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Oral semaglutide, the first oral glucagon-like peptide-1 (GLP-1) receptor agonist therapy approved for the treatment of type 2 diabetes, is now approved for obesity management and cardiovascular risk reduction in adults, demonstrating weight loss comparable to that of subcutaneous GLP-1 therapies, alongside improvements in cardiometabolic risk factors. The availability of oral semaglutide for the treatment of obesity provides healthcare professionals with additional opportunities to individualize therapy based on patient preferences, lifestyle, and clinical circumstances. However, the oral semaglutide formulation requires specific administration conditions to optimize absorption and effectiveness. Notably, oral semaglutide tablets should be taken first thing in the morning on an empty stomach with no more than half a glass of plain water (up to 120 mL or 4 fl oz), followed by 30 min before eating food, drinking additional fluids, or ingesting other oral medications. Person-centered clinical discussions between healthcare professionals (HCPs) and patients prior to treatment initiation are important to ensure patients understand administration requirements and why they are necessary, establish realistic expectations for obesity treatment targets, and cover approaches to maintain adherence. HCP-patient consultations should also include discussion of strategies to help patients minimize, prepare for, and manage adverse events. In this article, we provide practical guidance for incorporating oral semaglutide into obesity management, drawing on evidence from clinical trials, including the OASIS 4 trial, and the authors' clinical insights. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are medications that are prescribed for the treatment of obesity to help people lose weight by reducing their appetite and feelings of hunger. Most GLP-1RAs are injected into the fatty layer of tissue below the skin, which helps the body absorb the medication into the bloodstream. The GLP-1RA semaglutide has been available in an injectable format for the treatment of obesity for several years and is now also available as a tablet for adults who prefer not to use injections. In clinical trials, people who used the tablet form of semaglutide had similar weight loss to people who used injectable semaglutide. Semaglutide tablets have been designed in a way that resists break down by stomach acid, allowing more of the medication to be absorbed into the body, but there are important steps to follow when taking the tablet to ensure the medication works as well as possible. Based on learnings from clinical trials and the clinical experience of the authors, this article provides practical advice to support healthcare professionals in guiding their patients through these steps. It also covers important topics to discuss with patients before they start taking semaglutide tablets, including possible changes to how they take other medications, how to limit and manage potential side effects, and ways for patients to stay consistent with their treatment schedule.
To overcome limitations in traditional case-based teaching, this study developed an AI-driven workflow using DeepSeek to generate contemporary, interdisciplinary clinical biochemistry cases. Through human-AI collaboration, eight structured cases covering key topics such as carbohydrate and lipid metabolism were created, each including a clinical description, molecular mechanisms, and Q&A, followed by instructor review. Fifteen medical students and 15 instructors evaluated the cases using a 5-point Likert scale across multiple dimensions, while student performance was compared between a group using AI-generated cases and a control group. The AI generated each case in 10-15 min, significantly faster than manual development. Cases presented a logical progression from molecular mechanism to clinical management and incorporated recent advances such as CRISPR and PCSK9 inhibitors. Content integration received the highest ratings, though instructors scored pedagogical applicability lower. Error analysis indicated that AI excelled in maintaining logical consistency, whereas human reviewers enhanced precision in clinical details. Students who used the AI-generated cases achieved significantly higher examination scores than the control group (p < 0.05). In conclusion, DeepSeek-generated cases are efficient, interdisciplinary, and innovative. Human review remains essential for ensuring clinical rigor, particularly in nuanced scenarios. This collaborative approach enhances both the efficiency of case development and the educational quality of biochemistry teaching materials.
The outcome of clinical islet transplantation has been influenced by various factors, including the volume of islet transplanted (IEQ), frequency of transplantation, islet size, and purity. Most studies have compared the outcomes with these factors individually. This review attempts to comprehend the key factors that influence the outcome of clinical islet transplantation by understanding and analyzing the relationship between them. The purity of the islet preparation is often overlooked, as it is often believed to have a higher level of purity associated with better clinical outcome. However, a recent study documented long-term outcome of transplantation is better when purity less than 50%. Various studies have documented the decrease in the proportion of small islets with an increase in purity. Poor clinical outcomes have been documented when the transplanted islet preparation contains a lower proportion of small islets. This is not only because small islets survive better with diffusion, but also the higher proportion of large islets is prone to producing overestimation in IEQ calculation, leading to inadequate transplantation volume. Vigorous purification processes may remove the potential stem cells or progenitor cells present in pancreas and lack the paracrine effect that supports the viability and function of transplanted islets.
