Author: Jason Curtis

Complications After Hydrocele Repair: Solving a Persistent Challenge (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Lu Y.; *Abdellatif M.; *Desai C.; *Ali-Naja N.; *Han L.A.; *Kells L.; *Kachrilas S.;

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x179-x180), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Aim: Surgical intervention remains the gold-standard treatment for large or symptomatic hydroceles. Although hydrocele repair is a relatively minor procedure, complications such as haematoma and infection can have significant consequences. This study aims to evaluate the rates and severity of complications and explore strategies to minimise them following hydrocele repair Method: Aretrospective analysis was conducted of all hydrocele surgery performed in January 2021 to December 2022. Complication outcomes were classified using Clavien-Dindo grading. Result(s): A total of 85 hydrocele operations were included in the study, with an average patient age of 54.5. Post-operative complications occurred in 22 (25.88%) patients, including infection, haematoma and recurrence. Amount these, 7 complications (8.24%) were classified as Clavien-Dindo grade II, and 13 (15.29%) as grade III. No grade IV or V were recorded. Of the 22 patients with complications, 11 (12.94%) of them experienced recurrent hydroceles. Conclusion(s): Complications following hydrocele repair are relatively common, warranting further investigation. Comprehensive pre-operative counselling is essential to set realistic expectations and address potential risks with patients. Our centre implemented prophylactic antibiotics in high-risk group and the use of intra-operative betadine wash as potential solutions.

DOI: 10.1093/bjs/znaf128.718

Link to full-text [no password required]

Survey of the current experience of colonoscopy training for colorectal surgical trainees in the UK (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Siggens K.; Williams S.; Yiu A.; El Sayed C.; Fletcher J.; Mills S.; Yeadon K.; Reza L.; Rabie M.; Drami I.; Green S.; Tamanna R.; Couderq D.; Javanmard-Emamghissi H.; Argyriou O.; Okocha M.; Khasawneh F.; Kat-Zsummercorn A.; Shakir T.; Anya L.; Bramwell C.; Haji A.; Johnston R.; Joshi H.; Oliphant R.; Piramanayagam B.

Citation:

Frontline Gastroenterology. (no pagination), 2025. Date of Publication: 2025.[epub ahead of print]

Abstract:

Introduction: The primary aim was to understand the current experience of colonoscopy training among general surgical trainees with a subspeciality interest in colorectal surgery. Method(s): An electronic survey was developed and disseminated by members of the Dukes' Club (colorectal trainees network) and Association of Coloproctologists of Great Britain and Ireland colonoscopy subcommittee between February and April 2024 to assess key themes identified through formal and informal feedback from colorectal trainees of endoscopy training experience. Result(s): The survey was completed by 196 participants. This included 13.3% from core trainee (CT) 2-speciality trainee (ST) 4, 28.6% from ST5-ST6, 36.5% from ST7-ST8, 13.3% from post-certificate for completion of training fellows, senior clinical fellows and speciality and specialist (SAS) doctors and 8.7% from early years consultants. The median number of colonoscopies performed by respondents was 121.6 (range 0-8000). Only 33.7% (66/196) reported having one dedicated training list per week, and 56.6% (111/196) were not allocated to any regular training list. The barriers to training were service provision (71.9%), lack of dedicated training lists (69.9%) and access to training lists due to other trainees or healthcare professionals (42.3%). Only 25% of respondents had experience of immersion training, but they consistently reported high numbers of colonoscopy during these periods, with 40% achieving more than 30 colonoscopies. Conclusion(s): There is an urgent need to improve access to colonoscopy training. Regular endoscopy training lists and funding of academies and immersion training centrally are likely to greatly improve the experience of colonoscopy training. Senior colorectal trainees should be prioritised to avoid delay in the completion of training.

DOI: 10.1136/flgastro-2025-103106

Link to full-text [NHS OpenAthens account required]

Standardising the administration of joint injections across the Wolverhampton NHS Trust: a service improvement project in rheumatology through the lens of medical education (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Jayasekera H.; Agunbiade T.; Chalam S.V.

