This study aimed to evaluate the clinical efficacy and safety of hybrid closed-loop systems for glycemic control in children aged < 7 years with Type 1 diabetes. Relevant studies published up to July 30, 2025 were electronically retrieved from the PubMed, Cochrane Library, Embase, and Web of Science databases. Two investigators independently screened the literature, extracted valid data, and assessed the risk of bias of included studies, with a meta-analysis conducted via RevMan 5.4 software. Three randomized controlled trials, with 274 children enrolled, were incorporated into the analysis. The results indicated that 3 months of using the hybrid closed-loop system significantly increased the percentage of time in range (mean difference [MD] = 9.95%, 95% confidence interval [CI] [7.8, 12.09], p < 0.00001) and reduced glycated hemoglobin (MD = -0.51%, 95% CI [-0.64, -0.37], p < 0.00001). However, no significant difference was noted in the percentage of time below range between the two groups (MD = 0.56%, 95% CI [-0.13, 1.25], p = 0.11). A comparison of serious adverse events showed no statistically significant differences in the risk of diabetic ketoacidosis (p = 0.50) and severe hypoglycemia (p = 0.64) between the hybrid closed-loop system group and the conventional therapy group. The hybrid closed-loop system can effectively improve glycemic control in children under 7 years old with Type 1 diabetes without increasing the risk of adverse events. Further high-quality, large-sample clinical studies are still required to verify and supplement the present conclusions.

Open-source automated insulin delivery shows promise for managing type 1 diabetes, though pediatric efficacy and safety data remain limited. This study aimed to compare real-world glycemic outcomes of open-source automated insulin delivery systems with hybrid closed-loop systems in youth with type 1 diabetes. This retrospective cohort study included individuals aged ≤ 19 years with type 1 diabetes for at least one year who used either open-source automated insulin delivery systems (Loop, iAPS, or AndroidAPS) or hybrid closed-loop systems (Tandem t:slim) for at least six months between January 2015 and June 2024. Data were collected from one month before system initiation to 18 months after initiation or the last clinical visit. Glycated hemoglobin, time in range, and glucose management indicator were evaluated using regression analyses and adjusted linear mixed-effects models. A total of 198 participants (143 open-source automated insulin delivery and 55 hybrid closed-loop users) were included (mean age 13.8 years; 57% male). Over 18 months, glycated hemoglobin decreased from 7.40% to 6.96% in the open-source automated insulin delivery group and from 7.35% to 7.28% in the hybrid closed-loop group. Adjusted analyses showed no significant differences in glucose management indicator or time in range between groups across follow-up. Severe hypoglycemia occurred in one participant per group, and no diabetic ketoacidosis events were observed. Open-source automated insulin delivery systems demonstrated similar long-term glycemic outcomes and safety compared with hybrid closed-loop systems, supporting their use as a safe, non-inferior alternative.

Childhood diabetes continues to rise, with wide variation across regions and income levels. We performed a cross-sectional analysis using Global Burden of Disease 2023 estimates for children aged 0-14 years across super regions, regions, and countries from 1990 to 2023. The primary objective was to characterize regional inequalities in incidence, mortality, and disability-adjusted life years, and to assess whether these inequalities are likely to persist in the future. Age-standardized incidence, mortality, and disability-adjusted life year rates were estimated per 100,000 population with 95% uncertainty intervals. Regional and national comparisons, temporal trend analyses, and socioeconomic gradient analyses were employed as core analyses. Risk factor attribution, the Quality of Care Index, Shapley additive explanations-based predictor contribution analysis, and Bayesian age-period-cohort forecasting were used as supportive analyses to interpret risk-attributable mortality patterns, care-related performance gaps, demographic and temporal contributors, and future incidence trajectories. From 1990 to 2023, childhood diabetes incidence increased in most regions, while mortality and disability declined overall. High-income North America had the highest incidence in 2023, whereas Western Sub-Saharan Africa had the greatest mortality and disability burden. Finland had the highest incidence, Qatar, Chile, and South Korea showed rapid incidence increases, and Nigeria had the highest mortality burden. Projections suggested stabilizing incidence in the United States but continued increases in China, India, Poland, Finland, and Qatar. Childhood diabetes shows persistent regional inequalities, highlighting the need for earlier diagnosis, reliable insulin access, and stronger pediatric diabetes systems in resource-limited settings.

