Clinical Focus


  • Type 1 Diabetes mellitus
  • Diabetes devices and technology
  • Inpatient glucose management
  • Type 2 and other forms of Diabetes mellitus
  • Endocrinology
  • Diabetes and Metabolism

Administrative Appointments


  • Member, Stanford Diabetes Research Center (2023 - Present)

Professional Education


  • Board Certification: American Board of Internal Medicine, Endocrinology, Diabetes and Metabolism (2022)
  • Fellowship: Stanford University Endocrinology Fellowship (2022) CA
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2020)
  • Residency: Baylor College of Medicine Internal Medicine Residency (2020) TX
  • Medical Education: MD, John P. and Kathrine G. McGovern Medical School at UTHealth, Houston, TX (2017)
  • Undergrad: BM, Music Performance, Florida State University, Tallahassee, FL (2011)

Clinical Trials


  • Accuracy and Precision of the True Vie I3 Continuous Glucose Monitoring System: an Open Label, Multi-Center Trial Recruiting

    The purpose of the investigation is to evaluate the performance of the I3 CGM according to the FDA's special controls for iCGM.

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  • Omnipod 5 System Compared to Pump Therapy Recruiting

    Subject will undergo a 14-day outpatient, standard therapy phase during which sensor and insulin data will be collected. This will be followed by a 90-day outpatient phase where subjects will either use the Omnipod 5 system or continue to use their personal insulin pump with the study provided continuous glucose monitoring system.

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  • Safety Evaluation of an Advanced Hybrid Closed Loop System Using Lyumjev With the Tandem t:Slim X2 Insulin Pump With Control-IQ Technology in Adults, Adolescents and Children With Type 1 Diabetes Recruiting

    Prospective, multi-center, single-arm study in adults and children ages 6 to 80 with type 1 diabetes to evaluate the safety of Lyumjev with Control-IQ technology to achieve labeling updates for Lyumjev and the t:slim X2 insulin pump.

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  • Automated Insulin Delivery for INpatients With DysGlycemia (AIDING) Feasibility Not Recruiting

    This single-arm stepwise feasibility study will test initial deployment of hybrid closed-loop (HCL) automated insulin delivery (AID) using the Omnipod 5/Horizon HCL system with remote monitoring and device operation capabilities to hospitalized patients admitted to the general medical/surgical floor with diabetes (type 1 or type 2) requiring insulin therapy.

    Stanford is currently not accepting patients for this trial.

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  • Pivotal Omnipod Horizon™ Automated Glucose Control System Not Recruiting

    Subjects will undergo a 14-day outpatient, standard therapy phase during which sensor and insulin data will be collected. This will be followed by a 94-day (13-week) hybrid closed-loop phase conducted in an outpatient setting and an optional 12-month extension phase.

    Stanford is currently not accepting patients for this trial.

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  • Safety and Effectiveness of the MiniMed™ 780G System With DS5 CGM Not Recruiting

    The purpose of this study is to confirm the safety and effectiveness of the MiniMed 780G insulin pump used in combination with the DS5 CGM in type 1 diabetes adult and pediatric subjects in a home setting.

    Stanford is currently not accepting patients for this trial. For more information, please contact Bailey Suh, 925-389-8516.

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  • The Insulin-Only Bionic Pancreas Pivotal Trial Not Recruiting

    This multi-center randomized control trial (RCT) will compare efficacy and safety endpoints using the insulin-only configuration of the iLet Bionic Pancreas (BP) System versus Usual Care (UC) during a 13-week study period. Participants may be enrolled initially into a screening protocol and then transfer into the RCT protocol, or they may enter directly into the RCT protocol. The RCT will be followed by an Extension Phase in which the RCT Usual Care (UC) Group will use the insulin-only configuration of the iLet Bionic Pancreas (BP) System for 3 months. At the completion of use of the BP system in the RCT only, participants will enter a 2-4 day Transition Phase and be randomly assigned to either transition back to their usual mode of therapy (MDI or pump therapy) based on therapeutic guidance from the iLet BP System or transition back to their usual mode of therapy based on what their own insulin regimens were prior to enrolling in the RCT. There is an optional ancillary study to assess the safety of utilizing self-monitored blood glucose (SMBG) measurements instead of continuous glucose monitor (CGM) measurements as input into the iLet for ~48-60 hours. The Study is intended to mirror a real-world situation where CGM may not be available for an extended period of time (eg, user runs out of sensors and is awaiting new shipment).

