Endocrine Practice最新文献

{"title":"Thyroid Function and Non-alcoholic Fatty Liver Disease in Children and Adolescent With Obesity: A Systematic Review and Meta-Analysis","authors":"Elisa Gatta MD,&nbsp;Massimiliano Ugoccioni MD,&nbsp;Elena Gandossi MD,&nbsp;Andrea Delbarba MD,&nbsp;Barbara Agosti MD,&nbsp;Ilenia Pirola MD,&nbsp;Mario Rotondi MD,&nbsp;Carlo Cappelli MD","doi":"10.1016/j.eprac.2026.04.002","DOIUrl":"10.1016/j.eprac.2026.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between thyroid function and non-alcoholic fatty liver disease (NAFLD) in pediatric obesity remains incompletely defined. This systematic review and meta-analysis aimed to quantitatively assess the association between thyroid function parameters and NAFLD in children and adolescents with obesity.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted through December 31, 2025. Observational studies evaluating thyroid function in children and adolescents with obesity, stratified by the presence or absence of NAFLD, were included. Hepatic steatosis was diagnosed using imaging, histology, or validated noninvasive scores. Random-effects meta-analyses were performed to compare serum thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine levels between groups. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies version 2.</div></div><div><h3>Results</h3><div>Ten studies encompassing 5145 participants were included. Meta-analysis of 6 studies (<em>n</em>= 3076) demonstrated significantly higher TSH levels in patients with NAFLD compared with controls without NAFLD (mean difference 0.37 mIU/L; 95% confidence interval [CI] 0.07-0.66), with moderate heterogeneity (I²= 48.7%). No significant differences were observed for free thyroxine (standardized mean difference −0.35; 95% CI −1.15 to 0.45) or free triiodothyronine (standardized mean difference 0.35; 95% CI −0.26 to 0.96). Sensitivity analyses confirmed the robustness of the TSH association.</div></div><div><h3>Conclusion</h3><div>In pediatric obesity, NAFLD is associated with higher TSH levels in the absence of significant changes in circulating thyroid hormone concentrations. These findings suggest that hyperthyrotropinaemia may represent a metabolic marker of hepatic steatosis rather than an adaptive physiological response. Prospective studies are needed to clarify causality and clinical implications.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 9","pages":"Pages 1422-1429"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-exercise Glucose Management in Type 1 Diabetes: Comparing Carbohydrate Intake and Insulin Reduction Strategies","authors":"Sémah Tagougui PhD,&nbsp;Elsa Heyman PhD,&nbsp;Nadine Taleb MD, PhD,&nbsp;Joséphine Molveau PhD,&nbsp;Virginie Messier MSc,&nbsp;Corinne Suppere MSc,&nbsp;Roxane St-Amand MSc,&nbsp;Laurent Legault MD,&nbsp;Rémi Rabasa-Lhoret MD, PhD","doi":"10.1016/j.eprac.2026.03.106","DOIUrl":"10.1016/j.eprac.2026.03.106","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to compare 2 post-exercise glucose management approaches in type 1 diabetes patients using continuous subcutaneous insulin infusion.</div></div><div><h3>Methods</h3><div>A group of 46 adults and adolescents underwent a 60-minute ergocycling session at 60% of their VO_2peak at 4 <span>pm</span> After the exercise, participants were randomly assigned to post-exercise glucose management strategies: The first strategy involved a 20% reduction in basal insulin infusion rate for 10 h, along with a 20% reduction in the dinner insulin bolus. The second strategy consisted of consuming a post-exercise snack with 50% of their usual insulin bolus, followed by an evening snack without insulin bolus.</div></div><div><h3>Results</h3><div>During the 13-hours of recovery (5 PM to 6 AM post-exercise), there were no significant differences between the 2 strategies in terms of time spent within blood glucose levels of 4.0-10.0 mmol/l (54.4 ± 26.2 vs 57.7 ± 25.9%) and time spent below 4.0 mmol/l (1.8 ± 5.9 vs 5.5 ± 9.2%), this difference did not reach statistical significance, likely due to high interindividual variability as reflected by the large standard deviations. However, the time to first hypoglycemic event (eg, time from exercise end to first interstitial glucose &lt;4.0 mmol/L) was significantly longer with the basal insulin reduction strategy (140 vs 83 min, <em>P</em>= .04), indicating a clinically meaningful advantage in delaying post-exercise hypoglycemia.