Background: Coronary artery spasm can occur either in response to drugs or toxins. This response may result in hyper-reactivity of vascular smooth muscles or may occur spontaneously as a result of disorders in the coronary vasomotor tone. Hyperthyroidism is associated with coronary artery spasm. Case summary: A 49-year-old female patient with a 2-day history of intermittent chest pain and electrocardiographic evidence of myocardial ischaemia was referred for emergency coronary angiography. This revealed severe right coronary artery (RCA) and left main (LM) coronary artery ostial vasospasm, both subsequently relieved with administration of multiple doses intracoronary nitroglycerine. Intravascular optical coherence tomography showed absence of atherosclerosis and no evidence of thrombus or dissection confirming the diagnosis of coronary artery vasospasm. Laboratory tests of the thyroid function were performed immediately after coronary angiography revealing Graves’ disease as the cause of vasospasm. Discussion: Our case represents a rare presentation of Graves’ disease-induced RCA and LM coronary artery ostial vasospasm. In patients with coronary artery vasospasm thyroid function study should be mandatory, especially in young female patients.

A multicentre, randomised controlled trial (the CRISTAL trial), demonstrated the safety and efficacy of MiniMed™ 780G advanced hybrid closed loop (AHCL) therapy during pregnancy, showing improved glycaemic control overnight, less hypoglycaemia, and improved treatment satisfaction compared to standard insulin therapy (SoC, mainly open-loop insulin pump therapy). This study aimed to assess the cost-effectiveness of AHCL, which has a higher initial cost, compared to SoC in pregnant women with type 1 diabetes (T1D). A decision tree model was developed to estimate the cost-effectiveness of AHCL compared to SoC in pregnant women with T1D, covering pregnancy to birth and postpartum hospital discharge (a time horizon of 28 weeks). Total costs per strategy (in 2024 euros, €) were calculated from a healthcare payer perspective. The base-case analysis derived prevalence of pregnancy complications and hospitalisations directly related to diabetes management from the CRISTAL trial. Uncertainty was analysed by exploring multiple scenarios and sensitivity analyses. In the base-case analysis, the cost of using AHCL during pregnancy was estimated at €13,988.75 (95% CI: €12,240 to €16,062) compared to €14,221.33 (95% CI: €12,380 to €16,420) for SoC, indicating cost-savings of €232.57 per individual, alongside the demonstrated clinical benefits of AHCL. The primary cost driver was the AHCL device cost. This cost was offset by savings from shorter and less frequent hospital admissions (mainly due to severe hypoglycaemia and dysregulated diabetes) in the AHCL group compared to SoC. In our probabilistic sensitivity analysis, AHCL was dominant in 73% of the simulated cost-effectiveness pairs. AHCL might be cost-saving compared to SoC for pregnant women with T1D. However, more robust data are needed to assess the potential impact of AHCL therapy on pregnancy and long-term health outcomes. Diabetes Liga Research Fund and Medtronic.

Purpose: Women are generally protected against insulin resistance and related comorbidities when compared with men, potentially due to the role of sex hormones. While epidemiological and animal studies suggest that sex hormones may impact insulin sensitivity, studies in humans on the effects of estradiol and testosterone treatment on insulin sensitivity assessed by gold-standard measures remain limited. The molecular mechanisms involved are also not well understood. Therefore, we aimed to investigate changes in insulin sensitivity and associated change in plasma proteome following 3 months of sex hormone therapy. Methods: This prospective, observational study included 29 individuals initiating feminizing (estradiol with GnRH analogue; n = 16) or masculinizing (testosterone; n = 13) therapy. Measurements at baseline and after 3 months included insulin sensitivity, assessed via hyperinsulinemic-euglycemic clamp (M-value: adjusted for lean body mass and M/I ratio: M-value adjusted for plasma insulin concentrations), along with plasma proteomics. Results: During feminizing hormone therapy, insulin sensitivity increased (M-value: + 23.3%, M/I ratio: + 20.2%; P < .05), whereas during masculinizing hormone therapy, no changes were observed. Of the differentially expressed plasma proteins (49 during feminizing and 356 during masculinizing hormone therapy), 16 correlated with changes in insulin sensitivity. Several were involved in immunoregulation and inflammation (vascular endothelial growth factor D, 5′-nucleotidase), iron homeostasis and erythropoiesis (hepcidin, transferrin receptor protein 1:cytoplasmic domain), and oxidative stress (superoxide dismutase 3). Conclusion: Feminizing hormone therapy, characterized by high serum estradiol and low serum testosterone concentrations, enhanced insulin sensitivity. These findings highlight the impact of sex hormones on insulin sensitivity and may inform sex-specific precision medicine.