    Stanford is currently not accepting patients for this trial. For more information, please contact Liana Hsu, BS, 650-725-3939.

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Projects


  • Diabetes Technology Use in U.S. Hospitals | A Survey of Patient Experiences

    While diabetes devices have made a huge impact in the outpatient setting, there is very little known about their general use in hospitals around the US. We are working more broadly to improve glucose management for all individuals with diabetes during hospitalizations, both from a glucose control and patient experience standpoint, using diabetes technology. To gather more background on the current state of this outside our own institution, we created this survey to ask people who use diabetes devices about their experiences using these devices (or not) during hospitalizations over the past year. Available in English, Spanish, Chinese, Tagalog, and Vietnamese

    Location

    USA

    For More Information:

All Publications


  • Digital Technology for Diabetes. The New England journal of medicine Hughes, M. S., Addala, A., Buckingham, B. 2023; 389 (22): 2076-2086

    View details for DOI 10.1056/NEJMra2215899

    View details for PubMedID 38048189

  • Automated Insulin Delivery with Remote Real-Time Continuous Glucose Monitoring for Hospitalized Patients with Diabetes: A Multi-Center, Single-arm, Feasibility Trial. Diabetes technology & therapeutics Davis, G. M., Hughes, M. S., Brown, S., Sibayan, J., Perez-Guzman, M. C., Stumpf, M., Thompson, Z., Basina, M., Patel, R., Hester, J., Abraham, A., Ly, T. T., Chaney, C., Tan, M., Hsu, L. J., Kollman, C., Beck, R. W., Lal, R. A., Buckingham, B. A., Pasquel, F. 2023

    Abstract

    Introduction Multiple daily injection (MDI) insulin therapy frequently fails to meet hospital glycemic goals and is prone to hypoglycemia. Automated insulin delivery (AID) with remote glucose monitoring offers a solution to these shortcomings. Research Design and Methods In a single-arm multicenter pilot trial, we tested the feasibility, safety, and effectiveness of the Omnipod 5 AID System with real-time continuous glucose monitoring (CGM) for up to 10 days in hospitalized patients with insulin-requiring requiring diabetes on non-ICU medical-surgical units. Primary endpoints included the proportion of time in automated mode and percent time in range (TIR, 70-180 mg/dl) among participants with >48 hours of CGM data. Safety endpoints included incidence of severe hypoglycemia and diabetes-related ketoacidosis (DKA). Additional glycemic endpoints, CGM accuracy, and patient satisfaction were also explored. Results Twenty-two participants were enrolled; eighteen used the system for a total of 96 days (mean 5.3±3.1 days per patient), and sixteen had sufficient CGM data required for analysis. Median percent time in automated mode was 95% (IQR 92-98%) for the 18 system users, and the 16 participants with >48 hours of CGM data achieved an overall TIR of 68±16%, with 0.17±0.3% time <70 mg/dl and 0.06±0.2% time <54 mg/dl. Sensor mean glucose was 167±21 mg/dl. There were no DKA or severe hypoglycemic events. All participants reported satisfaction with the system at study end. Conclusions The use of AID with a disposable tubeless patch-pump along with remote real-time CGM is feasible in the hospital setting.

