Endocrine Practice最新文献

{"title":"A Systematic Review on the Impact of Electronic Consultations on Diabetes Care.","authors":"Elie Naous, Angela Achkar, Rebecca A Morin, Joanna Mitri","doi":"10.1016/j.eprac.2025.03.001","DOIUrl":"10.1016/j.eprac.2025.03.001","url":null,"abstract":"<p><strong>Objectives: </strong>Primary care physicians (PCPs) are increasingly challenged with managing glycemic control in people with diabetes (PWD), especially in the setting of a shortage in endocrinologists. Electronic consultations (e-consults), which enable asynchronous communication between PCPs and specialists through electronic health records, have been introduced to address these issues. This systematic review aims to evaluate the impact of e-consults on glycemic control in PWD, focusing on changes in HbA1c levels.</p><p><strong>Methods: </strong>Two independent reviewers searched PubMed, EMBASE, and the Cochrane Library, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review encompasses randomized controlled trials and observational studies. Two reviewers extracted data pertaining to prespecified outcomes of each interest from each included study.</p><p><strong>Results: </strong>Summary tables and narrative synthesis were used (PROSPERO 2024 CRD42024503278). Six studies were included, -two randomized controlled trials and 4 observational studies-assessing the role of e-consults in diabetes care. Most studies did not report significant differences in HbA1c levels between e-consult and control groups. However, benefits such as improved medication usage, reduced costs, enhanced access to specialist care, shorter wait times for in-person visits, and better educational opportunities for PCPs were noted. Implementation barriers included PCP familiarity with e-consults and patient adherence. Limitations include inclusion of only 2 trials and 4 observational studies and heterogeneity between them.</p><p><strong>Conclusions: </strong>E-consults provide valuable benefits in managing diabetes, particularly in resource-limited settings. E-consults offer a promising solution to the endocrinologist shortage, though further research is needed to identify which PWD would benefit most.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585061","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 Pragmatic Approach to Monitor for Adrenal Axis Recovery After a Failed Short Synacthen Test.","authors":"Anes Harid, Matthew Rowe, Nishchil Patel, Jinny Jeffery, Daniel Flanagan, Andrew McGovern","doi":"10.1016/j.eprac.2025.02.019","DOIUrl":"10.1016/j.eprac.2025.02.019","url":null,"abstract":"<p><strong>Objective: </strong>To identify a morning cortisol threshold value which confirms non-recovery of the adrenal axis and therefore negates the need for a short Synacthen test (SST) in those with known adrenal axis insufficiency.</p><p><strong>Methods: </strong>We collected data from all SSTs (n = 1570 tests; n = 952 individuals) conducted in our hospital over a 10-year period spanning between 1st February, 2013, and 30th January, 2023. We included all tests where baseline cortisol levels were taken before 9:30 am Both 30- and 60-minute cortisol values were measured. Cortisol was measured using the Abbott Architect method. We used the full SST dataset to construct a quantile regression model to predict the 95% centile of peak cortisol response. This model was refitted to the SST follow-up data for those who failed a first SST (n = 115 tests; n = 66 individuals) to identify the baseline cortisol value below which there was a less than 5% chance of passing an SST.</p><p><strong>Results: </strong>Those with an early morning cortisol of ≤126 nmol/L had ≥95% chance of failing an SST. Sixty percent of follow-up SSTs (69/115) exhibited baseline cortisol values below this threshold, and none of these passed an SST.</p><p><strong>Conclusion: </strong>An early morning cortisol ≤126 nmol/L is common in those followed for adrenal axis recovery and is an accurate indicator of non-recovery. Baseline cortisol measurements are therefore a simple way of screening for adrenal axis recovery. Those with a cortisol of >126 nmol/L should go on to have an SST. Using this approach could considerably reduce the need for follow up SSTs in this patient cohort.