Bingqi Fu1  · Yu Yu1  · Sijing Cheng1  · Hao Huang1  · Tianxin Long1  · Juweig Yang1  · Min Gu1  · Chi Cai1  · Xuhua Chen1  ·  Hongxia Niu1  · Wei Hua

Received: 23 February 2024 / Accepted: 11 June 2024 / Published online: 19 June 2024 © The Author(s) 2024

Abstract

Background The prognostic value of triglyceride-glucose (TyG) index is not yet known for older diabetic patients received right ventricular pacing (RVP). We aimed to investigate the association between TyG index and the risk of heart failure hospitalization (HFH) in older diabetic patients received RVP.

Methods This study was conducted between January 2017 and January 2018 at Fuwai Hospital, Beijing, China, and included older (age≥65 years) diabetic patients that received RVP for the first time. TyG index were obtained before implantation. The primary endpoint was HFH.

Results A total of 231 patients were divided into three groups according to the tertiles of TyG index:<8.5 (T1, N=77), 8.5–9.1 (T2, N=77), and>9.1 (T3, N=77). T3 group had higher rate of HFH (Log-rank=11.7, P=0.003). Multivariate analyses showed that, TyG index served as an independent predictor for HFH, both as numerical variable (HR=1.94, 95% CI 1.21–3.11, P=0.006), and as categorical variable (HR=2.31, 95% CI 1.09–4.89, P=0.03). RCS demonstrated that the risk of HFH was relatively low until TyG index exceeded 8.8, beyond which the risk began to increase rapidly (P-non-linear=0.006).

Conclusion Preimplantation TyG index emerges as a robust, independent predictor for HFH in older diabetic patients received RVP, and TyG index>8.8 might be the optimal cut-off value.

Keywords Triglyceride-glucose index · Older · Diabetes · Right ventricular pacing

Abbreviations

AF Atrial fibrillation

CABG Coronary artery bypass grafting

CKD Chronic kidney disease

CVD Cardiovascular disease

eGFR Estimated glomerular filtration rate

FBG Fasting blood glucose

HbA1C Hemoglobin A1C

HDL-C High-density lipoprotein cholesterol

HEC Hyperinsulinemic euglycemic clamp

HF Heart failure

HFH Heart failure hospitalization

HOMA-IR Homeostasis model assessment of insulin

resistance

IR Insulin resistance

LDL-C Low-density lipoprotein cholesterol

LVEF Left ventricular ejection fraction

NT-proBNP N-terminal pro-brain natriuretic peptide

PCI Percutaneous coronary intervention

PPMI Permanent pacemaker implantation

RCS Restricted cubic splines

RVP Right ventricular pacing

T2DM Type 2 diabetes mellitus

TC Total cholesterol

TyG index Triglyceride-glucose index

Dirk Lund Christensen1  · Cathrine Olesen Emborg1,2 · Kaushik Laxmidas Ramaiya3  · Venance Philip Maro4  · Ib Christian Bygbjerg1  · Joseph Sironga4,5 · Jens Juul Holst6  · Kajiru Kilonzo4  · Bolette Hartmann6  · Flemming Dela6,7 · Steen Larsen6,8 · Jørn Wulff Helge6

Received: 13 September 2025 / Accepted: 26 April 2026 © The Author(s) 2026

Abstract

Aims Rural, agro-pastoralist Maasai in East Africa exhibit low prevalence of diabetes, yet little is known about their physi-ological response to glucose loads and whether sex has an impact on glucose metabolism, including incretin hormones.

Methods We included 58 (29 men, 29 women) adult Maasai without diabetes living in rural Tanzania. Clinical background characteristics were measured, and they were exposed to an oral glucose tolerance test (OGTT) after an overnight fast. Plasma glucose, insulin/C-peptide, glucagon, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like pep-tide-1 (GLP-1) were analysed.

Results Mean age was 34.8 (range 17–65) years, and mean body mass index (BMI) was 20.3 (range 14.0-30.9) kg/m2 with two individuals being overweight and 14 being underweight. Men had a higher mean fasting glucose concentration (5.2 vs. 4.9 mmol/L, p=0.031), while women exhibited a higher OGTT-derived mean GLP-1 concentration at 2-h (8.5 vs. 5.1 pmol/L, p=0.005). Total area-under-the-curve (tAUC) for GLP-1 was higher in women compared to men (1336 vs. 870 pmol x min, p=0.011). Sex- and BMI-adjusted regression analyses for tAUC showed higher values of insulin, C-peptide and GLP-1 in women (p<0.10).

