Pablo Rodríguez de Vera Gómez

Aim: Continuous glucose monitoring (CGM) improves glycemic outcomes in insulin-treated type 2 diabetes (T2D), but evidence in individuals with complex care needs (CCN) is limited. We evaluated the association between CGM initiation and hospitalization outcomes in a population-based cohort of adults with insulin-treated T2D and CCN. Methods: We conducted a population-based quasi-experimental study including all eligible adults with insulin-treated T2D and CCN who initiated CGM through the Andalusian Public Health System. Rates of acute diabetes-related complications and cardiovascular admissions were compared before and after CGM initiation using Poisson regression models adjusted for person-time. Interrupted time-series analyses, length of stay (LOS), and hospitalization costs were also evaluated. Results: Of 17,561 adults initiating CGM, 5281 met criteria for CCN and were included (mean age 79 years; 55.1% aged ≥ 80 years). Acute diabetes-related hospitalization rates decreased from 144.27 to 41.04 per 10,000 person-years (rate ratio [RR] 0.28, 95% CI 0.19–0.42), and cardiovascular admission rates decreased from 387.25 to 251.96 per 10,000 person-years (RR 0.65, 95% CI 0.54–0.78). Interrupted time-series analyses showed post-intervention hospitalization rates consistently below counterfactual estimates. Mean LOS decreased by 3.68 days (95% CI −5.26 to −2.10; P < 0.001), and hospitalization costs decreased by USD657.39 per patient-year. Conclusion: In this population-based cohort of adults with insulin-treated T2D and CCN, CGM initiation was associated with fewer hospitalizations, shorter hospital stays, and lower hospitalization costs, supporting the integration of diabetes technology into chronic care strategies for highly vulnerable populations.

Objective: Pheochromocytoma is increasingly diagnosed at the extremes of age due to the availability of genetic screening in young patients and incidental detection on imaging in older patients. The aim of this study was to assess the effect of age on presentation and outcomes after adrenalectomy for pheochromocytoma. Methods: A retrospective international multicenter cohort study was performed on patients undergoing adrenalectomy for pheochromocytoma between 2012 and 2022 in 49 centers. Patients were divided into three cohorts: ≤40, 41–59, and ≥60 years old. Univariate and multivariate analyses were used to compare cohorts and assess the impact of age on postoperative outcomes. Results: Of the 2,301 included patients, 551 were ≤40 years (23.9%), 969 were between 41 and 59 years (42.1%), and 781 were ≥60 years (33.9%). Younger cohorts were more likely to have a genetic syndrome (≤40 years 29.4% vs 41–59 years 11.5% vs ≥60 years 6.2%, P < 0.001) and bilateral tumors (10.2 vs 2.3 vs 1.3%, P < 0.001). On multivariable analysis, overall complications seemed less frequent in older cohorts (adjusted odds ratio (aOR): 0.64, P = 0.012, and aOR: 0.66, P = 0.054, for 41–59 and ≥60 years versus ≤40 years), while there were no clear trends in severe complications (Clavien–Dindo grade 3a–5) (aOR: 0.81, P = 0.481, and aOR: 0.78, P = 0.486, respectively) or comprehensive complication index (beta coefficient: −1.49, P = 0.046, and −1.66, P = 0.083, respectively). Conclusion: Age is associated with significant differences in presentation in patients undergoing adrenalectomy for pheochromocytoma, but does not have a clear association with postoperative complications. Pheochromocytoma postoperative morbidity is more likely affected by ‘high-risk’ disease rather than exclusively by age.

OBJECTIVE: To assess the effect of a population-wide implementation of intermittently scanned continuous glucose monitoring (isCGM) on hospitalization rates and trends, length of stay, and inpatient health care costs among adults with insulin-treated type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: This population-based, longitudinal, quasi-experimental cohort study included adults with T2D taking multiple daily insulin injections who initiated publicly funded isCGM between April 2022 and December 2023. Hospitalizations for acute diabetes-related complications (diabetic ketoacidosis, hyperglycemic hyperosmolar state, simple hyperglycemia, and hypoglycemia) and cardiovascular complications (myocardial infarction, stroke, and major lower-extremity amputation) were identified using ICD-10 codes. Incidence rates and rate ratios (RRs) were estimated using Poisson models. Interrupted time series analyses were used to estimate counterfactual trends. RESULTS: Among 15,413 participants, the mean follow-up was 22.5 ± 4.6 months before and 19.1 ± 4.4 months after isCGM initiation. Mean HbA1c decreased from 8.09 to 7.65% (mean difference −0.44 [95% CI −0.47 to −0.42]). Diabetes-related hospitalization rates decreased from 74.6 to 27.5 per 10,000 person-years (RR 0.37 [95% CI 0.28–0.49]). Cardiovascular hospitalization rates remained stable (228.8 vs. 215.8 per 10,000 person-years; RR 0.94 [0.84–1.06]). Interrupted time series analyses showed a change in cardiovascular admission rates after isCGM initiation relative to the preintervention trend. Median length of stay decreased from 4 (interquartile range 5) to 3 (4) days. Total inpatient costs decreased by $3,806,776.90 (–$955,186.70 per 10,000 person-years). CONCLUSIONS: In this real-world study, implementation of isCGM among insulin-treated adults with T2D was associated with substantial reductions in acute diabetes-related hospitalizations, shorter hospital stays, lower health care costs, and changes in cardiovascular hospitalization trends.