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572475","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":"Benefits of Glucagon-like Peptide-1 Receptor Agonists After Kidney Transplantation.","authors":"Sukhdeep S Sahi, Oscar Garcia Valencia, Jie Na, Adley Lemke, Dustin Duffy, Byron Smith, Pavel Navratil, Pooja Budhiraja, Tayyab S Diwan, Naim Issa, Mark D Stegall, Aleksandar Denic, Ahmed A Abdelrheem, Hani M Wadei, Walter D Park, Pankaj Shah, Yogish C Kudva, Aleksandra Kukla","doi":"10.1016/j.eprac.2025.02.020","DOIUrl":"10.1016/j.eprac.2025.02.020","url":null,"abstract":"<p><strong>Objective: </strong>Benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in kidney transplant (KT) recipients have not been adequately studied.</p><p><strong>Methods: </strong>We retrospectively examined the effects of GLP-1 RA on mortality, kidney outcomes and metabolic parameters in KT recipients with type 2 diabetes mellitus (T2DM) treated versus not treated with GLP-1 RA. A reference group of KT recipients not treated with GLP-1 RA was used for comparison. Data were analyzed using analysis of variance, χ2 tests, and generalized estimating equation models. GLP-1 RA was used as a time-dependent model in Cox regression modeling. For survival analysis, the final model fitting was stratified by race-ethnicity.</p><p><strong>Results: </strong>Seventy-seven KT recipients with T2DM were treated with GLP-1 RA for at least 12 months. Reference group included 2094 patients not on GLP-1 RA. The mean (SD) age at transplant was 57.9 (9.5) and 60.8 (9.5) years for the treatment and reference groups, respectively. Median follow-up time from the index date for mortality was 1.5 (IQR 0.99, 2.4) in the treatment and 5.8 (IQR 3.4, 9.1) years in the reference group. GLP-1 RA use was associated with improved survival (P = .049), decreased urine albumin to creatinine ratio (net reduction of 10.62 mg/g per year, P = .003), slower estimated glomerular filtration rate decline (1.04 vs 1.56 mL/min/1.73 m² per year, P = .04), and lower troponin levels.</p><p><strong>Conclusions: </strong>GLP-1 RA in KT recipients with T2DM was associated with reduced mortality, and improved kidney function compared to the reference group. Larger, prospective studies are needed to fully evaluate the risks and benefits of GLP-1 RA therapy in KT recipients.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585064","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":"Adrenocorticotropic Hormone Measured by Immulite 1000 and Elecsys Assay Platforms in Suspected Cases of Hypocortisolism: A Word of Caution.","authors":"Arijit Singha, Pradip Mukhopadhyay, Sujoy Ghosh","doi":"10.1016/j.eprac.2025.02.018","DOIUrl":"10.1016/j.eprac.2025.02.018","url":null,"abstract":"<p><strong>Objective: </strong>Several reports suggested that adrenocorticotropic hormone (ACTH) level measured by Immulite 1000 may be falsely elevated leading to misdiagnosis of etiology of Cushing syndrome. However, when it comes to fallacies of ACTH measurement in suspected cases of hypocortisolism, evidence is limited. We explored the performance of ACTH assays using Immulite 1000 and Elecsys Cobas immunoassay platforms in subjects with hypocortisolism.</p><p><strong>Methods: </strong>In this observational, cross-sectional study, 104 patients with haemoglobin E/beta-thalassemia were subjected to 9 am serum cortisol, direct renin concentration, and plasma aldosterone. Plasma ACTH was measured in Immulite 1000 and Elecsys Cobas platforms. Both 1 μg and 250 μg Synacthen stimulation tests were performed to diagnose adrenal insufficiency.</p><p><strong>Results: </strong>Among 104 patients with haemoglobin E/beta-thalassemia, 34 had primary adrenal insufficiency, 9 had secondary adrenal insufficiency, and 33 had subclinical adrenal insufficiency. Mean plasma ACTH (n = 104) measured by Immulite 1000 and Elecsys was 83.42 ± 63.46 pg/mL versus 52.10 ± 38.14 pg/mL, respectively (P < .001). The values had good correlation (r = 0.341, P < .001); however, the agreement between measured values was not strong (Cohen's κ = 0.208, P = .001). With regard to the diagnosis of primary adrenal insufficiency, specificity of Immulite 1000 was low compared with Elecsys (27.86% vs 80.32%). Furthermore, 2 patients with secondary adrenal insufficiency had inappropriately elevated ACTH measured at Immulite 1000 assay platform.</p><p><strong>Conclusion: </strong>Use of Immulite 1000 platform may result in falsely elevated ACTH values. Physicians should exercise caution while interpreting the results and repeat test using a different assay platform may be considered.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572498","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":"Cardiovascular Outcomes of Patients With Type 2 Diabetes With Urinary Tract Infection Post Sodium-Glucose Cotransporter 2 Inhibitors Treatment: A Multicenter Observational Study.","authors":"Tse-Lun Hsu, Feng-Hsuan Liu, Jui-Hung Sun, Yi-Hsuan Lin, Chih-Yiu Tsai, Chia-Hung Lin","doi":"10.1016/j.eprac.2025.02.014","DOIUrl":"10.1016/j.eprac.2025.02.014","url":null,"abstract":"<p><strong>Objective: </strong>Urinary tract infection (UTI) is an adverse effect of sodium-glucose cotransporter 2 inhibitors (SGLT2is). However, its effect on cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients remains unclear.