Conclusions Sex differences were found in fasting glucose and OGTT-derived insulin/C-peptide and GLP-1 concentrations. Research using more sophisticated methodology is needed to further explain the glucose metabolism phenotype in Maasai

Keywords Oral glucose tolerance test · Incretin hormones · Sex differences · Maasai · Sub-Saharan Africa

Seiji Tomofuji1  · Shin Urai2  · Kei Yoshino2,3  · Hironori Bando1  · Yushi Hirota1

Received: 25 November 2025 / Accepted: 9 March 2026 © The Author(s) 2026

Abstract

Background Immune checkpoint inhibitor (ICI)-induced diabetes is a rare endocrine immune-related adverse event, and long-term pancreatic magnetic resonance imaging (MRI) findings after disease onset have not been well characterized.

Case presentation An individual developed abrupt hyperglycemia during pembrolizumab therapy for recurrent renal cell carcinoma and subsequently required insulin therapy. Serum C-peptide rapidly declined to below the detection threshold, whereas pancreatic enzyme levels remained within normal limits throughout follow-up. MRI performed 1 day after diagno-sis demonstrated diffuse high signal intensity on diffusion-weighted imaging (DWI) and reduced apparent diffusion coeffi-cient (ADC) values throughout the pancreas. Serial imaging over 25 months showed progressive pancreatic atrophy, whereas the DWI/ADC features persisted.

Conclusion This case provides a new descriptive longitudinal radiological observation of persistent diffusion-related pancre-atic MRI findings and progressive pancreatic atrophy after the onset of ICI-induced diabetes.

Keywords Type 1 diabetes · Immune checkpoint inhibitor · PD-1 antibody · Immune-related adverse event · Magnetic resonance imaging

A.Giaccari1 · G. Gliozzo1  · G. Ciccarelli1  · G. Di Giuseppe1  · C. Castellano2  · S. Cum3  · L. Delle Monache4,13 · M. Gallo5  ·M.Lastretti6 · G. Medea7  · M. Monesi8  · R. Napoli9  · B. Pintaudi10 · E. Succurro11 · G. Turchetti

Received: 9 January 2026 / Accepted: 17 March 2026 © The Author(s) 2026

Abstract

Background and aims Although continuous glucose monitoring (CGM) devices are now standard of care among Type 1 diabetes patients, they are still relatively underutilized in Type 2 diabetes (T2D), particularly in those patients not treated with insulin. Widespread adoption continues to be hindered by a combination of factors. Chief among these is the scarcity of long-term, large-scale clinical trials demonstrating the benefits of the use of CGM in T2D. This meta-analysis aimed to address this gap by comparing CGM with self-blood glucose monitoring (SBMG), with primary outcomes of HbA1c and time in range (TIR) in insulin-treated and non-insulin-treated TD2 patients.

Methods and results Following the stringent rules mandated by our National Health Service (which requires a panel com-posed of all stakeholders involved in diabetes treatment, and includes PICO, GRADE, AGREE, and meta-analyses), we performed a systematic review of RCTs that enrolled two groups of individuals with T2D, those treated with insulin (includ-ing basal and basal-bolus regimens), and those receiving treatments other than insulin. All included trials compared CGM with structured blood glucose monitoring (SBGM) with glycated hemoglobin (HbA1c) as the main endpoint. Based on the strength and consistency of the evidence, the panel issued a strong recommendation in favor of CGM for individuals with T2D treated with insulin (including those on basal insulin alone) and for individuals with T2D not treated with insulin, par-ticularly for those with glycated hemoglobin levels≥7%. From a pharmacoeconomic perspective, outcomes were positive in both patient groups.

Conclusion CGM represents a clinically effective and cost-efficient approach to optimizing glycemic control in T2D, becom-ing mandatory among individuals on insulin therapy. Our findings support a shift in clinical practice toward the more widespread use of CGM in T2D, with regulatory frameworks and reimbursement policies needing to adapt accordingly.

Keywords CGM · Type 2 Diabetes · Metanalysis · PICO · GRADE · Guidelines

Communicated by Massimo Federici, M.D.

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1 Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy

2 Azienda USL of Modena, Sassuolo Hospital, Sassuolo, Italy

3 Diabetes and Diabetic Foot Care Unit, ASUGI, Monfalcone, Italy

4 National Board Member of FAND (Italian Association for the Rights of Diabetic People), Roma, Italy

5 Department of Endocrinology and Metabolic Diseases, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

6 Order of Psychologists of Lazio, Rome, Italy

7 Italian Society of General Medicine (SIMG), Florence, Italy

8 Territorial Diabetology Unit, AUSL Ferrara, Ferrara, Italy

9 Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy

10 Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy

11 Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy

12 Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy

13 Patient Advocacy Lab, ALTEMS – Università Cattolica del Sacro Cuore, Rome, Italy