To determine the diagnostic yield of comprehensive genetic testing in patients with neuroimaging findings suggestive of lissencephaly spectrum disorders and to characterize novel pathogenic variants contributing to the genetic architecture of the spectrum. We reviewed clinical and genetic findings of 23 patients with neuroimaging features suspected of the lissencephaly spectrum who underwent genetic testing at the Children's Hospital Zagreb between 2016 and 2025. Clinical data were obtained from medical records and outpatient assessments by clinical geneticists. Genetic testing included chromosomal microarray, clinical exome sequencing, and whole-exome sequencing. A molecular diagnosis was established in 15 of 23 patients (65.2%). The pathogenic variants involved genes related to microtubule function (DCX, TUBA1A, TUBB2B, DYNC1H1) and variants in transcriptional and regulatory genes (FOXG1, WDR62). Four novel (likely) pathogenic variants were detected in well-established lissencephaly genes (DCX, TUBA1A, FOXG1, and WDR62). Although most cases involved single-gene variants, three patients had pathogenic copy number variants (1q43q44, 22q11.21, and Xq22.3q23 deletions). Exome sequencing when used as a first-line test, complemented by chromosomal microarray, provides a high diagnostic yield in patients with lissencephaly spectrum disorders. This integrated approach facilitates precise diagnosis, informs prognosis, enables targeted follow-up, and supports comprehensive genetic counselling.
Background/Objectives: Diabetes mellitus is a major global health burden, and inadequate glycemic control increases the risk of microvascular and macrovascular complications. Self-monitoring of blood glucose (SMBG) is essential for diabetes management, but conventional finger-prick sampling may reduce adherence due to pain and repeated skin injury. This study evaluated the analytical performance, clinical accuracy, and usability of a novel laser-assisted blood glucose monitoring system, HandyRay-Glu. Methods: A prospective clinical evaluation study was conducted in accordance with ISO 15197:2013. Capillary blood glucose values obtained using the HandyRay-Glu system were compared with reference measurements generated by the cobas c111 analyzer. Analytical performance was assessed by evaluating repeatability, linearity, hematocrit effect, and interference. Clinical performance was assessed according to ISO 15197:2013 system accuracy criteria, and method comparison was performed using Passing-Bablok regression and Bland-Altman analyses. Usability was evaluated using a structured participant questionnaire. Results: A total of 100 adult participants with diabetes mellitus were included. Overall, 97.8% of results met the ISO 15197:2013 accuracy criteria. Passing-Bablok regression showed strong agreement between HandyRay-Glu and the reference method (y = 1.694 + 0.9859x, r = 0.992). Bland-Altman analysis demonstrated a mean bias of -1.763 mg/dL, with 95% limits of agreement ranging from -29.333 to 25.808 mg/dL. Analytical evaluations showed acceptable repeatability, linearity across the tested measurement range, and no clinically significant interference. More than 97% of participants reported satisfaction with device usability. Conclusions: The HandyRay-Glu system met the performance requirements of ISO 15197:2013 and demonstrated high analytical accuracy, acceptable agreement with the reference method, and favorable usability. Laser-assisted blood sampling combined with electrochemical glucose measurement may offer a potential alternative to conventional SMBG systems, and its possible role in improving patient acceptance of regular monitoring warrants further investigation.