</p><p><strong>Methods: </strong>This multicenter retrospective observational study included diabetes patients who received SGLT2is between January 2016 and January 2019. Major adverse cardiovascular events (MACEs) were defined as a composite of nonfatal myocardial infarction, nonfatal stroke, cardiac death, all-cause death, or hospitalization due to heart failure. Outcomes were compared between patients with and without UTI. Multivariate analyses were conducted to adjust for baseline characteristics that might influence the outcomes.</p><p><strong>Results: </strong>We retrospectively reviewed 8862 T2DM patients who had been treated with SGLT2i. In total, 550 patients were identified as having UTIs and requiring antibiotics after SGLT2i treatment. We followed up on the cardiovascular outcomes for 30 months after SGLT2i treatment. After adjusting significant baseline characters, the UTI group exhibited increased risk of MACE (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] = 1.60-2.57, P < .0001), heart failure hospitalization (aHR = 1.66, 95% CI = 1.32-2.09, P < .0001), and all-cause mortality (aHR = 2.67, 95% CI = 2.10-3.40), P < .0001).</p><p><strong>Conclusion: </strong>UTI in patients with T2DM post-SLGT2i therapy is associated with an increased risk of MACE for up to 30 months.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566517","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":"People With Adrenal Insufficiency Who Are in Adrenal Crisis Are Frequently Unable to Self-Administer Rescue Injections.","authors":"Whitaker J Hover, Aiden D Krein, Julia Kallet, Gregory L Kinney, Phyllis W Speiser, Selma F Witchel, Diane Donegan, Alexandra Ahmet, Julia Anthony, Sofia Llahana, Susan L Majka, Michal F Slovick, Joshua D Stilley, Paul L Margulies, Michael T McDermott, Erin A Foley, Elizabeth A Regan","doi":"10.1016/j.eprac.2025.02.017","DOIUrl":"10.1016/j.eprac.2025.02.017","url":null,"abstract":"<p><strong>Objective: </strong>Individuals with adrenal insufficiency (AI) are at risk of acute adrenal crisis and death, particularly during illness or trauma, and may require rapid treatment with parenteral glucocorticoid such as hydrocortisone to manage a crisis. Current guidelines recommend timely self-injection in an evolving crisis. Little is known about the patient experience with emergency injections. We surveyed people with AI regarding success with emergency injections.</p><p><strong>Methods: </strong>In 2022 a survey was conducted through the National Adrenal Diseases Foundation website of individuals with AI or their caregivers about experience with managing an adrenal crisis. They reported on adrenal crisis events that required an emergency cortisol injection and the success or failure of the injection, context of the event and reasons for failure.</p><p><strong>Results: </strong>Nearly half (41%) of adrenal insufficient patients were unable to self-administer an emergency glucocorticoid injection, citing effects of their crisis-associated illness and confusion as major barriers. Failed injections led to bad outcomes (sicker, need for hospitalization, or death) in 36% of cases.</p><p><strong>Conclusions: </strong>Effective, timely, management of an impending adrenal crisis can prevent progression to hospitalization, multisystem failure requiring intensive care unit care, and death. Reliance solely on patient self-injection may result in worse outcomes. Treating physicians should include patient education about injections and specific practical instruction in the technique, as well as the potential need for assistance in a crisis. US Food and Drug Administration approval of a glucocorticoid autoinjector, greater engagement with Emergency Medical Services clinicians, hospital emergency staff, and other health care professionals, is key for future success in managing adrenal crises.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566520","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":"Iodine and Hyperthyroidism: A Double-Edged Sword","authors":"Kate D. Braverman,&nbsp;Elizabeth N. Pearce MD, MSc","doi":"10.1016/j.eprac.2024.10.014","DOIUrl":"10.1016/j.eprac.2024.10.014","url":null,"abstract":"<div><h3>Objective</h3><div>This article serves as an update to a 1995 review by Braverman and Roti that was publishsed in the inaugural issue of <em>Endocrine Practice</em>.