Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. Methods: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. Results: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm² and 3.66 cm² for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. Conclusions: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

Aim: Analyze the influence of Fear of Hypoglycemia (FoH) on quality of life and glycemic control in adults with Type 1 Diabetes Mellitus (T1D) who use Flash Glucose Monitoring (FGM)Methods: A cross-sectional study was conducted with 173 adults with T1D. FoH was assessed using the FH15 questionnaire, and quality of life was evaluated using the Spanish Diabetes Quality of Life questionnaire (EsDQOL). Glycemic control was analyzed through FGM-derived metrics (Ambulatory Glucose Profile) and HbA1c. Multivariate multiple linear regression models were developed to analyze the adjusted impact of FoH on quality of life and time in hyperglycemia.Results: FoH was present in 42% of participants (FH15 ≥28). Patients with FoH exhibited significantly higher EsDQOL scores, reflecting poorer quality of life, and higher HbA1c levels (7.41% vs. 7.08%, p=0.012). FGM metrics revealed higher mean glucose, glucose management indicator (GMI) (p=0.008), and time in hyperglycemia >250 mg/dL (p=0.035) in the FoH group, with lower time in range 70–180 mg/dl (p=0.035). Hypoglycemia unawareness was more frequent in the FoH group (25.4% vs. 6.5%, p=0.011). The FH15 score functioned as an independent predictor of quality of life (β = 1.98 [1.58; 2.37]) and time in hyperglycemia (β = 0.39 [0.17; 0.61]) in the multiple linear regression models.Conclusion: FoH is significantly associated with poor quality of life and worsened glycemic control in T1D patients, underscoring the need for systematic assessment and individualized interventions. FGM metrics, particularly time in hyperglycemia, may serve as valuable predictors of FoH. Comprehensive management strategies addressing both metabolic and psychological factors are essential for improving patient outcomes.

The objective of our study was to determine the prevalence of glycemic disorders (diabetes mellitus and prediabetes) in patients with pheochromocytomas and sympathetic paragangliomas (PPGLs) and identify risk factors for their development and the likelihood of their resolution after surgery. A multicentric retrospective study of patients with PPGLs submitted to surgery between 2000 and 2021 in 17 Spanish hospitals was performed. Diabetes-specific data were collected at diagnosis, in the immediate- and long-term postsurgical follow-up. A total of 229 patients with PPGLs were included (218 with pheochromocytomas and 11 with sympathetic paragangliomas). Before surgery, glycemic disorders were diagnosed in 35.4% of the patients (n = 81): 54 with diabetes and 27 with prediabetes. The variables independently associated with a higher risk of glycemic disorders were sporadic PPGL (odds ratio (OR) = 3.26 (1.14–9.36)) and hypertension (OR = 3.14 (1.09–9.01)). A significant decrease in fasting plasma glucose and HbA1c levels was observed after surgery, in the short-term and long-term follow-up (P < 0.001). After a median follow-up of 48.5 months (range 3.3–168.9), after surgery, 52% of diabetic and 68% of prediabetic patients experienced a complete resolution. Lower body mass index (BMI) (P = 0.001), lower glucose levels (P = 0.047) and shorter duration of diabetes prior to surgery (P = 0.021) were associated with a higher probability of diabetes resolution. In conclusion, glycemic disorders in patients with PPGLs are present in more than a third of them at diagnosis. Sporadic PPGLs and hypertension are risk factors for their development. More than 50% of cases experience a complete resolution of the glycemic disorder after resection of the PPGLs.

Objectives. The aim of this study is to investigate in depth diabetes mellitus associated with immune checkpoint inhibitors (DM-ICIs) by analysing a case series. We also evaluated the clinical impact of flash glucose monitoring (FGM) systems in the management of this entity. Methods. We conducted an observational cohort study of DM-ICIs diagnosed in two hospitals in Seville (Spain). Patients with a new diagnosis of diabetes mellitus (DM) or with sudden worsening of preexisting DM after starting treatment with ICIs, with a random 5 hour-postprandial C-peptide value of <0.6 nmol/L and without possibility of subsequent withdrawal of insulin treatment, were included. Results. A total of 7 cases were identified, mostly males ( $n=6$ ; 85.7%), with a mean age of 64.9 years. The mean glycated hemoglobin (HbA1c) upon diagnosis was 8.1%, with diabetic ketoacidosis (DKA) observed in 6 cases (85.7%). Subcutaneous flash glucose monitoring (FGM) systems were used in six cases, with a mean follow-up period of 42.7 weeks. During the first 90 days of use, mean average glucose was 167.5 mg/dL, with a coefficient of variation (CV) of 34.6%. The mean time in the range 70-180 mg/dL (TIR) was 59.7%, with a mean time above range (TAR) 181-250 mg/dL of 27.8% and a mean $\text{TAR}>250\text{mg}/\text{dL}$ of 10.2%. The mean time below range (TBR) 54-69 mg/dL was 2%, while the mean $\text{TBR}<54\text{mg}/\text{dL}$ was 0.3%. The mean glucose management indicator (GMI) was 7.3%. No significant differences were observed in FGM values for the following 90 days of follow-up. A progressive improvement in all parameters of glycaemic control was observed between the first month of FGM use and the sixth month of FGM use. Of note, there was a decrease in mean CV (40.6% to 34.1%, $p=0.25$ ), mean TAR 181-250 (30.3% to 26%, $p=0.49$ ), mean $\text{TAR}>250\text{mg}/\text{dL}$ (16.3% to 7.7%, $p=0.09$ ), mean TBR 54-69 mg/dL (5.2% to 2%, $p=0.16$ ), and mean $\text{TBR}<54\text{mg}/\text{dL}$ (1.8% to 0.2%, $p=0.31$ ), along with an increase in mean values of TIR 70-180 mg/dL (46.5% to 60.5%, $p=0.09$ ). The lack of statistical significance in the differences observed in the mean FGM values over the follow-up period may be related to the small sample size. Conclusion. DM-ICI is recognised by a state of sudden-onset insulinopenia, often associated with DKA. The use of FGM systems may be a valid option for the effective management of DM-ICIs and for the prevention of severe hyperglycaemic and hypoglycaemic episodes in this condition.