Endocrine Practice最新文献

{"title":"Effects of Continuous Glucose Monitoring Versus Blood Glucose Monitoring During a Carbohydrate-Restricted Nutrition Intervention in People With Type 2 Diabetes: 6-Month Follow-up Outcomes From a Randomized Clinical Trial.","authors":"Holly J Willis, Stephen E Asche, Rebecca N Adams, Caroline G P Roberts, Amy L McKenzie, Shannon Krizka, Shaminie J Athinarayanan, Alison R Zoller, Brittanie M Volk, Richard M Bergenstal","doi":"10.1016/j.eprac.2025.05.746","DOIUrl":"10.1016/j.eprac.2025.05.746","url":null,"abstract":"<p><strong>Objectives: </strong>Low and very-low carbohydrate eating patterns can improve glycemia in people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) may also help improve glycemic outcomes, like time in range (TIR). This research evaluated differences in diabetes-related outcomes when people with T2D used CGM or blood glucose monitoring (BGM) to support dietary choices and medication management for 6 months during a virtual, medically supervised ketogenic diet program (MSKDP). Three-month primary outcomes are published, and here we report 6-month follow-up outcomes.</p><p><strong>Methods: </strong>The IGNITE study (Impact of Glucose moNitoring and nutrItion on Time in rangE) randomized participants to use CGM (N = 81) or BGM (N = 82) to support care during 6 months in a MSKDP. Glycemia, diabetes medications, dietary intake, ketones, and weight were assessed at baseline (Base) and month 6 (M6); differences between and within arms were evaluated.</p><p><strong>Results: </strong>Adults (N = 163) with mean (SD) T2D duration of 9.7 (7.7) years and HbA1c of 8.1% (1.2%) participated. From Base to M6, TIR improved from 61% to 87% for CGM and from 63% to 88% for BGM (P < .001), with no difference in changes between arms (P = .99). HbA1c decreased at least 1.3% from Base to M6 in both arms (P < .001). Diabetes medications were deintensified in both arms based on medication effect scores (P < .01). Energy and carbohydrate intake decreased (P < .001) and participants in both arms had clinically meaningful weight loss (P < .001).</p><p><strong>Conclusions: </strong>The CGM and BGM arms achieved similar and significant improvements in glycemia and other diabetes-related outcomes after 6 months in this MSKDP.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224771","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":"Reducing Inpatient Hypoglycemia: A Diversified Approach to a Complex Problem.","authors":"Audrey Lane, Melissa McKnight, Kaeli Samson, Mitchell Nohner, Andjela Drincic","doi":"10.1016/j.eprac.2025.05.744","DOIUrl":"10.1016/j.eprac.2025.05.744","url":null,"abstract":"<p><strong>Objective: </strong>Hypoglycemia in hospitalized patients is a persistent adverse event. Three quality improvement interventions were implemented with the aim of reducing hypoglycemia. Each intervention was targeted at one component of typical inpatient insulin management (basal, prandial, and correction) to attempt to achieve this singular quality improvement aim.</p><p><strong>Methods: </strong>Incidence of hypoglycemia in nonobstetrics patients ≥ 19 years of age at a tertiary hospital receiving scheduled insulin before and after the implementation of quality improvement initiatives was compared. Incidence was defined as the number of unique patients with a hypoglycemic event in each month, divided by all admissions for that month. The interventions included integrating weight-based insulin guidance into the electronic medical record, the addition of a carbohydrate-limited diet, and increasing the threshold for correction insulin administration from 150 mg/dL to 180 mg/dL.</p><p><strong>Results: </strong>After implementation of the interventions, there was a significantly lower incidence of hypoglycemia associated with prandial insulin (P = .02) and correction insulin (P < .001). There was not a significant decrease in hypoglycemia associated with basal insulin in the overall sample (P = .25). There was a significant decrease in a subgroup analysis focused on hospital-associated hyperglycemia and type 2 diabetes (via exclusion of patients with type 1 diabetes or cystic fibrosis-related diabetes) (P = .005). Notably, following the interventions, there was a reduction in institutional blood glucose readings within goal range (71-179 mg/dL), which presumably translates to an increase in hyperglycemia, given the known decrease in hypoglycemia (P value < .0001).