To evaluate efficacy and safety of continuous glucose monitoring (CGM) and automated insulin delivery (AID) in infants. A retrospective multicenter study (13 centers) of 76 children diagnosed with antibody-positive type 1 diabetes before age 2. Outcomes at 12 months were compared between AID users (n = 47) and multiple daily injections (MDI)/SAP users (n = 29). AID systems included Medtronic 780 G (38%), Tandem Control-IQ (38%), and CamAPS FX (24%). CGM median wear time was 97.0% (93.3; 98.1). AID users achieved significantly higher TIR (65% vs. 56%, P = 0.041) and time in tight range (TITR) (42% vs 32.5%, P = 0.038). In multivariable regression, AID was the sole independent predictor of lower HbA1c (P = 0.035). Zero severe hypoglycemia (SH) events occurred in the AID group (vs. 7.1% in MDI/SAP). Use of CGM is safe in very young children, with AID systems proving superior to traditional therapy. This real-world evidence supports incorporating AID consideration into future international guidelines from the time of pediatric diagnosis.

There is a history of using the medicinal plant Chaetocarpus genus, native to Southeast Asia, to treat a wide range of illnesses. The absence of detailed pharmacological validation for this plant is unexpected, considering its importance in ethnopharmacology. This study was supposed to conduct a laboratory evaluation of the pharmacological properties of the methanol extract of Chaetocarpus castanocarpus bark (MECCB). The MECCB was prepared by cold maceration and then subjected to phytochemical measurement (total phenolic, flavonoid, and tannin content) and antioxidant testing ([2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging]). Oral glucose tolerance tests were utilized to evaluate hypoglycemic potential, yeast-induced pyrexia to measure antipyretic effects, castor oil-induced diarrhea to measure antidiarrheal activity, and acetic acid-induced writhing and formalin tests to evaluate analgesic effects in vivo. The study used standard treatments, 200 and 400 mg/kg MECCB in contrast to the control group in Swiss albino mice. At 400 mg/kg, MECCB exhibited a writhing inhibition of 73.86%, demonstrating dose-dependent antinociceptive effectiveness. MECCB-treated groups showed a significant reduction in fever compared to the vehicle control group. A decrease of 37.06% in intestinal motility and a reduction of 58.53% in diarrheal feces were among the antidiarrheal effects. The fast drop in glucose levels (Δ = 6.5 mmol/L) caused by hypoglycemia was comparable to the effects of glibenclamide. The IC50 of MECCB in the DPPH assay is 418.73 μg/mL, demonstrating its antioxidant activity. This activity is associated with the high amounts of flavonoids (280.143 ± 45.122 mg QE/g) and phenolics (364.917 ± 27.0159 mg GAE/g) present. MECCB's potential as a natural medication is supported by its positive effects on pain relief, fever reduction, diarrhea treatment, and glucose regulation. Additional research is needed to identify active compounds and elucidate their mechanisms.

Hypoglycemia is a frequent finding after simultaneous pancreas-kidney (SPK) transplantation, but its etiology is often multifactorial and challenging to interpret. We report a rare case of late-onset severe hypoglycemia secondary to a neuroendocrine tumor arising in a pancreatic allograft. A 60-year-old man with type 1 diabetes mellitus underwent SPK transplantation in 2007 with immediate graft function and long-term metabolic stability. Ten years post-transplant, partial pancreatic graft dysfunction and progressive vascular complications were noted. In 2024, 17 years after transplantation, the patient developed recurrent, documented hypoglycemic episodes despite withdrawal of glucose-lowering therapy, with fasting plasma glucose values as low as 40 mg/dL and a marked reduction in HbA1c. Biochemical evaluation suggested endogenous hyperinsulinism, with elevated chromogranin A levels. Imaging studies revealed a large hypervascular mass within the pancreatic graft, with high somatostatin receptor expression on 68Ga-DOTA-TOC PET-CT. Histology from biopsy and subsequent total graft pancreatectomy confirmed a well-differentiated grade 2 neuroendocrine tumor with focal insulin expression, consistent with insulinoma. Surgical resection resulted in complete resolution of hypoglycemia. This case highlights the need to consider rare but clinically significant causes of hypoglycemia in SPK recipients and underscores the importance of a comprehensive, multidisciplinary diagnostic approach integrating continuous glucose monitoring, biochemical markers, and advanced imaging.