Androgen receptor (AR) gene mutations are a common cause of 46, XY disorders of sex development (DSD), resulting in varying degrees of androgen insensitivity. This study aims to comprehensively evaluate the clinical features, hormone profiles, and AR gene variants of patients diagnosed with Androgen Insensitivity Syndrome (AIS), and to analyze the distribution of these variants across different functional domains. This retrospective, single-center study analyzed 16 cases of 46, XY DSD, all of whom were found to have AR variants from a single tertiary center in Turkey. Patients were evaluated based on their complaints, hormonal measurements, clinical features, and genetic diagnoses. Patients were classified as having Complete, Partial, or Mild AIS. The variants were categorized based on their location within the functional domains: The Ligand Binding Domain (LBD) and the N-terminal Domain (NTD). Patients were classified as having CAIS (8/16), PAIS (6/16), MAIS (1/16), and suspected diagnosis (1/16). The most common clinical finding was cryptorchidism (11/16). Ten different AR variants were detected: eight missense (p.Pro392Ser, p.Ala749Val, p.Val890Met, p.Asp733Asn, p.Arg856His, p.Arg856Cys, p.Glu494Ala, and p.Glu710Lys), one nonsense (p.Lys659Ter), and with p.Lys659Ter, p.Glu494Ala and being novel. A CAIS associated with p.Pro392Ser has been reported, and intrafamily variability has been documented in variants such as p.Arg856His and p.Pro392Ser. Most variants (10/16 patients) localized to the LBD. Individuals harboring LBD variants demonstrated lower external genital scores and shorter phallus lengths compared to those with NTD variants. T/DHT ratio was available in 11 patients and did not yield false-positive AIS diagnoses. Marked intrafamilial phenotypic variability was observed. This study expands the AR variant spectrum in AIS and represents one of the more comprehensively characterized cohorts from our country. While LBD variants were more often associated with severe phenotypes and NTD variants with milder presentations, marked phenotypic variability was observed. Nevertheless, considerable phenotypic variability, including marked intrafamilial heterogeneity, was evident. The T/DHT ratio provided supportive biochemical information but did not replace the need for molecular confirmation. Molecular confirmation remains essential, and multidisciplinary, patient-centered management is warranted.
Ethnic inequalities in COVID-19 outcomes are extensively documented, yet underlying causes remain unclear. We investigated ethnic disparities in clinical severity at admission with COVID-19 and their relation to mechanical ventilation (MV), 60-day mortality, and long COVID. Retrospective cohort study of adults (≥18 years) admitted with COVID-19 (March 2020-March 2022). Clinical and sociodemographic data extracted from patient records were linked to national register data. Using logistical regression, competing risk, and Cox proportional hazards models, we estimated risk of high-flow oxygen upon admission, MV, 60-day mortality, and long COVID comparing ethnic minority patients with patients of Danish origin. Of 1610 patients, 39.1% were ethnic minority patients. Ethnic minorities were younger, had longer symptom duration (7 vs 6 days, p < 0.001), and a higher risk of requiring high-flow oxygen upon admission (OR 1.41, 95% CI: 1.12;1.79) than patients of Danish origin until adjusted for age. However, ethnic minorities were not at higher risk of MV (HR 1.00, 95% CI: 0.69;1.44), 60-day mortality (HR 0.81, 95% CI: 0.61;1.09), long COVID (HR 0.82, 95% CI: 0.56;1.19) or related symptom diagnosis (HR 1.32, 95% CI: 0.85;2.05). While ethnic minorities presented later and more severely ill at admission with a higher risk of receiving high-flow oxygen, their risk of MV, 60-day mortality, and long COVID were comparable to patients of Danish origin. This was largely explained by a substantial difference in age. Our findings emphasise the need for public health interventions to ensure equitable and timely healthcare access for all populations.
Pheochromocytoma poses diagnostic challenges, especially in small or atypical tumors. Despite the use of various imaging modalities, their preoperative diagnostic accuracy remains limited. The study aimed to assess pathologically confirmed cases of pheochromocytoma and clarify diagnostic pitfalls and various imaging findings. Patients and methods: We retrospectively analyzed 47 pathologically confirmed pheochromocytomas treated at our institution between 2015 and 2022. Clinical characteristics, biochemical results, and imaging findings [computed tomography (CT), magnetic resonance imaging (MRI), and 123I-metaiodobenzylguanidine (MIBG) scintigraphy] were reviewed. MRI scans were independently reviewed by two board-certified radiologists, with consensus on discrepancies. The mean patient age was 59.3 years, and the mean tumor size was 4.26 cm. The 123I-MIBG scintigraphy positivity rate was 85.1%. Characteristic MRI features, including high signal intensity on T2-weighted images, internal heterogeneity, early enhancement, and lack of signal drop on fat-suppressed T2 images, were observed in >90% of cases. No adverse events occurred among 31 patients who underwent contrast-enhanced CT without α-blocker pretreatment. Three tumors were non-functional and 123I-MIBG-negative, diagnosed only via postoperative pathology. Diagnosing pheochromocytoma remains challenging in small or atypical cases, emphasizing the value of combining multiple imaging modalities, particularly MRI. These findings highlight the importance of a multimodal approach in clinical practice.
