Background: In recent years, technological advances in the field of diabetes have revolutionized the management, prognosis, and quality of life of diabetes patients and their environment. The aim of our study was to evaluate the impact of implementing the MiniMed 780G closed‐loop system in a pediatric and adolescent population previously treated with a continuous subcutaneous insulin infusion pump and intermittent glucose monitoring.Methods: Data were collected from 28 patients with type 1 diabetes aged 6 to 17 years, with a follow‐up of 6 months. We included both glucometric and quality of life variables, as well as quality of life in primary caregivers. Metabolic control variables were assessed at baseline (before system change) and at different cutoff points after initiation of the closed‐loop system (48 hours, 7 days, 14 days, 21 days, 1 month, 3 months, 6 months).Results: Time in range 70–180 mg/dL increased from 59.44% at baseline to 74.29% in the first 48 hours after automation of the new system, and this improvement was maintained at the other cutoff points, as was time in hyperglycemia 180–250 mg/dL (24.44% at baseline to 18.96% at 48 hours) and >250 mg/dL (11.71% at baseline to 3.82% at 48 hours).Conclusions: Our study showed an improvement in time in range and in all time spent in hyperglycemia from the first 48 hours after the automation of the system, which was maintained at 6 months.
The introduction of closed-loop systems in the pediatric population has been a revolution in the management and evolution of diabetes. However, there are not many published studies in situations in which the feeding, schedules, and activities of the children deviate from the routine for which the systems were programmed, as in the case of a summer camp for children and adolescents with diabetes, where the specific programming of this device is not well known. It was a single-center prospective preliminary study. A total of twenty-seven patients (mean age 11.9 ± 1.9 years, 40% male, duration of diabetes 6.44 ± 2.83 years) were included (twenty with Medtronic MiniMed 780G system and seven with Tandem Control-IQ). Glucometric variables and pump functionality were monitored during the 7-day camp and in the following 3 weeks. There was no decrease from the objective TIR 70% at any moment. The worst results in Time Below Range were at 72 h from starting the camp, and the worst results in Time Above Range were in the first 24 h, with a progressive improvement after that. No episodes of level 3 hypoglycemia or ketoacidosis occurred. The use of specific programming in two integrated systems, with complex blood glucose regulation algorithms and not-prepared-for situations with increased levels of physical activity or abrupt changes in feeding routines, did not result in an increased risk of level 3 hypoglycemia and ketoacidosis for our pediatric type 1 diabetes (T1D) patients, regardless of the closed-loop device.
Background: Guided bone regeneration (GBR) is a widely used technique in oral and maxillofacial surgery to restore lost bone. The aim of this study is to evaluate the effectiveness of titanium occlusive barriers in GBR for increasing bone volume in both vertical and horizontal dimensions. Methods: A prospective analysis was conducted on 11 patients (15 cases) undergoing bone augmentation with titanium barriers combined with bone graft biomaterials for dental implant placement. Bone gain was assessed using pre- and postoperative low-dose cone beam computed tomography (CBCT) measurements in vertical and horizontal planes. Histological analyses evaluated the quality and vascularization of the regenerated bone. Results: Significant bone volume increases were observed, with a mean vertical gain of 7.60 mm (SD 0.23) and a horizontal gain of 5.44 mm (SD 0.39). Histological examination confirmed well-vascularized regenerated bone with minimal residual graft material, effective integration, and the formation of keratinized gingiva. Conclusions: Titanium occlusive barriers in GBR provide a reliable and minimally invasive method for substantial bone regeneration, showing advantages such as ease of handling and reduced invasiveness. Additional studies are recommended to validate these findings and evaluate long-term outcomes.
