Daily Endocrinology Research Analysis
Three high-impact studies in endocrinology and metabolism stood out: an inpatient randomized trial showed continuous glucose monitoring (CGM)-guided insulin titration markedly improves glycemia and reduces complications; a prespecified postpartum extension of a randomized trial supports sustained benefits of hybrid closed-loop automated insulin delivery in type 1 diabetes; and a prospective multicenter study in diabetology validates practical two-step algorithms (FIB-4 with elastography) to scre
Summary
Three high-impact studies in endocrinology and metabolism stood out: an inpatient randomized trial showed continuous glucose monitoring (CGM)-guided insulin titration markedly improves glycemia and reduces complications; a prespecified postpartum extension of a randomized trial supports sustained benefits of hybrid closed-loop automated insulin delivery in type 1 diabetes; and a prospective multicenter study in diabetology validates practical two-step algorithms (FIB-4 with elastography) to screen for MASLD-related advanced fibrosis.
Research Themes
- Inpatient CGM-guided insulin titration improves outcomes
- Automated insulin delivery postpartum in type 1 diabetes
- Diabetology-led screening algorithms for MASLD-related advanced fibrosis
Selected Articles
1. In-Hospital Diabetes Management by a Diabetes Team and Insulin Titration Algorithms Based on Continuous Glucose Monitoring or Point-of-Care Glucose Testing in Patients With Type 2 Diabetes (DIATEC): A Randomized Controlled Trial.
In this two-center randomized trial of 166 hospitalized adults with type 2 diabetes, CGM-guided insulin titration increased time-in-range by 15 percentage points versus point-of-care guidance, and reduced time above range, time below range, glycemic variability, prolonged hypoglycemia, insulin dose, and a composite of complications. The findings support CGM-guided protocols for inpatient diabetes management.
Impact: High-quality RCT evidence shows CGM-guided inpatient insulin titration improves multiple clinically meaningful outcomes and reduces complications, likely changing hospital protocols.
Clinical Implications: Hospitals should consider implementing CGM-based insulin titration algorithms for non-ICU inpatients with type 2 diabetes, supported by diabetes teams, to improve glycemic control and reduce complications and insulin requirements.
Key Findings
- CGM arm achieved higher median TIR: 77.6% vs 62.7% (P<0.001).
- Time above range >10.0 mmol/L was lower with CGM: 21.1% vs 36.5% (P=0.001).
- Time below range <3.9 mmol/L reduced with CGM (relative difference 0.57; 95% CI 0.34-0.97; P=0.042) and prolonged hypoglycemia events decreased (IRR 0.13; P=0.001).
- Glycemic variability (coefficient of variation) was lower with CGM: 25.4% vs 28.0% (P=0.024).
- Total daily insulin dose was reduced (24.1 vs 29.3 IU/day; P=0.049), and composite in-hospital complications were lower (IRR 0.76; P=0.032).
Methodological Strengths
- Randomized controlled, two-center design with algorithm-guided insulin titration.
- Comprehensive CGM metrics (TIR, TAR, TBR), variability, hypoglycemia events, insulin dose, and complications assessed during hospitalization.
Limitations
- Conducted in non-ICU settings at two centers; generalizability to ICU or different hospital systems may be limited.
- Short assessment window restricted to hospitalization; no post-discharge outcomes reported.
Future Directions: Evaluate scalability, cost-effectiveness, and implementation strategies for CGM-guided inpatient insulin titration across diverse hospital systems, including ICU settings and post-discharge outcomes.
2. Automated insulin delivery during the first 6 months postpartum (AiDAPT): a prespecified extension study.
This prespecified extension of a multicenter RCT followed 57 women with type 1 diabetes for 6 months postpartum. Hybrid closed-loop automated insulin delivery maintained approximately 70% time-in-range compared with standard therapy plus CGM, supporting continued postpartum use.
Impact: Addresses a major evidence gap for postpartum glycemic management in type 1 diabetes with randomized data in a high-impact setting.
Clinical Implications: Postpartum individuals with type 1 diabetes who used HCL during pregnancy can safely continue hybrid closed-loop therapy to sustain near-target glycemia during the first 6 months after delivery.
Key Findings
- In the postpartum extension (n=57), the HCL group maintained approximately 70% time-in-range over 6 months.
- Randomized allocation from the original trial was preserved, comparing HCL vs standard insulin therapy with CGM.
- Primary endpoint assessed TIR at 0–3 months, 3–6 months, and cumulatively over 6 months postpartum.
Methodological Strengths
- Prespecified extension of a multicenter randomized controlled trial with site-stratified randomization.
- Use of standardized CGM metrics (TIR 3.9–10.0 mmol/L) across predefined postpartum intervals.
Limitations
- Modest postpartum sample size (n=57) with eligibility constraints may limit generalizability.
- Abstract does not report detailed secondary outcomes (e.g., hypoglycemia, patient-reported outcomes).
Future Directions: Assess maternal-infant outcomes, lactation-related factors, hypoglycemia burden, usability, and cost-effectiveness of postpartum hybrid closed-loop use in larger and more diverse populations.
3. Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease-Related Advanced Fibrosis in Diabetology: A Prospective Multicenter Study.
In 654 patients with MASLD and type 2 diabetes and/or obesity, noninvasive algorithms using FIB-4 followed by VCTE (or 2D-SWE/ELF) performed well for triaging advanced fibrosis. FIB-4/VCTE showed excellent diagnostic performance for referral; FIB-4/ELF at 9.8 offered high NPV but lower PPV, supporting practical screening pathways in diabetology clinics.
Impact: Provides prospective multicenter evidence to operationalize MASLD advanced fibrosis screening in diabetology using accessible tools (FIB-4, VCTE/ELF), addressing a major care gap.
Clinical Implications: Diabetology clinics can adopt a two-step screening algorithm—FIB-4 followed by VCTE where available, or ELF/2D-SWE—to efficiently triage patients for hepatology referral, leveraging high NPV to rule out advanced fibrosis.
Key Findings
- Among 654 patients, 17.6% had intermediate/high risk and 9.3% had high risk of advanced fibrosis.
- Diagnostic AUCs for high-risk AF: FIB-4 0.78, FibroTest 0.78, FibroMeter 0.74, ELF 0.82, SWE 0.84.
- FIB-4/VCTE algorithms showed strong performance for referral decisions; FIB-4/ELF (threshold 9.8) achieved NPV 88–89% with PPV 39–46%; FIB-4/2D-SWE achieved NPV 91% with PPV 58–62%.
- Age-adapted FIB-4 thresholds reduced NPV and PPV across algorithms.
Methodological Strengths
- Prospective multicenter design with comprehensive liver phenotyping and composite reference (biopsy, MRE, or VCTE ≥12 kPa).
- Direct head-to-head comparison of multiple NITs and pragmatic two-step algorithms relevant to diabetology workflows.
Limitations
- Interim analysis; not all participants had biopsy, and composite reference may introduce heterogeneity.
- Conducted in specialized settings; real-world performance in primary care or resource-limited clinics warrants evaluation.
Future Directions: Validate algorithm performance and thresholds across diverse populations and care settings, assess outcomes of referral strategies, and integrate with diabetes care pathways and EHR-based prompts.