Diabetes technology has transformed substantially over the past two decades, becoming central to modern diabetes management. Continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and smart insulin pens have reshaped both the assessment of glycemic control and diabetes treatment, particularly in people with type 1 diabetes (T1D) and selected individuals with insulin-treated type 2 diabetes (T2D). Among these technologies, CGM represents a major paradigm shift, providing continuous insight into glucose trends, variability, and time spent within clinically meaningful glycemic ranges, thereby complementing-and in many cases replacing-traditional self-monitoring of blood glucose. This narrative review summarizes evidence from randomized controlled trials and real-world studies regarding the evolution of CGM technology, insulin delivery strategies-including conventional insulin pumps, sensor-augmented pumps, and hybrid closed-loop systems-and the application of these technologies in specific clinical contexts, such as pregnancy, gestational diabetes, and perioperative and inpatient settings. While these systems offer clear metabolic and psychosocial benefits, important limitations remain, particularly those related to delayed insulin pharmacokinetics, sensor lag during rapid glucose changes, and user-dependent factors. Emerging developments, including fully closed-loop and dual-hormone systems as well as the growing role of artificial intelligence in CGM data analysis and risk prediction are also explored. Future development is expected to focus on improved personalization, tighter integration of technologies, and a transition toward more predictive and proactive diabetes care.
Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for the treatment of type 2 diabetes (T2D), are increasingly used for the management of overweight and obesity in children and adolescents. However, the impact of concomitant lifestyle interventions, which vary in scope, structure, and intensity, remains unclear. Methods: A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted from April to December 2025 (last update: 12 December 2025), in accordance with the PRISMA 2020 statement. Randomized and observational studies including patients aged 6-19 years with overweight or obesity, with or without T2D, treated with GLP-1 RAs or dual GIP/GLP-1 agonists, were included. Anthropometric outcomes, metabolic parameters, and the scope and structure of concomitant nutritional and behavioral interventions were assessed. Results: Fifteen studies (12 interventional [RCT/non-RCT] and 3 observational), including 1448 participants, were analyzed: liraglutide (n = 6), exenatide (n = 5), semaglutide (n = 1), dulaglutide (n = 1), tirzepatide (n = 1), and lixisenatide (n = 1). Intervention duration ranged from 6 to 68 weeks. Reported BMI reductions varied across studies and pharmacological agents, with semaglutide trials reporting reductions of up to -16.1%. Lifestyle interventions were heterogeneously reported, ranging from general dietary advice to structured, multidisciplinary programs including nutritional counseling, physical activity, and behavioral or family support. Due to heterogeneity in study design and reporting, the independent contribution of lifestyle interventions could not be determined. Conclusions: Available evidence suggests that GLP-1 RAs may represent an effective therapeutic option for children and adolescents with obesity and metabolic disorders. However, available evidence is largely derived from studies incorporating inconsistently reported lifestyle interventions, limiting the ability to disentangle pharmacological and lifestyle effects. Standardized reporting and studies specifically designed to assess their independent and combined effects are needed. Future research should standardize the reporting of lifestyle protocols (e.g., using TIDieR), incorporate validated measures of eating behavior, food preferences, and dietary intake, and use designs (e.g., factorial or stratified randomization of lifestyle intensity) that allow for the pharmacological and behavioral contributions to be quantified separately. This review highlights a critical and previously underexplored methodological gap regarding the structure and reporting of lifestyle co-interventions in pediatric GLP-1 trials.