Aim: To identify clinical, sociodemographic and glucometric factors associated with achieving international glycaemic targets derived from intermittently scanned continuous glucose monitoring (isCGM) in adults with type 1 diabetes mellitus (T1DM) treated with multiple daily injections (MDI) in Andalusia, a region with universal access to isCGM. Methods: A cross-sectional, population-based study was conducted using centralized electronic health records from the Andalusian Public Health System (APHS). Adults with T1DM using isCGM for ≥1 year and integrated glucometric data in Electronic Health Records in APHS in the 14 days preceding the download were included. Four glycaemic endpoints were evaluated: time in range (TIR ≥ 70%), time above range (TAR < 25%), time below range (TBR < 5%), and achievement of full AGP profile. Univariate analyses and multivariable logistic regression models were used to identify independent predictors. Results: A total of 7,885 individuals were included. Overall, 24.8% achieved TIR ≥ 70%, 35.0% TAR < 25%, 72.9% TBR < 5%, and 12.3% met the full AGP profile. Lower HbA _1c , lower glycaemic variability and a higher number of daily scans were consistently associated with achieving glycaemic targets. Older age and male sex were independent predictors of TIR ≥ 70%. Socioeconomic status showed a significant association: individuals in the intermediate-income group had higher odds of achieving TIR, TAR and full AGP criteria. No socioeconomic associations were observed for TBR < 5%. Conclusions: In a real-world setting with universal isCGM provision, clinical, sociodemographic and glucometric determinants independently influence the achievement of glycaemic targets in adults with T1DM. Integrating advanced monitoring metrics with explicit consideration of social determinants may enhance the precision and equity of glycaemic management strategies.

Background: Severe hypoglycemia is a major acute complication of type 1 diabetes (T1D) and is associated with increased morbidity, mortality, and impaired quality of life. Identifying individuals at the highest risk remains essential for optimising preventive strategies in real‐world practice. Methods: The SEHYPAN (SEvere HYpoglycemia in ANdalusia) study was a multicenter case–control analysis including adults with T1D treated with multiple daily insulin injections (MDI). Cases were individuals who required pre‐hospital emergency care for severe hypoglycemia between 2018 and 2022, each matched by sex, age, glucose‐monitoring method (SMBG/isCGM), reference health‐care area with controls who had not experienced severe events. Logistic regression models were used to identify independent predictors, and nomograms were generated for individualised risk estimation. Results: A total of 1464 participants were analysed (799 cases and 665 matched controls). Cases had longer diabetes duration, more comorbidities, and higher rates of smoking and alcohol use (all p < 0.001). Two nomogram‐based models were developed: one for the overall cohort, including glucose monitoring modality, history of severe and nocturnal hypoglycemia, comorbid depression, alcohol use, and chronic conditions; and another specific to isCGM users, which also incorporated time in range and time below range. In the full cohort model, isCGM use was independently associated with lower odds of severe hypoglycemia. Both models showed good discrimination (AUC 0.75–0.83) and high sensitivity (≥ 0.75). Conclusions: The SEHYPAN study identifies key predictors of severe hypoglycemia in adults with T1D on MDI therapy. The innovative nomogram‐based models provide personalised risk estimates that may enhance preventive care in everyday clinical practice.

