Endocrinology, Diabetes and Metabolism最新文献

{"title":"Risk Prediction Model for Elderly Differentiated Thyroid Cancer Based on Combined Sleep Quality Assessment and Multimodal Ultrasound","authors":"Xudan Lou,&nbsp;Na Yi,&nbsp;Yingchun Liu,&nbsp;Yuanyuan Xu,&nbsp;Jieyuzhen Qiu,&nbsp;Xiaoming Tao,&nbsp;Zhijun Bao","doi":"10.1002/edm2.70073","DOIUrl":"https://doi.org/10.1002/edm2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the differential diagnosis for benign and malignant thyroid nodules and the diagnostic value of sleep quality, to construct and validate a risk prediction model, providing the basis for clinical treatment decision for elderly thyroid cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical data, Pittsburgh Sleep Quality Index (PSQI), and multimodal ultrasound were collected from elderly patients undergoing fine needle aspiration biopsy or thyroid surgery in our department of endocrinology and general surgery. Postoperative pathological results served as the gold standard, binary logistic regression identified significant risk factors, and the receiver-operating characteristic (ROC) curves were plotted to construct and validate the prediction model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 763 enrolled patients (566 benign and 197 malignant), multivariate analysis revealed independent risk factors: TPOAB positive, daytime dysfunction, PSQI &gt; 7, irregular nodule shape, calcification, blood flow, high elasticity scores, and low contrast enhancement. The area under the curve (AUC) for the combined model was 0.860, significantly higher than models using multimodal ultrasound alone (AUC = 0.824) or multimodal ultrasound with TPOAB (AUC = 0.831), <i>p</i> &lt; 0.05. The nomogram-based prediction model demonstrated excellent discrimination, calibration, and clinical utility in internal and external validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating sleep quality assessment with multimodal ultrasound assisted in the differentiation of thyroid nodules in the elderly, thus may improve the preoperative diagnostic levels. Risk prediction model in a nomogram format provided an intuitive and reliable tool for clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Comparison of the Gut Microbiome Composition, Serum Inflammatory Markers and Faecal Short-Chain Fatty Acids Among Individuals With Type 1 and 2 Diabetes Mellitus With Healthy Controls: A Case–Control Study","authors":"Hossein Yarmohammadi,&nbsp;Masood Soltanipur,&nbsp;Mahdi Rezaei,&nbsp;Hanieh-Sadat Ejtahed,&nbsp;Maedeh Raei,&nbsp;Alireza Razavi,&nbsp;Seyed Mohsen Mirhosseini,&nbsp;Mehrangiz Zangeneh,&nbsp;Delaram Doroud,&nbsp;Abolfazl Fateh,&nbsp;Seyedalireza Seyed Siamdoust,&nbsp;Seyed Davar Siadat","doi":"10.1002/edm2.70071","DOIUrl":"https://doi.org/10.1002/edm2.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to compare the gut microbiome (GM) composition, serum inflammatory markers and faecal short-chain fatty acids among individuals with type 1 and type 2 diabetes mellitus (DM) and healthy controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This case–control study examined 49 subjects with type 2 DM, 21 with type 1 DM and 40 healthy controls. Blood and faecal samples were collected. Serum inflammatory markers, including CRP, IL-1β, IL-6, TNF-α and IFN-γ, were measured using enzyme-linked immunosorbent assays (ELISA). Bacterial populations were quantified using RT-qPCR and NGS. Faecal metabolites were analysed using gas chromatography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Simpson's alpha diversity was higher among types 1 and 2 DM than in the control. The frequency of the bacterial genera <i>Gemmiger</i>, <i>Dorea</i>, <i>Collinsella</i>, <i>Escherichia/Shigella</i>, <i>Dialister</i>, <i>Coprococcus</i>, <i>Achromobacter</i>, <i>Intestinimonas</i> and <i>Allisonella</i> in type 2 DM was higher than in the control, and the frequency of the genera <i>Romboutsia</i> and <i>Clostridium</i> was decreased in type 2 DM. The frequency of the <i>Prevotella</i>, <i>Bacteroides</i> and <i>Faecalibacterium</i> genera in type 1 DM was lower than in the other groups. Acetate, propionate and butyrate levels were significantly higher in type 2 DM patients compared to the other