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Obesity is a common, complex, and often persistent chronic disease associated with serious health and social consequences. In the United States, recent data indicates that almost 20% of children and adolescents have obesity. Management of pediatric obesity involves multidisciplinary teams, including pediatricians, pediatric specialists, dietitians, behavioral health specialists, and exercise professionals, who deliver intensive health behavior and lifestyle treatment. Prior survey data from Pediatric Endocrine Society (PES) members indicate variability in practice patterns. There is an urgent need to assess current practices across groups and use these data to establish a standard of care across institutions. This is a cross-sectional survey of 38 providers who treat pediatric obesity. We report descriptive statistics (mean/median/IQR) only. Of 168 potential respondents, 38 completed the survey. 61% of the clinics are run within the Pediatric Endocrine division. All clinics offer pharmacotherapy, while only some offer bariatric surgery treatment. There is a wide divergence in the structure, staffing, visit frequency, intake process, and operational workflow between programs. All programs are staffed with a physician or APP, 97% with dieticians, 60% with psychologists or behavioral health therapists, and 39% with bariatric surgeons. Ideal and actual follow up times were mismatched, with programs wanting to see patients for follow up more often than they were able to. The survey provides a detailed snapshot of current practices within pediatric weight management programs, highlighting the strengths and the substantial variability that characterize the field. While many clinics share core elements, there remains a divergence in others. These differences reflect the diverse environments in which programs operate and underscore the benefit of standardized models for delivering pediatric obesity care. This survey is an important foundation, but broader national efforts are essential to guide standardization, inform policy, and support the development of high-quality, accessible pediatric obesity care.
Malabsorption is a frequent and clinically relevant condition associated with a high risk of disease-related malnutrition across multiple gastrointestinal and systemic disorders. Despite its prevalence, standardized nutritional management algorithms remain limited. Following a previously published Delphi consensus on the use of oligomeric enteral formulas, the present study aimed to develop and validate a practical nutritional management algorithm for patients with malabsorption. A structured expert questionnaire was conducted among 173 physicians with clinical experience in malabsorption, including specialists in endocrinology, gastroenterology, internal medicine, and oncology. Participants gained experience using the preliminary algorithm by applying it to five real-life cases before completing the questionnaire. The survey addressed symptom type, intensity, and duration required for screening, diagnostic criteria for malnutrition, timing of reassessment, indications for oligomeric oral nutritional supplements (ONSs), and criteria for reintroducing polymeric formulas. Statistical analyses were performed using SAS v9.4. Of the 173 participants, 67.1% were women, with a mean age of 39.6 ± 8.2 years and a mean clinical experience of 10.9 ± 7.9 years. In clinicians' opinion, diarrhea was the most frequently considered symptom to trigger screening (88.6%), followed by abdominal distension (72.6%), abdominal pain (65.4%), and increased gastric residuals (45.8%). Experts agreed that symptoms should present with at least moderate intensity and persist for more than 3 weeks to justify screening. Most respondents agreed with using the GLIM criteria for malnutrition assessment (97.7%). For patients with poor tolerance to polymeric ONSs or moderate-to-severe symptoms, initiation of oligomeric ONSs was recommended, with diarrhea identified as the main indication (31.1%). Symptom severity prompting oligomeric formulas was rated between 2.8 and 3.3 on a 5-point scale. The mean recommended duration of symptom improvement before transitioning back to polymeric formulas was 6.24 ± 4.45 weeks. This study presents a consensus-based, clinically applicable algorithm for nutritional screening, diagnosis, and intervention in patients with malabsorption. The algorithm provides clear guidance on symptom assessment, use of GLIM criteria, selection of ONS type, and follow-up, potentially improving standardization and quality of nutritional care in this high-risk population.
Background/Objectives: Permanent pacemaker implantation (PPI) remains one of the most common complications following transcatheter aortic valve replacement (TAVR). Identifying patients at increased risk for post-procedural conduction disturbances is clinically important for procedural planning and patient management. The aim of this study was to develop and evaluate a machine learning-based model for predicting the risk of PPI after TAVR. Methods: This prospective study was conducted between 2019 and 2025, and included 179 patients with severe aortic stenosis who underwent TAVR. Patient eligibility was determined by a multidisciplinary Heart Team based on clinical, echocardiographic, and imaging criteria. The primary endpoint was PPI occurring during hospitalization or within 30 days after the procedure. Statistical analyses were performed using RStudio (v. 2024.09.1+394)and Python (v.3.12.3), including comparative tests for continuous and categorical variables, receiver operating characteristic analysis to assess model performance, and SHapley Additive exPlanations (SHAP) to evaluate feature importance and model interpretability. Results: A total of 179 patients undergoing TAVR were included in the analysis. PPI occurred in 17 patients (9.5%) within 30 days after the procedure. A machine learning model was developed to predict post-TAVR PPI. The model demonstrated good predictive performance, with an overall accuracy of 0.944 and a weighted F1-score of 0.947. The confusion matrix showed that the model correctly classified 155 patients without PPI and 14 patients with PPI, with only a small number of false predictions. Explainability analyses using SHAP and permutation feature importance revealed that anatomical and procedural variables had the greatest impact on model predictions. The most influential predictors included valve size, right coronary sinus diameter, prosthetic valve diameter, and mean aortic annulus diameter. In contrast, baseline clinical variables such as left ventricular ejection fraction, previous myocardial infarction, and mean transaortic gradient showed a comparatively lower contribution to the prediction of PPI after TAVR. Conclusions: This study demonstrates that machine learning models can effectively predict the risk of PPI after TAVR. Anatomical characteristics of the aortic root and prosthesis-related parameters were the main determinants of PPI, whereas baseline clinical variables had a lower impact. The use of explainable artificial intelligence methods, such as SHAP analysis, may improve risk stratification and support procedural planning in patients undergoing TAVR.
