Endocrine Practice最新文献

{"title":"Expanding Access to Continuous Glucose Monitoring in Medicare Patients Receiving Specialty Diabetes Care: A Quality Improvement Project.","authors":"Kristen L Flint, Tiffany Ting, Kyianna Rivera, Prakriti Tamang, Caitlin A Colling, Josephine H Li, Melissa S Putman","doi":"10.1016/j.eprac.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.04.001","url":null,"abstract":"<p><strong>Objective: </strong>Despite recent revisions of Medicare coverage guidelines for continuous glucose monitoring (CGM) in 2023, the policy change has been slow to disseminate to providers and patients. This quality improvement project aimed to increase CGM prescriptions and utilization amongst qualifying Medicare patients with diabetes on insulin.</p><p><strong>Methods: </strong>An interprofessional study team used process mapping to define the baseline state of CGM ordering and opportunities for improvement at a single diabetes specialty clinic. Several interventions were trialed through Plan-Do-Study-Act (PDSA) cycles, including general and targeted provider education, provider-facing technology support documents, a formulary guide, and patient-facing education about the new coverage requirements. The primary outcome was percentage of eligible patients using CGM. Process measures included the number of CGM orders started monthly. Demographic and socioeconomic factors in patients using and not using CGM were measured to assess for differences in prescribing practices.</p><p><strong>Results: </strong>Over 8 months of intervention, the percentage of eligible Medicare patients using CGM increased from 49.6% to 62.6%. The median number of CGM orders started monthly increased from 34 to 60. Both pre- and postintervention, compared to patients not using CGM, patients using CGM were younger, had lower A1c, and were more often enrolled in the electronic health record patient portal. There were no differences in other demographic factors between the groups.</p><p><strong>Conclusion: </strong>Quality improvement interventions targeting providers and patients can help translate policy changes into clinical practice. Creating interventions with all patients in mind can prevent new differences in care as innovations are adopted.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474286","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":"Preoperative Fine-Needle Aspiration in Goiter With Compressive Symptoms: A Systematic Review and Meta-analysis.","authors":"Moeen Sbeit, Rania Faris, Ohad Ronen","doi":"10.1016/j.eprac.2025.05.002","DOIUrl":"10.1016/j.eprac.2025.05.002","url":null,"abstract":"<p><strong>Objective: </strong>There are currently no firm recommendations regarding the necessity of preoperative fine-needle aspiration (FNA) in patients with symptomatic goiter. FNA is an efficient and reliable method for determining the risk of malignancy of thyroid nodules; thus, it became the primary procedure for diagnosing neoplasms and guiding surgical treatment. We performed this systematic review of articles to establish the necessity of FNA in patients with compressive goiter.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic literature search was conducted using electronic databases. Included were studies dealing with euthyroid goiter and compressive symptoms in adult patients designated to undergo therapeutic surgery. Two reviewers independently extracted the data and assessed the risk of bias using the risk of bias visualization (ROBVIS; visualization tool). Our main outcome measure was final histology compared with preoperative FNA.</p><p><strong>Results: </strong>The initial search identified 3304 relevant studies. After screening and quality assessment, 14 studies were included in the systematic review. The FNA accuracy of malignant and nonmalignant nodules diagnosed correctly preoperatively was 88.4%. In a meta-analysis that included both benign and malignant preoperative FNA results with subsequent postoperative histology, we observed a relative risk of 0.79.</p><p><strong>Conclusion: </strong>Our data underscore the significant value of preoperative FNA when planning a thyroidectomy for patients with a goiter. The FNA results enable both the physician and the patient to make informed decisions, consider a staged surgical approach if necessary, determine an appropriate follow-up strategy, and discuss potential complications based on the preoperative findings.