Magnetic resonance imaging as a predictor of therapeutic response to pasireotide in acromegaly

OBJECTIVE

Hyperintensity signal in T2-weighted magnetic resonance imaging (MRI) has been related to better therapeutic response during pasireotide treatment in acromegaly. The aim of the study was to evaluate T2 MRI signal intensity and its relation with pasireotide therapeutic effectiveness in real-life clinical practice.

DESIGN, PATIENTS AND MEASUREMENTS

Retrospective multicentre study including acromegaly patients treated with pasireotide. Adenoma T2-weighted MRI signal at diagnosis was qualitatively classified as iso-hyperintense or hypointense. Insulin-like growth factor (IGF-I), growth hormone (GH) and tumour volume reduction were assessed after 6 and 12 months of treatment and its effectiveness evaluated according to baseline MRI signal. Hormonal response was considered 'complete' when normalization of IGF-I levels was achieved. Significant tumour shrinkage was defined as a volume reduction of ≥25% from baseline.

RESULTS

Eighty-one patients were included (48% women, 50 ± 1.5 years); 93% had previously received somatostatin receptor ligands (SRLs) treatment. MRI signal was hypointense in 25 (31%) and hyperintense in 56 (69%) cases. At 12 months of follow-up, 42/73 cases (58%) showed normalization of IGF-I and 37% both GH and IGF-I. MRI signal intensity was not associated with hormonal control. 19/51 cases (37%) presented a significant tumour volume shrinkage, 16 (41%) from the hyperintense group and 3 (25%) from the hypointense.

CONCLUSIONS

T2-signal hyperintensity was more frequently observed in pasireotide treated patients. Almost 60% of SRLs resistant patients showed a complete normalization of IGF-I after 1 year of pasireotide treatment, regardless of the MRI signal. There was also no difference in the percentage tumour shrinkage over basal residual volume between the two groups.

Real-world outcomes of two different sensor-augmented insulin pumps with predictive low glucose suspend function in type 1 diabetes patients

AIM

To analyse the real-life outcomes of two sensor-augmented pumps (SAP) with predictive low glucose suspend (PLGS) function, Medtronic Minimed 640G™ with SmartGuard (MM640G) and Tandem T Slim X2™ with Basal-IQ™ (TTSX2), in Type 1 Diabetes Mellitus (T1DM) patients.

METHODS

Observational cross-sectional study using data obtained from computerized clinical records. All T1DM patients on TTSX2 therapy were compared (1:1) with MM640G treated patients selected through stratified sampling. Primary efficacy outcome was to describe time in rage (TIR, 70-180 mg/dL, 3.9-10 mmol/L) interstitial glucose differences according to a non-inferiority hypothesis with TTSX2 compared to MM640G.

RESULTS

Forty-four patients were analyzed (female 66%). Mean age was 38.9 yrs. (range 23-59 yrs.) and mean diabetes duration was 23.4 ± 9.2 yrs. Patients treated with TTSX2 showed a numerically slightly lower, but non-statistically significantly different, TIR from the MM640G pump group (64.9 ± 16.4% vs. 72.4 ± 17.0%, P = 0.108). Similarly, we did no find differences in HbA1c between T1D patients treated with TTSX2 and MM640G (6.8 ± 1.0% vs. 7.0 ± 0.9%, 51 ± 11 mmol/mol vs. 53 ± 10 mmol/mol, P = 0.312). Moreover, rest of evaluated glycemic outcomes were similar between both treatment groups.

CONCLUSIONS

Patients using two different SAP with PLGS automatic function showed similar glycaemic control in a real-world scenario. NCT04741685.

Metabolic effects of an enteral nutrition formula for diabetes: comparison with standard formulas in patients with type 1 diabetes

AIM

To evaluate the metabolic response (glucose, cholesterol, triglycerides and beta-hydroxy-butyrate) in patients with type 1 diabetes after a trial breakfast with an enteral nutrition formula designed for patients with diabetes and compare it with standard formulas (with and without fibre).

MATERIAL AND METHODS

Each of 11 patients with type 1 diabetes consumed three types of liquid breakfast with a 1 week interval between each. (1). A standard diet (SD) with 49% carbohydrates, 35% lipids, 16% proteins-casein-and without fibre; (2). A fibre-enriched diet (FD): with 49% carbohydrates, 35% lipids, 16% casein and 15 g/1000 ml fibre; (3). A diet designed for patients with diabetes (DD) with 45% carbohydrates, 38% lipids, 16% soy protein and 15 g/1000 ml fibre. Each subject consumed 250 ml of each preparation at 9.00 AM after having administered their usual insulin dose, which was the same for each diet. Blood samples were taken at baseline and each 30 min, up to 150 min.

RESULTS

The increase in postprandial glycaemia was lower with DD than with the standard preparations, reaching statistical significance at 60 min. There were no significant variations in the levels of cholesterol, triglycerides or beta-hydroxy-butyrate between the three preparations.

CONCLUSIONS

After a trial breakfast, a diet designed for patients with diabetes provoked lower increases in postprandial glycaemia (with no changes in lipid or beta-hydroxy-butyrate levels) compared to the standard diets evaluated (with and without fibre).