</div></div><div><h3>Conclusions</h3><div>Both strategies were comparably effective in maintaining similar blood glucose stability during the 13-hours recovery period post-exercise. However, the basal insulin reduction strategy significantly delayed the onset of the first hypoglycemic episode, suggesting a potential advantage for post-exercise hypoglycemia management.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 9","pages":"Pages 1347-1352"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Effects of Alogliptin, Linagliptin, Saxagliptin, and Sitagliptin: A Target Trial Emulation of a Comparative Effectiveness Study","authors":"Urja N. Kalathiya BS,&nbsp;Kimberly Yuang MD,&nbsp;Jeph Herrin PhD,&nbsp;Kavya Sindhu Swarna MPH,&nbsp;Yihong Deng PhD,&nbsp;Eric C. Polley PhD,&nbsp;Joshua J. Neumiller PharmD,&nbsp;Rodolfo J. Galindo MD,&nbsp;Guillermo E. Umpierrez MD,&nbsp;Joseph S. Ross MD, MHS,&nbsp;Juan P. Brito MD,&nbsp;Victor M. Montori MD,&nbsp;Bijan J. Borah PhD,&nbsp;Bradley A. Maron MD,&nbsp;Mindy M. Mickelson MA,&nbsp;Rozalina G. McCoy MD, MS","doi":"10.1016/j.eprac.2026.04.004","DOIUrl":"10.1016/j.eprac.2026.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>To compare major adverse cardiovascular event (MACE) risks among available dipeptidyl peptidase-4 inhibitors among adults with type 2 diabetes at moderate cardiovascular risk.</div></div><div><h3>Methods</h3><div>Using claims data of enrollees in commercial, Medicare Advantage, and traditional Medicare plans between 2014 and 2021, we identified adults (≥21 years) with type 2 diabetes, moderate cardiovascular risk, and not requiring insulin who initiated alogliptin, linagliptin, saxagliptin, or sitagliptin. Random treatment assignment was emulated using propensity scores estimated using the super learner ensemble and incorporated as inverse probability of treatment weights into Cox models examining MACE (myocardial infarction, stroke, all-cause mortality), heart failure hospitalization (HHF), arterial revascularization, and hypoglycemia requiring emergency department/hospital use, with weighted median follow-up times calculated for each treatment arm.</div></div><div><h3>Results</h3><div>The weighted study cohort included 184,660 patients starting alogliptin (<em>N</em>= 2541), linagliptin (<em>N</em>= 42,433), saxagliptin (<em>N</em>= 15,649), and sitagliptin (<em>N</em>= 124,038) with median weighted follow-up of 39.5 (95% CI 35.8-41.6), 40.9 (95% CI 40.5-41.3), 42.6 (95% CI 41.7-43.3), and 42.4 (95% CI 42.2-42.6) months, respectively. One year after DDP4i initiation, MACE rates were 2.2%, 2.2%, 2.0%, and 1.7% for sitagliptin, linagliptin, saxagliptin, and alogliptin, respectively; HHF rates were 0.42%, 0.41%, 0.41%, and 0.37%; and hypoglycemia rates were 0.2%, 0.2%, 0.2%, and 0.2%. Saxagliptin was associated with modestly decreased risk of MACE vs sitagliptin (HR 0.94; 95% CI 0.88-0.99) and linagliptin (HR 0.94; 95% CI 0.87-1.00). There was no significant difference in HHF or hypoglycemia risk among the study drugs.</div></div><div><h3>Conclusion</h3><div>Risks of MACE, HHF, and hypoglycemia were comparable with all DPP4i. Choice of medication may be determined based on local availability.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 9","pages":"Pages 1353-1361"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of ACR TI-RADS and Sonographic Predictors of Malignancy in Pediatric Thyroid Nodules","authors":"Nofar Edri MD,&nbsp;Nir Tsur MD,&nbsp;Roy Hod MD,&nbsp;Eyal Robenshtok MD,&nbsp;Gideon Bachar MD,&nbsp;Dan Yaniv MD,&nbsp;Moshe Yehuda MD,&nbsp;Amit Ritter MD,&nbsp;Eyal Yosefof MD","doi":"10.1016/j.eprac.2026.05.004","DOIUrl":"10.1016/j.eprac.2026.05.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Pediatric thyroid nodules are uncommon but carry a substantially higher risk of malignancy than adult nodules. Accurate risk stratification is crucial, as even modest false-negative rates can have significant clinical implications. Adult-based Thyroid Imaging Reporting and Data System (TI-RADS) is widely used for sonographic risk assessment. However, its performance in children remains unclear.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of 99 pediatric patients surgically treated for a thyroid nodule. Preoperative sonographic characteristics and TI-RADS category were assessed, and associations with malignancy were analyzed. Diagnostic performance metrics were calculated, and Srivatsa PED TI-RADS biopsy thresholds were externally validated.