Citation:

Future Healthcare Journal. Conference: Medicine 2025: The future of medicine. RCP annual conference. 11 St Andrews Pl, London United Kingdom. 12(2 Supplement) (no pagination), 2025. Article Number: 100432. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: The Rheumatology Resident Doctors' Forum identified a pressing need to standardise steroid injection training due to varying experience and confidence levels among resident doctors. Many expressed a strong interest in learning injection techniques but faced barriers in accessing training and achieving formal competency. Addressing this gap had the potential to enhance service delivery, support professional development and reduce patient wait times. General practice trainees also highlighted the value of joint injection skills in primary care, helping to alleviate pressure on rheumatology services. The Dreyfus model of skill acquisition describes five levels of competency in skill development, ranging from 'novice' to 'competent' and eventually 'expert'.1 The model shows how individuals progress from rule-based, analytical thinking to experience-driven mastery of a skill.1 A recent study demonstrates that structured training can enhance competency in procedural skills, such as joint injections.2 Methods: A SMART aim was used to design learning outcomes. Fourteen applicants were selected at random. Pre-course surveys collected quantitative and qualitative data on performance challenges, confidence, and baseline knowledge. Process mapping (Fig 1) and radar diagrams (Fig 2) highlighted gaps for intervention. Four trained rheumatology doctors, supervised by a consultant, led a teaching program. Virtual meetings guided plan-do-study-act (PDSA) cycles and driver diagrams to ensure constructive alignment. The goal was to advance learners from the Dreyfus level of 'Novice 1' to 'Competent 1'. The course, conducted in the clinical suite, used training mannikins of knees and shoulder joints, providing real-time feedback. Teaching combined interactive lectures, small-group sessions and individualised feedback. Formative assessments maximised educational impact. Post-course data were compared to baseline, with quality improvement (QI) sustainability tools used to draw portal diagrams, highlight improvement gains and discuss long-term impacts of the project. Results and discussion: Initially, 50% of participants were novices, with none having ever injected a shoulder joint. Confidence in consenting patients increased from 14% to 100% post-course. 64% of participants were unfamiliar with medications used for injections, while 28.6% were unsure of the evidence base. Post-course, both categories improved to 100%. Additionally, 43% initially lacked confidence in clinical decision-making regarding safe joint injection. There was a 100% increase in overall confidence surrounding decision-making (43% 'strongly confident' and 57% 'confident'). All doctors passed the criterion-referenced standard assessment, acquiring formal recognition of skills in their portfolios. The course was oversubscribed and received excellent feedback. QI tools, including radar diagrams, process mapping, and PDSA cycles, had a crucial role in refining training and driving measurable improvements. The structured application of QI methodology successfully upskilled doctors, advancing them from 'Novice' to 'Competent'. Simulation-based learning, combined with real-time feedback, proved to be a highly effective strategy for accelerating skill development while enhancing clinical decision-making and confidence. By integrating this training into departmental inductions, the initiative ensured sustainability and continuous professional development, benefiting both individual practitioners and the wider healthcare service. Conclusion(s): The project led to significant improvements in confidence and competency. It demonstrated sustainability through reproducibility and was incorporated into the rheumatology departmental induction. Positive feedback highlights the course's broader applicability in QI-driven medical training.

DOI: 10.1016/j.fhj.2025.100432

Link to full-text [no password required]

Normal creatinine-kinase levels in post-COVID myositis: insights into localised muscle involvement (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Jayasekera H.S.; *Elshehawy M.; *Olarewaju J.; Askari A.

Citation:

Clinical Medicine, Journal of the Royal College of Physicians of London. Conference: Medicine 2025: The future of medicine. RCP annual conference. 11 St Andrews Pl, London United Kingdom. 25(4 Supplement) (no pagination), 2025. Article Number: 100437. Date of Publication: 01 Jul 2025.

Abstract:

Introduction: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2; coronavirus 2019; COVID-19) has been increasingly implicated in post-infectious inflammatory complications, including varied presentations of inflammatory myopathies.1,2 Most literature highlights severe, systemic muscle involvement requiring immunosuppression, whereas localised myositis with normal creatine kinase (CK) levels remains underrecognised.3 This case presents a rare instance of localised paraspinal and proximal thigh myositis post-COVID-19, where CK levels remained normal, despite significant muscle involvement. Method(s): A 41-year-old previously healthy man presented with severe diffuse back and leg pain, muscle cramps, and low-grade fever for 2 weeks after confirmed COVID-19 infection. Examination revealed proximal thigh weakness (MRC Grade 3/5) and tenderness without neurological deficits. Investigations, including blood tests, magnetic resonance imaging (MRI), computed tomography (CT), autoimmune screening, echocardiography, blood cultures and electromyography (EMG) studies. were conducted.1 Management required evaluating the progression of symptoms in the light of test results to identify the aetiology of disease, considering differential diagnosis and early establishment of localised vs systemic inflammatory myopathy.2 The patient was diagnosed as post-viral myositis with a normal CK. Empirical intravenous piperacillin-tazobactam was discontinued after infection was excluded. Simple analgesia and vitamin D sufficed for symptom control. The patient showed resolution of fever, significant improvement in muscle pain and normalisation of inflammatory markers, preventing the need for immunosuppression. Results and Discussion: Laboratory findings showed elevated C-reactive protein (237 mg/L), white cell count (12.0 x 109/L), and neutrophilia (9.4 x 109/L). Alkaline phosphatase (192 U/L) and gamma glutamyl transferase (202 U/L) were mildly elevated, while CK levels were normal (22 U/L, peaking at 56 U/L). MRI revealed diffuse oedema in posterior paraspinal muscles without abscess or infection, and CT imaging confirmed intermuscular oedema in paraspinal and proximal thigh muscles without systemic involvement. Autoimmune screening (antinuclear antibodies, weakly positive; extractable nuclear antigen antibodies and anti-neutrophil cytoplasmic antibodies, negative) and echocardiogram were unremarkable. Blood cultures showed no growth and EMG displayed a myopathic pattern in the right shoulder. This case provides insight into an atypical presentation of post-COVID 19 myositis, where the CK level remains normal despite muscle weakness.3 It evaluates the diagnostic and management challenges in this scenario. Other differentials include amyopathic dermatomyositis (ADM). However, differentiating localised post-viral myositis from ADM is essential, because ADM presents with cutaneous manifestations, which are absent in this case. A detailed history of recent viral illness and advanced imaging (eg, MRI) are critical for identifying myositis and excluding systemic or infectious causes.1Conclusion(s): This case highlights that post-viral localised myositis can present with significant muscle involvement despite normal CK levels, necessitating MRI for diagnosis.1,3 Early rheumatology input can optimise management by differentiating self-limiting inflammatory myopathies from those requiring immunosuppression.

DOI: 10.1016/j.clinme.2025.100437

Link to full-text [no password required]

Complex lupus management: when multiple organs demand precision (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Jayasekera H.S.; Askari A.; *Chand S.

Citation:

Clinical Medicine, Journal of the Royal College of Physicians of London. Conference: Medicine 2025: The future of medicine. RCP annual conference. 11 St Andrews Pl, London United Kingdom. 25(4 Supplement) (no pagination), 2025. Article Number: 100376. Date of Publication: 01 Jul 2025.

Abstract:

Introduction: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with a wide spectrum of severity, ranging from mild manifestations to life-threatening organ damage. Its multisystem involvement poses a significant treatment challenge, because interventions targeting one organ system may inadvertently impact another. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) is a widely used tool for assessing disease activity, with a score above 12 indicating severe disease. However, studies estimate that approximately 20% of patients present with severe manifestations at diagnosis. One of the most serious complications of SLE is lupus nephritis, which is classified into six classes by the International Society of Nephrology/Renal Pathology Society (ISN/RPS), ranging from Class I (minimal-mesangial lupus nephritis) to Class VI (advanced-sclerosing lupus nephritis). We present a case of a patient newly diagnosed with severe SLE and lupus nephritis, characterised by high disease activity and multisystemic involvement. This case highlights the complex treatment considerations necessary when managing severe lupus.