groups. Participants with diabetes had significantly higher hs-CRP, IL1-β, TNF, IL-6 and IFG levels compared to the controls. Compared to healthy controls, both T1DM and T2DM patients showed a significant increase in the abundance of the <i>Lactobacillus</i> genus (<i>p</i> = 0.01) and a decrease in <i>Faecalibacterium</i> (<i>p</i> = 0.02). Additionally, serum levels of IL-6 and TNF-α were significantly elevated in T2DM patients (<i>p</i> = 0.003 and <i>p</i> = 0.005, respectively). Faecal levels of butyrate were significantly reduced in both diabetic groups compared to the controls (<i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By determining the GM alterations in patients with diabetes, interventional strategies could be designed to modulate the GM composition as an adjunctive therapy in diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Hypocalcemia Post Parathyroidectomy for Primary Hyperparathyroidism; a Single Center Study","authors":"Khaled A. Obeidat,&nbsp;Nesreen A. Saadeh,&nbsp;Renad Msameh,&nbsp;Ajwad Obeidat,&nbsp;Omar Mar'ey,&nbsp;Ahmad Bakkar,&nbsp;Qutaiba Manasrah","doi":"10.1002/edm2.70070","DOIUrl":"https://doi.org/10.1002/edm2.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypocalcemia is a common event after parathyroidectomy for primary hyperparathyroidism (PHPT). This study aimed to explore the incidence of hypocalcemia, determine risk factors, and identify serum biomarkers associated with the development of this condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study that included 116 patients with PHPT who underwent parathyroidectomy at a tertiary care facility in Jordan over 16 years (2006–2022) in this study. Patients were classified as having postoperative hypocalcemia if they developed serum calcium levels &lt; 2.15 mmol/L within the first week following parathyroidectomy. Logistic regression analysis was performed to determine predictors of hypocalcemia. Spearman's rank correlation coefficient and ROC curves were used to assess relationships between variables as well as determine cutoffs for these predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 116 patients studied, 57.7% developed hypocalcemia after parathyroidectomy. High preoperative alkaline phosphatase (ALP), low preoperative corrected calcium, high preoperative parathyroid (PTH), and younger age were shown to be significantly higher in patients who developed hypocalcemia after parathyroidectomy. Multivariate logistic regression showed a low preoperative corrected calcium level was an independent predictor of postoperative hypocalcemia (<i>p</i> = 0.036). A high level of preoperative alkaline phosphatase was also considered an independent predictor of hypocalcemia development (OR = 1.007, 95% CI: 1.002–1.012). Patients who had pre-operative ALP less than 208.5 U/L were unlikely to develop postoperative hypocalcemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified higher preoperative ALP, lower pre-operative corrected calcium, higher pre-operative PTH levels, and younger age as risk factors for postoperative hypocalcemia. Preoperative ALP and preoperative corrected calcium were shown to be independent predictors of hypocalcemia development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring and Hypoglycaemia Metrics With Once-Weekly Basal Insulin Fc Versus Insulin Degludec: A Systematic Review and Meta-Analysis","authors":"Saaed Abunada,&nbsp;Sheela Bai,&nbsp;Usha Kumari,&nbsp;F. N. U. Nancy,&nbsp;Areeba Khan,&nbsp;Nikeeta Bai,&nbsp;F. N. U. Shevani,&nbsp;Anusha Bai,&nbsp;Shah Dev,&nbsp;Noshad Zain ul Abiddin,&nbsp;F. N. U. Umer,&nbsp;Abdul Manan,&nbsp;Sadia Habib Bhutto,&nbsp;Salih Abdella Yusuf","doi":"10.1002/edm2.70067","DOIUrl":"https://doi.org/10.1002/edm2.