</div></div><div><h3>Results</h3><div>Of 99 patients, 60 (60.6%) had malignant pathology. Malignancy increased across TI-RADS categories, reaching 100% in TR5; however, rule-out performance was limited, with a negative predictive value of 74.4% for TR1–TR3 and an overall missed malignancy rate of 18.3%. Overall sensitivity and specificity were 81.7% and 82.1%, with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.78-0.92). Only irregular margins (OR 13.3; <em>P</em> = .03) and microcalcifications (OR 5.9; <em>P</em> &lt; .001) were independently associated with malignancy. Srivatsa PED TI-RADS increased biopsy eligibility (62.9% vs 53.6%) and improved sensitivity (77.6% vs 69.0%), with lower specificity (59.0% vs 69.2%).</div></div><div><h3>Conclusions</h3><div>In this tertiary-care, surgically managed pediatric cohort, American College of Radiology TI-RADS showed reasonable discrimination but limited rule-out performance in TR1–TR3. Srivatsa PED TI-RADS improved sensitivity at the cost of lower specificity. Findings may not generalize to unselected pediatric populations. Irregular margins and microcalcifications were the strongest predictors and may inform pediatric-specific risk stratification. Prospective validation in unselected cohorts is warranted.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 9","pages":"Pages 1340-1346"},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Hyperthyroidism in Pregnancy.","authors":"Sangeetha Gummalla, Mayura R Kesara, Spyridoula Maraka","doi":"10.1016/j.eprac.2026.08.017","DOIUrl":"10.1016/j.eprac.2026.08.017","url":null,"abstract":"<p><p>Hyperthyroidism in pregnancy most commonly results from gestational transient thyrotoxicosis (GTT), though Graves' disease and, less frequently, toxic nodular disease also occurs. Differentiating these conditions requires integration of clinical findings, trimester-specific thyroid function test thresholds, and thyroid-stimulating immunoglobulin measurement when an autoimmune etiology is suspected. Untreated or inadequately managed overt maternal hyperthyroidism that is not due to GTT is associated with significant maternal and fetal complications, including preeclampsia, thyroid storm, growth restriction, and fetal or neonatal thyrotoxicosis. Graves' disease management requires a delicate balance between achieving maternal euthyroidism and minimizing fetal drug exposure. Propylthiouracil is preferred during the first trimester to reduce teratogenic risk. If antithyroid drug (ATD) therapy is still required beyond 16 weeks of gestation, the decision to continue propylthiouracil or switch to methimazole should be guided by shared decision-making between the patient and clinician. The use of the lowest effective ATD dose and close biochemical monitoring remain fundamental principles. Beta-adrenergic blockade may provide short-term symptomatic relief, whereas iodides are reserved for selected patients who are intolerant to ATDs. Thyroidectomy is typically reserved for patients with refractory hyperthyroidism or contraindications to ATDs and is preferably performed during the second trimester of pregnancy. Postpartum relapse of Graves' disease is common. Methimazole is considered safe during lactation at low doses, with no adverse effects on infant growth or neurodevelopment, while radioactive iodine therapy remains contraindicated. Collectively, contemporary evidence emphasizes early diagnosis, individualized therapy, and multidisciplinary care as central to optimizing maternal and fetal outcomes in hyperthyroidism during the reproductive years.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Artificial Intelligence in Diagnosis and Management of Thyroid Disease.","authors":"Johnson Thomas, Gonzalo Diaz Soto","doi":"10.1016/j.eprac.2026.08.018","DOIUrl":"10.1016/j.eprac.2026.08.018","url":null,"abstract":"<p><p>Artificial intelligence (AI) is transforming thyroid care, with applications spanning ultrasound risk stratification, cytopathology, histopathology, radiogenomics, prognosis, intraoperative parathyroid identification, thyroid eye disease, functional thyroid disorders, and clinical decision support. This narrative review summarizes the evidence and barriers to adoption. Ultrasound-based AI for