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075922","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":"Life-Saving Drug or Potential Threat? The Role of Mineralocorticoid Receptor Antagonists in Myocardial Infarction: A Meta-Analysis.","authors":"Xiangfeng Guan, Ju Zhang, Yang Yu, Chunxiang Zhang","doi":"10.1016/j.eprac.2025.05.001","DOIUrl":"10.1016/j.eprac.2025.05.001","url":null,"abstract":"<p><p>Mineralocorticoid receptor antagonists (MRAs) have been studied as a potential therapeutic option to improve outcomes in patients with myocardial infarction (MI). Although several randomized controlled trials have evaluated the effectiveness of MRAs in post-MI patients, the specific effects remain debated. We systematically searched databases including Web of Science, PubMed, Embase, and Cochrane Library. The primary efficacy outcome was death from any cause. Secondary efficacy outcomes included death from cardiovascular causes, death from MI, and others. Subgroup analyses were performed based on the presence of heart failure and the type of MRA used. Safety outcomes included hyperkalemia, hypokalemia, breast tenderness, and gynecomastia. A total of 13 randomized controlled trials involving 17 851 patients were included. The results demonstrated that MRAs significantly reduced the risk of death from any cause (relative risk [RR] 0.87; 95% CI 0.79-0.95; P = .004). Subgroup analysis indicated that the effectiveness of MRAs varied based on the presence of heart failure. MRAs significantly reduced the risk of death from cardiovascular causes in heart failure patients (RR 0.87; 95% CI 0.78-0.97), but had no significant effect in patients without heart failure (RR 0.69; 95% CI 0.34-1.38). Furthermore, subgroup analysis based on different MRA drugs showed varying effects on outcomes. While some adverse events, such as hyperkalemia (RR 1.95; 95% CI 1.55-2.46; P < .01), were significantly more frequent, other safety events did not show significant differences. MRAs improve cardiovascular outcomes in MI patients, especially in those with heart failure. When choosing a specific MRA drug, eplerenone or spironolactone is recommended.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992292","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":"Clinical Accuracy of Continuous Glucose Monitoring Immediately After Kidney Transplant in Patients With Type 2 Diabetes.","authors":"Qurrat-Ul-Ain Aziz, Kavita Batra, Sanna Fatima, Jared Splinter, Amber Laurel Champion, Ajay M Kumar, Kenneth E Izuora","doi":"10.1016/j.eprac.2025.04.022","DOIUrl":"10.1016/j.eprac.2025.04.022","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the accuracy of a blinded continuous glucose monitoring (CGM) device compared with point-of-care testing (POCT) and serum glucose measurements in the immediate postoperative period among kidney transplant recipients with type 2 diabetes mellitus (DM).</p><p><strong>Methods: </strong>In this prospective study, we enrolled 22 participants aged ≥18 years, with type 2 DM, immediately after kidney transplant. We applied a blinded CGM device that sampled interstitial glucose every 15 minutes and collected POCT and serum glucose values. Using matched pairs of glucose readings between CGM and POCT and between CGM and serum glucose, we calculated bias and absolute relative difference and conducted a Clarke Error Grid Analysis.</p><p><strong>Results: </strong>Eighty-two percent of the participants were male, with a mean age of 58 ± 9.69 years, mean body mass index of 30 ± 6.41 kg/m², and baseline mean A1C level of 6.7 ± 1.07%. The mean durations of type 2 DM and end-stage kidney disease were 19 ± 10.6 and 3 ± 2.27 years, respectively. There were 327 and 72 matched pairs of CGM/POCT and CGM/serum glucose data, respectively. Clarke Error Grid Analysis comparing CGM/POCT showed 83.79% of values in zone A and 15.29% in zone B (combined 99.08%), with a mean absolute relative difference of 13.24%. For CGM/serum glucose, values of 83.1% were in zone A, and values of 16.9% were in zone B (combined 100%), with a mean absolute relative difference of 13.10%.</p><p><strong>Conclusion: </strong>CGM provided accurate blood glucose measurements compared with POCT and serum glucose values in patients with type 2 DM after kidney transplant. When used in this patient population, CGM devices have the potential to improve clinical outcomes through earlier detection and intervention for glycemic excursions.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992727","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 Noninvasive Tests for Identifying Advanced Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease With Mixed Etiologies.","authors":"He Yi, Yan Zhang, Ziwei Zhou, Weixia Sun, Yifan Wang, Wenxuan Tao, Hekai Yu, Liqin Yao, Jia Li, Ling Li","doi":"10.1016/j.eprac.2025.04.021","DOIUrl":"10.1016/j.eprac.2025.04.021","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the performance of fibrosis-4 index (FIB-4), nonalcoholic fatty liver disease fibrosis score (NFS) and aspartate aminotransferase to platelet ratio index (APRI) for advanced fibrosis in metabolic dysfunction-associated fatty liver disease (MAFLD) subgroups categorized by concomitant liver conditions.