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Once-weekly basal insulin Fc (BIF) offers a promising alternative to daily basal insulin by reducing injection burden while maintaining glycaemic control. However, comprehensive comparisons with insulin degludec regarding continuous glucose monitoring (CGM) metrics and hypoglycaemia outcomes remain limited. This meta-analysis evaluates these critical parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing once-weekly BIF with once-daily insulin degludec in type 1 and type 2 diabetes. Outcomes included CGM-derived glycaemic variability, time in range, time above/below range and hypoglycaemia event rates. Data were pooled using random-effects models, with heterogeneity assessed via <i>I</i>² statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five RCTs (<i>n</i> = 2427) were included. BIF demonstrated comparable glycaemic variability (within-day CV: MD = 0.06, <i>p</i> = 0.90; between-day CV: MD = -0.26, <i>p</i> = 0.30) and Time in range (MD = 0.56, <i>p</i> = 0.27) versus degludec. However, BIF increased time spent in the mild hypoglycaemia range (54–69 mg/dL) (MD = 0.30, <i>p</i> = 0.0004) and clinically significant hypoglycaemia event rates (rate ratio = 1.20, <i>p</i> &lt; 0.00001). Severe hypoglycaemia event rates were higher with BIF (rate ratio = 3.34, <i>p</i> &lt; 0.0001). Nocturnal hypoglycaemia and time above range (&gt; 250 mg/dL) did not differ significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Once-weekly BIF provides similar overall glycaemic control to insulin degludec but with increased time in mild hypoglycaemia and higher event rates of clinically significant and severe hypoglycaemia. These findings highlight the need for individualised dosing and monitoring when transitioning to weekly insulin regimens.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Updated Systematic Review and Meta-Analysis on the Efficacy and Safety of Metformin as Add-on Therapy to Insulin in Patients With Type 1 Diabetes","authors":"Mohammad Mahdi Masouri,&nbsp;Rasoul Ebrahimi,&nbsp;Shokoofe Noori","doi":"10.1002/edm2.70060","DOIUrl":"https://doi.org/10.1002/edm2.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study aims to perform an updated meta-analysis evaluating the efficacy and safety of metformin adjunct therapy in type 1 diabetes mellitus (T1DM) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Cochrane, PubMed and Embase were searched for randomised controlled trials (RCTs) that reported the efficacy and safety of metformin in T1DM patients. Statistical analyses were performed using STATA software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine placebo-controlled RCTs enrolling 2051 T1DM patients were included. Adolescents experienced a notable reduction in total insulin daily dose (TIDD) (mean difference [MD] = −0.61 [95% confidence interval (CI): −1.02, −0.20] units/kg per day) and levels of haemoglobin A1c (HbA1c) (MD = −0.45 [95% CI: −0.79, −0.11]), total cholesterol (TC) (MD = −0.78 [95% CI: −1.54, −0.02]), and low-density lipoprotein (LDL) (MD = −0.69 [95% CI: −1.36, −0.02]) at 3 months of follow-up with metformin. In adults, metformin significantly reduced Body Mass Index (BMI) (MD = −0.71 [95% CI: −1.23, −0.19]), TIDD (MD = −0.44 [95% CI: −0.73, −0.16]), and levels of HbA1c (MD = −0.70 [95% CI: −1.10, −0.30]) and TC (MD = −0.60 [95% CI: −1.09, −0.10]) at 6 months. The risk of gastrointestinal adverse events (GIAEs) was significantly higher in both adolescents (Relative Risk [RR] = 1.74 [95% CI: 1.38, 2.21]) and adults (RR = 3.24 [95% CI: 1.49, 7.02]). All of the above had <i>p</i>-values less than 0.05. The metformin group showed no differences in BMI Z-score, high-density lipoprotein (HDL) level, or diabetic ketoacidosis (DKA) risk. No statistical difference was identified for any of the outcomes at other follow-up endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Metformin may reduce TIDD and levels of HbA1c, TC, triglycerides (TG), and LDL in T1DM adolescents. BMI, TIDD, and levels of HbA1c and TC may decrease in adults. Moreover, it may raise the risk of GIAEs in both age groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Glaucoma in Type 2 Diabetes Patients Treated With GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis","authors":"Maheen Asif,&nbsp;Aliza Asif,&nbsp;Ummi Aiman Rahman,&nbsp;Hanzala Ahmed Farooqi,&nbsp;Oshaz Fatima,&nbsp;Waqar Ali,&nbsp;Uzair Jafar,&nbsp;Mohammed Hammad Jaber","doi":"10.1002/edm2.70059","DOIUrl":"https://doi.org/10.1002/edm2.