Background/Objectives: Diabetic foot disease is one of the most severe and disabling complications of type 2 diabetes mellitus, resulting from the interaction between peripheral neuropathy, peripheral arterial disease, and infection. It is associated with a high risk of ulceration, lower-limb amputation, hospitalisation, and mortality, and is currently recognised as a marker of advanced systemic vascular disease. Although glucagon-like peptide-1 receptor agonists have demonstrated robust cardiometabolic benefits, their potential impact on diabetic foot disease outcomes remains insufficiently explored. Methods: This narrative review critically synthesises clinical, experimental, and translational evidence evaluating the association between glucagon-like peptide-1 receptor agonist therapy and diabetic foot disease-related outcomes. A comprehensive literature search was conducted in PubMed and related databases, focusing on studies published over the last decade that assessed diabetic peripheral neuropathy, foot ulceration, amputations, hospitalisations, and mechanistic pathways potentially linking glucagon-like peptide-1 receptor agonists to diabetic foot pathophysiology. Results: Available observational studies and population-based analyses suggest that glucagon-like peptide-1 receptor agonist treatment is associated with a reduced incidence of diabetic foot ulcers, lower-limb amputations, and related hospitalisations. Experimental and translational data provide biological plausibility for these findings, demonstrating neuroprotective effects, attenuation of neuroinflammation, and improvement of endothelial function and microvascular perfusion, as well as modulation of inflammatory and reparative pathways involved in wound healing. These pleiotropic actions extend beyond glycaemic control and may influence the natural history of diabetic foot disease. Conclusions: Glucagon-like peptide-1 receptor agonists emerge as promising therapeutic agents with potential benefits in the prevention and progression of diabetic foot disease. Their integrated neurovascular and immunometabolic effects may contribute to improved clinical outcomes and a reduced healthcare burden. Prospective studies and dedicated clinical trials are warranted to confirm these associations and to define the role of glucagon-like peptide-1 receptor agonists in the multidisciplinary management of diabetic foot disease.

Background/Objectives: Plantar fasciitis (PF) is a leading cause of heel pain and functional impairment in adults. Laser therapy, in its low-intensity laser therapy (LLLT), high-intensity laser therapy (HILT), and photobiomodulation (PBMT) modalities, has been proposed as a non-invasive alternative, although its clinical effectiveness remains a subject of debate. The aim of this systematic review and meta-analysis was to evaluate the efficacy of laser therapy in reducing pain, improving function, and modifying fascial thickness in patients with PF. Methods: A comprehensive search was conducted in PubMed, Embase, and PEDro (last search: August 2025). Randomized controlled trials comparing laser therapies versus placebo or alternative physical interventions were included. Two reviewers performed study selection, data extraction, and risk of bias assessment using the PEDro scale. Random-effects meta-analyses were performed for pain (VAS), heel tenderness (HTI), function (FFI, AOFAS, ASQoL, SF-36), and fascial thickness, expressing effects as standardized mean differences (SMDs) or mean differences (MDs). Results: Thirteen trials with 784 participants were included. Laser therapy showed a significant improvement in heel tenderness (SMD = −0.40; 95% CI −0.71 to −0.09; I² = 0%). No significant differences were observed in overall pain (SMD = −0.18), function (SMD = 0.20), or fascial thickness (MD = −0.18 mm). Pain and function analyses showed high heterogeneity. Conclusions: Laser therapy may reduce heel tenderness in plantar fasciitis, but it does not consistently improve overall pain, function, or fascial thickness. Its use should be considered as a therapeutic adjunct and not as a primary intervention. Larger trials with standardized protocols are needed.

Aim: This study aims to evaluate clinical, biochemical, and histopathological determinants of disease severity and postoperative outcomes in parathyroid tumors and to assess whether a composite histology–biomarker risk score provides an integrated framework to better characterize tumor behavior beyond conventional histological classification. Methods: This retrospective multicenter cohort study included patients with primary hyperparathyroidism caused by typical adenoma (TA), atypical parathyroid tumor (APT), or nonmetastatic parathyroid carcinoma (PC) diagnosed between 2000 and 2021 in three tertiary hospitals. Outcomes included preoperative parathyroid hormone (PTH) and calcium levels, postoperative hypocalcemia, and persistent hyperparathyroidism at 6 months. A composite unweighted risk score (range 0-5) was developed, assigning one point for each adverse feature: atypical/malignant histology, loss of parafibromin, Ki-67 ≥ 3%, and positive galectin-3 or PGP9.5 expression. Results: A total of 139 patients were analyzed (64.7% women; mean age 58.3 ± 13.6 years), including 90 TA, 20 APT, and 29 PC. Preoperative PTH and calcium levels increased progressively with the risk score (P < .001). Postoperative hypocalcemia rising from 0% in score 0% to 53% in scores ≥ 4, while persistent hyperparathyroidism increased from 6% to 45% (P < .01). Each one-point increase in the score was associated with postoperative hypocalcemia (odds ratio [OR] = 2.00) and persistent hyperparathyroidism (OR = 1.87), independent of age, sex, chronic kidney disease, and surgical extent. Model discrimination was good (area under the curve [AUC] of an analysis using receiver operating characteristic [ROC] curves 0.78-0.81) with stable calibration. Conclusion: The composite histology–biomarker risk score was linearly associated with biochemical severity and postoperative outcomes, offering a practical tool to refine risk stratification beyond histological classification.