cuyo resultado es esta primera producción intelectual. ¿Qué transformaciones están experimentando las familias? ¿Cómo han cambiado los modelos familiares en los últimos cincuenta años? ¿Cuáles son los principales retos a los que se enfrentan las familias y los profesionales que las acompañan? Las preguntas aquí planteadas no tratan de moldear una nueva definición de familia; más bien, se centran en el proceso de “crecer en familia” para saber qué lugar ocupan los niños y las niñas en la vida familiar y comunitaria. A pesar de que es posible identificar tendencias transversales a nivel europeo, es en la pluralidad donde hemos identificado el principal desafío. La diversificación de los modelos familiares, la multiplicidad legislativa en la que se basa el derecho de familia y los procesos de acompañamiento, que implican una constelación de actores y vulnerabilidades, constituyen la base sobre la que se cimienta esta pluralidad. Tal y como dice el proverbio africano, para educar a un niño hace falta la tribu entera. Por ello, desde una visión ecológica del desarrollo humano y desde la parentalidad entendida como una fenómeno complejo, dinámico y multifactorial, nos hemos basado en nuestras experiencias personales y profesionales para reflexionar sobre aquellos lugares, prácticas, personas, instituciones y redes que forman parte del desarrollo la infancia. La pregunta “¿Qué hace hoy a una familia?” se aborda, por tanto, desde el punto de vista específico de los profesionales e investigadores que trabajan en los servicios sociales o en las universidades con el objetivo de brindar el mayor apoyo posible a los progenitores y a las comunidades locales en la educación y en el desarrollo de niños y niñas. A partir de las diferencias contextuales que caracterizan a los cuatro países participantes, la puesta en conjunto nos ha permitido adquirir, en un intercambio fructífero de prácticas y herramientas, una visión panorámica que va de lo específico a lo general