</p><p><strong>Conclusion: </strong>Through a multipronged approach consisting of three unique QI interventions - each targeting one aspect of inpatient insulin management - our academic institution was able to significantly reduce the number of inpatient hypoglycemic events.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224772","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":"The Nondipping Blood Pattern in Type 1 Diabetes Mellitus: Pathophysiology, Complications, and Management Strategies","authors":"Michał Kulecki MD ,&nbsp;Dariusz Naskręt MD, PhD ,&nbsp;Aleksandra Uruska MD, PhD ,&nbsp;Dorota Zozulińska-Ziółkiewicz MD, PhD","doi":"10.1016/j.eprac.2025.02.015","DOIUrl":"10.1016/j.eprac.2025.02.015","url":null,"abstract":"<div><h3>Background</h3><div>The nondipping blood pressure (BP) pattern, characterized by a less than 10% decline in sleep-time BP compared to awake-time values, is prevalent in individuals with type 1 diabetes mellitus (T1DM) and is associated with increased cardiovascular (CV) risk.</div></div><div><h3>Case Report</h3><div>This review discusses the prevalence, pathophysiological mechanisms, complications, and management strategies of the nondipping pattern in T1DM. The nondipping pattern is linked to poor cardiac autonomic function, higher rates of albuminuria, early markers of diabetic kidney disease, and increased arterial stiffness. It is also associated with a two-fold increase in all-cause mortality.</div></div><div><h3>Discussion</h3><div>Despite its clinical significance, there is no consensus on specific treatment recommendations for nondippers with T1DM. While some studies suggest that bedtime administration of antihypertensive medications, such as ACE inhibitors and angiotensin II receptor blockers, can improve the dipping pattern and reduce CV events, these findings are primarily based on studies in the general hypertensive population. Emerging evidence also indicates a potential role for vitamin D supplementation and lifestyle interventions in improving BP variability.</div></div><div><h3>Conclusion</h3><div>Further research is needed to develop evidence-based management strategies tailored to nondippers with T1DM, aiming to reduce CV risk and improve long-term outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 821-828"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536907","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":"ChatGPT-4's Accuracy in Estimating Thyroid Nodule Features and Cancer Risk From Ultrasound Images","authors":"Esteban Cabezas MD ,&nbsp;David Toro-Tobon MD ,&nbsp;Thomas Johnson MD ,&nbsp;Marco Álvarez MD ,&nbsp;Javad R. Azadi MD ,&nbsp;Camilo Gonzalez-Velasquez MD ,&nbsp;Naykky Singh Ospina MD ,&nbsp;Oscar J. Ponce MD, MSc ,&nbsp;Megan E. Branda MS ,&nbsp;Juan P. Brito MD, MS","doi":"10.1016/j.eprac.2025.03.008","DOIUrl":"10.1016/j.eprac.2025.03.008","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the performance of GPT-4 and GPT-4o in accurately identifying features and categories from thyroid nodule ultrasound images following the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS).</div></div><div><h3>Methods</h3><div>This comparative validation study, conducted between October 2023 and May 2024, utilized 202 thyroid ultrasound images sourced from 3 open-access databases. Both complete and cropped versions of each image were independently evaluated by expert radiologists to establish a reference standard for TI-RADS features and categories. GPT-4 and GPT-4o were prompted to analyze each image, and their generated TI-RADS outputs were compared to the reference standard.</div></div><div><h3>Results</h3><div>GPT-4 demonstrated high specificity but low sensitivity when assessing complete thyroid ultrasound images across most TI-RADS categories, resulting in mixed overall accuracy. For low-risk nodules (benign), GPT-4 achieved 25.0% sensitivity, 99.5% specificity, and 93.6% accuracy. In contrast, in the higher risk moderately suspicious category GPT-4 showed 75% sensitivity, 22.2% specificity, and 42.1% accuracy. While GPT-4 effectively identified features like smooth margins (73% vs 65% the reference standard), it struggled to identify other features like isoechoic echogenicity (5% vs 46%), and echogenic foci (3% vs 27%). The assessment of cropped images using both GPT-4 and GPT-4o followed similar patterns, though with slight deviations indicating a decrease in performance compared to GPT-4's assessment of complete images.