Antibiotic use in early life is associated with autoimmune diseases like Type 1 diabetes (T1D), but evidence is inconsistent. We examined associations of prenatal and early-childhood (0-5 years) antibiotic use and T1D in New Zealand, a country with high antibiotic consumption. Using linked data, we identified antibiotic use during pregnancy and the first 5 years for all children born between 2005 and 2010 (n = 315,789), followed until 2021. Associations were assessed using Cox proportional hazard regression, adjusted for parental and perinatal factors. For prenatal exposure, we assessed associations with T1D-diagnosis from birth; for early-childhood exposure, associations were assessed with T1D-diagnosis from age 5. Antibiotic use (≥ 1 course) was 29.2% for pregnant mothers and 96.3% for children aged 0-5 years. T1D was diagnosed in 0.36% (n = 1,131), with 0.28% (n = 906) diagnosed after age 5 years. Antibiotic use during pregnancy was associated with T1D, both expressed as a continuous variable (HR 1.05, 95% CI 1.03-1.08) and as a dichotomous variable (0 vs ≥ 1 course; HR 1.20, 1.05-1.38). When categorised into 0, ≤ 1, ≤ 2, and ≥ 3 courses, a significant (p = 0.0008) positive trend was observed. For postnatal exposure, the HR was 1.02 (1.02-1.03) and 1.62 (1.00-2.63), respectively; when categorised into 0, ≤ 4, ≤ 7, ≤ 12, and ≥ 13 courses, a significant dose-response trend (p = 0.0017) was shown. Strongest associations were found for moderate and broad-spectrum antibiotics in both periods. Prenatal penicillin and cephalosporins/cephamycins-use, and postnatal exposure to all antibiotic classes except tetracyclines were associated with a higher risk of T1D. In conclusion, antibiotic use during both prenatal and early childhood is associated with an increased risk of T1D.

Though school-partnered interventions have the potential to improve health outcomes, data are limited to support their implementation for type 1 diabetes. The objective was to characterize barriers and facilitators (i.e., determinants) to implementing school-partnered collaborative care (SPACE), an intervention designed to improve care coordination, nurse education, and diabetes management in school. We conducted semistructured interviews with school nurses in two states. The interview guide was adapted from the Consolidated Framework for Implementation Research, which organizes determinants by the intervention, the individuals involved, the inner setting, (i.e., school district), the outer setting (i.e., external to the district), and the implementation processes. Major themes were summarized. We included 32 school nurses representing broad geographic regions, district sizes, and levels of nursing experience. School nurses reported that SPACE presented an advantage in care coordination compared with existing practice. Prominent barriers included (1) the intervention's complexity; (2) information sharing between schools and health systems; (3) high school nurses' caseloads, which may limit their availability; and (4) variable levels of parent engagement. Specific facilitators included (1) the intervention's adaptability and low cost, (2) high perceived need for interventions, (3) existing school resources that increase feasibility, (4) a focus on holistic outcomes which align with district priorities, and (5) relationships between school district nurses and leaders. Facilitators were perceived to be crucial to garnering buy-in from decision-makers within district leadership. The themes re-affirmed that school interventions for young people with type 1 diabetes are prioritized by school nurses. Implementation science frameworks can guide pre-implementation work and identify targets for implementation strategies which will mitigate barriers or leverage facilitators.

The prevalence of celiac disease (CeD) in children with type 1 diabetes mellitus (T1DM) is significant, and celiac serology screening is routinely done in T1DM patients. The sequence of CeD and T1DM diagnosis and the natural history of transient celiac serology in T1DM is poorly defined. We aimed to investigate the temporal relationship between T1DM and CeD diagnoses, and the long-term natural history of celiac serology and CeD diagnosis in children with T1DM. A retrospective cohort study of 1,799 children with T1DM, treated at a single tertiary center (2009-2024), was evaluated for clinical, laboratory, and histologic data. Patients with positive anti-tissue-transglutaminase IgA antibodies (anti-TTG) were stratified based on CeD diagnosis or long-term serological behavior on a gluten-containing diet. Among 136 patients with T1DM and positive anti-TTG, 113 were diagnosed with CeD, 15 had persistent seropositivity (without confirmed CeD), and eight had a single borderline result (< ×3 upper limit of normal). CeD was diagnosed after T1DM in 81.4% of cases, and prior to TIDM in 18.6%. Patients diagnosed with CeD prior to T1DM exhibited more gastrointestinal symptoms, higher EMA positivity, and poorer glycemic control (p < 0.05). HbA1c values at follow-up were significantly higher in patients with CeD, compared to those with a single borderline anti-TTG, p < 0.01. In conclusion, most, but not all, patients with T1DM and elevated celiac serology, eventually develop biopsy-confirmed CeD. CeD can precede T1DM in a significant number of cases, emphasizing the need for continued monitoring for celiac serology in children diagnosed with T1DM and monitoring for developing T1DM in patients with CeD.

