Background: Type 1 gastric neuroendocrine tumors (GC-1) represent an uncommon subtype of neoplasms. Endoscopic resection has been proposed as the treatment of choice; active surveillance may be performed in those smaller than 1 cm, while gastric surgery may be performed for those with frequent recurrences. The antiproliferative effect of somatostatin analogues (SSA) is well known, and their action on GC-1s has been postulated as a chronic treatment to reduce recurrence. Methods: A two-centered, retrospective, observational study that included nine patients (55.6% women) diagnosed with GC-1, receiving long-term treatment with SSA, with a median follow-up from baseline of 22 months, was undertaken. Endoscopic follow-up, extension study, and analytical values of chromogranin A (Cg A) and gastrin were collected. Results: In total, 88.9% of patients presented partial or complete response. Treatment with SSA was the only independent factor with a trend to prevent tumor recurrence (Odds Ratio 0.054; p = 0.005). A nonsignificant tendency toward a decrease in CgA and gastrin was observed; lack of significance was probably related to concomitant treatment with proton pump inhibitors in some patients. Conclusions: Chronic treatment with SSA is a feasible option for recurrent GC-1s that are difficult to manage using endoscopy or gastrectomy. Randomized clinical trials to provide more scientific evidence are still needed.

Objective: The objective of this study is to assess whether the provision of free intermittently scanned continuous glucose monitoring (isCGM) systems can reduce socioeconomic disparities in glycemic control among individuals with Type 2 diabetes mellitus (T2D) treated with multiple daily insulin injections. Methods: This is a cohort study involving 402 T2D patients from three hospitals, all of whom initiated isCGM use as part of routine clinical practice. The isCGM systems were provided free of charge through public healthcare funding, with no out‐of‐pocket cost to the patients. Glycated hemoglobin (HbA1c) levels were recorded before and after at least 3 months of sensor use. Socioeconomic status (SES) was determined based on the average annual net income per person within the census tract for each patient. Results: Prior to the sensor placement, the mean HbA1c was 8.9% for patients in the lowest SES quartile and 8.2% for those in the highest quartile ( p = 0.009). Following isCGM implementation, significant HbA1c reductions were observed across all SES groups, with decreases of 1.0% in the lowest quartile and 0.6% in the highest ( p < 0.001). Postintervention differences in HbA1c between SES quartiles were not statistically significant ( p = 0.509). Conclusion: Public funding of isCGM systems is associated with a significant improvement in glycemic control and contributes to the reduction of pre‐existing socioeconomic disparities in healthcare among T2D patients treated with insulin.

Aims/hypothesis: Connected insulin pens and smart caps automatically capture dosing data and can prompt patients about missed prandial boluses, but independent randomised evidence in type 1 diabetes is scarce. We aimed to assess whether a connected insulin pen cap improves glycaemic management compared with an otherwise identical non-connected cap. Methods: We conducted an investigator-initiated, randomised, open-label, parallel-group trial in a European public hospital over 8 weeks. Adults with type 1 diabetes treated with multiple daily injections and who had suboptimal glycaemic management (baseline time above range [>10.0 mmol/l, >180 mg/dl] >25%) were randomly assigned (1:1) to a connected pen cap (Insulclock 2.0; Insulcloud, Madrid, Spain) or an identical cap for which the Bluetooth connectivity had been disabled (disconnected). Allocation was performed using opaque sealed envelopes, and no masking was applied. The primary outcome was time above range, with two thresholds (>10.0 mmol/l, >180 mg/dl and >13.9 mmol/l, >250 mg/dl) based on intermittently scanned CGM downloads. Analyses followed the intention-to-treat principle, using longitudinal mixed models and multiple imputation. Secondary outcomes included time in range, glycaemic variability (standard deviation and coefficient of variation), HbA _1c and patient-reported outcomes (fear of hypoglycaemia). Results: Forty-two participants were randomised for inclusion in the study (21 per group: 25 women, 17 men). One withdrew before baseline, leaving 41 in the intention-to-treat analysis. Compared with the control group, the connected-cap group had lower time above range >13.9 mmol/l (mean difference −4.8 percentage points; 95% CI −9.5, −0.1; p =0.045) and reduced glucose standard deviation (−0.35 mmol/l; 95% CI −0.64, −0.06; p =0.018). HbA _1c showed a borderline reduction of −3.5 mmol/mol (−0.32%) (95% CI −7.1, 0.0 mmol/mol; −0.65, 0.00%; p =0.050). Per-protocol analyses suggested an 8% absolute increase in time in range among adherent users. No adverse events or device-related serious adverse events occurred. No between-group differences were observed in avoidance behaviours based on the hypoglycaemia fear survey significantly decreased in the treatment group (β=−2.44; 95% CI −4.45, −0.43; p =0.019). Conclusions/interpretation: In routine clinical care, use of a connected pen cap reduced severe hyperglycaemia, glycaemic variability and hypoglycaemia avoidance behaviours in adults with type 1 diabetes and suboptimal glycaemic management. These findings support the integration of low-burden, data-driven tools into public diabetes care. Larger and longer trials should evaluate the durability and cost-effectiveness of these interventions. Trial registration: ClinicalTrials.gov NCT06845891 Funding: Investigator-initiated study without industry funding; devices were procured by the hospital. Funders had no role in study design, conduct, analysis or reporting