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Glaucoma, a leading cause of irreversible blindness, is particularly prevalent among individuals with Type 2 Diabetes Mellitus (T2DM), a known risk factor for the disease. This systematic review and meta-analysis aimed to evaluate the incidence of glaucoma in T2DM patients treated with Glucagon-Like Peptide 1 Receptor Agonists (GLP-1RAs) compared to those using other antihyperglycaemic agents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A comprehensive search of literature was conducted using MEDLINE (PubMed), the Cochrane Library, Google Scholar, and Scopus up to September 14, 2024. Observational studies that reported the incidence of glaucoma among T2DM patients using GLP-1RAs versus other antihyperglycaemic drugs were included. Data analysis employed the random-effects model, presenting odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using <i>I</i>² statistics, and a sensitivity analysis was performed to test the result's robustness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five observational studies involving 2,500,430 participants met the inclusion criteria. The meta-analysis indicated that GLP-1RA use was associated with a nonsignificant reduction in the incidence of glaucoma (OR: 0.78; 95% CI: 0.60 to 1.02; <i>p</i> = 0.01: <i>I</i>² = 88%). Sensitivity analysis by leave-one-out method showed a significant reduction of glaucoma in GLP-1 RA users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In conclusion, GLP-1RA usage in T2DM patients may be beneficial in lowering the risk of glaucoma under some circumstances. These results advocate for further clinical studies to confirm GLP-1RAs' protective ocular effects, potentially influencing future treatment guidelines and preventive care strategies for glaucoma patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effectiveness of Insulin Plus Oral Medications Versus Oral Anti-Diabetes Therapy Alone in Patients With Newly Diagnosed Type 2 Diabetes With Very High hbA1c and Acute Coronary Syndrome","authors":"Adeel Ahmad Khan,&nbsp;Fateen Ata,&nbsp;Afia Aziz,&nbsp;Aya Janan Qassim,&nbsp;Ahmed Shukri,&nbsp;Khaled Abdallah Aboujabal,&nbsp;Yazan Almohtasib,&nbsp;Amin Jayyousi,&nbsp;Mohammed Bashir,&nbsp;Haval Surchi","doi":"10.1002/edm2.70069","DOIUrl":"https://doi.org/10.1002/edm2.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Many patients with Acute Coronary Syndrome (ACS) are newly diagnosed with Type 2 Diabetes Mellitus (T2DM) with very high hbA1c levels (&gt; 10%). Early achievement of glycaemic control is of prime importance in such cases, and many guidelines recommend starting insulin together with oral anti-diabetic drugs (OAD) as part of discharge medications. However, large numbers of treatment-naïve patients are hesitant to use insulin due to various factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective, single-centre, observational study, we compared the hbA1c at 1-year follow-up between newly diagnosed DM patients with initial hbA1c &gt; 10% who were discharged on insulin plus OAD versus those only on OAD after admission with ACS. Pairwise comparisons between continuous and categorical study variables were performed using t-test, Mann–Whitney test, and chi-square. We used STATA 18 for analysis. Baseline characteristics have been described for all the patients included in the study. In the analysis of outcomes at follow-up, only patients who had follow-up at 1-year were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 149 patients eligible for inclusion, the majority were males (97.3%). The mean age was 47 ± 8.3 years. The baseline hbA1c at diagnosis was 11.2 (10.5–12.3) %. 38 (25.5%) Were Discharged on insulin + OADs, whereas 111 (75.5%) Were Discharged Only on OADs. There was no statistically significant difference in change in hbA1c from baseline between the two groups (Mean (SD) 4.4% ± 1.8% vs. 4% ± 1.5%, <i>p</i> = 0.07). None of the patients had any hyperglycaemic emergency, and there were no differences in recurrent admissions due to cardiac indications (<i>p</i> = 0.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An anti-DM regimen consisting of multiple oral agents is a safe and effective alternative to insulin plus OAD and can lead to a comparable reduction in hbA1c at 1-year in patients who are not willing to use insulin early after diagnosis of T2DM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Low-Dose Spironolactone in Management of Diabetic Kidney Disease in a Real-World Setting","authors":"Manochehr Amini,&nbsp;Davood Dalil,&nbsp;Fatemeh Yaghoubi,&nbsp;Zoleykha Valizadeh,&nbsp;Farnaz Tavakoli,&nbsp;Zohreh Koohpayezadeh","doi":"10.1002/edm2.70058","DOIUrl":"https://doi.org/10.1002/edm2.