We evaluated the performance of the interoperable Cambridge hybrid closed-loop app with FreeStyle Libre 3 glucose sensor, and YpsoPump insulin pump in a real-world setting. Data from 100 users (63 adults [mean ± SD age 41.9 ± 14.0 years], 15 children [8.6 ± 5.2 years)] and 22 users of unreported age) for a period of 28 days were analyzed. Time in range (3.91- 10.0mmol/L) was 72.6 ± 11.1% overall. Time below range (<3.9mmol/L) was 3.1% (1.4-5.1) (median [interquartile range]). Auto-mode was active for 95.8% (91.8-97.9) of time. This real-world analysis suggests that the performance of Cambridge hybrid closed-loop app with this glucose sensor is comparable to other commercially available hybrid closed-loop systems.
Abstract Objective Primary hyperparathyroidism is a common endocrine disorder, with 80% of all cases usually caused by one single hyperfunctioning parathyroid adenoma. Conventional imaging modalities for the diagnostic work‐up of primary hyperparathyroidism (PHPT) include ultrasound of the neck, 99mTc‐sestamibi scintigraphy, and four‐dimensional computed tomography (4D‐CT). However, the role of other imaging modalities, such as 11C‐methionine PET/CT, in the care pathway for PHPT is currently unclear. Here, we report our experience of the diagnostic utility of 11C‐methionine PET/CT in a single‐center patient cohort ( n = 45). Design Retrospective single‐center cohort study. Patients and Measurements The data of eligible patients that underwent 11C‐methionine PET/CT between 2014 and 2022 at Addenbrooke's Hospital (Cambridge, UK) were collected and analyzed. The clinical utility of imaging modalities was determined by comparing the imaging result with histopathological and biochemical outcomes following surgery. Results In patients with persistent primary hyperparathyroidism following previous surgery, 11C‐methionine PET/CT identified a candidate lesion in 6 of 10 patients (60.0%), and histologically confirmed in 5 (50.0%). 11C‐methionine PET/CT also correctly identified a parathyroid adenoma in 9 out of 12 patients (75.0%) that failed to be localized on other imaging modalities. 11C‐methionine PET/CT had a sensitivity of 70.0% (95% CI 55.8 – 84.2%) for the detection of parathyroid adenomas. Conclusions This study highlights a diagnostic role for 11C‐methionine PET/CT in patients that have undergone unsuccessful prior surgery or have equivocal or negative prior imaging results, aiding localization and a targeted surgical approach.
The optimal approach to managing GDM is uncertain. We sought to determine whether early introduction of metformin (at diagnosis) plus lifestyle modification was superior to standard care (lifestyle modification alone). Methods: EMERGE is a phase III, superiority, parallel-group, 1:1 randomized trial comparing effectiveness of early metformin vs placebo initiated before 28 weeks +6 days. GDM was confirmed using WHO 2013 criteria. Metformin (or placebo) was initiated at 500mg/day titrated to 2500mg. The primary outcome was the composite of insulin initiation or fasting glucose ≥ 5.1 mmol/L at weeks 32 or 38. Results: Between June 2017-September 2022, 535 women were randomized, 268 to metformin, 267 to placebo; mean (SD) age of 34.3 (4.8), 23.7% primigravid, 17.6% non-Caucasian, 31.4% had prior GDM, 39.4% had BMI<30, mean gestation 25.4 weeks. There was no significant difference in the primary outcome between metformin and placebo treatments (56.8% vs 63.7%; RR=0.89 95%CI: 0.78-1.02). Insulin initiation was significantly lower in metformin (38.4%) vs placebo (51.1%) group (RR 0.75; 95%CI 0.62-0.91). Compared to placebo, metformin treated women achieved better glycemic control (HbA1C at 38 weeks; 33.9 vs 35 mmol/mol; P=0.004) and gained less weight between randomization and delivery (0.8kg vs 2.0kg; P=0.03), while infants were less likely to weigh >4000g (7.6% vs 14.8%; P=0.013). There was no significant difference in infants weighing <2500g (6.1% vs 3.4%; P=0.215), in infants needing NICU admission (15.3% vs 12.5%; P=0.439) or in infants born preterm <37weeks (9.2% vs 6.5%; P=0.329) in the metformin versus placebo groups. Conclusions: In a Phase III trial, early introduction of metformin did not reduce the composite of insulin initiation or elevated fasting glucose at week 32 or 38 in women with GDM, but was associated with important maternal and neonatal benefits with no increase in adverse perinatal events. Disclosure F. P. Dunne: None. A. Alvarez-Iglesias: None. C. Newman: None. A. Smyth: None. M. Browne: None. D. Devane: None. P. Gillespie: None. M. O'Donnell: None. Funding Health Research Board of Ireland
Hypertriglyceridemia is a rare but potentially severe complication of pregnancy. It is seen in women with inherited lipid disorders, thyroid disease, nephrotic syndrome, diabetes and is associated with certain medication. Hypertriglyceridaemia can cause pancreatitis, pre-eclampsia and foetal compromise. Treatment is often challenging-many medications are not approved during pregnancy and much of the evidence comes from small case reports and case series. Here was present the case of a lady with type 2 diabetes and hypertriglyceridemia, outline our treatment plan and progress and review the literature. We describe the case of a 37 year old pregnant lady with obesity and type 2 diabetes mellitus who developed severe hypertriglyceridemia in her third trimester. Baseline body mass index and triglyceride level entering pregnancy were 45.2 kg/m2 and 2.2 mmol/L (0.4–2.0). At week 31 this lady required >1 unit/kg of insulin. A random lipid level done to investigate large foetal size identified a triglyceride level of 27 mmol/L. Treatment with a reduced fat diet, strict glycaemic control and omega 3 fatty acids was initiated and triglycerides reduced to <5mmol/L. A healthy infant weighting 3.3kg was delivered at 36 + 5. Post-partum lipids returned to baseline levels without treatment and insulin was discontinued after delivery. Treatment of this rare condition is often complex and required multi-disciplinary input. In cases such as this dietic support and strict glycaemic control are the corner stones of treatment, however a number of oral and parenteral treatment options are available for those with severe complications.
Klinefelter syndrome (KS) is the most common sex-chromosomal disorder in males. Frequently under-recognized, it occurs in 1 in 500-600 male births. It is caused by the inheritance of at least one additional X chromosome from either parent. Patients often have uncommon or atypical malignancies.We describe the case of a 35-year-old man with 47XXY KS and previous cryptorchidism, presenting with a painful testicular mass. Histology confirmed Leydig cell hyperplasia.Cryptorchidism is an established risk factor for testicular tumours and occurs six times more commonly in KS than in the general population. Despite this, large epidemiological studies have shown a reduced burden of testicular cancer in these patients. The presentation of a hypoechoic lesion on ultrasound will prompt consideration of testicular tumours, however orchalgia represents an atypical presentation. In patients with KS, Leydig cell hyperplasia is a much more common entity and should be considered early in the differential diagnosis.The differential diagnosis of a testicular mass in Klinefelter syndrome includes malignancy and nodular Leydig cell hyperplasia.Diagnosis can be challenging, both radiologically and histologically.Orchalgia is atypical in Leydig cell hyperplasia.
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