I Siqueira, J Jenkinson, P Briggs, H Picker, X Chen, A H Abdelhafiz
{"title":"De-escalation, palliation and end of life care in frail older people with diabetes-a critical review.","authors":"I Siqueira, J Jenkinson, P Briggs, H Picker, X Chen, A H Abdelhafiz","doi":"10.1080/17446651.2025.2535668","DOIUrl":"https://doi.org/10.1080/17446651.2025.2535668","url":null,"abstract":"<p><strong>Introduction: </strong>Frail older people with diabetes will need regular medications review and individualized care, especially at the final phase of life. Although guidelines are detailed on escalation of medications, there is little detail on how to de-escalate therapy when need arises. In addition, there is no description of patients' criteria in whom de-escalation should be considered.</p><p><strong>Area covered: </strong>In the guidelines, frailty is referred to as one homogeneous group. However, frailty is a metabolically heterogeneous condition with a span of variability in insulin resistance depending on proportional ratios of visceral body fat mass, muscle mass, and total body weight. Therefore, cardiovascular risk and the need for tight targets are variable depending on frailty metabolic phenotype. Taking this into consideration, the phenotype of frailty should be taken into account when considering de-escalation of therapy. Furthermore, de-escalation of cardiovascular therapy will differ by frailty phenotype and underlying cardiovascular risk.</p><p><strong>Expert opinion: </strong>This manuscript addresses the issue of metabolic variability of frailty and suggests three chronological stages, from de-escalation, palliation to end-of-life care in a patient-centered perspective. Future research is required to develop de-escalation pathways and strategies, which will impact on health care costs, patients' safety, and quality of life.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariana Lourenço, Ana Rita Leite, Patrícia Ferreira, Inês Meira, João Menino, Ana Margarida Lopes, Joana Lagoa, Beatriz Viveiros, Maria João Barbosa, Sílvia Santos Monteiro, Joana Queirós, João Sérgio Neves, Celestino Neves
{"title":"Association of thyroid function within the normal range with glycemic control and cardiovascular risk factors in type 1 diabetes.","authors":"Mariana Lourenço, Ana Rita Leite, Patrícia Ferreira, Inês Meira, João Menino, Ana Margarida Lopes, Joana Lagoa, Beatriz Viveiros, Maria João Barbosa, Sílvia Santos Monteiro, Joana Queirós, João Sérgio Neves, Celestino Neves","doi":"10.1080/17446651.2025.2532560","DOIUrl":"https://doi.org/10.1080/17446651.2025.2532560","url":null,"abstract":"<p><strong>Background: </strong>Thyroid hormone (TH) variations, even within the normal range, influence cardiometabolic health. In type 1 diabetes (T1D), optimizing glycemic control and cardiovascular risk is crucial to prevent complications. We aim to explore the association of TH within normal range with cardiometabolic profile in T1D.</p><p><strong>Research design and methods: </strong>Cross-sectional analysis including adult patients with T1D followed at our Endocrinology Department between 2022-2024. We excluded patients with TSH or fT4 outside the reference range. Associations between TH (TSH, fT4, fT3 and fT3/fT4 ratio) and glycemic, anthropometric, and cardiometabolic parameters, were evaluated using linear regression models unadjusted and adjusted for relevant variables. Restricted cubic splines between TH and glycemic control parameters were performed to assess non-linear associations.</p><p><strong>Results: </strong>We included 296 patients (median age 35 years, 42.6% female). Patients with mid-range TSH had better glycemic control, with higher time in range and a lower time above range. Waist circumference and body mass index were negatively associated with fT4, and positively with fT3 and fT3/fT4 ratio. Estimated glomerular filtration rate was negatively associated with TSH and fT4, and positively with fT3 and fT3/fT4.</p><p><strong>Conclusions: </strong>Variations in TH within the normal range were associated with glycemic control and cardiovascular risk factors in T1D.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sally D Poppitt, Jennifer Miles-Chan, Marta P Silvestre
{"title":"Prediabetes phenotypes: can aetiology and risk profile guide lifestyle strategies for diabetes prevention?","authors":"Sally D Poppitt, Jennifer Miles-Chan, Marta P Silvestre","doi":"10.1080/17446651.2025.2532559","DOIUrl":"https://doi.org/10.1080/17446651.2025.2532559","url":null,"abstract":"<p><strong>Introduction: </strong>Type 2 diabetes (T2D) continues to worsen globally alongside rise in obesity. Asymptomatic dysglycaemia, which precedes T2D, provides opportunities to identify those at risk and target prevention but prediabetes is highly variable. Not all with overweight develop dysglycaemia and not all with dysglycaemia are overweight. Important is the deposition of ectopic lipids in the pancreas, liver, and muscle. With no international definition, several prediabetes phenotypes exist, each based on one or more components of fasting glucose, postprandial glucose and/or HbA<sub>1c</sub>.</p><p><strong>Areas covered: </strong>We address variability in prediabetes phenotype and absence of a universal definition. With four main phenotypes based on the various glycemic definitions, it is likely they have different etiologies, risk profiles, timelines to T2D, and response to lifestyle intervention. Who do we treat, and when? Do we treat early or late? What is the optimum diet for T2D prevention? Do different phenotypes require different prevention approaches?