Kleoniki I. Athanasiadou

Aims: Immune checkpoint inhibitors (ICI) have transformed oncology treatment. This study presents a case series of adults diagnosed with ICI‐induced diabetes mellitus (ICI‐DM) and evaluates the challenges involved in the diagnosis and management of this rare immunotherapy side‐effect. Methods: A single‐centre case series from the UK involved individuals who developed new onset insulin dependent diabetes after ICI treatment between 2017 and 2026. Data were extracted from the electronic medical records (EPIC® Systems Corporation). Results: Thirteen individuals (61.5% male, median age: 61 years [IQR 45–71]) diagnosed with ICI‐DM were included. The majority were from a White ethnic background (84.6%). Time from ICI start to ICI‐DM presentation had a median of 4 months (IQR 2–18). Most ( n = 9, 69.2%) presented with diabetic ketoacidosis (DKA), with two requiring intensive care. Importantly three cases of DKA were potentially avoidable with earlier insulin initiation. Diabetes autoantibodies were positive in 54.5% (5 with GAD65 and 1 with IA‐2 antibodies) with median C‐peptide levels at diagnosis 161 pmol/L (IQR 10–232). The mean HbA1c before ICI start was 40 7 mmol/mol (5.8 ± 2.8%) climbing to 80 ± 15 mmol/mol (9.5 ± 3.5%) at diagnosis, within a median interval of 3 months (IQR 2–4). Conclusions: It is essential to increase healthcare professional awareness of immunotherapy side‐effects to achieve early recognition and prompt management. Increased use of capillary glucose testing and immunotherapy alert card can improve outcomes. Future studies can investigate the relationship between potential risk factors and predisposition to ICI‐DM development.

Purpose: To identify ethnic differences among women with gestational diabetes mellitus (GDM) in a multiethnic cohort. Methods: This observational study included pregnant women with GDM (IADPSG criteria) attending a tertiary centre between January 2020-December 2023, classified according to their ethnic group as White, Black, Asian, or Other. Multivariable logistic and linear regression analyses were performed. Results: A total of 633 women (513 White, 64 Black, 32 Asian, and 24 Other/Middle Eastern) were considered eligible for inclusion. Asian women had higher HbA1c than White, Black, and Other (5.5% (37 mmol/mol) vs. 5.1% (32 mmol/mol), 5.2% (33 mmol/mol), and 5.1% (32 mmol/mol), respectively, p < 0.001). The mean birth weight was higher in Asian than White, Black, or Other groups (3429 g vs. 3102 g, 3279 g, and 3159 g, respectively, p = 0.05). Insulin therapy during pregnancy was more common in Asian and Other/Middle Eastern than White and Black women (71% and 79.2% vs. 54.5% and 52.4%, respectively, p = 0.03) and was independently associated with Middle Eastern ethnicity (aOR 6.73, 95% CI 1.31–34.46, p = 0.02). Conclusion: This study confirmed the presence of ethnic differences in pregnancies complicated by GDM and the higher metabolic burden in Asian and Middle Eastern populations. Ethnicity-specific strategies for GDM prevention and early screening should be implemented.

Purpose: To determine whether the abnormal glucose concentrations at various oral glucose tolerance test (OGTT) time points are associated with adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Methods: A retrospective study included 257 pregnant women with GDM (IADPSG criteria) who delivered between 2020–2023 at a tertiary hospital. Women were classified based on their OGTT results: isolated fasting hyperglycemia (group A), isolated post-load hyperglycemia (group B), and combined hyperglycemia (group C). Multivariable linear and logistic regression analyses were performed. Results: Most women had fasting hyperglycemia (54.1%), followed by isolated post-load hyperglycemia (29.2%), and combined hyperglycemia (16.7%). In the univariate analysis, women in Groups A and C had higher BMI before pregnancy (29.0 [7.6] kg/m² and 30.6 [9.3] kg/m², respectively) compared with women in Group B (26.3 [6.2] kg/m²). Groups A and C had a higher prevalence of insulin use compared with Group B (81.3 and 88.4% vs. 49.3%, p < 0.001). Their neonates had higher birth weights (3221 ± 525 g and 3208 ± 512 g vs. 3030 ± 591 g, p = 0.039) and higher rates of large-for-gestational-age (11.5 and 16.3% vs. 2.7%, p = 0.032). However, the multivariable analyses did not show significant differences among the groups. Conclusion: The GDM subtypes identified through the OGTT were related to distinct metabolic phenotypes and pregnancy outcomes, indicating the presence of heterogeneity in GDM. Future studies are required to confirm these findings and explore whether the OGTT could be used to guide individualized GDM treatment.

Background/Objectives: Diabetes camps for children and adolescents with Type 1 Diabetes mellitus (T1DM) offer the opportunity to have a camping experience in a safe and supportive environment where they can receive diabetes skills education, such as glucose self-monitoring, insulin injections, management of hypoglycemia/hyperglycemia, and nutritional recommendations, including meal planning and carbohydrate counting. The ultimate goal of diabetes camps is to educate children to manage their condition independently, without parental involvement. Additionally, attending a diabetes camp is an excellent opportunity to meet peers and share their experiences and concerns about their condition, enhancing their confidence and reducing diabetes-related emotional distress. The aim of this review was to assess whether the nutritional planning and education offered at diabetes camps has a favorable effect on the glycemic control of attending children and adolescents. Methods: A literature search in PubMed and Scopus databases was performed. Eligible for inclusion were studies evaluating the effect of nutritional education offered in diabetes camps on glycemic control of children and adolescents with T1DM. Results: The majority of identified eligible studies supported the beneficial impact of the nutritional education offered in diabetes camps on glycemic control during and after the camp sessions. The favorable effect, though, seemed to be temporarily sustained (<6 months). Conclusions: Continuous nutritional education is required to prolong the duration of these beneficial outcomes. Further interventional studies are required to evaluate the direct effect of nutritional education provided at diabetes camps on glycemic control of children and adolescents with T1DM and the actual duration of favorable outcomes.

Purpose: To evaluate whether there is an association between age at menarche (AAM) and the risk of gestational diabetes mellitus (GDM). Methods: A retrospective cohort study was conducted, including 5390 pregnant women who were screened for GDM at Alexandra Hospital in Athens, Greece over a 15-year period (2000–2014). Maternal age, pre-pregnancy body mass index (BMI), height, family history of type 2 diabetes mellitus, parity, educational and smoking status, and AAM were recorded. The results were expressed as odds ratios (OR) with a 95% confidence interval (95% CI). Results: Pregnant women with GDM experienced earlier menarche compared to normoglycemic women (12.9 ± 1.5 vs 13.1 ± 1.6, p < 0.001, respectively). The OR for a woman with AAM <12 years to develop GDM was 1.08 (95% CI 1.03–1.14), while the OR to be obese was 1.70 (95% CI 1.50–1.90). The multivariate logistic regression analysis showed that AAM is a risk factor for GDM. However, that effect was lost after adjusting for BMI. Conclusion: Early AAM may be associated with an increased risk of GDM. Therefore, it can be used to identify high-risk women and implement preconception interventions for GDM prevention. Future studies should be conducted to confirm these findings.

Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60 years or > 10 years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.