    View details for DOI 10.1089/dia.2023.0304

    View details for PubMedID 37578778

  • Swimming With the Omnipod 5 Automated Insulin Delivery System: Connectivity in the Water. Diabetes care Hughes, M. S., Kingman, R. S., Hsu, L., Lal, R. A., Buckingham, B. A., Zaharieva, D. P. 2023

    View details for DOI 10.2337/dc23-0470

    View details for PubMedID 37311429

  • Frequency and detection of insulin infusion site failure in the Type 1 Diabetes Exchange Online Community. Diabetes technology & therapeutics Hughes, M. S., Douvas, J. L., Layfield-Bryan, M., Blanco, L. E., Gray, J. C., Zapotoczny, G., Espinoza, J., Wilcox, J. H., Lal, R. A. 2023

    Abstract

    Insulin infusion site (IIS) failures are a weakness in insulin pump therapy. We examined experience with IIS failures among US individuals with diabetes on insulin pump via survey distributed to the T1D Exchange Online Community. Demographic factors, IIS characteristics, and diabetes-related perceptions were assessed by logistic regression to determine odds of higher (≥1 per month) or lower (<1 per month) reported IIS failure frequency. IIS failures were common; 41.4% reported ≥1 per month. IIS failure is usually detected through development of hyperglycemia rather than pump alarm. No assessed demographic factor or IIS characteristic was predictive; however, higher odds of ≥1 failure per month was associated with feelings of burnout (OR 1.489 [1.024, 2.165]) and considering pump discontinuation (OR 2.233 [1.455, 3.427]). IIS failures are frequent and unpredictable, typically require hyperglycemia for detection, and are associated with negative perceptions. More should be done toward preventing IIS failures and/or detecting them sooner.

    View details for DOI 10.1089/dia.2023.0005

    View details for PubMedID 36856574

  • Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. The New England journal of medicine Russell, S. J., Beck, R. W., Damiano, E. R., El-Khatib, F. H., Ruedy, K. J., Balliro, C. A., Li, Z., Calhoun, P., Wadwa, R. P., Buckingham, B., Zhou, K., Daniels, M., Raskin, P., White, P. C., Lynch, J., Pettus, J., Hirsch, I. B., Goland, R., Buse, J. B., Kruger, D., Mauras, N., Muir, A., McGill, J. B., Cogen, F., Weissberg-Benchell, J., Sherwood, J. S., Castellanos, L. E., Hillard, M. A., Tuffaha, M., Putman, M. S., Sands, M. Y., Forlenza, G., Slover, R., Messer, L. H., Cobry, E., Shah, V. N., Polsky, S., Lal, R., Ekhlaspour, L., Hughes, M. S., Basina, M., Hatipoglu, B., Olansky, L., Bhangoo, A., Forghani, N., Kashmiri, H., Sutton, F., Choudhary, A., Penn, J., Jafri, R., Rayas, M., Escaname, E., Kerr, C., Favela-Prezas, R., Boeder, S., Trikudanathan, S., Williams, K. M., Leibel, N., Kirkman, M. S., Bergamo, K., Klein, K. R., Dostou, J. M., Machineni, S., Young, L. A., Diner, J. C., Bhan, A., Jones, J. K., Benson, M., Bird, K., Englert, K., Permuy, J., Cossen, K., Felner, E., Salam, M., Silverstein, J. M., Adamson, S., Cedeno, A., Meighan, S., Dauber, A. 2022; 387 (13): 1161-1172