Type 2 diabetes mellitus-associated cognitive dysfunction (T2DACD) is strongly linked to disruption of cognition-supporting brain networks. Electroacupuncture (EA) has increasingly been examined as a nonpharmacological intervention targeting cognitive impairment; however, the longitudinal neurobiological patterns accompanying EA in T2DACD have not been fully characterized. In this exploratory pilot study, we evaluated alterations in resting-state functional connectivity (RSFC) across hippocampal subregions and default mode network (DMN) nodes in individuals with T2DACD.

For this exploratory, open-label, non-randomized, uncontrolled pilot investigation, we enrolled 20 individuals with T2DACD and 26 healthy controls (HCs). Longitudinal analyses included 15 participants who had usable post-treatment data. T2DACD was defined according to clinical type 2 diabetes mellitus criteria, and a Montreal Cognitive Assessment (MoCA) score <26. Patients underwent an 8-week Adjust Zang-fu and Arouse Spirit electroacupuncture (AZASE) intervention. Cognitive, emotional, metabolic, and seed-based resting-state functional magnetic resonance imaging (rs-fMRI) outcomes were evaluated. Clinical longitudinal analyses were carried out according to protocol, whereas imaging analyses were limited to participants with usable scans after treatment.

At baseline, individuals with T2DACD showed lower MoCA scores than HCs and had poorer executive and working-memory outcomes. Among the 15 participants with complete longitudinal neuroimaging data, MoCA scores increased from 23.27 ± 1.71 to 26.07 ± 1.53 over the intervention period. Within-group alterations were observed for Flanker-conflict reaction time and accuracy, Stroop-conflict reaction time, 1-back reaction time, Self-Rating Anxiety Scale score, and Hamilton Depression Rating Scale score. Omnibus group analyses detected significant effects for the left anterior hippocampus-left angular gyrus connection and the left posterior hippocampus-right middle occipital gyrus connection. Post-treatment scans demonstrated reduced RSFC in several hippocampal-DMN and intra-DMN connections. The association between change in left anterior hippocampus-left angular gyrus RSFC and change in Stroop-conflict performance was no longer statistically significant after Bonferroni correction. For neuroimaging outcomes, cluster-level family-wise error (FWE) correction (p < 0.05) was applied to control for multiple comparisons; clinical outcomes are reported descriptively as hypothesis-generating findings.

In this exploratory pilot study, we identified preliminary alterations in cognitive outcomes and hippocampal-DMN connections over an 8-week EA intervention in individuals with T2DACD. In view of the small sample size and the open-label, non-randomized, uncontrolled design, the findings should be interpreted as hypothesis-generating observations rather than definitive evidence of a specific causal treatment effect. Larger controlled studies will be needed to determine whether the observed neural and behavioral alterations are reproducible and clinically meaningful in practice.

No: ChiCTR2000040268, https://www.chictr.org.cn/hvshowproject.html?id=76145&v=1.3.

The C-reactive protein-triglyceride glucose index (CTI) is a novel composite biomarker that integrates inflammation and insulin resistance. However, its association with the severity of coronary artery disease (CAD) in patients with H-type hypertension under different glucose metabolism statuses remains unclear.

This retrospective study enrolled 1392 hypertensive patients who underwent coronary angiography. CTI was calculated as 0.412 × ln(CRP[mg/L]) + ln(TG[mg/dL] × FPG [mg/dL]/2). Patients were divided into three groups according to CTI tertiles: T1 group (6.748 ≤ CTI < 8.674), T2 group (8.674 ≤ CTI < 9.549), and T3 group (9.549 ≤ CTI ≤ 12.713). Based on the Gensini score derived from coronary angiography, the study cohort was divided into three groups according to the severity of stenosis: low stenosis, medium stenosis, and high stenosis. Logistic regression, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis were used to investigate the association between CTI and CAD severity across different glucose metabolism statuses and H‑type hypertension subgroups. Incremental utility of CTI was evaluated using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).

