Endocrine Practice最新文献

{"title":"Evaluating the Economic Impact of Project ECHO Diabetes: Cost Savings from HbA1c Reduction in Type 1 and Type 2 Diabetes.","authors":"Noah Hammarlund, Ara Jo, Ashby F Walker, Michael J Haller, David M Maahs, Benjamin Churba, Keilecia G Malden, Molly Jacobs","doi":"10.1016/j.eprac.2025.06.025","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.025","url":null,"abstract":"<p><strong>Objectives: </strong>Elevated HbA1c levels (>9%) increase the risk of complications and drive higher healthcare costs, particularly in communities with limited access to specialty care. Project ECHO Diabetes offers a scalable tele-education model to empower primary care providers in delivering effective diabetes management. This study assessed the economic impact of Project ECHO Diabetes by estimating healthcare cost savings from reductions in HbA1c levels >9% and comparing these savings against program costs.</p><p><strong>Methods: </strong>A stepped-wedge design was used to implement Project ECHO Diabetes across Federally Qualified Health Centers (FQHCs) in California and Florida between 2021 and 2022. Data were collected before and after the 6-month intervention to assess HbA1c changes, with healthcare cost savings estimated using established literature and adjusted to 2023 USD.</p><p><strong>Results: </strong>The study included 32,796 adults with Type 1 diabetes (T1D; n=1,127) or Type 2 diabetes (T2D; n=31,669). The intervention consisted of bi-monthly tele-education sessions, real-time medical support, and access to diabetes management resources over six months. The primary outcome was healthcare cost savings derived from HbA1c reductions >9% and comparison with program costs. The proportion of patients with HbA1c >9% decreased from 31.7% to 26.7% for T1D and 24.0% to 18.9% for T2D. Estimated first-year per-patient savings were $3,205.95, with total program savings exceeding $5 million, far outweighing implementation costs of $513,257.</p><p><strong>Conclusions: </strong>Project ECHO Diabetes achieved substantial cost savings through improved glycemic control, supporting its broader implementation to enhance diabetes care and reduce healthcare costs.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567328","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":"DIFFERENT GLYCEMIC VARIABILITY IN WOMEN WITH POLYCYSTIC OVARY SYNDROME WITH AND WITHOUT INSULIN RESISTANCE: A PILOT STUDY.","authors":"Alessandro Rizzi, Teresa Polimeno, Maria Laura Leo, Ambra Moriconi, Martina Policriti, Linda Tartaglione, Annamaria Merola, Anna Tropea, Rosanna Apa, Dario Pitocco","doi":"10.1016/j.eprac.2025.06.020","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.020","url":null,"abstract":"<p><strong>Introduction: </strong>Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder that affects 10-13% of women in reproductive age and it is often associated with insulin resistance (IR). There is lack of evidence about glucose profiles evaluated throughout continuous glucose monitoring (CGM) in women with PCOS, especially according to the presence of IR.</p><p><strong>Methods: </strong>Women with PCOS ≥18 years old underwent CGM (Freestyle Libre 2, Abbott®) for 14 days. Insulin resistance was defined by homeostatic model assessment for insulin resistance (HOMA-IR) >2 or quantitative insulin sensitivity check index (QUICKI) <0.357. CGM metrics were compared between the two groups. Associations between hormonal assays and CGM metrics were also evaluated.</p><p><strong>Results: </strong>In 36 women with PCOS, median age 22 [18-26] years, BMI 27.5 (6.6) Kg/m², time in range (TIR, 70-180 mg/dl) and time in tight range (TiTR, 70-140 mg/dl) were comparable between women with and without IR (p>0.05). Independently to the score used to evaluate IR, women with IR presented lower coefficient of variation compared to those without IR (using HOMA-IR, CV non-IR 17.1 [12.0-19.8] vs IR 13.5 [11.2-15.5], p=0.04; using QUICKI non-IR 17.3 [11.2-19.9] vs IR 13.8 [10.9-15.7], p=0.04). Follicle stimulating hormone was also correlated with mean sensor glucose, time spent above 140 mg/dl and glucose management indicator.