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adding spironolactone to renin-angiotensin-aldosterone system (RAAS) blockers has been shown to reduce albuminuria in patients with diabetic kidney disease (DKD). However, the increased risk of hyperkalaemia is a major concern. This study aimed to evaluate the efficacy and safety of low-dose (12.5 mg/day) spironolactone in reducing albuminuria and improving renal function in Iranian adults with DKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a pre-post-treatment study of 60 patients with type 2 diabetes, age &gt; 18 years, albuminuria ≥ 30 mg, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m², and serum potassium level ≤ 5 mEq/L, who were referred to the diabetes clinic of Shariati Hospital, Tehran, Iran. The patients were prescribed spironolactone (12.5 mg) once daily. Changes in urinary albumin excretion (U.Alb), urine albumin-to-creatinine ratio (uACR), blood pressure, serum creatinine (Cr) levels, and serum potassium levels from the baseline over the 12-week intervention period were measured. Statistical significance was set at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 12 weeks of taking 12.5 mg/day spironolactone, there was a statistically significant but modest increase in eGFR (<i>p</i> = 0.042), and a statistically significant decrease was observed in both the U.Alb and uACR (<i>p</i> &lt; 0.001). There was a significant reduction in the mean Cr level (<i>p</i> = 0.003). Systolic blood pressure did not decrease significantly (<i>p</i> = 0.079), but diastolic blood pressure decreased significantly (<i>p</i> = 0.007). Changes in serum potassium levels over time were not significant (<i>p</i> = 0.302). The reduction in albuminuria in patients taking only spironolactone and those taking spironolactone with SGLT2i was not significantly different (<i>p</i> = 0.916 and <i>p</i> = 0.948, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study found that adding spironolactone to RAAS blockers effectively reduced albuminuria, mildly increased eGFR, and improved renal outcomes in patients with DKD. Additionally, spironolactone significantly reduced albuminuria, regardless of the concurrent use of SGLT2i.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on “Are Individuals With Type 2 Diabetes Metabolically Inflexible? A Systematic Review and Meta-Analysis”","authors":"Katerina Koudelkova,&nbsp;Cedric Moro,&nbsp;Jan Gojda","doi":"10.1002/edm2.70068","DOIUrl":"https://doi.org/10.1002/edm2.70068","url":null,"abstract":"&lt;p&gt;We read with great interest the recent systematic review examining metabolic flexibility (MetFlex), as assessed by respiratory exchange ratio (ΔRER) during hyperinsulinaemic-euglycaemic clamp, across lean, overweight/obese, and type 2 diabetes (T2D) groups [&lt;span&gt;1&lt;/span&gt;]. We commend the authors for their comprehensive effort and agree that such a synthesis was timely and much needed. However, we believe that several methodological limitations and the conceptual framing of MetFlex in the review warrant further discussion to avoid oversimplification of this physiologically complex phenomenon, and we would like to offer a few reflections and suggestions in that regard.&lt;/p&gt;&lt;p&gt;Firstly, the authors concluded that MetFlex is not linked to the T2D diagnosis but rather to BMI. However, BMI alone is an imprecise measure of adiposity and does not capture important differences in body composition or fat distribution, both of which are highly relevant to metabolic health [&lt;span&gt;2&lt;/span&gt;]. For example, individuals with similar BMI can have markedly different proportions of visceral adipose tissue, ectopic lipid deposition, and lean mass [&lt;span&gt;3&lt;/span&gt;], all of which can influence MetFlex [&lt;span&gt;4&lt;/span&gt;]. The limitations of relying solely on BMI have also been acknowledged in the recently proposed diagnostic criteria for obesity, which emphasise the need to assess body composition and functional impairments rather than BMI thresholds alone [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Also, some studies included in the review used BMI matching to compare individuals with type 2 diabetes and those with overweight/obesity [&lt;span&gt;5&lt;/span&gt;], while others specifically used patients with overweight/obesity and insulin resistance [&lt;span&gt;6&lt;/span&gt;], making it even harder to disentangle the relationship between these two phenomena.