</p><p><strong>Methods: </strong>We conducted a multicentered study comprising inpatients with type 2 diabetes mellitus and MAFLD. Participants were categorized into 2 groups: MAFLD with pure metabolic etiologies (MAFLD-P) and MAFLD with mixed etiologies (MAFLD-M). Diagnostic performance of FIB-4, NFS, and APRI was assessed by area under the curve (AUC), sensitivity, and specificity.</p><p><strong>Results: </strong>This study comprised a total of 1475 participants, with a mean (SD) age of 58.4 (13) years and 835 (56.6%) males. FIB-4 and APRI had higher AUCs for advanced fibrosis in the MAFLD-M group than in the MAFLD-P group (MAFLD-M vs MAFLD-P: FIB-4 0.680 vs 0.591, P = .0442; APRI 0.723 vs 0.631, P = .0363). No significant difference was observed in the AUC of NFS between the 2 subgroups (MAFLD-M 0.572 vs MAFLD-P 0.617; P = .3237). Besides, the sensitivity of FIB-4 (69.6% vs 54.0%; P = .019) and APRI (43.5% vs 26.1%; P = .005) was higher in the MAFLD-M group. However, no significant difference in sensitivity of NFS and specificity of FIB-4, NFS, and APRI was observed between subgroups.</p><p><strong>Conclusions: </strong>In this diagnostic study of the type 2 diabetes mellitus population, FIB-4 and APRI showed better performance for identifying advanced fibrosis in MAFLD with mixed etiologies.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990688","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":"Efficacy and Safety of Teprotumumab in Thyroid Eye Disease: A Systematic Review and Meta-Analysis","authors":"Wenxin Huang MM ,&nbsp;Xiaodan Ou MD ,&nbsp;Shuzhen Lin MM ,&nbsp;Wei Lin MD ,&nbsp;Gang Chen MD, PhD ,&nbsp;Huibin Huang MD ,&nbsp;Junping Wen MD, PhD","doi":"10.1016/j.eprac.2025.01.012","DOIUrl":"10.1016/j.eprac.2025.01.012","url":null,"abstract":"<div><h3>Objective</h3><div>Teprotumumab was approved by the US Food and Drug Administration (FDA) for treating Graves' orbitopathy in adults on January 21, 2020. This study evaluates its efficacy and safety in treating thyroid eye disease (TED).</div></div><div><h3>Methods</h3><div>We reviewed studies on teprotumumab for TED treatment from PubMed, Web of Science, EMBASE, Cochrane library, and Clinical trials. gov up to January 1, 2024. Outcomes included proptosis response, diplopia, Clinical Activity Score (CAS) score, and adverse events (AEs).</div></div><div><h3>Results</h3><div>Our analysis included 10 studies, 4 randomized controlled trials, and 6 observational studies. The randomized controlled trials involved 210 teprotumumab patients and 193 controls. Teprotumumab significantly improved proptosis response (relative risk [RR] 4.18, 2.72-6.43), diplopia regression (RR 2.29, 1.54-3.41), and CAS score (RR 3.09, 1.98-4.80) compared to placebo. A significant reduction in proptosis was observed (standardized mean difference −8.38, −9.25 - −7.52). The risk of AEs and serious AEs was higher with teprotumumab. The 6 observational studies included 211 patients, showing an 82% proptosis response rate, a −3.31 mm change in proptosis, a 0.58 diplopia improvement rate, and a 0.66 pooled effect size for CAS score. AE incidence was 0.78, and serious AEs were 0.31.</div></div><div><h3>Conclusion</h3><div>Teprotumumab effectively reduces proptosis, improves diplopia, and lowers disease activity in TED, regardless of previous treatments, severity, or dosage, albeit with increased AEs. It has the potential to become a vital first-line treatment for TED, enhancing patient quality of life.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 5","pages":"Pages 640-649"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424595","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":"Exploring the Link Between Thyroid Disorders and Obesity: Mechanisms, Impacts, and Clinical Implications","authors":"Ashni Dharia MD ,&nbsp;Dimpi Desai MD ,&nbsp;Kaniksha Desai MD","doi":"10.1016/j.eprac.2025.02.005","DOIUrl":"10.1016/j.eprac.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity and thyroid dysfunction are among the most significant challenges in endocrinology, frequently overlapping to create complexities in weight management. Even after achieving euthyroidism, weight variations persist, significantly affecting patients' quality of life. This review explores the mechanisms linking hypothyroidism and hyperthyroidism to weight fluctuations, emphasizing their impact on basal metabolic rate, appetite regulation, glucose and lipid metabolism, and thermogenesis.