</p><p><strong>Conclusion: </strong>Women with PCOS presented overall good glucose control. No differences in TIR and TiTR were detected but women with IR presented lower coefficient of variation.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564698","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":"A Scoping Review of Self-Medication in Exogenous Cushing Syndrome: The Role of Social Determinants of Health in the Case Report Literature.","authors":"Meghana Koleti, Claramence Dokyi, Jean Kim, L Maria Belalcazar","doi":"10.1016/j.eprac.2025.06.024","DOIUrl":"10.1016/j.eprac.2025.06.024","url":null,"abstract":"<p><strong>Objective: </strong>The occurrence of exogenous Cushing syndrome (E-CS) after self-medication with over-the-counter products containing steroids is well documented. However, the potential role of underlying social determinants of health (SDoH) on the practice of self-medication resulting in CS has not been systematically investigated. We aimed to examine the contribution of SDoH on the occurrence of E-CS due to self-treatment in the case report literature.</p><p><strong>Methods: </strong>Adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, we performed a scoping review using primary sources published in the form of case reports or case series from 1998-2024. Only reports in English and on adults were included. Information extracted included SDoH, demographics, product and reason for use, and clinical complications.</p><p><strong>Results: </strong>Thirty-six publications met the inclusion criteria. Seven of 8 reports from the United States involved an over-the-counter product with undisclosed steroid content marketed for joint disease; 19 of 28 international case reports/series involved self-medication with labeled pharmaceutical products. Although complications were consistently identified, SDoH were discussed in only 5 of 36 reports and mentioned in 3. Social factors identified included lack of access to health care, low health literacy, language barriers, and traditional and cultural practices. All reports, except 2, were found in journals with prepublication peer review processes.</p><p><strong>Conclusion: </strong>The presence of SDoH in the case report literature on E-CS due to self-medication is weak. It is necessary to move away from solely disease-focused approaches to those that incorporate SDoH. Peer reviewers and journal editors may help advance change by requesting that case reports/series on self-medication inform on SDoH.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564697","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":"Navigating Uncertainty in Adjuvant Mitotane Therapy","authors":"Massimo Terzolo MD ,&nbsp;Martin Fassnacht MD ,&nbsp;Alfredo Berruti MD ,&nbsp;Cristina Ronchi MD, PhD","doi":"10.1016/j.eprac.2025.03.012","DOIUrl":"10.1016/j.eprac.2025.03.012","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 975-976"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771518","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":"Simplification of the oral sodium loading test: 2-day method replacing 3-day method.","authors":"Zewen Li, Jian Zhong, Yunying Cui, Songlin Yu, Ling Qiu, Anli Tong","doi":"10.1016/j.eprac.2025.06.021","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.021","url":null,"abstract":"<p><strong>Objectives: </strong>As one of the diagnostic tests for primary aldosteronism (PA), the oral sodium loading test (OSLT) usually takes 3 days, which is time-consuming.This study aims to investigate the possibility of the 2-day method replacing the 3-day method in the OSLT.</p><p><strong>Methods: </strong>In this prospective study, both PA patients and healthy participants were recruited and underwent an oral high-sodium diet for 3 consecutive days from December 2023 to December 2024. Daily fasting blood and 24h urine samples were collected before, on the second day, and on the third day of the OSLT.