</p><p><strong>Expert opinion: </strong>Personalized lifestyle, or phenotype-specific treatments, are likely to be more successful for T2D prevention than a 'one-size-fits-all' approach. Artificial intelligence (AI) methods, currently in their infancy, are expected to revolutionize personalized nutrition with integration of 'big data' better characterizing and predicting prediabetes phenotype, and phenotype-specific response to diet and lifestyle interventions.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Digenic, oligogenic and genetic modifiers in disorders/differences of sex development (DSD).","authors":"Ken McElreavey, Maeva Elzaiat, Anu Bashamboo","doi":"10.1080/17446651.2025.2529391","DOIUrl":"https://doi.org/10.1080/17446651.2025.2529391","url":null,"abstract":"","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-3"},"PeriodicalIF":2.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How do we balance metabolic surgery and emerging incretin-based medical therapies for type 2 diabetes?","authors":"Hamayle Saeed, Mary Elizabeth Patti","doi":"10.1080/17446651.2025.2529386","DOIUrl":"https://doi.org/10.1080/17446651.2025.2529386","url":null,"abstract":"","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-3"},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Differential metabolic responses to very-low calorie diets in individuals with, and without type 2 diabetes: a review.","authors":"Oluwaseun Anyiam, Iskandar Idris","doi":"10.1080/17446651.2025.2527791","DOIUrl":"https://doi.org/10.1080/17446651.2025.2527791","url":null,"abstract":"<p><strong>Introduction: </strong>Very-low calorie-diets (VLCD) are becoming increasingly popular for managing overweight, obesity and type 2 diabetes (T2D). Beta-cell dysfunction and insulin resistance (IR) is present in individuals living with overweight and obesity, with or without T2D. Results from metabolic studies investigating the effect of VLCD on beta cell function (BCF) and IR are inconsistent, despite the well-documented effects on weight and glycaemic control.</p><p><strong>Areas covered: </strong>We undertook a narrative review of studies identified from PubMed and their associated reference lists, examining apparent discrepancies in the literature on this topic. Evidence broadly suggests a positive impact of VLCD, although the outcome being measured, and method of assessment could influence the observed effect. The VLCD duration is a critical factor, as longer-term interventions are required to consistently demonstrate improvements in BCF and peripheral IR. Hepatic IR appears to be particularly responsive to short-term caloric restriction.</p><p><strong>Expert opinion: </strong>When interpreting metabolic results of VLCD intervention studies, particular attention must be paid to the selected method of assessing BCF and IR. Improvement in BCF exhibits significant heterogeneity, possibly related to individual participant's clinical characteristics. Beneficial effects on hepatic IR occur in the early stage of VCLD intervention, preceding changes in peripheral IR and BCF.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-12"},"PeriodicalIF":2.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria S Martinez-Cruz, Neesha Namasingh, Anastasia-Stefania Alexopoulos, Bryan C Batch, Matthew J Crowley, Hayden B Bosworth
{"title":"The forgotten - overcoming challenges in diabetes care for marginalized populations.","authors":"Maria S Martinez-Cruz, Neesha Namasingh, Anastasia-Stefania Alexopoulos, Bryan C Batch, Matthew J Crowley, Hayden B Bosworth","doi":"10.1080/17446651.2025.2526200","DOIUrl":"https://doi.org/10.1080/17446651.2025.2526200","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes disproportionately affects marginalized populations, leading to poorer glycemic control, higher complications, and reduced quality of life. Unequal access to care, mediated by multiple social determinants of health (SDoH), further exacerbates these risks. Addressing SDoH is crucial to mitigate health disparities and downstream impacts on the United States (U.S.) population and healthcare system.</p><p><strong>Areas covered: </strong>This review explores SDoH that disproportionately affect marginalized communities, including socio-economic (SE), geographic, cultural and linguistic, health literacy-related, psychologic, and systemic barriers to equitable diabetes care. We also explore evidence-based care strategies such as telehealth, social media and internet-based education strategies, integration of community health workers (CHW), integrated care models and policy changes.</p><p><strong>Expert opinion: </strong>While small-scale interventions have demonstrated success in overcoming challenges in diabetes care for marginalized populations, significant research gaps remain. Studies focusing on long-term outcomes and addressing the root causes of disparities tied to SDoH are urgently needed. Furthermore, rather than merely characterizing SDoH, researchers and clinicians must actively address them at the patient, provider, and system levels. Advancing diabetes care and reducing disparities requires equity-focused policies, inclusive research, and culturally tailored interventions. Without systemic reforms, however, these advancements risk perpetuating existing inequalities.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"1-17"},"PeriodicalIF":2.