Method(s): A 62-year-old woman presented with flu-like symptoms followed by a malar rash, mouth ulcers, fatigue, alopecia and pancytopenia. She was diagnosed with SLE with lupus nephritis confirmed by renal biopsy, and SLE on skin biopsy. Management required significant consideration because of high disease activity (SLEDAI 16) complicated by pancytopenia and liver dysfunction. Therapeutic options were systematically evaluated to balance efficacy and safety given the patient's pancytopenia, liver dysfunction and renal involvement. Mycophenolate mofetil (MMF), effective for lupus nephritis, was excluded because of its potential to worsen pancytopenia. Azathioprine, suitable for mild renal involvement, was ruled out because of liver dysfunction. Cyclophosphamide, typically used for severe SLE, was contraindicated because of its haematological and hepatic toxicity. Tacrolimus was considered for renal SLE, given the biopsy Class of I, but was unsuitable for non-renal lupus without MMF. Belimumab, an FDA-approved agent with steroid-sparing effects and a favourable safety profile, was considered but deemed challenging because of its slower onset of action and approval barriers. Hydroxychloroquine (300 mg daily) and corticosteroids (40 mg prednisolone) were ultimately chosen as the safest and most effective initial therapy. Close liaision with the renal team was essential to optimise management. Results and Discussion: Laboratory results revealed low complements (C3 0.38 g/L, C4 0.03 g/L), pancytopenia (WBC 1.2 x 109/L, platelets 126 x 109/L), elevated ferritin (5,490 mug/L), and positive dsDNA. Skin biopsy was consistent with SLE and renal biopsy confirmed lupus nephritis (ISN/RPS Class I). CT-TAP imaging showed axillary lymphadenopathy without malignancy. This case highlights the challenges of managing multisystemic lupus presenting with renal and non-renal SLE symptoms of varying degree, in a patient not already established on baseline treatment. Hydroxychloroquine and corticosteroids formed the cornerstone of treatment, while other options were systematically excluded based on contraindications. Multidisciplinary collaboration was pivotal in tailoring therapy.

Conclusion(s): There are two key learning points highlighted in this case. First, that treating multisystemic lupus requires understanding the degrees of individual organ involvement to determine immunosuppressive needs. Second, that management decisions should balance efficacy and toxicity, guided by interdisciplinary input6 and renal biopsy findings to inform immunosuppression.

Link to full-text [no password required]

Therapeutic Duel of Rifaximin Versus Lactulose in Hepatic Encephalopathy: A Systematic Review (2025)

Posted on by

Type of publication:

Systematic Review

Author(s):

Oriko, David O; Khawaj, Zainab; Cheema, Muhammad Usairam; Talreja, Anjali; Tayyab, Muhammad Abbas; Zamir, Muhammad Hamza; Iqbal, Maheen; Farooq, Umer; *Ekomwereren, Osatohanmwen; Tariq, Muhammad M; Hasan, Abdul Haseeb.

Citation:

Cureus. 17(6):e86193, 2025 Jun.

Abstract:

This systematic review aimed to compare the clinical efficacy of rifaximinversus lactulose in the management of hepatic encephalopathy (HE) by analyzing evidence from randomized controlled trials (RCTs). A comprehensive search across major databases identified seven eligible RCTs encompassing 693 adult patients diagnosed with overt or minimal HE. Findings demonstrated that rifaximin is at least as effective as lactulose in reversing HE symptoms, with some studies reporting significantly higher HE reversal rates when rifaximin was used in combination with lactulose (e.g., 76% vs. 50.8%, p<0.004), reduced mortality (23.8% vs. 49.1%, p<0.05), and shorter hospital stays (5.8 vs. 8.2 days, p=0.001). While other trials reported similar efficacy between the two agents (e.g., HE improvement: 84.4% vs. 95.4%, p=0.315), rifaximin was generally associated with better tolerability and fewer gastrointestinal side effects. These results support rifaximin as an effective and well-tolerated therapeutic option, either as monotherapy or in combination with lactulose. Further large-scale, multicenter trials are warranted to assess long-term outcomes, recurrence rates, and cost-effectiveness.

DOI: 10.7759/cureus.86193

Link to full-text [open access - no password required]

Survival outcomes in basaloid squamous cell carcinoma of the anorectal region: A Surveillance, Epidemiology, and End Results (SEER) database analysis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Arunachalam J.

