Aim To conduct a systematic review and meta‐analysis to understand the timing and factors associated with anti‐programmed cell death protein‐1 ( PD ‐1)/anti‐programmed cell death protein‐1 ligand ( PD ‐L1) inhibitor‐induced Type 1 diabetes. Methods We searched MEDLINE , EMBASE , SCOPUS and Cochrane databases (August 2000–2018) for studies of any design on immune checkpoint inhibitors. A total of 71 cases were reviewed from 56 publications. Comparisons were made using Fisher's exact and Student's t ‐tests. Results The mean ± sd age at Type 1 diabetes presentation was 61.7±12.2 years, 55% of cases were in men, and melanoma (53.5%) was the most frequent cancer. The median time to Type 1 diabetes onset was 49 (5–448) days with ketoacidosis in 76% of cases. The average ± sd HbA 1c concentration was 62 ± 0.3 mmol/mol (7.84±1.0%) at presentation. All cases had insulin deficiency and required permanent exogenous insulin treatment. Half of the cases had Type 1 diabetes‐associated antibodies at presentation, and those with antibodies had a more rapid onset ( P =0.005) and higher incidence of diabetic ketoacidosis ( P =0.02) compared to people without antibodies. Conclusions Many people developed Type 1 diabetes within 3 months of initial PD ‐1/ PD ‐L1 inhibitor exposure. People presenting with Type 1 diabetes‐associated antibodies had a more rapid onset and higher incidence of ketoacidosis than those without antibodies. Healthcare providers caring for people receiving these state‐of‐the‐art therapies need to be aware of this potential severe adverse event.

SummaryObjective: Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined. Design:We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters. Methods:We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in metaanalysis and plotted over time. Results:We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, womenand patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response. Conclusions:The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response. K E Y W O R D Sadrenal cortex, adrenal insufficiency, cortisol, hydrocortisone, pituitary-adrenal system, stress, surgery | 555 PRETE ET al. | INTRODUC TI ONThe controlled trauma of a surgical insult activates adaptive changes in the neuro-hormonal system and the inflammation response.1 The primary mechanism responsible for cortisol hypersecretion in response to stress is executed by the afferent nerve signals derived from the surgical site, which in turn stimulate the hypothalamus to release corticotropin-releasing hormone and arginine vasopressin.

Men consume more alcohol than women in populations with and without diabetes. Light-to-moderate alcohol consumption decreases the incidence of diabetes in the majority of the studies, whereas heavy drinkers and binge drinkers are at increased risk for diabetes. Among people with diabetes, light-to-moderate alcohol consumption reduces risks of cardiovascular diseases and all-cause mortality. Alcohol consumption is less common among populations with diabetes compared to the general population. Moderate alcohol consumption reduces the risk of diabetes and, as in the general population, improves cardiovascular health in patients with diabetes. Type of alcoholic beverage, gender, and body mass index are factors that affect these outcomes.

Aim To compare glycaemic metrics at 3 and 6 months in patients with type 1 diabetes on a 670G hybrid closed‐loop (HCL) system after using a sensor‐augmented pump (SAP) for at least 3 months. Materials and Methods A retrospective study from a centre that has the largest number of 670G users in the United States was conducted. Data from 202 SAP users were reviewed. Sixty‐one patients were excluded (two for steroid use, four for pregnancy, 27 for previous Enlite use, and 28 for non‐continuous use of 670G). Out of 141 patients who met the inclusion criteria, 127 (aged 21–68 years) had complete data. Results HbA1c levels decreased by 0.4% at 3 months and were maintained at 6 months (7.6 ± 0.07 vs. 7.2 ± 0.08, P < 0.001) with no weight gain at 6 months. Time‐in‐range (70–180 mg/dL) increased from 59.5% ± 1.1% to 70.2% ± 1.2% and 70.1% ± 1.1% at 3 and 6 months (P < 0.001), respectively. At 6 months, time spent in hypoglycaemia (<70 mg/dL) and time spent in hyperglycaemia (>180 mg/dL) were reduced by 30% (2.2% ± 0.2% vs. 3.2% ± 0.2%; P < 0.05) and 26% (28.3% ± 1.2% vs. 38.1% ± 1.2%; P < 0.001), respectively. More time in auto‐mode was associated with improved continuous glucose monitoring metrics, lower HbA1c and decreased glycaemic variability. Time in auto‐mode declined in men after 3 months, while women maintained similar auto‐mode use throughout the study. Conclusions The HCL system improved HbA1c levels and time‐in‐range, and decreased time spent in hypoglycaemia and hyperglycaemia at 6 months. Auto‐mode use was significantly correlated with continuous glucose monitoring metrics and glycaemic outcomes.

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