</div></div><div><h3>Methods</h3><div>We searched PubMed for relevant English-language literature and identified additional papers cited in recent reviews.</div></div><div><h3>Results</h3><div>Iodine is a trace element found in the Earth’s crust that is necessary for the biosynthesis of thyroid hormones. Excessive iodine exposure can lead to hyperthyroidism due to the failure of normal homeostatic mechanisms. Iodine-induced hyperthyroidism occurs most frequently in historically iodine-deficient regions, where there is an increased prevalence of autonomously functioning thyroid nodules, but this can also occur in regions with optimal background iodine intakes. Potential sources of iodine excess include iodized salt, seaweed, iodine-containing supplements, drinking water, iodinated contrast media, and amiodarone. In addition to being a potential cause of hyperthyroidism, inorganic iodine may be used to treat Graves’ hyperthyroidism and thyroid storm, although there is a risk that this may worsen hyperthyroidism in some patients. Inorganic iodine is also used as a preoperative treatment to reduce thyroid vascularity before thyroidectomy.</div></div><div><h3>Conclusion</h3><div>Recognizing potential sources of iodine and patients who may be particularly vulnerable to the effects of iodine excess can help to identify and prevent hyperthyroidism.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 3","pages":"Pages 390-395"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603644","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":"Glucose Disorders in Patients With Pheochromocytoma/Paraganglioma: Profile and Influence Effects in a Large Cohort With 705 Patients","authors":"Wenqian Zhang MD ,&nbsp;Jie Yu MD ,&nbsp;Yinghan Chen MD ,&nbsp;Yue Zhou MD ,&nbsp;Yunying Cui MD ,&nbsp;Tianyi Li MD ,&nbsp;Yu Wang MD ,&nbsp;Weidong Ren MD ,&nbsp;Anli Tong MD ,&nbsp;Yuxiu Li MD","doi":"10.1016/j.eprac.2024.11.004","DOIUrl":"10.1016/j.eprac.2024.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>Some patients with pheochromocytoma and paraganglioma (PPGL) suffer from glucose metabolic disorders. The aim was to investigate the relationship between glucose metabolic disorders and catecholamine levels in 705 patients with PPGL.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the clinical data of 705 patients diagnosed with PPGL at Peking Union Medical College Hospital from 2018 to 2023. Bar chart was utilized to depict the manifestations of glycemic disorder across different genders, age groups, body mass index, and catecholamine secretion types. Comparison of characteristics between patients with PPGL who had glycemic disorders and those who did not was conducted. Binary logistic regression analysis coupled with receiver operating characteristic curves was utilized to predict the occurrence of glycemic disorders.</div></div><div><h3>Results</h3><div>Of 705 patients, 492 patients were diagnosed with glucose abnormalities, while the remaining 213 had normal glucose metabolism. Compared to the normal glycemic group, the glycemic disorder group had significantly higher levels of HOMA-IR and TyG index, as well as higher high density lipoprotein, low-density lipoprotein, and total cholestrol. Univariate logistic regression identified age, norepinephrine, and epinephrine as independent risk factors for the occurrence of glucose metabolism disorders. After adjusting for confounding variables, age at diagnosis and norepinephrine levels both remained significant, confirming their roles as key risk factors.</div></div><div><h3>Conclusions</h3><div>Almost 70% of the patients manifested disturbances in glucose metabolism, with over one-third diagnosed with diabetes. These findings underscore the pivotal role catecholamines play in metabolic processes and emphasize the imperative need for close monitoring of blood glucose levels in patients with PPGL.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 3","pages":"Pages 269-277"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647012","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":"Prospects and Challenges of Immunotherapy for Thyroid Cancer","authors":"Ping Song PhD ,&nbsp;Gang Pan MM ,&nbsp;Yu Zhang MD ,&nbsp;Yeqin Ni MM ,&nbsp;Qianyu Wang BD ,&nbsp;Jingjng Shi MM ,&nbsp;You Peng MM ,&nbsp;Ruirui Jing PhD ,&nbsp;Dingcun Luo BM","doi":"10.1016/j.eprac.2024.11.012","DOIUrl":"10.1016/j.eprac.