    Abstract

    Currently available semiautomated insulin-delivery systems require individualized insulin regimens for the initialization of therapy and meal doses based on carbohydrate counting for routine operation. In contrast, the bionic pancreas is initialized only on the basis of body weight, makes all dose decisions and delivers insulin autonomously, and uses meal announcements without carbohydrate counting.In this 13-week, multicenter, randomized trial, we randomly assigned in a 2:1 ratio persons at least 6 years of age with type 1 diabetes either to receive bionic pancreas treatment with insulin aspart or insulin lispro or to receive standard care (defined as any insulin-delivery method with unblinded, real-time continuous glucose monitoring). The primary outcome was the glycated hemoglobin level at 13 weeks. The key secondary outcome was the percentage of time that the glucose level as assessed by continuous glucose monitoring was below 54 mg per deciliter; the prespecified noninferiority limit for this outcome was 1 percentage point. Safety was also assessed.A total of 219 participants 6 to 79 years of age were assigned to the bionic-pancreas group, and 107 to the standard-care group. The glycated hemoglobin level decreased from 7.9% to 7.3% in the bionic-pancreas group and did not change (was at 7.7% at both time points) in the standard-care group (mean adjusted difference at 13 weeks, -0.5 percentage points; 95% confidence interval [CI], -0.6 to -0.3; P<0.001). The percentage of time that the glucose level as assessed by continuous glucose monitoring was below 54 mg per deciliter did not differ significantly between the two groups (13-week adjusted difference, 0.0 percentage points; 95% CI, -0.1 to 0.04; P<0.001 for noninferiority). The rate of severe hypoglycemia was 17.7 events per 100 participant-years in the bionic-pancreas group and 10.8 events per 100 participant-years in the standard-care group (P = 0.39). No episodes of diabetic ketoacidosis occurred in either group.In this 13-week, randomized trial involving adults and children with type 1 diabetes, use of a bionic pancreas was associated with a greater reduction than standard care in the glycated hemoglobin level. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT04200313.).

    View details for DOI 10.1056/NEJMoa2205225

    View details for PubMedID 36170500

  • Swimming with Hybrid Closed-Loop: Connectivity Data from Seven Swimmers in the Omnipod 5 Trial Hughes, M. S., Kingman, R. S., Hsu, L., Lal, R., Buckingham, B. A., Zaharieva, D. P. AMER DIABETES ASSOC. 2022

    View details for DOI 10.2337/db22-782-P

    View details for Web of Science ID 000854899301283

  • Swimming with Hybrid Closed Loop: Encouraging Data from Three Swimmers in the Omnipod 5 Trial Hughes, M. S., Kingman, R. S., Lal, R., Buckingham, B. A., Zaharieva, D. P. AMER DIABETES ASSOC. 2021

    View details for DOI 10.2337/db21-694-P

    View details for Web of Science ID 000728369702281

  • Off-label use of SGLT inhibitors among adults in T1D Exchange Registry. Diabetes, obesity & metabolism Hughes, M. S., Bailey, R., Calhoun, P., Shah, V. N., Lyons, S. K., DeSalvo, D. J. 2021

    View details for DOI 10.1111/dom.14556

    View details for PubMedID 34545988

  • Real-World Evidence of SGLT2 Inhibitor (SGLT2i) Use among Adults in the T1D Exchange Registry (T1DX) Hughes, M. S., Bailey, R., Calhoun, P., Lyons, S., Desalvo, D., Shah, V. N. AMER DIABETES ASSOC. 2020
  • Checking the Checkpoint Inhibitors: A Case of Autoimmune Diabetes After PD-1 Inhibition in a Patient with HIV. Journal of the Endocrine Society Hughes, M. S., Pietropaolo, M. n., Vasudevan, M. M., Marcelli, M. n., Nguyen, H. n. 2020; 4 (12): bvaa150