</p><p><strong>Results: </strong>12 PA patients [median age of 51.5 (42.0∼57.0) years, 75% men] and 12 healthy participants [median age of 30.5(24.0-39.8)years, 25% men] were recruited in this study. After oral sodium loading, all participants had a 24h urinary sodium> 200 mmol/24h. 24h urinary aldosterone (UALD) was not significantly different between the second day and the third day in PA patients [18.24 (15.58∼33.83) vs. 17.25 (12.74∼27.06) μg/24h, P=0.583], as well as in healthy participants [2.65 (1.67∼3.82) vs. 2.63 (1.63∼4.34) μg/24h, P=0.747]. There was a strong correlation of 24h UALD on the second day and the third day in both PA patients and healthy participants (r=0.8322 and 0.9333, respectively). Aldosterone-related steroid hormone profile showed no statistically significant difference between the two days, either for PA patients or for healthy participants.</p><p><strong>Conclusions: </strong>This study confirms that the 2-day method can replace the 3-day method in OSLT for a more convenient diagnosis of PA.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559531","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":"Technology Use and Diabetes Management Across Elder Age Groups in Type 1 Diabetes and Latent Auto-Immune Diabetes in Adults, a BETTER Registry Cross-Sectional Analysis","authors":"Yue-Pei Wang MD, MSc ,&nbsp;Laure Alexandre-Heymann MD, PhD ,&nbsp;Virginie Messier MSc ,&nbsp;Valérie Boudreau PhD ,&nbsp;Aude Bandini PhD ,&nbsp;Barbara Kelly MA ,&nbsp;Amélie Gravel MD, PhD ,&nbsp;Claudia Gagnon MD ,&nbsp;Anne-Sophie Brazeau RD, PhD ,&nbsp;Rémi Rabasa-Lhoret MD, PhD","doi":"10.1016/j.eprac.2025.03.009","DOIUrl":"10.1016/j.eprac.2025.03.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Real-world data on diabetes management among a heterogenous aging population remain limited. This study aims to provide an overview of technology use and factors associated to its use, diabetes management, and psychosocial aspects experienced by adults aged 50 and over living with type 1 diabetes or latent autoimmune diabetes in adults.</div></div><div><h3>Methods</h3><div>This cross-sectional study analyzed data from the Canadian BETTER registry, mostly based on self-reported outcomes from individuals living with type 1 diabetes or latent autoimmune diabetes in adults. Comparative analyses were conducted across 3 age groups: 50-59, 60-69, and ≥ 70.</div></div><div><h3>Results</h3><div>Participants (<em>n</em> = 674) were predominantly Caucasian (97% to 98% across groups) and residing in Quebec, Canada (71% to 79%). Insulin pump use was similar across age groups (36% to 39%, <em>P</em> = .822), while continuous glucose monitoring was lower among those aged ≥ 70 years (85% for both 50-59 and 60-69 vs 73% for ≥ 70 years, <em>P</em> = .020). Among other factors, having private insurance and living outside of Quebec were positively associated with both insulin pump and continuous glucose monitoring use. A high proportion (80% to 86%) of participants achieved an HbA1c ≤ 8% across all groups. Level 2 hypoglycemia events in the last month were more frequent among participants aged 50-59 years compared to those aged ≥70 years (6.9 vs 3.4, <em>P</em> = .001). Level 3 hypoglycemia, social and professional support were similar between groups. Interestingly, diabetes-related distress was lower in older age groups.</div></div><div><h3>Conclusions</h3><div>Most individuals in this cohort adopted technology use but in lower proportion among the group aged ≥70. Overall, diabetes management was good and similar between age groups.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 849-857"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729473","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":"Impact of the Addition of Beta-Hydroxybutyrate in the 72-Hour Fast Protocol on Hospitalization Duration: A Quality Improvement Report","authors":"Michelle D. Lundholm MD ,&nbsp;Dianna Jo Copley DNP, APRN-CNS ,&nbsp;Vinni Makin MD ,&nbsp;Pratibha P.R. Rao MD, MPH","doi":"10.1016/j.eprac.2025.04.015","DOIUrl":"10.1016/j.eprac.2025.04.015","url":null,"abstract":"<div><h3>Objective</h3><div>The 72-hour fast is the “gold standard” test for detecting insulinoma but imposes significant burdens on patients and expends hospital resources. Balancing diagnostic accuracy with patient comfort and cost remains challenging. We aimed to leverage the metabolic indicator beta-hydroxybutyrate (BHB), indicative of insulin suppression, to curtail inpatient fasting time without missing insulinoma cases.