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive review using PubMed and Google Scholar, applying the search criteria: (obesity OR overweight) AND (Hashimoto's thyroiditis OR hyperthyroidism OR hypothyroidism OR Thyroid Cancer). From this search, we reviewed 500 publications and finally included 71 publications, focusing on broad clinical questions regarding the role of thyroid hormones in weight regulation and metabolism, the impact of thyroid disorders and their treatments on obesity, and approaches for managing obesity in the context of thyroid dysfunction.</div></div><div><h3>Results</h3><div>In hypothyroidism, the impact of levothyroxine therapy on weight changes is discussed, along with the potential role of T3 supplementation. For hyperthyroid patients, the effects of antithyroid medications, radioactive iodine therapy, and thyroidectomy on weight regulation are explored. Pharmacological and nonpharmacological strategies for managing obesity in thyroid disorders are reviewed. Lifestyle interventions and pharmacotherapies are evaluated for their efficacy and potential effects on thyroid function. Lastly, the implications of bariatric surgery are explored, including its effects on thyroid function, medication absorption, and postsurgical management of thyroid disorders.</div></div><div><h3>Conclusion</h3><div>This review underscores the importance of an integrated, multidisciplinary approach to managing obesity in the context of thyroid dysfunction to optimize patient outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 5","pages":"Pages 660-667"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424789","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":"Antiresorptive Therapy to Reduce Fracture Risk and Effects on Dental Implant Outcomes in Patients With Osteoporosis: A Systematic Review and Osteonecrosis of the Jaw Taskforce Consensus Statement","authors":"Dalal S. Ali MD, MSc, FRCPI ,&nbsp;Aliya A. Khan MD, FRCPC, FACP, FACE, FASBMR ,&nbsp;Archibald Morrison DDS, PhD ,&nbsp;Sotirios Tetradis DDS, PhD ,&nbsp;Reza D. Mirza MD, MSc, FRCPC ,&nbsp;Mohamed El Rabbany DDS, MSc, PhD, FRCDC ,&nbsp;Bo Abrahamsen MD, PhD ,&nbsp;Tara L. Aghaloo DDS, MD, PhD ,&nbsp;Hatim Al-Alwani MD ,&nbsp;Rana Al-Dabagh DDS ,&nbsp;Athanasios D. Anastasilakis MD ,&nbsp;Mohit Bhandari O.Ont, MD, PhD, FRCSC ,&nbsp;Jean-Jacques Body MD ,&nbsp;Maria Luisa Brandi MD, PhD ,&nbsp;Romina Brignardello-Petersen PhD ,&nbsp;Jacques P. Brown MD ,&nbsp;Angela M. Cheung MD ,&nbsp;Juliet Compston MD ,&nbsp;Cyrus Cooper MD ,&nbsp;Adolfo Diez-Perez MD, PhD ,&nbsp;Salvatore L. Ruggiero DMD, MD, FACS","doi":"10.1016/j.eprac.2025.02.016","DOIUrl":"10.1016/j.eprac.2025.02.016","url":null,"abstract":"<div><h3>Objective</h3><div>Placement of a dental implant in a patient on antiresorptive therapy has been hypothesized to increase the risk of medication-related osteonecrosis of the jaw (MRONJ) and/or impact implant survival. In patients with osteoporosis, the risk of MRONJ with antiresorptive therapy is only marginally higher than observed in the general population.</div></div><div><h3>Methods</h3><div>The International ONJ Taskforce conducted a systematic review of the literature and evaluated the outcomes of implant placement in individuals with osteoporosis receiving antiresorptive therapy.</div></div><div><h3>Results</h3><div>The data were reviewed by the International Taskforce, and consensus was achieved on the following GRADEd recommendation. In patients with osteoporosis on antiresorptive therapy, the Taskforce suggests that antiresorptive therapy does not need to be stopped prior to proceeding with dental implant (weak recommendation, very low-quality evidence). Long-term bisphosphonate use maybe associated with a small increase in the risk of MRONJ (3 cases per 1000 patients; adjusted hazard ratio: 4.09, 95% CI: 2.75-6.09, <em>P</em> &lt; .001, moderate certainty).</div></div><div><h3>Conclusion</h3><div>Current evidence does not suggest an association between antiresorptive therapy in patients with osteoporosis and dental implant failure. Implants may be safely placed in the presence of concomitant use of bisphosphonates or denosumab in patients with osteoporosis with no evidence of an increased risk of implant failure/compromise.