</div></div><div><h3>Conclusion</h3><div>While GPT-4 and GPT-4o models show potential for improving the efficiency of thyroid nodule triage, their performance remains suboptimal, particularly in higher-risk categories. Further refinement and validation of these models are necessary before clinical implementation.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 716-723"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729471","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":"Virta Intervention in CommuniTies in ColORado (VICTOR) Pilot Study to Improve Diabetes and Cardiovascular Risk in Rural Communities - Primary Results","authors":"Cecilia C. Low Wang MD ,&nbsp;Ray Estacio MD ,&nbsp;Stephanie Coronel-Mockler MPH ,&nbsp;Nick Flattery MPH ,&nbsp;Pete D. Hanson MS ,&nbsp;Rebecca N. Adams PhD ,&nbsp;Amy L. McKenzie PhD ,&nbsp;David Harrison MD ,&nbsp;Marc P. Bonaca MD, MPH","doi":"10.1016/j.eprac.2025.03.013","DOIUrl":"10.1016/j.eprac.2025.03.013","url":null,"abstract":"<div><h3>Objective</h3><div>Innovative strategies combining local community health workers (CHWs) and digital health may improve type 2 diabetes (T2D) care and cardiovascular risk in rural communities. To conduct a cluster-randomized, open-label, multisite study to evaluate the hypothesis that in rural communities served by CHW in the Colorado Heart Healthy Solutions (CHHS) program, referral to a digital continuous care intervention (CCI) would improve hemoglobin A1c (A1c) in patients with T2D as compared with CHHS alone.</div></div><div><h3>Methods</h3><div>Adults in the CHHS program with T2D taking at least 1 antihyperglycemic medication, A1c ≥ 7.5%, body mass index ≥25 kg/m² and who provided electronic informed consent were cluster-randomized to CHHS vs CCI+CHHS. The primary outcome was change in A1c from baseline to end of phase 1 (3 months).</div></div><div><h3>Results</h3><div>Fifty-one individuals had evaluable data. Mean ± SD age was 59.6 ± 10 years, body mass index 34.4 ± 7 kg/m², and A1c 8.9 ± 1.3% at baseline. The change in A1c from baseline was not significant between groups. However, A1c decreased from baseline to end of phase 1 by −1.2% in CHHS and −1.5% in CCI+CHHS, <em>P</em> &lt; .001 in each group. A higher proportion of individuals in CCI+CHHS achieved 5% or greater weight loss (<em>P</em> &lt; .05), and significant net decrease in number and/or dose of antihyperglycemic medications (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Combining a CHW program with referral to CCI did not result in greater A1c reduction, but led to improvements in A1c, weight, and medication burden in individuals with T2D in a rural setting.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 790-797"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969861","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":"Global Incidence, Risk Factors, and Temporal Trends of Adrenal Cancer: A Systematic Analysis of Cancer Registries","authors":"Junjie Huang PhD ,&nbsp;Yat Ching Fung BSocSc ,&nbsp;Sze Chai Chan MSc ,&nbsp;Wing Sze Pang BSocSc ,&nbsp;Veeleah Lok MPH ,&nbsp;Lin Zhang PhD ,&nbsp;Xu Lin MD ,&nbsp;Don Eliseo Lucero-Prisno III PhD ,&nbsp;Wanghong Xu PhD ,&nbsp;Zhi-Jie Zheng PhD ,&nbsp;Edmar Elcarte MA ,&nbsp;Claire Chenwen Zhong PhD ,&nbsp;Mellissa Withers PhD ,&nbsp;Martin C.S. Wong MD ,&nbsp;NCD Global Health Research Group, Association of Pacific Rim Universities (APRU)","doi":"10.1016/j.eprac.2025.03.002","DOIUrl":"10.1016/j.eprac.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>Adrenal gland cancer (AGC) is a rare cancer with a poor prognosis. Studies on this cancer have been limited. This study, for the first time, aims to analyze the global disease burden and trends of AGC in country level and examine lifestyle and socioeconomic risk factors to generate hypotheses.