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Hyperinsulinemic hypoglycaemia (HH) presents significant management challenges, especially in cases refractory to standard therapies. This case series aims to report the efficacy and safety of sirolimus, an mTOR inhibitor, as an adjunctive therapy in persistent HH, noting that current clinical guidelines caution its use outside of research. We report a case series from two paediatric endocrinology centres across Australia, describing use of sirolimus in four infants with persistent HH refractory to conventional treatments or post near-total pancreatectomy. Retrospective chart reviews provided clinical and biochemical data, documenting each patient's sirolimus dosing, treatment responses, and adverse events. Sirolimus emerged as a useful and safe adjunct, enabling hospital discharge, and demonstrating efficacy even at lower serum trough levels. Despite safety concerns, including recurrent viral infections in one patient, sirolimus was generally well-tolerated. We advocate for implementing risk mitigation strategies, including a multidisciplinary approach, and maintaining lower sirolimus trough levels than previously recommended. Careful consideration of sirolimus is warranted in select cases of severe diffuse HH, emphasising ongoing monitoring for adverse effects and further research to refine treatment guidelines. [ABSTRACT FROM AUTHOR]

This paper presents the design of two wideband bandpass filters (BPF) operating in the 10–14 GHz and 14–18 GHz ranges for a five port 1-18GHz frequency multiplexer. The 10–14 GHz BPF utilises an interdigital array of resonators with asymmetrical widths and is combined with a low-pass filter for wide stopband characteristics. Sharp attenuation in the stop bands is achieved by including quarter wavelength open stubs. The 14–18 GHz BPF incorporates three interdigital resonators with a modified middle resonator, introducing a variable gap width for improved impedance matching. Open-circuited stubs and a bandstop filter further enhance attenuation in the stop bands. Equivalent circuit models accompany both filters. Both filters exhibit excellent performance, as evidenced by the reflection coefficients below −12 dB within their respective frequency ranges. The insertion loss remains below 2.5 dB throughout the passband, indicating efficient signal transmission. Moreover, the group delay for both filters is less than 0.8 ns, indicating minimal signal delay. These results demonstrate the high-quality characteristics of the designed filters, making them suitable for a wide range of applications requiring efficient signal filtering and multiplexing. [ABSTRACT FROM AUTHOR]

This article presents two ultra-broadband bandpass filter (BPF) designs for multi-standard applications, operating from 1–6 GHz and 6–10 GHz, with wide stopband characteristics. 1–6 GHz BPF (Filter 1) is based on the circuit model for an optimum distributed bandpass filter consisting of 3 shunt short-circuited stubs separated by non-redundant unit elements. By varying the length ratio between the unit elements and stubs and introducing stepped impedance in the unit elements, a 143% fractional bandwidth (FBW) is achieved, which is 20% higher than that obtained through the conventional optimum shunt short-circuited stub method. In addition, a stepped impedance elliptic lowpass filter was cascaded to achieve wide stopband characteristics from 7 GHz to 20 GHz. Filter 2 (6–10 GHz) is constructed by cascading a shunt short-circuited stub optimum high pass filter having a stepped impedance unit element with a stepped impedance low pass filter. The analytical model, transmission line equivalent circuit model, and full wave electromagnetic simulated model are presented along with the measured results. The measured in-band return loss of Filter 1 and Filter 2 is >12 dB, and the measured insertion loss is < 2 dB. The measured group delay of Filter 1 and Filter 2 is <0.8 ns. [ABSTRACT FROM AUTHOR]