</div></div><div><h3>Methods</h3><div>Our institution implemented an inpatient 72-hour fast protocol in 2018, and updated the protocol in 2020 to include a BHB &gt;2.7 mmol/L stopping criterion. In this quality improvement and patient safety project, we retrospectively reviewed all patients who completed a 72-hour fast at our institution by the original (January 2018 to June 2020) and updated (June 2020 to December 2022) protocols.</div></div><div><h3>Results</h3><div>Sixty-four patients (78% female, mean age 48 ± 17 years) underwent fasting: 34 patients by the original protocol and 30 patients by the revised protocol. The original protocol had an average fast duration of 57.6 hours (median 72 hours, IQR [49,72]). After the update, 50% (N = 15) ended for BHB &gt;2.7 mmol/L, with an average fast duration of 49.7 hours (median 53 hours, IQR [39.1, 71.8], <em>P</em> = .03). This reduced cumulative inpatient fasting by 376.5 hours and reduced medical costs. All insulinoma cases (N = 7) developed hypoglycemia within 43 hours with BHB ≤1.2 mmol/L; no cases were missed.</div></div><div><h3>Conclusion</h3><div>Adding a BHB &gt;2.7 mmol/L stopping criterion reduced inpatient hospitalization time, medical costs, and patient burden without compromising insulinoma detection. This evidence-based intervention improves patient adherence and more effectively uses hospital resources.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 884-889"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970509","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":"Comment on “ChatGPT-4's Accuracy in Estimating Thyroid Nodule Features and Cancer Risk From Ultrasound Images”","authors":"Amnuay Kleebayoon PhD,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.eprac.2025.04.013","DOIUrl":"10.1016/j.eprac.2025.04.013","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Page 981"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974645","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":"Comment on Patel et al American Association of Clinical Endocrinology Clinical Practice Guideline on Pharmacologic Management of Adults With Dyslipidemia","authors":"Aidar R. Gosmanov MD, PhD, FACE,&nbsp;Niyaz R. Gosmanov MD","doi":"10.1016/j.eprac.2025.03.015","DOIUrl":"10.1016/j.eprac.2025.03.015","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 977-978"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974394","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":"Menopause in Cystic Fibrosis: Special Considerations for Bone Health, Menopausal Symptoms, and Treatment","authors":"Sarah Haroon MD ,&nbsp;Crystal Cobb DO ,&nbsp;Sandy Sufian PhD, MPH ,&nbsp;Raksha Jain MD ,&nbsp;Naim M. Maalouf MD ,&nbsp;Melissa S. Putman MD, MMSc","doi":"10.1016/j.eprac.2025.04.011","DOIUrl":"10.1016/j.eprac.2025.04.011","url":null,"abstract":"<div><div>Cystic fibrosis (CF) is a multisystem autosomal recessive disease arising from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Dysfunction of the CFTR protein leads to progressive pulmonary disease, pancreatic exocrine insufficiency, and nutritional deficiencies. Survival has significantly increased over the last several decades due to improved pulmonary and nutritional management, including CFTR modulator therapy. The adult CF population now faces new challenges of aging, such as menopause-related symptoms and age-related osteoporosis superimposed on underlying CF-related bone disease. The menopausal transition and early postmenopause are characterized by rapid bone loss and represent a window of opportunity to preserve bone mass. Menopausal hormone therapy may alleviate vasomotor symptoms and improve bone density in appropriately selected people. This review will discuss the current knowledge of menopause and bone health in females with CF, address CF-specific considerations on osteoporosis and menopause treatment options, and explore opportunities for future areas of research.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 946-955"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989542","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}