Aims/hypothesis: Women with type 1 diabetes experience changes in insulin requirements in pregnancy and throughout the menstrual cycle. It remains to be explored whether women with type 1 diabetes perceive changes in glucose regulation during and after the menopausal transition, another period of marked hormonal change in a woman’s life. Methods: We conducted a cross-sectional survey to investigate whether women with type 1 diabetes perceive changes in glucose regulation after their final menstrual period. The online questionnaires were distributed through advertisements in hospitals and through online platforms for people living with type 1 diabetes in the Netherlands. Postmenopausal women (≥1 year of amenorrhoea) with type 1 diabetes, aged 45–65 years, were included. Participants with primary amenorrhoea, premenopausal hysterectomy or a postmenopausal diabetes diagnosis were excluded from the study. The primary outcome was the extent to which participants perceived changes in their glucose regulation following their final menstrual period, assessed using a five-point Likert scale. Menopausal symptom severity was estimated using the Greene climacteric scale (GCS). Results: Questionnaires from a total of 159 women were eligible for inclusion. Participants had a mean age of 54.9 years (SD 3.8), a mean diabetes duration of 30.3 years (SD 12.8), and had their final menstrual period at a mean age of 50.1 years (SD 5.0). Overall, 67.4% of participants reported moderate to severe postmenopausal changes in glucose regulation. Increased blood glucose levels were perceived by 41.9% of participants, 19.6% perceived lower glucose levels and 38.5% perceived no change in blood glucose levels. For fluctuations in glucose levels, 55.0% experienced more fluctuations and 18.1% experienced less fluctuation. More hyperglycaemic events were experienced by 61.6% of participants, while 38.5% experienced more hypoglycaemic events and 28.0% experienced fewer hypoglycaemic events. Reported menopausal symptoms were more severe after the final menstrual period compared with before the final menstrual period (mean GCS score ± SD: 18.8±9.9 vs 11.7±8.3, p5, indicating poor sleep quality. Poor sleep quality was not associated with perceived glycaemic changes after menopause (global PSQI >5) (adjusted OR 1.10; 95% CI 0.58, 2.08; p=0.731). Conclusions/interpretation: Approximately two-thirds of women with type 1 diabetes perceive changes in their glucose regulation after menopause, including subjective changes in the number of hyperglycaemic and hypoglycaemic events. Changes in perceived glucose regulation were associated with the severity of reported menopausal symptoms. These results highlight the need for awareness among medical professionals treating women with type 1 diabetes, as those going through the menopausal transition may experience changes in glucose metabolism, which can affect their diabetes management. Data availability: The data that support the findings of this study are available on request from DataVerseNL with the identifier https://doi.org/10.34894/84QJOO. Graphical

Sex‐based disparities in the incidence, prevalence and disease manifestations have been observed across various medical conditions, including type 1 diabetes (T1D). Differences in glycaemic control and quality of life between men and women have been reported, with women experiencing lower rates of glycaemic targets and a higher risk for long‐term complications, particularly cardiovascular disease. Additionally, women face a greater economic and mental health burden related to T1D. This narrative review explores the challenges that complicate glycaemic management in women living with T1D, including hormonal influences during puberty, pregnancy and the (peri‐) menopausal period. We also summarize current available evidence on the safety and efficacy of the MiniMed™ 780G (MM780G) system in addressing these challenges for women living with T1D. Finally, recent real‐world data are reported on the absence of significant sex‐related differences in glycaemic outcomes of over 280 000 real‐world users of the MM780G, across various age groups from childhood and adolescence to the (peri‐) menopausal period.