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gut microbiota alterations and their role in the pathophysiology of obesity following bariatric surgery.","authors":"Bas Voermans, Victor Gerdes, Max Nieuwdorp","doi":"10.1080/17446651.2025.2512551","DOIUrl":"10.1080/17446651.2025.2512551","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is a global epidemic associated with significant health risks, including type 2 diabetes, cardiovascular diseases, and metabolic disorders. Bariatric surgery remains the gold standard for achieving significant and sustained weight loss. This narrative review was created using literature searches in PubMed, Web of Science, and Scopus.</p><p><strong>Areas covered: </strong>Bariatric surgery induces shifts in gut microbiota composition, with changes in alpha and beta diversity and alters microbial phyla, such as Bacillota, Bacteroidota, Actinomycetota, Pseudomonadota, and Verrucomicrobiota. Genera and species belonging to these groups that have been associated with the pathophysiology of obesity are reported altered as well. These microbial changes, particularly after Roux-en-Y gastric bypass surgery, are generally linked to cardiometabolic improvements to gut hormone profiles and bile acid metabolism.</p><p><strong>Expert opinion: </strong>This review focuses on the changes in gut microbiota following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), highlighting longitudinal human studies. Despite conflicting results, some genera, such as <i>Veillonella</i>, <i>Streptococcus</i>, and <i>Akkermansia muciniphila</i>, show consistent increases post-surgery and may serve as markers of metabolic improvements. The predominance of facultative anaerobes suggests a shift in the gut environment post-surgery. These findings are mainly associations and could be further developed into treatment with the use of next-generation probiotics.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"291-305"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urooj Lal Rehman, Maliha Khalid, Marium Fatima, Muhammad Saad Khan, Muhammad Tarish Abro, Aminath Waafira
{"title":"Anxiety and depression among adolescents and young adults with thyroid function disorders: a cross-sectional study.","authors":"Urooj Lal Rehman, Maliha Khalid, Marium Fatima, Muhammad Saad Khan, Muhammad Tarish Abro, Aminath Waafira","doi":"10.1080/17446651.2025.2480693","DOIUrl":"10.1080/17446651.2025.2480693","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and depression are significant mental health issues affecting adolescents globally. Moreover, Thyroid disorders frequently coexist with anxiety and depression, leading to overlapping symptoms that complicate diagnosis and treatment. The objective of this study is to determine the prevalence of anxiety and depression among adolescents and young adults with thyroid functional disorders and their associated factors.</p><p><strong>Research design and method: </strong>A cross-sectional study was conducted at the Department of endocrinology, from (June to August) 2024. Variables included were patient demographics such as gender, age, occupation etc. For anxiety assessment: Beck Anxiety Inventory (BAI) was used. For depression assessment: Beck Depression Inventory (BDI) was used.</p><p><strong>Result: </strong>In patients with hyperthyroidism, severe anxiety and depression are strongly associated with common symptoms like tremors, difficulty sleeping, and frequent bowel movements (<i>p</i> < 0.05). In hypothyroidism, severe anxiety and depression is also prevalent, especially with symptoms like constipation, forgetfulness, and muscle weakness.</p><p><strong>Conclusion: </strong>Our study concluded that the mental health of adolescents and young adults is influenced by factors such as age, education, employment status, and thyroid function disorders - hypothyroidism and hyperthyroidism.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"279-289"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mingqian Jiang, Amna Subhan Butt, Ian Homer Cua, Ziyan Pan, Said A Al-Busafi, Nahum Méndez-Sánchez, Mohammed Eslam
{"title":"MAFLD vs. MASLD: a year in review.","authors":"Mingqian Jiang, Amna Subhan Butt, Ian Homer Cua, Ziyan Pan, Said A Al-Busafi, Nahum Méndez-Sánchez, Mohammed Eslam","doi":"10.1080/17446651.2025.2492767","DOIUrl":"10.1080/17446651.2025.2492767","url":null,"abstract":"<p><strong>Introduction: </strong>In 2023, metabolic dysfunction-associated steatotic liver disease (MASLD) was introduced following metabolic dysfunction-associated fatty liver disease (MAFLD). Both aim to address the limitations of nonalcoholic fatty liver disease (NAFLD). This review analyzes the similarities and differences between MAFLD and MASLD, focusing on their impacts on epidemiology, diagnosis, stigma, and related liver diseases.</p><p><strong>Areas covered: </strong>Current evidence suggests that MAFLD criteria effectively identify individuals at higher risk through a good balance of sensitivity and specificity. Moreover, MAFLD is a more generalizable term that is easily understood globally.</p><p><strong>Expert opinion: </strong>The transition from NAFLD to MAFLD and MASLD marks a significant advance in understanding fatty liver disease within hepatology. MAFLD identifies a homogeneous cohort of patients with fatty liver due to metabolic dysfunction and provides a valuable framework for holistic, patient-centered management strategies that consider various contributing factors to improve health outcomes.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":" ","pages":"267-278"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}