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 5","pages":"Pages 686-698"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906535","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":"Delivery Mode and Neonatal Thyrotropin Levels: Insights From a Systematic Review and Meta-Analysis","authors":"Mohadese Dashtkoohi MD ,&nbsp;Mohammadamin Parsaei MD ,&nbsp;Mohammad Sadeq Najafi MD ,&nbsp;Elahe Amirkhalili PhD ,&nbsp;Mohammadreza Chashmyazdan PhD ,&nbsp;Pantea Nazeri PhD","doi":"10.1016/j.eprac.2025.02.006","DOIUrl":"10.1016/j.eprac.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Optimal thyroid function is particularly crucial during infancy. This systematic review and meta-analysis aimed to investigate the relationship between the mode of delivery and neonatal thyrotropin levels at birth.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library for studies published up to 2023. Hedges’ g with 95% confidence intervals was calculated to compare mean thyroid-stimulating hormone (TSH) levels based on the mode of delivery. Additionally, TSH levels were compared based on blood sampling methods, heel blood vs cord blood, using the same meta-analytic approach. A random effects model was employed due to the presence of heterogeneity. This study is registered with PROSPERO under the number CRD42024533649.</div></div><div><h3>Results</h3><div>A total of 1438 studies were identified, of which 18 met the criteria for the systematic review. The meta-analysis of ten studies revealed significantly higher pooled TSH levels in neonates born via vaginal delivery compared to those delivered by cesarean section (Hedges’ g = 0.390; <em>P</em> = .002). In the heel blood subgroup, no significant difference in TSH levels was found between vaginal and cesarean deliveries (Hedges’ g = 0.167; <em>P</em> = .111). However, in the cord blood subgroup, neonates delivered vaginally exhibited significantly higher TSH levels than those delivered by cesarean section (Hedges’ g = 0.493; <em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>The study found that the method of delivery has a significant impact on neonatal TSH levels, especially in umbilical cord blood samples, highlighting the need to consider delivery mode in evaluating neonatal health.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 5","pages":"Pages 631-639"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424427","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":"Diabetes Status and Cardiovascular Complications Risk in Noncardiac Surgery: A Population-Based Cohort Study","authors":"Yunxi Ji MD ,&nbsp;Zhihan Lyu MD ,&nbsp;Bin Cui PhD ,&nbsp;Weiqing Wang MD, PhD","doi":"10.1016/j.eprac.2025.02.011","DOIUrl":"10.1016/j.eprac.2025.02.011","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with diabetes are considered to be at high surgical risk due to the potential occurrence of cardiovascular and diabetes-related complications. Limited research exists on the cardiovascular risk profiles of patients with prediabetes and undiagnosed diabetes in noncardiac surgery. In this population-based cohort study, we investigated different glycated hemoglobin levels and their associated postoperative cardiovascular risks.</div></div><div><h3>Methods</h3><div>In this perioperative cohort study, participants were categorized into four groups: nondiabetes, prediabetes, undiagnosed diabetes, and diagnosed diabetes. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) at 30 days postoperatively, with secondary outcomes assessed at 90 days. The association between various groups and postoperative MACE was evaluated using Cox proportional hazards models and Kaplan-Meier curves. Subgroup analyses and sensitivity analyses were also performed.</div></div><div><h3>Results</h3><div>We enrolled 13 207 eligible patients undergoing noncardiac surgeries, among whom 3841 (29.08%) had prediabetes and 1521 (11.52%) had undiagnosed diabetes. In the 30-day postoperative period, the prediabetes group (hazard ratio [HR] [95% CI]: 1.70 [1.15, 2.52]), undiagnosed diabetes group (HR [95% CI]: 2.36 [1.15, 3.68]), and diagnosed diabetes group (HR [95% CI]: 2.33 [1.54, 3.53]) exhibited increased risks of MACE compared to the nondiabetes group. Similar findings were observed for the 90-day postoperative MACE. Further subgroup analysis revealed a significant interaction between sex and states of glycemic regulation (P for interaction &lt; 0.005).</div></div><div><h3>Conclusion</h3><div>In this cohort, a notable proportion of patients with prediabetes or undiagnosed diabetes were found to be undergoing noncardiac surgeries. They were associated with an increased risk of developing postoperative MACE.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 5","pages":"Pages 585-591"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523060","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}