The clinical and genetic spectrum of inherited Fanconi renotubular syndrome (FRTS) remains incompletely characterized, and the role of recently recognized genes such as GATM has not been systematically assessed. This retrospective study included 20 families with FRTS (14 pediatric and 6 adult index cases) who underwent targeted panel sequencing between 2016 and 2024. The variant spectrum and clinical characteristics were evaluated. Previously reported cases were reviewed to elucidate the phenotypic spectrum and renal prognosis in patients with GATM variants. Pathogenic variants were identified in 13 of 20 index cases (65%; 4 pediatric, 9 adult cases). Disease-causing genes detected included GATM (n = 7), CLCN5 (n = 2), HNF4A (n = 1), BCS1L (n = 1), CTNS (n = 1), and EHHADH (n = 1). Notably, 4 of the 7 GATM variants were completely novel, and 2 others were first reported by our group. The review, incorporating our cases, revealed that patients with GATM variants frequently exhibited incomplete FRTS, expanding the known clinical spectrum. Kidney function exhibited progressive decline, with combined analyses of our cohort and published cases indicating a median kidney survival age of 51.9 years, establishing GATM-associated FRTS as progressive tubulopathy. Over half of the patients with primary FRTS displayed detectable monogenic etiologies, with GATM variants being unexpectedly prevalent. Our findings provide new insights into the genetic and clinical spectrum of FRTS with GATM variants, highlighting its under-recognition, phenotypic variability, and progressive kidney dysfunction. GATM variants should be considered in patients with incomplete proximal tubular abnormalities or unexplained chronic kidney disease (CKD).
This study aimed to compare demographic and clinical information of teens and emerging adults with type 1 diabetes (T1D) by endocrinology visit completion status (no-showed, cancelled last minute [within 8 days], attended). Three endocrinology clinic schedules (two paediatric, one adult) were reviewed weekly over a 6-month period to identify people with T1D (≥1 year) ages 15-35. A1c, demographics and use of emergency department (ED)/inpatient care over the last year were recorded. We compared these factors by visit completion status using ANOVA, chi-squared and Fisher's exact tests. Of 529 individuals, 9% no-showed and 21% cancelled their visit last minute. Among those who cancelled, private insurance was more common than public (60% vs. 38%, respectively), which differed from those who no-showed (40% vs. 53%, p < 0.001). A1c was higher in people who no-showed (79 mmol/mol, 9.4%) than cancelled (67 mmol/mol, 8.2%) or completed visits (62 mmol/mol, 7.8%, p < 0.001). Those who no-showed were more likely to have 2+ ED visits/hospitalizations in the last year compared with those who cancelled or attended (21% vs. 11% vs. 6%, respectively; p = 0.013). Among 15-35-year-olds with T1D, no-shows and last-minute cancellations were common. Those who cancelled last minute had higher A1cs and greater ED/hospital use than those who completed visits, although these were not as high as in those who no-showed. Mechanisms to identify and ensure appropriate follow-up among individuals with last-minute cancellations should be explored.
