Daily Endocrinology Research Analysis

BACKGROUND AND AIMS: Although continuous glucose monitoring (CGM) devices are now standard of care among Type 1 diabetes patients, they are still relatively underutilized in Type 2 diabetes (T2D), particularly in those patients not treated with insulin. Widespread adoption continues to be hindered by a combination of factors. Chief among these is the scarcity of long-term, large-scale clinical trials demonstrating the benefits of the use of CGM in T2D. This meta-analysis aimed to address this gap by comparing CGM with self-blood glucose monitoring (SBMG), with primary outcomes of HbA1c and time in range (TIR) in insulin-treated and non-insulin-treated TD2 patients. METHODS AND RESULTS: Following the stringent rules mandated by our National Health Service (which requires a panel composed of all stakeholders involved in diabetes treatment, and includes PICO, GRADE, AGREE, and meta-analyses), we performed a systematic review of RCTs that enrolled two groups of individuals with T2D, those treated with insulin (including basal and basal-bolus regimens), and those receiving treatments other than insulin. All included trials compared CGM with structured blood glucose monitoring (SBGM) with glycated hemoglobin (HbA1c) as the main endpoint. Based on the strength and consistency of the evidence, the panel issued a strong recommendation in favor of CGM for individuals with T2D treated with insulin (including those on basal insulin alone) and for individuals with T2D not treated with insulin, particularly for those with glycated hemoglobin levels ≥ 7%. From a pharmacoeconomic perspective, outcomes were positive in both patient groups. CONCLUSION: CGM represents a clinically effective and cost-efficient approach to optimizing glycemic control in T2D, becoming mandatory among individuals on insulin therapy. Our findings support a shift in clinical practice toward the more widespread use of CGM in T2D, with regulatory frameworks and reimbursement policies needing to adapt accordingly.

BACKGROUND: Semaglutide is not approved for glycemic management in type 1 diabetes (T1D) due to limited evidence and safety concerns. Nevertheless, its use is increasing. We investigated glycemic and safety outcomes of semaglutide in a nationwide cohort of individuals with T1D. METHODS: Using Danish registries (2018-2024), we identified individuals with T1D initiating semaglutide and matched them 1:4 using exposure density matching to unexposed control persons with T1D following them for up to two years. Glycemic trajectories were modeled using a piecewise mixed model. Cause-specific Cox models were used to estimate hospitalization rates for hypoglycemia and diabetic ketoacidosis compared with matched controls. Aalen-Johansen estimator was used to estimate adherence while accounting for death as a competing risk. FINDINGS: We identified 879 individuals with T1D initiating semaglutide (multiple daily injections (MDI): n = 622; insulin pump: n = 257). HbA1c decreased by 5.7 mmol/mol (0.52%) (95% CI: 5.0-6.3) during the first six months and remained stable thereafter in semaglutide users while remaining unchanged in the control group. Compared with matched controls semaglutide use was not associated with an increased rate of hospitalization for hypoglycemia (HR 0.64; 95%CI: 0.35; 1.19) or diabetic ketoacidosis (HR 0.73; 95%CI; 0.34; 1.57). The cumulative probability of adherence to semaglutide at one year was 50% (95% CI: 47-54). No difference in HbA1c reduction from 0 to 6 months was observed between MDI compared to insulin pump users (P = 0.42). The median semaglutide dose redeemed during follow-up was 1.0 mg. INTERPRETATION: In this nationwide cohort of individuals with T1D, semaglutide use was associated with no increased rate of hospitalization for hypoglycemia and no increased diabetic ketoacidosis rate, and a clinically meaningful reduction of HbA1c. FUNDING: This study received no funding.

BACKGROUND: Early-life temperature exposure, especially during oogenesis, may impact ovarian function later in life. However, the effect of ambient temperature during sensitive developmental windows on ovulation disorders remains unknown. METHODS: We investigate the associations of early-life ambient temperature exposure with incident polycystic ovary syndrome (PCOS) in the Growing Up Today Study II, a United States (US) nationwide prospective cohort. We included females born after 1989 with available outcome and exposure data during the preconception (N = 3265), gestation (N = 3265), and childhood period (N = 3521). Monthly average residential mean temperatures were estimated using the PRISM Climate Group data. We considered exposure windows included preconception (3 months prior to conception), gestational (from conception month to birth), individual trimesters, and childhood (from birth to 1 year before age at menarche). PCOS was identified by self-reported clinical diagnosis. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for PCOS per interquartile range (IQR) increase of mean temperature using Cox models. RESULTS: We identified 234 (7.2%) PCOS cases over the 14.3 ± 4.2 years from age at menarche to 2021. Higher ambient temperatures during the preconception (HR 1.38 per 13.4°C, 95% CI, 0.84-2.27), gestation (HR 1.08 per 6.4°C, 95% CI, 0.74-1.60), and childhood (HR 1.20 per 4.1°C, 95% CI, 0.91-1.59) periods were suggestively associated with higher risk of PCOS. In gestation period, only the first-trimester temperature was associated with higher risks of PCOS (HR 1.75 per 14.4°C, 95% CI, 1.06-2.87). CONCLUSION: Intervention to mitigate heat exposure during pregnancy, especially in the first trimester, may help reduce the risk of PCOS in offspring. Further research is needed to confirm these associations.