</div></div><div><h3>Methods</h3><div>The Global Cancer Observatory database was used to extract the incidence rate of AGC in 2020. Age-standardized rates (ASRs) of AGC incidence and lifestyle/metabolic risk factor prevalence were obtained from databases. Linear regression and Joinpoint regression were used to assess associations with risk factors and Average Annual Percentage Change of AGC incidence.</div></div><div><h3>Results</h3><div>Globally, there were an estimated 16 961 new AGC cases in 2020 (ASR: 0.14 per 100 000 persons). Higher disease burden was observed mainly in European regions. ASRs were comparable between sexes (males: 0.16; females: 0.14). The higher ASR was observed among the older population aged 50 to 74 years with an ASR of 0.31 compared with the younger population aged 15 to 49 years with an ASR of 0.07. Higher AGC incidence was associated with higher Human Development Index, gross domestic product, and lifestyle-related factors such as physical inactivity, obesity, hypertension, and lipid disorder (β = 0.005-0.052).</div></div><div><h3>Conclusion</h3><div>The overall incidence trend showed a decrease, with 3 countries reporting significant decreases and 1 country reporting a significant increase. Similar patterns were observed by sex and age group, except for an overall increase among the younger population.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 739-749"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613989","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":"Early-Life Risks of Central Precocious Puberty","authors":"Wei-Jou Yin ,&nbsp;Jhih-Wei Hsu PhD ,&nbsp;Chun-Chang Chen PhD ,&nbsp;Emily Chia-Yu Su PhD ,&nbsp;San-Yuan Wang PhD ,&nbsp;Yan-Jen Chen BSc ,&nbsp;Yang-Ching Chen MD, PhD","doi":"10.1016/j.eprac.2025.03.004","DOIUrl":"10.1016/j.eprac.2025.03.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the factors in early life that may contribute to central precocious puberty (CPP).</div></div><div><h3>Methods</h3><div>The study utilized data from the Taiwan Puberty Longitudinal Study, including 2241 children under pubertal assessment and a questionnaire of risk factors. We analyzed associations using the Fitting Generalized Linear Models in R (R Core Team, 2023), with R studio (Posit, 2023) version 4.3.1.</div></div><div><h3>Results</h3><div>Among the 2241 children examined, 745 had CPP. Overall, higher gestational weight gain (GWG) increased the risk of CPP (odds ratio [OR]: 1.03, 95% CI: 1.01-1.05); while higher GWG served as a protective factor in females (OR: 0.97, 95% CI: 0.95-0.99). Maternal gestational diabetes mellitus (GDM) also increased the CPP risk, particularly in males (OR: 2.66, 95% CI: 1.00-7.25). Longer exclusive breastfeeding was linked to lower CPP risk overall (OR: 0.96, 95% CI: 0.93-1.00) but was not significant when analyzed by gender.</div></div><div><h3>Conclusions</h3><div>Higher maternal GWG was associated with an increased risk of CPP overall, while GWG became negatively associated with CPP, only in females. Maternal GDM was linked to a higher risk of CPP, particularly in males. The duration of exclusive breastfeeding was inversely correlated with CPP risk, but this effect was not significant when analyzed by gender.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 758-765"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639670","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":"What Features Predict Poorer Outcomes in Micropapillary Thyroid Carcinoma? A Retrospective Cohort Study","authors":"Shahaboddin Khamooshi MD ,&nbsp;Soghra Rabizadeh MD ,&nbsp;Leila Seddigh MD ,&nbsp;Sahar Karimpour Reyhan MD ,&nbsp;Fatemeh Mohammadi MD, MPH ,&nbsp;Amirhossein Yadegar MD ,&nbsp;Elahe Saffari MD ,&nbsp;Alireza Esteghamati MD ,&nbsp;Manouchehr Nakhjavani MD","doi":"10.1016/j.eprac.2025.03.003","DOIUrl":"10.1016/j.eprac.2025.03.003","url":null,"abstract":"<div><h3>Objective</h3><div>Micropapillary thyroid carcinoma (MPTC), a variant of papillary thyroid carcinoma sized ≤10 mm, is increasingly detected due to advanced ultrasound. This study aimed to describe characteristics and risk assessment of patients with MPTC to predict outcomes and guide initial management.