Advanced hybrid closed-loop (AHCL) therapy with the Medtronic MiniMed™ 780G system improves glycemia; however, the clinical outcomes in younger children remain less established. This pilot study aimed to explore the continuous glucose monitoring (CGM) metrics in very young children on AHCL. Children between 2 and 7 years of age and on insulin pump therapy were recruited. A 2-week phase in manual mode was followed by a 6-week AHCL phase. CGM metrics were analyzed to review glycemic outcomes. Out of 11 participants enrolled [mean (standard deviation [SD]) age 5.3 (0.8) years], 10 completed the study. Time in closed loop was 96.7 (3.9)%. In AHCL, participants had a mean (SD) time in range of 72.6 (7.4)% and spent 3.0 (1.74)% and 0.63 (0.46)% in time <70 and <54 mg/dL, respectively. AHCL is a feasible option for management of young children with type 1 diabetes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Technology use in type 1 diabetes (T1D) is impacted by socioeconomic status (SES). This analysis explored relationships between SES, glycemic outcomes, and technology use. RESEARCH DESIGN AND METHODS: A cross-sectional analysis of HbA1c data from 2,822 Australian youth with T1D was undertaken. Residential postcodes were used to assign SES based on the Index of Relative Socio-Economic Disadvantage (IRSD). Linear regression models were used to evaluate associations among IRSD quintile, HbA1c, and management regimen. RESULTS: Insulin pump therapy, continuous glucose monitoring, and their concurrent use were associated with lower mean HbA1c across all IRSD quintiles (P < 0.001). There was no interaction between technology use and IRSD quintile on HbA1c (P = 0.624), reflecting a similar association of lower HbA1c with technology use across all IRSD quintiles. CONCLUSIONS: Technology use was associated with lower HbA1c across all socioeconomic backgrounds. Socioeconomic disadvantage does not preclude glycemic benefits of diabetes technologies, highlighting the need to remove barriers to technology access. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of advanced hybrid closed loop (AHCL) therapy in a high-risk cohort of youth on continuous subcutaneous insulin infusion (CSII) ± continuous glucose monitoring (CGM) with suboptimal glycemia., Research Design and Methods: In a 6-month multicenter clinical trial, youth with type 1 diabetes with mean and most recent HbA1c > 8.5% (65 mmol/mol) were randomly assigned 1:1 to AHCL or treatment as usual (CSII ± CGM). The primary outcome was the 24-week between-group difference in HbA1c. Secondary outcomes included CGM metrics from masked CGM and psychological measures (youth-reported problem areas in diabetes [PAID], quality of life, anxiety, depression, and hypoglycemia fear) assessed using validated questionnaires., Results: A total of 42 participants were randomized (mean [SD] age 16.2 [2.5] years, HbA1c 9.8 [1.1]% or 84 [12] mmol/mol, PAID score 50.3 [19.8]). At study end, the mean (SD) HbA1c was 8.8 (1.1)% or 73 (12) mmol/mol with AHCL and 9.9 (1.2)% or 85 (13.1) mmol/mol with CSII ± CGM, with mean adjusted group difference of -0.77% (95% CI -1.45 to -0.09) or -8.4 mmol/mol (-15.8 to -1.0); P = 0.027. AHCL increased time in range 70-180 mg/dL (difference 19.1%; 95% CI 11.1 to 27.1), reduced time >180 mg/dL (difference -17.7%; 95% CI -26.6 to -8.8), with no increase in time spent <70 mg/dL (difference -0.8%; 95% CI -2.7 to 0.6). There was no evidence for difference in psychosocial outcomes between the two groups at study end., Conclusions: AHCL should be encouraged in youth with suboptimal glycemia, as AHCL improves glycemia. However, psychological support remains vital, as technology alone may not be able to reduce the burden of diabetes care in this subgroup., (© 2024 by the American Diabetes Association.)

Advanced hybrid closed-loop (AHCL) therapy with the Medtronic MiniMed™ 780G system improves glycemia; however, the clinical outcomes in younger children remain less established. This pilot study aimed to explore the continuous glucose monitoring (CGM) metrics in very young children on AHCL. Children between 2 and 7 years of age and on insulin pump therapy were recruited. A 2-week phase in manual mode was followed by a 6-week AHCL phase. CGM metrics were analyzed to review glycemic outcomes. Out of 11 participants enrolled [mean (standard deviation [SD]) age 5.3 (0.8) years], 10 completed the study. Time in closed loop was 96.7 (3.9)%. In AHCL, participants had a mean (SD) time in range of 72.6 (7.4)% and spent 3.0 (1.74)% and 0.63 (0.46)% in time <70 and <54 mg/dL, respectively. AHCL is a feasible option for management of young children with type 1 diabetes.