Reactive hypoglycaemia is characterised by symptomatic hypoglycaemia occurring several hours after food intake and can significantly impair quality of life. Management is often challenging, particularly in patients who fail dietary modification or cannot tolerate conventional pharmacological therapies. We present the case of a 50-year-old woman with longstanding, debilitating reactive hypoglycaemia who experienced marked symptomatic and biochemical improvement following treatment with semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist. The patient presented with recurrent episodes of dizziness, profound fatigue, tremulousness, and syncope despite adherence to dietary recommendations. Previous treatment with acarbose was discontinued because of gastrointestinal intolerance, and metformin failed to improve symptoms. Continuous glucose monitoring and an oral glucose tolerance test confirmed reactive hypoglycaemia. Following initiation of semaglutide, the patient experienced a substantial reduction in hypoglycaemic episodes with corresponding improvement in glucose profiles and quality of life. This case highlights the potential role of semaglutide as a novel therapeutic option in patients with refractory reactive hypoglycaemia and contributes to the emerging evidence supporting the use of GLP-1 receptor agonists in this condition.

New-onset sexual dysfunction in men, particularly erectile dysfunction, should not be regarded merely as an isolated sexual complaint. It may represent an early manifestation of endothelial dysfunction, atherosclerotic disease, diabetes mellitus type 2, obesity, arterial hypertension, dyslipidemia, hypogonadism, hyperprolactinemia, thyroid disorders, or adverse drug effects. The aim of this review is to summarize current evidence on the relationship between sexual dysfunction and cardiometabolic risk and to provide a practical outpatient approach for primary care, internal medicine, diabetology, urology, and sexual medicine. This narrative review is based mainly on the current European Association of Urology recommendations, the Princeton IV Consensus, and selected systematic reviews and meta-analyses. Particular attention is paid to focused history taking, physical examination, basic laboratory work-up, risk stratification, and the differential diagnosis of vasculogenic, endocrine, iatrogenic, and psychogenic causes. The review also incorporates the Czech clinical context and proposes a pragmatic referral framework for situations requiring further evaluation or specialist care.

Fructose-1,6-bisphosphatase deficiency is a rare inherited metabolic disorder of gluconeogenesis characterized by recurrent hypoglycemia and lactic acidosis, typically triggered by inadequate glucose intake or increased consumption of fructose, sucrose, or sorbitol. During pregnancy, the risk of hypoglycemia and lactic acidosis increases because endogenous glucose production is limited while fetal glucose demand rises. Here we report three patients with fructose-1,6-bisphosphatase deficiency who had successful pregnancies and deliveries. These patients were managed by a multidisciplinary team of obstetricians, maternal-fetal medicine specialists, metabolic physicians, and metabolic dieticians. All patients were obese; one had morbid obesity. Two patients developed gestational diabetes mellitus. One responded to dietary intervention, whereas the patient with morbid obesity had poor dietary adherence, suboptimal glycemic control, and experienced an episode of severe life-threatening hypoglycemia with lactic acidosis requiring intensive care. She recovered fully, with no adverse maternal or fetal effects. All patients had normal vaginal deliveries and were closely monitored during labor, delivery, and the postpartum period. Both patients with gestational diabetes developed lactic acidosis immediately after delivery despite stable blood glucose levels. Managing gestational or type 2 diabetes in patients with fructose-1,6-bisphosphatase deficiency is particularly challenging because the disorder predisposes them to hypoglycemia. This case series contributes to the limited literature on pregnancy outcomes and highlights key management challenges in this rare condition.