</div></div><div><h3>Methods</h3><div>This retrospective cohort study (June 1980 to September 2023) assessed patients with MPTC using 2015 American Thyroid Association guidelines for risk stratification and determination of response to treatment. Outcomes ranged from excellent to structural incomplete responses.</div></div><div><h3>Results</h3><div>Among 208 patients with papillary thyroid carcinoma with a primary tumor focus ≤10 mm, 68.8% were low risk, 29.3% intermediate risk, and 1.9% high risk. Higher risk was linked to larger tumor size (≥7 mm) (odds ratio [OR], 3.196; <em>P</em> value = .001) and multifocality (OR, 2.431; <em>P</em> value = .004). Age (OR, 0.973; <em>P</em> value = .048) and background Hashimoto thyroiditis (OR, 0.439; <em>P</em> value = .014) were found as protective factors. Excellent response to therapy was observed in 48.4% of patients, whereas structural and biochemical incomplete responses were found to be 11.2% and 7.5%. Recurrence was detected in 14 (8.18%) patients.</div></div><div><h3>Conclusion</h3><div>MPTC generally has a good prognosis and responds well to the treatment. Larger tumors (≥7 mm), younger age (&lt;40 years), multifocality, and absence of Hashimoto thyroiditis correlate with a higher American Thyroid Association risk and poorer outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 707-715"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630325","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":"Disparities in Outcomes and Health Care Utilization for Diabetic Ketoacidosis Among Patients With Type 1 and Type 2 Diabetes Mellitus: A 6-Year National Retrospective Cohort Study","authors":"Shellsea Portillo-Canales MD ,&nbsp;John Peters DO, MS ,&nbsp;Garry Francis-Morel MD, MS ,&nbsp;Sandeep Dhindsa MD","doi":"10.1016/j.eprac.2025.04.002","DOIUrl":"10.1016/j.eprac.2025.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>Diabetic ketoacidosis (DKA) represents a significant burden on the health care system. The impact of diabetes type on DKA outcomes remains unclear. This study aims to compare mortality, length of stay (LOS), and hospital costs between patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) hospitalized with DKA.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the 2016-2021 National Inpatient Sample Healthcare Cost and Utilization Project database, focusing on patients admitted for acute care with a diagnosis of DKA. Patients were categorized into 2 cohorts: T1DM versus T2DM. The primary end point was mortality, assessed using multiple logistic regression. Secondary end points included LOS and total hospital charges, analyzed using multiple linear regression, adjusting for potential confounders. Multiple imputations accounted for missing data, and a Bonferroni correction was applied for multiple comparisons.</div></div><div><h3>Results</h3><div>The study included 1 244 184 patients, with 770 109 (62%) T1DM and 474 075 (38%) T2DM. Mortality was significantly higher in patients with T2DM (0.91%) compared to patients with T1DM (0.22%; <em>P</em> &lt; .001). LOS was longer for patients with T2DM (average 3.92 days vs 3.02 days for T1DM; <em>P</em> &lt; .001), as were hospital charges ($10 146.78 for T2DM vs $7811.98 for T1DM; <em>P</em> &lt; .001). Significant disparities were also observed in the demographic and hospital characteristics, including median household income, insurance type, and hospital region.</div></div><div><h3>Conclusion</h3><div>In this national retrospective cohort study, patients with T2DM and DKA had higher mortality rates, longer LOS, and higher health care costs than those with T1DM. These findings highlight critical disparities that may guide future interventions to improve DKA outcomes in patients with T2DM.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 784-789"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998055","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 Systematic Review on the Impact of Electronic Consultations on Diabetes Care","authors":"Elie Naous MD ,&nbsp;Angela Achkar MD, MSc ,&nbsp;Rebecca A. Morin MLIS, MAS ,&nbsp;Joanna Mitri MD, MS","doi":"10.1016/j.eprac.2025.03.001","DOIUrl":"10.1016/j.eprac.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 829-838"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","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}