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S87), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Basaloid squamous cell carcinoma (BSCC) of the anorectal region is a rare and aggressive variant of squamous cell carcinoma, arising primarily in the transitional zone of the anal canal and lower rectum. Historically referred to as cloacogenic carcinoma, BSCC is characterized by distinctive histological features. Chemoradiation remains the standard of care. Given its rarity, data on survival outcomes and demographic disparities are limited. We aimed to assess clinical characteristics and survival outcomes using a large U.S. population-based dataset. Method(s): We conducted a retrospective analysis using the SEER database (2000-2021) to identify patients with BSCC, defined by ICD codes 8083/3 and 8124/3, located in C21.0, C20.9, C21.1, C21.2, and C21.8. Variables extracted included age, sex, race, tumor stage, and treatments. Kaplan-Meier survival analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). Group comparisons were evaluated using the log-rank test. Result(s): A total of 3,446 patients were identified. At diagnosis, 54% were under 65 years, 75% were female, and 80% were White. Metastatic disease was present in 11%. Median OS (mOS) was 120 months. The 1-, 3-, and 5-year CSS rates were 91.1%, 78.9%, and 73.3%, respectively; 10- and 20-year CSS rates were 67.4% and 61.5%. Male patients had poorer survival (mOS 66 months) compared to females (mOS 143 months; p < 0.0001; HR 1.595, 95% CI 1.420-1.791). Patients aged >=65 had a mOS of 72 months versus 219 months for those <65 (p < 0.0001; HR 2.124, 95% CI 1.926-2.342). Median OS by stage was 25 months (metastatic), 124 months (regional), and 175 months (localized) (p < 0.0001). Patients undergoing surgery had a mOS of 154 months, and those receiving radiation therapy had a mOS of 134 months. Lack of chemotherapy was associated with worse survival (mOS 50 months; HR 1.780, 95% CI 1.570-2.020; p < 0.0001). Race was not significantly associated with survival differences. Conclusion(s): Favorable outcomes were associated with younger age, female sex, early stage, and chemotherapy. Future studies should refine treatment strategies and explore targeted therapies in BSCC to guide precision medicine. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.230

Prognostic impact of microsatellite instability and survival disparities in rectal cancer: A SEER-based retrospective analysis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Nabeta G.; Naagendran M.S.; Hegde U.;

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S97), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Microsatellite instability (MSI), a molecular marker of defective DNA mismatch repair (MMR), is observed in ~7% of rectal cancers. MSI-high (MSI-H) tumors, arising from sporadic or germline MMR deficiency, are highly responsive to immune checkpoint inhibitors. We aimed to evaluate the prognostic significance of MSI in rectal cancer in the era of immunotherapy and to explore demographic disparities in survival using real-world data from the U.S. Method(s): We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) cancer database for patients diagnosed with rectal cancer between 2018 and 2021. We assessed cancer-specific survival (CSS) across MSI subtypes-MSI-H, MSI-low (MSI-L), and microsatellite stable (MSS)-and evaluated survival differences by age, gender, race, and stage. Analyses were performed using R. Kaplan-Meier curves visualized survival outcomes, and group comparisons were done using the log-rank test. <br/>Result(s): Among 17,487 patients, 3.6% were MSI-H (n=637), 1.9% MSI-L (n=332), and 94.5% MSS (n=16,518). Overall 1-year and 3-year CSS were 90% and 75%, respectively. In metastatic patients, median CSS (mCSS) was 25 months, increasing to 36 months in those with MSI-H tumors. By MSI status, 1- and 3-year CSS were 90.6% and 77.7% for MSI-H, 89.9% and 74.9% for MSS, and 84.8% and 68.6% for MSI-L (p=0.0087). Racial disparities were evident: 1- and 3-year CSS were 92% and 80% in White patients, 88% and 70% in Black patients, and 90% and 75% in Hispanic patients (p<0.0001). Age impacted survival significantly: 1- and 3-year CSS were 91% and 74% in patients <65 years vs. 86% and 61% in those >=65 (p<0.0001). Females had better long-term survival than males, with 3-year CSS under 80% for both, but significantly higher in females (p<0.0001). Conclusion(s): MSI-H status is associated with improved survival, reinforcing its role as a favorable prognostic biomarker in rectal cancer and highlighting the importance of routine MSI testing to guide treatment decisions. Worse outcomes among older adults, males, and Black patients reflect persistent disparities in rectal cancer care. These findings underscore the urgent need to identify and address the drivers of these differences to ensure equitable outcomes. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.261

Refractory Dyspnoea in Palliative Care: Implementing High Flow Oxygen Therapy AIRVO2 Into Palliative Care and End of Life Care in the Community (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Raton M.; *Rowe N.; *Wood G.;

Citation:

American Journal of Respiratory and Critical Care Medicine. Conference: American Thoracic Society International Conference, ATS 2025. San Francisco, CA United States. 211 (no pagination), 2025. Date of Publication: 01 May 2025.