thyroid nodule risk stratification is the most mature application. Deep learning-assisted cytopathology and intraoperative frozen-section analysis show promise in resolving indeterminate Bethesda nodules. Radiomics and digital pathology can non-invasively predict BRAF V600E, RAS, fusion alterations, and inflammatory subtypes, although most tools remain investigational. Machine learning refines recurrence prediction beyond conventional risk stratification and informs radioiodine response and dose selection. In thyroid and parathyroid surgery, AI-augmented near-infrared autofluorescence is advancing toward real-time intraoperative gland identification. AI also supports thyroid eye disease activity assessment and glucocorticoid response prediction, and emerging tools target hyper- and hypothyroidism, including differentiation of Graves' disease from thyroiditis and levothyroxine dose optimization. Large language models are improving in patient education but are not approved for diagnostic use and remain prone to fabricated citations and version drift. AI should be regarded as a decision-support adjunct that augments, rather than replaces, endocrinologist judgment, contingent on prospective multicenter validation, equitable access, transparent reporting, and defined reimbursement frameworks.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild Autonomous ACTH Secretion: A Narrative Review of 52 Cases from the Literature.","authors":"Federico Nicoli, Cristina Eller-Vainicher, Renato Cesare Cozzi, Iacopo Chiodini, Vittoria Favero","doi":"10.1016/j.eprac.2026.08.016","DOIUrl":"10.1016/j.eprac.2026.08.016","url":null,"abstract":"<p><p>Mild autonomous adrenocorticotroph hormone secretion (MAAS) is an autonomous pituitary-derived hypercortisolism occurring in the absence of overt signs and symptoms of Cushing syndrome. MAAS is still an underdiagnosed and poorly understood condition. We systematically collected 52 cases of MAAS published in the literature from 1994 to 2026 with the purpose to outline MAAS onset, clinical and biochemical features, pituitary-imaging findings, therapy and clinical outcome, histological and molecular features. MAAS affects a wide age range (18-83 years), with a predominance in women (60%). It is found in about 5% of patients with pituitary adenomas and should not be overlooked in patients with acromegaly. It is associated with significant metabolic complications including hypertension (56%) and type 2 diabetes (57%). A 1 mg-dexamethasone suppression tests value > 1.8 μg/dL with nonsuppressed adrenocorticotroph hormone levels support the diagnosis of MAAS, while low dose dexamethasone suppression tests and 24 hours free urinary cortisol may have limited sensitivity in this setting. MAAS may present with pituitary microadenomas, macroadenomas, or even radiologically occult lesions. Surgery often leads to improvements in glycemic control and blood pressure while clinical follow up may be essential in case of nonidentifiable lesion. Further prospective research is needed to better clarify clinical, biochemical and molecular feature of MAAS.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of vitamin D combined with probiotic-assisted insulin pump on glucose-lipid metabolism, intestinal flora and pregnancy outcome in gestational diabetes mellitus.","authors":"Min Chen, Chanjuan Li, Zhijing Miao","doi":"10.1016/j.eprac.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.08.015","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to observe the effect of vitamin D combined with probiotic-assisted insulin pump on glucose-lipid metabolism, intestinal flora and pregnancy outcome in gestational diabetes mellitus (GDM).</p><p><strong>Methods: </strong>A total of 150 GDM patients were randomized into the study and control groups (n=75 each). All patients were admitted to the hospital to receive diet, nutrition and exercise guidance, the control group was given insulin aspart pump therapy plus vitamin D, and the study group received insulin aspart pump therapy plus vitamin D and Viable Bifidobacterium Tablets. Outcomes included glycemic and lipid metabolic indices, gut microbiota changes, standard-reaching rates of blood glucose, and adverse pregnancy outcomes.