The discordance between glycated haemoglobin (HbA1c) and the glucose management indicator (GMI) has been proposed as a marker of vascular risk in diabetes. This study evaluated whether the GMI/ HbA1c ratio independently predicts diabetic retinopathy (DR) in adults with type 1 diabetes (T1D) using continuous glucose monitoring. We conducted a multicenter cross-sectional study involving 1,070 adults using flash glucose monitoring. Participants were stratified as high glycators (ratio < 0.9) or non-high glycators based on the GMI/HbA1c ratio. DR status was assessed by ophthalmologic evaluation. Multivariable logistic regression and 1:1 propensity score matching were used to assess independent associations with DR, adjusting for age, sex, diabetes duration, smoking, hypertension, LDL cholesterol, BMI and insulin dose. While high glycators had a higher crude DR prevalence (31.3% vs. 23.1%, p = 0.020), the GMI/HbA1c ratio was not independently associated with DR in adjusted models (OR 1.19; 95% CI: 0.34–4.15; p = 0.785) or in the matched cohort (OR 1.23; 95% CI: 0.76–1.99; p = 0.391). Absolute HbA1c remained the strongest glycemic predictor. These findings suggest that the GMI/HbA1c ratio may aid in interpreting discordant glycemic profiles, serving as a contextual tool in clinical practice, but it lacks independent prognostic value for DR.

Background: Advanced hybrid closed-loop (AHCL) systems have improved the glycemic control in type 1 diabetes (T1D). While time in range (TIR) (70–180 mg/dL) is the standard metric, time in tight range (TITR) (70–140 mg/dL) offers a stricter assessment. Real-world comparisons using the TITR are limited. This study compared the TIR and TITR metrics between the MiniMed™ 780G and Tandem Control-IQ™ in adults with T1D. Methods: This retrospective, single-center study included 42 propensity-score-matched adults with T1D (28 MM780G users and 14 Tandem Control-IQ users), each with ≥3 months of AHCL system use. Glycemic metrics from continuous glucose monitoring (CGM) were analyzed over a 14-day period. Comparisons between groups were conducted using Mann–Whitney U tests, adjusted linear regression, and linear mixed-effects models accounting for repeated measures. Results: At three months, the MM780G users achieved significantly higher TITR (60.1% ± 12 vs. 49.5% ± 9.3; p = 0.005) and TIR (83.7% ± 7.6 vs. 72.1% ± 7.5; p < 0.001) values, along with lower glucose variability, compared to these values in the Tandem Control-IQ users. The linear regression model confirmed that the MM780G was independently associated with a higher TITR (β = 14.2; p = 0.005). Mixed-effects modeling for the TIR showed a significant interaction between timepoint and device type (β = 4.81; p = 0.006), favoring the MM780G. Conclusions: In this real-world analysis, both AHCL systems improved glycemic control, but the MiniMed 780G could be associated with a superior performance in achieving tighter glucose targets without increasing hypoglycemia. TITR may serve as a valuable complementary metric alongside TIR in evaluating AHCL systems’ effectiveness. However, these findings should be interpreted cautiously due to limitations such as the retrospective design, small sample size, potential residual confounding, and lack of standardization in the device settings. Further studies are warranted to confirm these results and assess their generalizability.

Objective: The use of transcatheter aortic valve implantation (TAVI) has expanded in patients with severe aortic stenosis who are deemed inoperable. However, sarcopenia may be a determining factor in their survival. The aim of our study is to assess the impact of sarcopenia, evaluated by computed tomography (CT), on mortality in this patient population. Methods: Patients with severe aortic stenosis undergoing follow-up after TAVI at Hospital Universitario de la Princesa were recruited. Body composition was analyzed using routine CT scans and open-source software. Survival analysis was performed, and correlations between body composition parameters at the T12 and L3 vertebral levels were assessed. Results: Our sample comprised 97 subjects. Time to mortality was associated with diabetes mellitus (p = 0.050), atrial fibrillation (p = 0.02), and respiratory disease (p = 0.03). Interestingly, sarcopenia (p = 0.039) and normal-density muscle area (p = 0.025) were also associated with time to mortality, with the association between sarcopenia and time to mortality becoming stronger after adjusting for covariates (p < 0.001). The correlation between different body composition parameters at the T12 and L3 vertebral levels was substantial and statistically significant. Conclusions: The use of CT to assess sarcopenia in patients with severe aortic stenosis undergoing TAVI is highly valuable and can predict time to mortality. Sarcopenia should be considered as a relevant parameter in the comprehensive evaluation of these patients.