Abstract:

Palliative patients often present to secondary care settings with respiratory distress during the endstage of their disease. Conventional oxygen therapy alongside opioid therapy has widely been considered the treatment of choice for dyspnoea and symptom alleviation. With an increasing number of palliative patients and the national drive for service improvement, the Respiratory Team have identified an additional method to enhance current practice. Based on previous positive experience gained since 2013 from utilising High Flow Oxygen Therapy (HFOT) during the acute stages of respiratory disease, it was decided to extend this therapy to patients with chronic disease and palliative needs. The physiological and clinical benefits of HFOT include reduction in dyspnoea and decreased work of breathing, augmentation of respiratory drive, improved quality of life, and comfort level in this patient population. During work on the COVID cohort ward (March 2020- Dec 2021) AIRVO2 was used routinely as a first-line treatment in over 300 patients and continued in over 70 patients in the palliation/ End of Life (EoL) pathway. Since then, AIRVO2 in combination with lowdose opioids has been used in Palliative/ EoL care routinely. In 2022 the first discharge from the hospital was facilitated to continue optimised treatment. Benefits from HFOT in EoL/ Palliative usage should be focused on comfort and symptom control with optimised FiO2 requirements. We looked at three patients who were discharged from hospital on HFOT: two patients to the hospice and one home. With the combined HTOT and conventional palliative management, we observed a significantly decreased requirement of opioid use, leading to a reduction in side effects such as drowsiness or palliative sedation. This enabled patients to experience interaction with family and friends at the end of their life. On each occasion, good feedback has been received from the family, hospice, and patients. Extending HTOT usage to the community enhances best interest care for individuals and avoids abrupt termination of therapy initiated in the hospital. This prevents palliative patients with symptomatic breathlessness from having to compromise on either place of death or symptomatic breathlessness. HFOT usage out of the hospital decreases the number of readmissions with the focus on extended care in the community. Discharging patients to the community requires a clear advanced care plan and close cooperation within Multidisciplinary Team. Correct patients' selection for discharge on HFOT needs to be considered due to the limited FiO2 concentration delivery in the community.

DOI: 10.1164/ajrccm.2025.211.Abstracts.A4177

Real-World Outcomes of Transition From CGM-Augmented Non-Closed Loop (NCL) Omnipod Dash To Omnipod 5 Hybrid Closed Loop (HCL) Continuous Subcutaneous Insulin Infusion (CSII) in Adult Type 1 Diabetes(T1D) (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Cane C.; *Cooksey M.; *Wilkes V.; *Brown H.; *Jones A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e179), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: HCL CSII has recently been commissioned nationally by NHS England for type1 diabetes (T1D). We looked into the impact of transitioning from CGMaugmented non-closed loop (NCL) CSII to HCL CSII with the same insulin delivery system. Method(s): We analysed a database of T1D on CSII managed in a single district general hospital under one Consultant Diabetologist team. Patients were on Omnipod DASH with Freestyle Libre2/DexcomG6 CGM and transitioned to Omnipod 5 with Dexcom G6 with built in SmartAdjustTM technology. Data was analysed with paired sample T-test (SPSS) at baseline and 6months. Result(s): 53 patients were included, with 31females (59%) and 22males (41%). Baseline mean age was 47years (20-80), diabetes duration 24years (5-62), BMI 27.6kg/m2 (20-41), HbA1c 55-mmol/mol (30-80). At 6 months, mean weight increased by 1.2-kg (p=0.04), BMI increased by 0.2kg/m2 (p=0.617), HbA1c reduced by 3.4mmol/mol (p=0.002), Time in range: TIR (glucose 3.9-10mmol/L) improved from 63% to 71% (p <0.005). GOLD score remained unchanged at 2.0. Serum creatinine increased from 77 to 80umol/L (p=0.007), eGFR reduced from 92 to 80ml/ min (p<0.001), mean urine microalbumin, total cholesterol, grading of retinal screening remained unchanged. Diabetes Treatment Satisfaction Questionnaire, hypoglycaemia fear survey scores were unchanged and mean INSPIRE (Insulin delivery Systems: Perceptions, Ideas, Reflections and Expectations) score was 77 (40-100). Conclusion(s): This analysis demonstrates statistically significant improvement in glycaemic parameters (HbA1c and TIR) at 6 months with minimal but statistically significant weight loss. There were no significant changes in retinal screening but surprisingly some reduction in renal function was observed. Quality of life questionnaires remained unchanged but INSPIRE questionnaire for automated insulin delivery (AID) showed promising results.

DOI: 10.1089/dia.2024.78502.abstracts