    Abstract

    Immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) is a known immune-related adverse event (irAE) following treatment with programmed cell death protein 1 (PD-1), with a reported 0.9% incidence. We hereby present the first case, to our knowledge, of ICI-DM following ICI use in a human immunodeficiency virus (HIV) patient. In this case, a 48-year-old man with HIV stable on highly active antiretroviral therapy (HAART) was diagnosed with Hodgkin lymphoma and initiated treatment with the PD-1 inhibitor nivolumab. His lymphoma achieved complete response after 5 months. However, at month 8, he reported sudden polydipsia and polyuria. Labs revealed a glucose level of 764 mg/dL and glycated hemoglobin A1c (HbA1c) of 7.1%. Low C-peptide and elevated glutamic acid decarboxylase 65 (GAD65) antibody levels confirmed autoimmune DM, and he was started on insulin. Major histocompatibility complex class II genetic analysis revealed homozygous HLA DRB1*03-DQA1*0501-DQB1*02 (DR3-DQ2), which is a known primary driver of genetic susceptibility to type 1 DM. Autoimmune DM has been reported as an ICI-associated irAE. However, patients with immunocompromising conditions such as HIV are usually excluded from ICI trials. Therefore, little is known about such irAEs in this population. In this case, risk of ICI-DM as an irAE was likely increased by several factors including family history, a high-risk genetic profile, islet-related immunologic abnormalities, active lymphoma, and HIV infection with a possible immune reconstitution event. Clinicians should maintain a high index of suspicion for development of irAEs associated with ICI, particularly as use of these therapies broadens. Thorough investigation for presence of higher-risk features should be conducted and may warrant inclusion of pre-therapy genetic and/or autoantibody screening.

    View details for DOI 10.1210/jendso/bvaa150

    View details for PubMedID 33225197

    View details for PubMedCentralID PMC7660136

  • Checking the Checkpoints: A Case of Type 1 Diabetes following PD-1 Inhibition in a Patient with HIV Hughes, M. S., Bedrose, S., Vasudevan, M., Marcelli, M. AMER DIABETES ASSOC. 2019
  • Critical Role of ADAMTS-4 in the Development of Sporadic Aortic Aneurysm and Dissection in Mice. Scientific reports Ren, P. n., Hughes, M. n., Krishnamoorthy, S. n., Zou, S. n., Zhang, L. n., Wu, D. n., Zhang, C. n., Curci, J. A., Coselli, J. S., Milewicz, D. M., LeMaire, S. A., Shen, Y. H. 2017; 7 (1): 12351

    Abstract

    Sporadic aortic aneurysm and dissections (AADs) are common vascular diseases that carry a high mortality rate. ADAMTS-4 (a disintegrin-like and metalloproteinase with thrombospondin motifs-4) is a secreted proteinase involved in inflammation and matrix degradation. We previously showed ADAMTS-4 levels were increased in human sporadic descending thoracic AAD (TAAD) samples. Here, we provide evidence that ADAMTS-4 contributes to aortic destruction and sporadic AAD development. In a mouse model of sporadic AAD induced by a high-fat diet and angiotensin II infusion, ADAMTS-4 deficiency (Adamts-4-/-) significantly reduced challenge-induced aortic diameter enlargement, aneurysm formation, dissection and aortic rupture. Aortas in Adamts-4-/- mice showed reduced elastic fibre destruction, versican degradation, macrophage infiltration, and apoptosis. Interestingly, ADAMTS-4 was directly involved in smooth muscle cell (SMC) apoptosis. Under stress, ADAMTS-4 translocated to the nucleus in SMCs, especially in apoptotic SMCs. ADAMTS-4 directly cleaved and degraded poly ADP ribose polymerase-1 (a key molecule in DNA repair and cell survival), leading to SMC apoptosis. Finally, we showed significant ADAMTS-4 expression in aortic tissues from patients with sporadic ascending TAAD, particularly in SMCs. Our findings indicate that ADAMTS-4 induces SMC apoptosis, degrades versican, promotes inflammatory cell infiltration, and thus contributes to sporadic AAD development.