Background: Bone resorption following tooth loss poses significant challenges for dental implant success. Guided bone regeneration (GBR) techniques, particularly in vertically deficient ridges, often require complex procedures and soft tissue management. This case report introduces a modified occlusive barrier with a window, combined with tricalcium phosphate, to address these challenges. Methods: A 26-year-old female with significant bone loss in the mandibular anterior region underwent GBR using a digitally designed titanium occlusive barrier. The barrier was fabricated using CAD/CAM technology and secured with screws. A blood clot mixed with tricalcium phosphate was used to promote bone regeneration. Postoperative care included regular irrigation, de-epithelialization, and follow-up over six months. Implant placement and histological analysis were performed to evaluate outcomes. Case Presentation: The patient achieved 8.8 mm of vertical and 7.6 mm of horizontal bone regeneration. Histological analysis confirmed the presence of mature, mineralized bone, and keratinized gingiva. The implant was successfully placed, and a fixed prosthesis was restored after four months, with stable results at a three-year follow-up. Conclusion: This technique demonstrates effective bone and soft tissue regeneration in a single procedure, eliminating the need for autologous bone grafts and secondary surgeries. The use of a digitally designed occlusive barrier offers precision, reduces morbidity, and simplifies the surgical process, suggesting a promising advancement in GBR. Further studies are needed to validate these findings.
Background: The integration of continuous glucose monitoring systems with insulin infusion pumps has shown improved glycemic control, with improvements in hyperglycemia, hypoglycemia, Hb1Ac, and greater autonomy in daily life. These have been most studied in adults and there are currently not many articles published in the pediatric population that establish their correlation with age of debut. Methods: Prospective, single-study. A total of 28 patients (mean age 12 ± 2.43 years, 57% male, duration of diabetes 7.84 ± 2.46 years) were included and divided into two groups according to age at T1D onset (≤4 years and >4 years). Follow-up for 3 months, with glucometric variables extracted at different cut-off points after the start of the closed-loop (baseline, 1 month, 3 months). Results: Significant improvement was evidenced at 1 month and 3 months after closed-loop system implantation, with better glycemic control in the older age group at baseline at TIR (74.06% ± 6.37% vs. 80.33% ± 7.49% at 1 month, p < 0.003; 71.87% ± 6.58% vs. 78.75% ± 5.94% at 3 months, p < 0.009), TAR1 (18.25% ± 4.54% vs. 14.33% ± 5.74% at 1 month, p < 0.006; 19.87% ± 5.15% vs. 14.67% ± 4. 36% at 3 months, p < 0.009) and TAR2 (4.75% ± 2.67% vs. 2.75% ± 1.96% at 1 month, p = 0.0307; 5.40% ± 2.85% vs. 3% ± 2.45% at 3 months, p < 0.027). Conclusions: the use of automated systems such as the MiniMedTM780G system brings glucometric results closer to those recommended by consensus, especially in age at T1D onset >4 years. However, the management in pediatrics continues to be a challenge even after the implementation of these systems, especially in terms of hyperglycemia and glycemic variability.
Background/Objectives: Type 1 diabetes mellitus (T1D) is the most common metabolic disorder in children, with significant physical and emotional impacts. Achieving optimal glucometric control is challenging due to the complex management and limitations of insulin therapy. Advances in pharmacology and technology, including continuous glucose monitoring (CGM) systems, offer new options for diabetes management. We developed Andiacare, an open-source platform for macro/micro-management of diabetes and analyzed its application in a pediatric T1D cohort to evaluate glucometric control patterns. Methods: A retrospective cohort study was conducted in a pediatric population (<18 years old) in Andalusia, Spain. Patients treated with Multiple Daily Injections of Insulin (MDI) and FreeStyle Libre 2 System (Abbott, Spain) were included. The patient data were analyzed using the Andiacare platform, which categorizes patients based on the Advanced Technologies and Treatments for Diabetes (ATTD) panel’s targets for glucometric control. Results: The study included 2215 patients from 18 pediatric hospitals. The Andiacare platform categorized patients into four groups based on glucometric control parameters, enabling patient stratification based on their glucometric control. Only 25.8% of the cohort achieved the recommended Time in Range (TIR), and 9.5% of the patients achieved all target parameters of glucometric control. Age is a determinant factor in adherence and achievement of set goals. Conclusions: This study offers insights into glucometric control in a large pediatric population with T1D in Andalusia. Few patients achieved the recommended glucometric control targets, highlighting the need for improved management strategies. The use of digital platforms such as Andiacare might contribute to facilitating the management of large pediatric cohorts. New algorithms integrating glucometric and non-glucometric parameters are required for improved individual and cohort categorization to optimize therapeutic interventions.