Background Automated insulin delivery (AID) in young children (<7 years) with type 1 diabetes has not yet been systematically evaluated. Materials and Methods Web of Science, PubMed, Scopus, CENTRAL, and ClinicalTrials.gov were searched from inception to December 9, 2025. Studies reporting glycemic outcomes in children younger than 7 years were included in this meta-analysis. Studies not published in English were excluded. The primary outcome was the change in time-in-range (TIR; 70–180 mg/dL). Pooled estimates were calculated using random-effects models and expressed as mean changes (MCs) with 95% confidence intervals (CIs). Results This study included 30 studies (9 randomized controlled trials, 7 single-arm studies, and 14 cohort studies) involving 1,155 young children. AID systems were associated with a significant increase in TIR (MC, 9.88% [95% CI 9.14 to 10.62], I² = 8%, p < 0.0001, moderate certainty), equivalent to 2.37 h/day. Favorable improvement was also observed during the daytime (MC, 6.88% [95% CI 5.70 to 8.07]) and overnight (MC, 16.85% [95% CI 13.48 to 20.22]). TIR improvements were comparable across devices: MiniMed 670G (9.65%), MiniMed 780G (10.04%), CamAPS FX (10.58%), Control-IQ (9.51%), Omnipod 5 (10.25%), and Open Source (6.77%). AID use was also associated with reduced hyperglycemia exposure and modest reductions in glycated hemoglobin, without significant changes in hypoglycemia exposure. Episodes of severe hypoglycemia and diabetic ketoacidosis were infrequent. Conclusion This systematic review with meta-analysis revealed that AID systems have greater benefits for improving glycemic outcomes and have good safety profiles in young children with type 1 diabetes.

Objective. The positive effects of exercise on adiponectin and vitamin D have independently been reported. Recent studies have suggested that vitamin D increases adiponectin synthesis through inhibition of the rennin-angiotensin system in adipose tissue. However, studies evaluating the effects of an aerobic exercise on adiponectin and vitamin D simultaneously investigating the potential mechanism of vitamin D-dependent adiponectin pathways in patients with type 2 diabetes mellitus (T2DM) are still limited. This study was undertaken to examine the effects of aerobic exercise on adiponectin and its association with vitamin D in patients with T2DM. Methods. Total twenty-two patients with T2DM were randomly divided into intervention and control group. The intervention group underwent a moderate intensity of a walking mode treadmill aerobic exercise for four weeks. The exercise protocol was adapted from modified Bruce test with a periodic speed and inclination increase. In both groups, body mass index (BMI), vitamin D, and adiponectin levels, were measured before and after four weeks of the lasting program. Results. The mean of the increased adiponectin and vitamin D levels after exercise was significantly higher in the intervened than the control group, but statistically significant difference was only found in the adiponectin effect (p=0.017). There was a significant association found between vitamin D and adiponectin in the intervention group after data adjustments to age and BMI (p=0.005). Conclusion. Moderate intensity of treadmill exercise with increased speed and inclination periodically increased adiponectin level in patients with T2DM. The increased adiponectin might potentially be mediated by increased vitamin D, but the level of their association impact was dependent on the age and BMI.

Introduction: The success of therapy did not follow the increasing number of type 2 diabetes mellitus patients. This systematic review aimed to evaluate the relationship between diabetes distress and HbA1c in type 2 diabetes mellitus patients during therapy. Methods: The authors systematically searched databases (PubMed, Cochrane library, and ScienceDirect) up to January 2021. Articles were screened according to PRISMA 2020 statements. The selection criteria of this study were patients’ characteristics, type of therapy, and outcomes. Results: The search started from 1.303 articles to 17 eligible articles. Furthermore, seventeen studies included 11,976 patients. The mean HbA1c level was around 6.4% to 9.9%. The result of diabetes distress scores were five studies with low scores, eight moderate scores, and two high scores. Emotional burden and regimen-related distress were the highest domain score. Age, health facilities, and type of therapy affected diabetes distress. The correlation between diabetes distress and HbA1c was dominant in the range of 0.15 to 0.26. Conclusion: Diabetes distress had a low-moderate correlation with HbA1c. The dominant domains were emotional burden and regiment-related distress. There were two mechanisms of effect, direct by hormones and indirect through medication adherence, self-management, and 12 months of quality of life.

The use of insulin for patients with diabetes mellitus in Indonesia appears to be under expectation; moreover, there are gaps in knowledge regarding the proper injection technique and pen needle reuse by both healthcare professionals (HCPs) and patients. To address these issues, a scientific expert meeting was held with the participation of endocrinologists and public health specialist from many different organizations in Indonesia to identify the challenges and problem related to injection technique, high pen needle reuse rate, and the need of all stakeholders. The experts agreed that it is necessary to ensure physicians to start the initiation phase as early as indicated, continue optimizing its dosage to reach targeted blood sugar based on guideline, and involve all relevant stakeholders to improve insulin distribution and patient access in every primary care facility in order to optimize the use of insulin or other injectable diabetes medications in Indonesia. Additionally, the experts believed that education on proper injection technique and improved reuse rate of pen needle is necessary. To date, Indonesian Diabetes Educators Association (IDEA/PEDI) has established guideline on injection technique. There are also recommendations on injection technique and needle reuse from Indonesian Society of Endocrinology (PERKENI) and Forum for Injection Technique & Therapy: Expert Recommendations (FITTER); however, this guideline/recommendation should be disseminated more widely among HCPs. In addition, cost-effectiveness studies based on local data are needed to propose and convince the Payors and other stakeholders. This article can be used as a guidance for HCPs and policymakers to improve current practice on injection technique, pen needle reuse, needle prescription and reimbursement policy in Indonesia and elsewhere.