    View details for DOI 10.1038/s41598-017-12248-z

    View details for PubMedID 28955046

    View details for PubMedCentralID PMC5617887

  • Valve-sparing aortic root replacement: early and midterm outcomes in 83 patients. The Annals of thoracic surgery Coselli, J. S., Hughes, M. S., Green, S. Y., Price, M. D., Zarda, S. n., de la Cruz, K. I., Preventza, O. n., LeMaire, S. A. 2014; 97 (4): 1267–73; discussion 1273–74

    Abstract

    Valve-sparing aortic root replacement (VSARR) is an alternative to traditional composite valve graft (CVG) root replacement. We examined early and midterm outcomes after VSARR.A combined retrospective/prospective study was performed in 83 patients who underwent VSARR (16%) among 515 patients who underwent aortic root replacement during a nearly 12-year period. Thirty-six patients (43%) had a connective tissue disorder, 3 patients (4%) had acute aortic dissection, and 40 (48%) patients had at least moderate aortic regurgitation (AR). Twenty-eight patients (34%) had left ventricular hypertrophy or dilatation. The reimplantation VSARR technique was used in 82 patients (99%), and the Florida sleeve technique was used in 1 patient. Thirty-two patients (39%) underwent concomitant aortic arch replacement. For early survivors, the median duration of follow-up was 3.5 years (range, 5 days-12.2 years).One patient had severe AR after VSARR that necessitated intraoperative conversion to a mechanical CVG. The 1 operative death and 1 stroke occurred in a patient with acute dissection. Actuarial survival was 96.4%±2.0% at 2 years and 86.9%±5.6% at 8 years. Six patients (7%) had late valve-related complications: 1 died of endocarditis, 4 underwent reoperation for severe AR and received replacement valves, and 1 had severe AR and is being monitored. Freedom from repair failure (reoperation, endocarditis, or severe AR) was 94.8%±2.6% at 2 years and 87.3%±5.7% at 8 years.Valve-sparing aortic root replacement can have excellent early and respectable midterm outcomes, even when combined with arch repair. Further follow-up remains necessary to evaluate the long-term durability of VSARR.

    View details for DOI 10.1016/j.athoracsur.2013.10.076

    View details for PubMedID 24424011

  • Outcomes of open distal aortic aneurysm repair in patients with chronic DeBakey type I dissection. The Journal of thoracic and cardiovascular surgery Coselli, J. S., Green, S. Y., Zarda, S. n., Nalty, C. C., Price, M. D., Hughes, M. S., Preventza, O. n., de la Cruz, K. I., LeMaire, S. A. 2014; 148 (6): 2986–93.e1–2

    Abstract

    In patients with acute DeBakey type I dissection, endovascular repair of the descending thoracic aorta during proximal aortic repair is an increasingly popular approach to preventing distal aortic sequelae and subsequent repair. To better define the risks and outcomes associated with these secondary operations, we examined our contemporary experience with open distal aortic repair in patients with chronic type I aortic dissection.Data were collected between January 2005 and June 2013 regarding 198 consecutive open descending thoracic (n = 27) or thoracoabdominal (n = 171) aortic repairs performed in patients with chronic type I dissection. The median interval between the dissection onset and the subsequent distal operation was 5.0 years (interquartile range, 2.4-10.5 years). A total of 110 repairs (56%) were performed in patients with genetic disorders.There were 14 early deaths (7%). Permanent paraplegia developed in 2 patients (1%), 5 patients (3%) had permanent stroke, and 9 patients (5%) had permanent renal failure. Factors associated with early death included greater age (P = .01), chronic obstructive pulmonary disease (P = .01), clamping proximal to the left subclavian artery (P = .004), and use of hypothermic circulatory arrest (P = .002). The use of cold renal perfusion (P < .001) was associated with early survival. Early death was not associated with genetic disorders, emergency surgery, or extent of aortic repair. There were 36 late deaths, yielding an actuarial 8-year survival of 65.6% ± 5.9%. At 7 years, freedom from repair failure was 95.7% ± 1.7%, and freedom from subsequent repair for disease progression was 84.8% ± 4.6%.In survivors of DeBakey type I aortic dissection with distal aneurysm, open repair of the descending thoracic or thoracoabdominal aorta can be performed with excellent early survival, acceptable morbidity, and relatively few late aortic events.

    View details for DOI 10.1016/j.jtcvs.2014.07.048

    View details for PubMedID 25212053