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Thyroid cancer generally boasts a favorable prognosis; however, advanced and refractory cases exhibit aggressive characteristics and resistance to conventional therapies, necessitating the investigation of innovative treatment modalities. Immunotherapy, which harnesses the body's immune system to target cancer cells, has shown considerable promise for specific thyroid cancer subtypes.</div></div><div><h3>Objective</h3><div>This review article aims to encapsulate the latest advancements in immunotherapy for thyroid cancer, examining its mechanisms, therapeutic efficacy, ongoing challenges, and the potential benefits of combination therapy approaches.</div></div><div><h3>Methods</h3><div>An extensive literature review and critical analysis of clinical trial data were conducted to inform this synthesis.</div></div><div><h3>Results</h3><div>The review reveals that immunotherapy strategies, encompassing immune checkpoint inhibitors, CAR-T cell therapy, tumor vaccines, and immunomodulators, are demonstrating efficacy in the treatment of thyroid cancer. Notably, checkpoint inhibitors have been particularly effective in anaplastic and poorly differentiated thyroid cancers, albeit with challenges such as treatment resistance and adverse effects. The application of CAR-T cell therapy, successful in hematologic cancers, provides a novel perspective for thyroid cancer treatment, although its efficacy in solid tumors requires further study. Additionally, research into tumor vaccines and immunomodulators is advancing, with preliminary evidence suggesting their therapeutic potential for thyroid cancer patients.</div></div><div><h3>Conclusion</h3><div>The recognition of the immune microenvironment's role in treatment responsiveness is pivotal for enhancing the care of thyroid cancer patients. This review underscores the significance of combination therapy as a means to optimize treatment outcomes and charts a course for future research endeavors to broaden the spectrum of effective treatment options available to thyroid cancer patients.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 3","pages":"Pages 373-379"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779263","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":"Randomized Study Comparing Continuous Glucose Monitoring and Capillary Glucose Testing in Patients With Type 2 Diabetes After Hospital Discharge","authors":"Guillermo E. Umpierrez MD, CDCES, MACP ,&nbsp;Iris Castro-Revoredo MD, MPH ,&nbsp;Bobak Moazzami MD ,&nbsp;Irina Nayberg RN, BSN, CDE, CDTC ,&nbsp;Zohyra Zabala MD ,&nbsp;Rodolfo J. Galindo MD ,&nbsp;Priyathama Vellanki MD ,&nbsp;Limin Peng PhD ,&nbsp;David C. Klonoff MD","doi":"10.1016/j.eprac.2024.11.018","DOIUrl":"10.1016/j.eprac.2024.11.018","url":null,"abstract":"<div><h3>Objective</h3><div>The benefits of continuous glucose monitoring (CGM) in managing hyperglycemia in hospitalized patients with type 2 diabetes (T2D) have been documented in observation and intervention clinical studies. However, the benefits of CGMs after hospital discharge in improving the care of patients with T2D remain unknown.</div></div><div><h3>Methods</h3><div>This pilot randomized clinical trial aimed to compare the effectiveness and safety of using the FreeStyle Libre 2 CGM vs capillary point-of-care (POC) glucose testing (standard of care) in insulin-treated patients with T2D for up to 12 weeks after hospital discharge. We assessed safety (hypoglycemia), efficacy (mean daily glucose), and healthcare utilization (emergency room visits and hospital admissions) associated with the use of FreeStyle Libre 2 CGM compared to capillary POC testing following hospital discharge.</div></div><div><h3>Results</h3><div>Among 100 participants (mean age 54.3 ± 10.7 years, HbA1c 10.46 ± 2.24%, median diabetes duration of 9.0 years, IQR 1.0, 42), there were no significant differences in baseline clinical characteristics between the groups at discharge. We observed a trend toward improved glycemic control in the CGM group, including increased time in range 70-180 mg/dl, reduced time above range &gt; 180 and 250 mg/dl, and decreased hypoglycemia and insulin requirements after discharge compared to the POC group. There were no differences in emergency room visits or hospitalization between the study groups.</div></div><div><h3>Conclusion</h3><div>The results of this pilot study indicate that the use of CGM leads to improved glycemic control, reduced hypoglycemia, and decreased glucose variability compared to POC glucose testing after hospital discharge.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 3","pages":"Pages 286-291"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853545","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}