This study evaluated the performance and safety of a 15-day real-time continuous glucose monitoring (rtCGM) system in Chinese adults with diabetes, focusing on its accuracy and clinical utility for long-term glucose management. A clinical evaluation was conducted using four rtCGM sensors per participant, with placement sites on both the upper arm and the abdomen. The system's accuracy was assessed using a factory-calibrated model. Primary outcomes included the mean absolute relative difference (MARD), the 20/20% agreement rate, and the proportions of Clarke and Consensus Error Grid in zones A+B. A total of 74 participants were screened. The MARD values were 8.44% for the upper arm and 8.91% for the abdomen under factory-calibrated model. The 20/20% agreement rates were 95.78% for the upper arm and 94.41% for the abdomen under factory-calibrated model. The Clarke and Consensus Error Grid A+B proportions were 99.53% and 99.96% for the upper arm, and 99.46% and 99.82% for the abdomen under factory-calibrated model, respectively. The CGM system showed high accuracy, robust alert performance, stable repeatability, and favorable safety over 15 days in Chinese adults with diabetes, supporting its clinical utility for glucose monitoring in these adult patients.
Vitamin D deficiency is a common global health problem and remains highly prevalent in Türkiye, where limited food fortification and heterogeneous clinical practices contribute to variability in testing and supplementation strategies. To provide Türkiye-specific best practice recommendations for defining clinically relevant serum 25-hydroxyvitamin D [25(OH)D] thresholds, identifying adult risk groups for targeted testing, and recommending evidence-based prevention, treatment, and monitoring approaches while minimizing under-treatment and inappropriate high-dose use. This national expert consensus document was developed by endocrinologists from across Türkiye using a structured, modified Delphi methodology. Draft statements informed by systematic literature reviews were rated via online surveys using a 9-point Likert scale, followed by two Delphi rounds and a face-to-face consensus meeting in İstanbul in October 2025. Recommendations addressed sun exposure, laboratory assessment, screening, supplementation, treatment, and follow-up. Serum 25(OH)D <20 ng/mL was defined as deficiency and <12 ng/mL as severe deficiency, with a target range of 20-50 ng/mL. Routine population-wide screening was not recommended; instead, targeted testing in high-risk adults and symptom-driven biochemical evaluation were endorsed. Empiric supplementation was recommended for selected high-risk groups, with cholecalciferol as the preferred agent. Higher individualized doses were suggested in obesity or malabsorption, while loading regimens were reserved for specific clinical indications, such as severe deficiency or certain medical conditions that impair vitamin D metabolism. Reassessment of 25(OH)D at 8-12 weeks was recommended. These consensus-based recommendations provide a practical, context-specific framework for assessing, preventing, treating, and monitoring vitamin D deficiency in adults in Türkiye.
Selecting patients at higher baseline risk of fragility fracture may optimise clinical outcomes and cost-effectiveness of hospital fracture liaison services (FLS). In this cohort study, we found a risk-stratified approach led to a higher rate of treatment initiation and estimated number of fractures prevented compared to the traditional FLS strategy. Hospital-based fracture liaison services (FLS) are cost-effective and reduce refracture risk. However, optimal FLS characteristics to maximise clinical and cost-effectiveness are uncertain. We reviewed data for FLS patients at Royal North Shore Hospital, Sydney (2015-2023). In 2018, the patient selection strategy was adjusted from a traditional approach (any fragility fracture, ≥ 50 years) to preferentially invite those either ≥ 60 years with any fragility fracture, or any presenting with hip and/or vertebral fractures. Cohorts entering the service pre-(FLS1) and post-this timepoint (FLS2) were compared regarding clinical characteristics, estimated fracture risk and pharmacotherapy initiation. Modelling was performed to estimate fractures averted. The total cohort (n = 1903) was median 68-years-old and predominantly female (77%). Both cohorts were similar in sex distribution and prevalence of various fracture risk factors. The FLS2 cohort was older (median 69 vs 65 years, p < 0.001), more frequently presented with hip/vertebral fracture (21.4% vs 13.8%, p < 0.001), had higher Garvan-estimated 10-year fracture-risk (median 36.0% vs 27.4%, p < 0.001) and more frequently initiated pharmacotherapy (79.0% vs 64.6%, p < 0.001). In the overall cohort, strongest predictors of treatment initiation were older age, osteoporotic bone density, hip/vertebral fracture and female sex. Over 5 years, risk-stratified FLS was estimated to avert more osteoporotic (72 vs 44, p < 0.001) and hip fractures (20 vs 10, p < 0.001) per 1000 patients compared with traditional FLS. In this large hospital-based FLS study, a risk-stratified selection strategy was associated with more frequent pharmacotherapy initiation and estimated to avert more fractures; however, longitudinal assessment of treatment adherence and refracture rates is required to confirm utility.