&lt;/p&gt;&lt;p&gt;The interpretation of MetFlex in individuals with T2D presented in the review also warrants caution due to several sources of heterogeneity across the included studies. First, as the authors mentioned, the use and type of antidiabetic medication varied widely, ranging from diet-only management to regimens including metformin, sulfonylureas, insulin, thiazolidinediones, and DPP-4 inhibitors, often in combination. Notably, medications such as metformin are known to increase insulin sensitivity, which could alter substrate utilisation and obscure differences between T2D and obese individuals without diabetes [&lt;span&gt;7&lt;/span&gt;]. The duration of diabetes ranged from as little as 3 months [&lt;span&gt;8&lt;/span&gt;] to nearly 30 years [&lt;span&gt;9&lt;/span&gt;], spanning distinct stages of disease progression with likely differences in microvascular complications, insulin secretion, and insulin resistance, which all could impact independently on substrate metabolism. These factors critically influence metabolic health and should not be overlooked.&lt;/p&gt;&lt;p&gt;Another important point is that although the authors state that the analysis was adjusted for sex, it is unclear how this was ach","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Erythrocytosis Among Type 2 Diabetes Mellitus Patients With Hypogonadism Using Sodium-Glucose Cotransporter 2 Inhibitors and Testosterone Replacement Therapy","authors":"Maharan Kabha,&nbsp;Hadar Dana,&nbsp;Sameer Kassem,&nbsp;Yoram Dekel,&nbsp;Hilla Cohen,&nbsp;Adnan Zaina","doi":"10.1002/edm2.70064","DOIUrl":"https://doi.org/10.1002/edm2.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Hypogonadism is commonly linked to type 2 diabetes mellitus (T2DM), with testosterone replacement therapy (TRT) representing a key treatment option. Sodium glucose cotransporter-2 inhibitors (SGLT-2i) class is part of T2DM management. Both treatments can increase Hct, Hb and RBC levels with a potential risk for secondary erythrocytosis. This study compares Hct, RBC and Hb changes between T2DM patients treated with and without SGLT-2i and TRT for hypogonadism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from Clalit Healthcare Services (2015–2023) was analysed from male T2DM patients with hypogonadism. Mixed linear regression assessed SGLT-2i effects on Hct, Hb and RBC levels, while generalised estimation equations were used to predict the proportion of patients with Hct &gt; 54%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 5235 male patients met the inclusion criteria, with 3146 in the SGLT-2i (+) group, while 2089 comprised the SGLT-2i (−) group. Mean age was 63.8 ± 11.0 years, mean Hct was 43.3% ± 4.4%, BMI was 30.8 ± 5.2 kg/m² and eGFR was 84.9 ± 19.3 mL/min/1.73m². The SGLT-2i (+) group demonstrated a statistically significant increase in Hct, Hb, and RBC after TRT initiation (<i>p</i> &lt; 0.001). While the overall increase in Hct &gt; 54% was not statistically significant after TRT initiation with OR = 1.85 [95% CI 0.96–3.67], <i>p</i> = 0.06. However, in the SGLT2i (+) group, it was significantly higher than for those in the SGLT2i (−) group, OR = 4.85 [95% CI 3.06–7.69], <i>p</i> = 0.02.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SGLT-2i and TRT co-administration are associated with an increased chance of developing secondary erythrocytosis in T2DM. Awareness and potential treatment discontinuation may prevent unnecessary investigations. Frequent monitoring of these parameters is essential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36522,"journal":{"name":"Endocrinology, Diabetes and Metabolism","volume":"8 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/edm2.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}