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ASVS with a fixed low dose of calcium gluconate is a highly accurate and safe method for preoperative localization of insulinomas. Sampling in the left hepatic vein can be routinely omitted. Additional stimulation in the distal splenic artery seems helpful in surgical decision making, but additional experience is needed.

IntroductionEmpagliflozin reduced morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) in clinical trials. A registry study was undertaken to describe evolution of patient characteristics and assess the real-world effectiveness/safety of empagliflozin.Research design and methodsData from the Diabetes Patienten Verlaufsdokumentation (DPV)/Diabetes Versorgungsevaluation (DIVE) registries on 9571 adults with T2DM (registered in 2014–2019) receiving empagliflozin were used. Patients were grouped according to the following: early users (group 1; n=505) received empagliflozin before the EMPA-REG OUTCOME study publication (mid-September 2015); intermediate users (group 2; n=2961) started empagliflozin after the EMPA-REG OUTCOME publication but before the European Medicines Agency label change (from mid-September 2015 to mid-January 2017); and late users (group 3; n=6105) started empagliflozin after mid-January 2017. Data on clinical and treatment characteristics were collected.ResultsOver time, the proportion of recipients aged <65 years decreased (71.1% vs 54.4% among early and late adopters), male patients increased (from 50.9% to 66.5%), body mass index (mean±SD) decreased (from 35.5±6.7 to 32.7±6.6 kg/m2), proportion with cardiovascular morbidities increased (from 20.4% to 26.4%), and mean estimated glomerular filtration rate decreased (from 83.2±19.5 to 78.5±21.1 mL/min/1.73 m2) (all p<0.001). Patients increasingly received empagliflozin in combination with metformin (60.8% vs 68.6% of early and late adopters; p<0.001), glucagon-like peptide-1 (GLP-1) agonists (11.0 vs 14.1%; p<0.001) or insulin (34.3% vs 49.9%; p<0.001). Empagliflozin was generally added to existing antidiabetic regimens. Six months after empagliflozin initiation, the mean glycated hemoglobin (HbA1c) decreased by 0.4%, the proportion of patients with HbA1c <6.5% increased (19.2% vs 12.8%), and the mean fasting plasma glucose decreased (155.8±49.7 vs 168.0±55.1 mg/dL) (all p<0.001). No significant changes in rates of severe hypoglycemia and no cases of diabetic ketoacidosis were seen.ConclusionsOver time, empagliflozin is being prescribed to a broader patient range in routine practice, is usually added to existing antidiabetic regimens, and is increasingly used in combination with metformin, GLP-1 agonists and/or insulin. Empagliflozin had a beneficial effect on glycemic control, with no increase in hypoglycemia.

In patients with insulin therapy, a simple to use, reliable and safe insulin application device is a prerequisite to achieve good glucose control, and for reducing and avoiding progression of secondary complications. Modern injection pen systems provide the patient with a high degree of flexibility and quality of life. However, the integration of further and appropriate therapeutic aids into a device can make a positive contribution to compliance and therapy satisfaction. In this multicentre, open, randomised, three‐month, cross‐over study, the new insulin application device Autopen 24® (designed for Sanofi‐Aventis insulin cartridges) was evaluated in comparison to the established OptiPen® Pro device with regard to clinical efficacy (HbA1c, frequency of severe hypoglycaemic episodes) and patients' preference and acceptance in 40 patients (20 women, 20 men; 20 type 1, 20 type 2; age [mean±SD] 49.3±15.1 years; BMI 29.0±5.0 kg/m2). No differences were seen regarding HbA1c and hypoglycaemic episodes between the treatment groups. The Autopen 24 showed a high level of acceptance by patients in comparison to OptiPen Pro and was preferred by older patients with type 2 diabetes. In conclusion, Autopen 24 is a suitable alternative to other injection devices in patients with diabetes mellitus treated with Sanofi‐Aventis insulin products. Copyright © 2005 John Wiley & Sons, Ltd.

GGT is an unspecific marker of oxidative stress and both high plasma glucose and triglycerides levels may produce oxidative stress. Thus, patients with IFG + IGT seem to have higher levels of oxidative stress than those with isolated IFG. Based on the known association between GGT levels and cardiovascular risk factors, IFG + IGT patients may be at higher risk for the development of cardiovascular diseases. The specific effect of regular exercise on GGT in pre-diabetic patients may contribute to the understanding of the preventive effects related to exercise.

High productivity associated with the meat quality and low costs are the main objectives of meat poultry production. Removal of antibiotics from poultry diets in many parts of the world has amplified the interest in using feed additives in commercial poultry production to improve intestinal health and nutrient utilisation. We have conducted an experiment to assess whether the dietary inclusion of a microbial feed additive (MFA) has an effect on the small intestinal micro-architecture and oxidative stress biomarker (thiobarbituric acid reactive substance, TBARS) in the liver and brain of broiler chickens. Two dietary treatments (n = 10/ treatment), consisting of a basal diet (control group) or the basal diet supplemented with 2.5 kg of MFA/ton of feed (MFA group), were fed to broiler chicks from 1 to 35 days of age. On day 35, birds were slaughtered to collect tissue samples from the duodenum and jejunum for histo-morphometry and from the liver and brains for measuring TBARS. The results showed that addition of MFA to the broiler diet only increased (P = 0.019) the crypt depth of the villi in the duodenum, without affecting the villus height, villus width and thickness of the muscularis of the duodenum and the jejunum. Furthermore, supplementation of MFA in the diet decreased the level of TBARS in the brain (P = 0.013) and in the liver (P = 0.017), suggesting a decrease in the level of lipid peroxidation and oxidative stress. We conclude that the addition of microbial supplement to broiler diets had limited effects on the intestinal integrity but has the potential to alleviate the level of oxidative stress in broilers.

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