</p><p><strong>Results: </strong>After treatment, levels of HDL-C, counts of Bifidobacterium and Lactobacillus were increased in both groups (P < 0.05), and levels of FINS, FPG, 2hPG, HbA1c, LDL-C, TC, TG, counts of Coccidioides, Enterobacteriaceae, and Saccharomycetes were all reduced (P < 0.05); and all of them were improved in the study group versus the control group (P < 0.05). The study group also showed higher standard-reaching rates of blood glucose (96.00% vs. 84.00%) and lower overall incidence of adverse pregnancy outcomes (14.67% vs. 33.33%) than the control group (all P < 0.05).</p><p><strong>Conclusion: </strong>Compared with insulin pump plus vitamin D therapy, the addition of probiotics may improve blood glucose and lipid metabolism in GDM patients, maintain intestinal microbiota balance, and reduce the risk of adverse pregnancy outcomes. Further multicenter, large sample size, double blind and placebo-controlled studies are needed to confirm these findings.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Year-in-Review 2025-2026: Precision Medicine and De-escalation in Contemporary Thyroidology.","authors":"Anupam Kotwal, Ana-Maria Chindris, Kaniksha Desai, Omar El Kawkgi, Malini Gupta, Shuchie Jaggi, Rokshana Thanadar","doi":"10.1016/j.eprac.2026.08.014","DOIUrl":"10.1016/j.eprac.2026.08.014","url":null,"abstract":"<p><p>The \"Thyroid: Year in Review,\" presented at the AACE 2026 annual meeting, synthesized practice-influencing peer-reviewed clinical research published between March 1, 2025 and February 15, 2026. This narrative review, based on that presentation, highlights 2 overarching themes in clinical thyroidology: precision medicine and de-escalation when appropriate. In thyroid dysfunction, recent studies support lean body mass-based levothyroxine dosing and the metabolic integration of liothyronine. The management of thyroid nodules and differentiated thyroid cancer has shifted toward de-escalation, favoring nonsurgical interventions, active surveillance for low-risk malignancies, selective omission of radioactive iodine, de-escalation of surveillance strategies, and the complementary use of artificial intelligence with molecular testing to improve diagnostic accuracy in indeterminate nodules. This review summarizes these findings and their implications for contemporary evidence-based endocrine practice.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Year Real-Life Achievements of MiniMed 780G Advanced Closed-Loop System in Youth With Type 1 Diabetes: AWeSoMe Study Group Multicenter Prospective Extended Follow-Up.","authors":"Yael Lebenthal, Talia Jacobi-Polishook, Shirli Abiri, Kineret Mazor-Aronovitch, Avivit Brener, Tal Ben Ari, Neriya Levran, Noah Levek, Avigail Wittenberg, Zohar Landau, Marianna Rachmiel, Orit Pinhas-Hamiel, Noah Gruber","doi":"10.1016/j.eprac.2026.08.013","DOIUrl":"10.1016/j.eprac.2026.08.013","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether glycemic benefits of the MiniMed 780G Advanced Hybrid Closed-Loop system are sustained over 2 years in youth with type 1 diabetes, and to identify outcome predictors.</p><p><strong>Methods: </strong>This prospective multicenter study collected continuous glucose monitoring (CGM) and clinical data at 1, 3, 6, 12, and 24 months in 96 children and adolescents with type 1 diabetes. Outcomes included hemoglobin A1c, CGM metrics, composite glycemic control score, glycemia risk index, composite CGM index, SmartGuard use, and anthropometric changes, analyzed by repeated-measures linear mixed models.</p><p><strong>Results: </strong>Hemoglobin A1c and time in range were maintained from 12 to 24 months, but time below range increased (1.8-2.5%, P = .015). Composite targets were rarely met: CGC by 14.6%, best GRI by 9.4%, best COGI by 10.4%. SmartGuard use declined from 91.3% to 82.7% (P = .013); lower socioeconomic position and lower 12-month SmartGuard use were independently associated with this decline. Girls had lower glycemic variability than boys and greater BMI z-score increase. Five DKA and 2 severe hypoglycemia events occurred, all device-or behavior-related.</p><p><strong>Conclusion: </strong>The 780G Advanced Hybrid Closed-Loop system sustained meaningful glycemic benefits over 2 years, yet most youth failed to achieve optimal composite glycemic control. SmartGuard decline during the second year suggests the 12-month visit as a candidate checkpoint for monitoring device engagement, warranting evaluation in a future interventional trial.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}