The results show that CTI is significantly associated with CAD severity in hypertensive patients. After adjusting for risk factors, CTI remained significantly associated with multi-vessel CAD (OR = 2.155, 95%CI 1.839-2.455) and moderate-to-severe coronary stenosis (OR = 1.818, 95% CI 1.603-2.062). RCS analysis revealed a linear dose-response relationship between CTI and CAD severity (P for non-linearity > 0.05). Notably, we observed significant interaction between CTI and H-type hypertension on CAD severity (P = 0.033). Under different glycemic statuses, high CTI levels were associated with CAD severity; however, no association between CTI and moderate‑to‑severe coronary stenosis was observed in patients with diabetes mellitus (DM). In the DM subgroup of patients with H-type hypertension, after adjustment for risk factors, patients in the T3 group had a 6.475-fold increased risk of multi-vessel CAD compared with those in the T1 group (95% CI 1.693-24.773, P = 0.006). ROC analysis demonstrated that, across different glucose metabolism subgroups, CTI showed the highest discriminative ability for multi‑vessel CAD in patients with H‑type hypertension and comorbid DM (AUC = 0.712, 95% CI 0.619-0.804, P < 0.001).

CTI is an independently associated factor for coronary stenosis severity in patients with hypertension, particularly in those with H‑type hypertension and comorbid diabetes. This simple and cost‑effective composite biomarker holds promise as a practical tool for early risk stratification and for guiding individualized prevention strategies.

Proximal tubular epithelial cells (PTECs) are more susceptible to damage due to their high energy requirements. The apoptosis of PTECs has been thought as the main cause of diabetic kidney disease (DKD). However, the reported apoptotic rate was around 5%-25%, suggesting that apoptosis alone cannot fully explain disease progression. An important question is arised: what happens to these surviving PTECs? Studies showed that many surviving PTECs lost their mature phenotype and entered a dedifferentiated, scattered tubular cell-like state. This adaptive change may offer some protective benefit. However, chronic persistent high-glucose stimulates those dedifferentiated PTECs (dPTECs) to secrete proinflammatory or profibrotic factors and drove tubulointerstitial fibrosis, even renal failure. Therefore, PTECs are not only the "victim", but also the "driver" in the development of DKD. Current therapeutic strategies, including SGLT2 inhibitors, gut microbiota modulation, and traditional Chinese medicine, may improve the pathological microenvironment associated with dPTECs, but direct evidence that they can reverse PTEC dedifferentiation remains limited. This review summarizes the characteristics and regulatory mechanisms of dPTECs in DKD, discusses their pathogenic roles, heterogeneity, repair potential, and therapeutic relevance, aiming to provide new perspectives for redirecting maladaptive tubular remodeling toward renal repair.

Immune checkpoint inhibitors (ICIs) are widely used in tumor therapy, and the immune-related adverse events (irAEs) they induce can involve multiple organs. As an organ with both endocrine and exocrine functions, pancreatic involvement may manifest as acute pancreatitis, new-onset diabetes mellitus, or even a combination of both. Among these, ICI-induced acute pancreatitis concurrent with fulminant type 1 diabetes mellitus (FT1DM) is extremely rare but highly critical and easily missed in clinical practice.

A 59-year-old male patient with squamous cell carcinoma of the left base of the tongue received toripalimab combined with chemotherapy. On day 7 after treatment, he presented with nausea, vomiting, and altered mental status. Emergency examination revealed hyperglycemia (17.4 mmol/L), severe diabetic ketoacidosis (blood ketones 9.52 mmol/L, pH 7.28), and significantly elevated serum amylase (370 U/L). Abdominal CT showed swelling of the body and tail of the pancreas with surrounding exudation, consistent with acute pancreatitis. His glycated hemoglobin (HbA1c) was normal (5.4%), pancreatic autoantibodies were negative, and islet function was completely lost. He was diagnosed with toripalimab-associated acute pancreatitis (Grade 3) concurrent with FT1DM. ICIs were permanently discontinued immediately. The patient was treated with fasting, fluid replacement, somatostatin to inhibit pancreatic enzyme secretion, and intensive insulin pump therapy for glycemic control. Glucocorticoids were not administered. After 11 days of comprehensive treatment, his symptoms resolved, and he was discharged upon normalization of pancreatic enzymes and blood glucose levels.

PD-1 inhibitors can simultaneously impair both the endocrine and exocrine functions of the pancreas, leading to the coexistence of acute pancreatitis and FT1DM. Clinicians must maintain a high index of suspicion for this dual injury. For patients receiving ICI therapy, emergency evaluation of pancreatic function is warranted once gastrointestinal symptoms or unexplained hyperglycemia/ketosis occur. Early drug withdrawal and individualized management centered on supportive care can effectively prevent life-threatening complications. Notably, this case represents the first report of such dual pancreatic injury in a patient with locally advanced tongue base squamous cell carcinoma receiving first-cycle toripalimab combined with paclitaxel plus cisplatin chemoimmunotherapy, with distinct atypical clinical manifestations and a faster steroid-free recovery trajectory compared with the single previously published toripalimab-associated case.